Pituitary最新文献

{"title":"Etomidate in severe hypercortisolism: early cortisol kinetics and clinical outcomes in a real-world cohort.","authors":"Vivek Jha, Tushar Bhadada, Amal Shaharyar, Rama Walia, Sanjay Kumar Bhadada","doi":"10.1007/s11102-026-01718-1","DOIUrl":"10.1007/s11102-026-01718-1","url":null,"abstract":"<p><strong>Purpose: </strong>Severe hypercortisolism is a life-threatening endocrine emergency requiring rapid cortisol reduction. Oral steroidogenesis inhibitors may be limited in critically ill patients due to delayed onset, impaired absorption, and toxicity. Intravenous etomidate enables rapid, titratable suppression of cortisol synthesis, but data on early treatment response and real-world safety remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective study of consecutive patients with severe endogenous hypercortisolism treated with intravenous etomidate at a tertiary care centre over a 3-year period. Serum cortisol was measured at baseline and at 12 and 24 h to assess early response. Biochemical control was defined as serum cortisol < 500 nmol/L (< 18.1 µg/dL). Clinical, biochemical, and safety outcomes were analysed.</p><p><strong>Results: </strong>Ten patients [median baseline cortisol 1285 nmol/L (46.6 µg/dL)] received etomidate infusion. Serum cortisol declined early, with median reductions of 45% at 12 h and 58.5% at 24 h. Biochemical control was achieved within 24 h in 80% of patients. Response categories included rapid (30%), intermediate (50%), and delayed (20%). Patients with < 25% cortisol reduction at 12 h tended to have delayed biochemical control. Serum potassium improved during treatment and normalized before discontinuation of infusion in all patients with available serial data, while clinical stabilization was achieved in 90%. Etomidate was well tolerated; one death due to sepsis was not related to therapy.</p><p><strong>Conclusions: </strong>In this real-world cohort of patients with severe hypercortisolism, low-dose intravenous etomidate was associated with early cortisol reduction and clinically useful biochemical control in most patients. Early cortisol trajectories may help guide dose titration, but these findings should be interpreted as descriptive and hypothesis-generating because of the small sample size and retrospective design.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative changes in circulating brain injury biomarkers in relation to long-term fatigue and cognitive outcomes after surgery for nonfunctioning pituitary adenomas.","authors":"Kristin Eyglóardóttir, Thomas Skoglund, Victor Hantelius, Oskar Ragnarsson, David Krabbe, Katharina S Sunnerhagen, Sofie Jakobsson, Henrik Zetterberg, Gudmundur Johannsson, Tobias Hallén","doi":"10.1007/s11102-026-01720-7","DOIUrl":"10.1007/s11102-026-01720-7","url":null,"abstract":"<p><strong>Purpose: </strong>Circulating brain injury biomarker levels increase after transsphenoidal surgery for pituitary tumors. However, their relationship with long-term fatigue and cognitive outcomes remains unclear. We investigated whether postoperative changes in glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau are associated with fatigue and cognitive outcomes in patients with nonfunctioning pituitary adenomas (NFPAs).</p><p><strong>Methods: </strong>This prospective cohort study included 68 patients with NFPAs undergoing endoscopic transsphenoidal surgery. Plasma GFAP, NfL, and tau were measured pre- and postoperatively using ultrasensitive assays. Fatigue was assessed using the Multidimensional Fatigue Inventory and cognitive performance with the Repeatable Battery for the Assessment of Neuropsychological Status preoperatively and at 12-months postsurgery. Clinically meaningful changes were defined as ≥ 0.5 standard deviations from baseline.</p><p><strong>Results: </strong>All biomarkers increased significantly after surgery, with tau peaking immediately, GFAP on day 1, and NfL on day 5 (all p < 0.01). Patients with preoperative hypothalamic compression showed greater postoperative increases in GFAP and NfL. At 12-months, fatigue improved at the group level, and cognitive performance remained stable. However, individual outcomes were heterogeneous: clinically meaningful worsening was observed for fatigue in 8/58 patients (14%) and for cognitive performance in 6/31 patients (19%). We identified no significant associations between increased postoperative biomarker levels and changes in fatigue or cognitive performance.