Dominic A. Siler , Kate U. Rosen , Stephen G. Bowden , Andrew Y. Powers , Jesse J. Liu , Aclan Dogan , Holly E. Hinson , Maria Fleseriu , Randy L. Woltjer , Justin S. Cetas
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引用次数: 0
摘要
延迟性脑缺血(DCI)和脑血管痉挛(VS)是垂体大腺瘤术后罕见但严重的并发症;其机理尚不清楚。垂体腺苷酸环化酶激活多肽(PACAP)是一种在垂体腺瘤中表达的血管活性神经肽,可能在DCI/VS中发挥作用。本病例对照研究的目的是研究垂体手术后PACAP的肿瘤表达与DCI/VS之间的关系。通过免疫组织化学方法评估5例垂体手术后DCI/VS患者和9例匹配对照的肿瘤组织中PACAP的表达。与对照组相比,垂体手术后DCI/VS患者的细胞核PACAP表达显著升高(0.396±0.0.16 a.u.VS 0.093±0.04 a.u.,p<;0.0001)。细胞核PACAP的表达