</p><p><strong>Conclusions: </strong>Endoscopic transsphenoidal surgery for NFPAs is associated with transient increases in circulating brain injury biomarkers, particularly in patients with hypothalamic compression. Our findings revealed that these elevations were not related to long-term fatigue or cognitive decline, suggesting that they may reflect short-term surgical effects without sustained functional consequences.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13323199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining surgical decision-making in patients with prolactinomas.","authors":"Gianluigi Zona, Diego Ferone","doi":"10.1007/s11102-026-01719-0","DOIUrl":"10.1007/s11102-026-01719-0","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focus on renal morphology, chronic kidney disease, and urinary system malignancies in acromegaly: report on data collected over a 40-year period.","authors":"Polat Ercan, Busra Firlatan Yazgan, Suleyman Nahit Sendur, Seda Hanife Oguz, Selcuk Dagdelen, Tomris Erbas","doi":"10.1007/s11102-026-01712-7","DOIUrl":"10.1007/s11102-026-01712-7","url":null,"abstract":"<p><strong>Purpose: </strong>Long-term renal consequences of acromegaly remain poorly characterized. We assessed prevalence and independent predictors of renal cysts, chronic kidney disease (CKD), and the frequency of urinary-system malignancies, in a large acromegaly cohort.</p><p><strong>Methods: </strong>394 acromegaly patients managed at a single tertiary center over four decades were retrospectively evaluated. Renal cyst and CKD predictors were identified by binary multivariate logistic regression with sensitivity analyses including IGF-1 exposure metrics; eGFR trajectories by nested analysis of covariance (ANCOVA). Standardized prevalence (SPRs) and incidence (SIRs) ratios were computed against age- and sex-stratified population references.</p><p><strong>Results: </strong>In 394 patients (202 male; median disease duration 17 years), renal cysts were present in 41.0% of imaged patients (47.4% bilateral), CKD in 16.1%, and nephrolithiasis in 15.1%. Among CKD patients, 64.9% had preserved eGFR (KDIGO G1-G2), reflecting albuminuria- or structure-driven ascertainment. Independent cyst predictors were age, nephrolithiasis, liver cysts, and multiple neoplasms; higher baseline potassium was inversely associated (OR 0.37, p = 0.013). Independent CKD predictors were age, male sex, hypertension, and nephrolithiasis. Cross-sectional and cumulative GH/IGF-1×ULN did not predict either outcome; cumulative IGF-1 was positively associated with follow-up eGFR (β=+1.69, p = 0.022), consistent with hyperfiltration. Age-matched SPRs were 1.23-1.98 for cysts (both p < 0.05) and 0.67 for CKD (p = 0.002); urinary-system cancers showed a > 7-fold excess (SIR 7.38, 2.97-15.20; p < 0.001).</p><p><strong>Conclusions: </strong>Renal cysts, CKD, and urinary-system malignancies are prevalent in acromegaly, with the long-term renal burden predominantly morphological and tubular rather than glomerular. Cross-sectional and cumulative GH/IGF-1 metrics did not predict CKD; age-matched CKD prevalence was lower than expected while cyst prevalence was elevated. The cyst and urinary-cancer excess support dedicated renal surveillance in long-term acromegaly management.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world insights in the use of temozolomide for aggressive pituitary tumours remind us what we still don't know.","authors":"Ann McCormack","doi":"10.1007/s11102-026-01701-w","DOIUrl":"10.1007/s11102-026-01701-w","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-secretion of growth hormone and prolactin defines a high-risk acromegaly phenotype.","authors":"Won Kyu Lee, Hyeong-Cheol Oh, Jin-Kyung Shim, Hyeyeon Oh, So Young Won, Seonah Choi, Yoon-A Hwang, Ju Hyung Moon, Cheol Ryong Ku, Eun Jig Lee, Sun Ho Kim, Eui Hyun Kim","doi":"10.1007/s11102-026-01713-6","DOIUrl":"10.1007/s11102-026-01713-6","url":null,"abstract":"<p><strong>Background: </strong>Data on GH and prolactin (PRL) co-secreting pituitary neuroendocrine tumors (GH/PRL-PitNETs), a subtype of acromegaly, remain limited. In particular, comparative analyses of clinical outcomes, including remission rates, between GH/PRL-PitNETs and GH-secreting pituitary neuroendocrine tumors (GH-PitNETs) are scarce.</p><p><strong>Objective: </strong>This study aimed to characterize and compare the clinical course and remission outcomes of GH/PRL-PitNETs and GH-PitNETs.</p><p><strong>Methods: </strong>We retrospectively analyzed 188 patients with acromegaly who underwent surgery between 2018 and 2024. GH/PRL-PitNETs (n = 46) were compared with GH-PitNETs (n = 142) in terms of their clinical, biochemical, and radiological features. Kaplan-Meier analysis was used to assess differences in biochemical remission between the groups, after which Cox proportional hazards modeling-including a time-dependent treatment variable-was used to identify covariates independently associated with remission.</p><p><strong>Results: </strong>GH/PRL-PitNETs were significantly larger and more invasive than GH-PitNETs. The surgical remission rate was lower in the GH/PRL-PitNET group (P = .023). In multivariable Cox analysis, tumor size and cavernous sinus invasion independently predicted inferior outcome in biochemical remission. GH-PitNETs showed a higher incidence of medical comorbidities such as hypertension and thyroid carcinoma.</p><p><strong>Conclusion: </strong>GH/PRL-PitNETs demonstrated greater tumor burden and more pronounced structural invasiveness, resulting in a significantly lower likelihood of endocrinological remission.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: long-term endocrine trajectories and reoperation risk after surgery for Rathke's cleft cysts: a single-center cohort study of 177 patients.","authors":"Yue Hu, Xinjie Bao","doi":"10.1007/s11102-026-01706-5","DOIUrl":"10.1007/s11102-026-01706-5","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Limited Role of Hypocortisolism in the Development of Delayed Postoperative Hyponatremia After Pituitary Surgery.","authors":"Jong Ha Hwang, Hye Seok Park, Sun Mo Nam, Seung Shin Park, Jung Hee Kim, Min-Sung Kim, Chul-Kee Park, Yong Hwy Kim","doi":"10.1007/s11102-026-01702-9","DOIUrl":"10.1007/s11102-026-01702-9","url":null,"abstract":"<p><strong>Purpose: </strong>Delayed postoperative hyponatremia (DPH) is a common complication following pituitary surgery. Although hypocortisolism has been proposed as a contributing factor, the temporal interplay between cortisol and sodium levels remains unclear. This study aimed to elucidate the relationship between postoperative cortisol and sodium dynamics, identify independent predictors of DPH and assess potential protective factors.</p><p><strong>Methods: </strong>We retrospectively analyzed 261 patients who underwent fully endoscopic surgery for clinically non-functioning pituitary neuroendocrine tumors (Pit-NETs, also known as pituitary adenomas) between 2021 and 2024. Serial measurements of serum sodium and morning cortisol were collected from the immediate postoperative period through 3-month follow-up. Comparative analyses between patients with and without DPH were performed to characterize hormonal and electrolyte trends. The frequency of hypocortisolism during hyponatremic episodes was compared, and multivariable logistic regression identified independent predictors. The potential protective role of preoperative steroid replacement was also evaluated.</p><p><strong>Results: </strong>DPH occurred in 54 patients (20.7%), with symptomatic cases accounting for 4.2% of the cohort. The median time to nadir sodium was 8 days with a median nadir of 129 mEq/L. The serum cortisol level between hyponatremia and non-hyponatremia group did not show significant differences. For propensity score matched comparison, median nadir cortisol levels were lower in the DPH group (6.10 vs. 7.34 µg/dL, p = 0.29), and hypocortisolism during hyponatremic episodes was more frequent (48.2% vs. 40.7%, p = 0.52), though neither difference reached statistical significance. Multivariate analysis identified age > 60 years (OR 2.09, 95% CI 1.11-3.96, p = 0.023) and postoperative pneumocephalus (OR 3.28, 95% CI 1.59-6.81, p = 0.001) as independent predictors. Preoperative cortisol replacement did not demonstrate a protective effect against DPH.</p><p><strong>Conclusion: </strong>Hypocortisolism does not appear to be the primary mechanism underlying DPH following pituitary surgery, as evidenced by the lack of temporal correlation. Advanced age and postoperative pneumocephalus emerge as key risk factors for DPH, supporting a multifactorial etiology. Although preoperative ACTH deficiency was linked to a higher incidence of DPH, preoperative cortisol replacement was not associated with protection.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13272243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal biomarkers for visual prognosis in pituitary surgery: a narrative review.","authors":"Darshan Hr, Arvind Kumar Singh, Ajit Singh, Shrey Kumar Shah, Asmita Indurkar, Biren Khimji Patel","doi":"10.1007/s11102-026-01709-2","DOIUrl":"10.1007/s11102-026-01709-2","url":null,"abstract":"<p><strong>Background: </strong>Pituitary macroadenomas frequently cause visual impairment through compression of the optic chiasm, and endoscopic transsphenoidal surgery remains the standard of care for achieving decompression. Despite favorable surgical outcomes in many patients, visual recovery following chiasmal decompression is heterogeneous and difficult to predict using conventional visual field testing alone. Over the past two decades, optical coherence tomography (OCT) has emerged as a noninvasive retinal imaging modality capable of quantifying structural changes in the retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) with micrometer-level resolution. A growing body of evidence suggests that preoperative RNFL thinning and GCC loss reflect irreversible axonal degeneration from chronic chiasmal compression and that these measurements carry prognostic value for postoperative visual outcomes.</p><p><strong>Objective: </strong>To examine the current evidence linking preoperative retinal OCT parameters to visual recovery following transsphenoidal surgery for pituitary macroadenomas.</p><p><strong>Methods: </strong>This narrative review evaluates published studies investigating the association between preoperative OCT-derived retinal structural measurements and postoperative visual outcomes in patients undergoing transsphenoidal surgery for pituitary macroadenomas.</p><p><strong>Results: </strong>The available evidence suggests that preoperative RNFL and GCC measurements may serve as useful biomarkers of irreversible optic pathway injury and predictors of postoperative visual recovery.</p><p><strong>Conclusions: </strong>We discuss the pathophysiological rationale, summarize key clinical studies, consider the limitations of existing evidence, and outline the clinical implications for a multidisciplinary approach that integrates neurosurgical and ophthalmic expertise in preoperative assessment.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer risk in a large acromegaly cohort: a standardized incidence ratio analysis.","authors":"Polat Ercan, Busra Firlatan Yazgan, Suleyman Nahit Sendur, Selcuk Dagdelen, Tomris Erbas","doi":"10.1007/s11102-026-01700-x","DOIUrl":"10.1007/s11102-026-01700-x","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate overall and site-specific cancer risk in a large Turkish acromegaly cohort and assess the contribution of surveillance bias.</p><p><strong>Methods: </strong>We retrospectively analyzed 393 acromegaly patients followed at a single tertiary center (1980-2023). Standardized incidence ratios (SIRs) were calculated against Turkish national cancer rates. Sensitivity analyses included thyroid exclusion, graded landmarks (1, 2, 5 years), temporal restrictions, and reference rate variation (± 20%). Multivariable logistic regression assessed predictors of cancer, including cumulative IGF-1 exposure (time-weighted average, TWAvg×ULN).</p><p><strong>Results: </strong>Sixty-four patients (16.3%) developed cancer over a median follow-up of 9 years. The overall cancer SIR was 5.48 (95% CI: 4.15-7.10), driven by thyroid (46.25), renal/urinary (7.38), and breast cancer (3.75; all p < 0.001 except breast p = 0.006). The non-thyroid SIR remained significant at 2.76 (1.86-3.94, p < 0.001) and stable across graded landmarks (range 2.42-2.53; all p < 0.001) and other sensitivity analyses. TWAvg IGF-1 was higher in the cancer group (1.26 vs. 0.97 ×ULN; p = 0.002) and independently predicted cancer (OR: 1.80; 95% CI: 1.21-2.69; p = 0.004).</p><p><strong>Conclusions: </strong>In this large single-center Turkish acromegaly cohort, the overall SIR (5.48) exceeded the pooled population-based estimate of 1.45. The non-thyroid SIR remained significant across all sensitivity analyses (range 2.22-3.45), indicating multi-site predisposition beyond surveillance bias. Cumulative IGF-1 exposure independently predicted cancer, supporting sustained hormonal excess as a driver of oncogenesis. These findings support systematic thyroid screening and heightened vigilance for non-thyroid malignancies in tertiary-managed acromegaly.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"29 4","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148259462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}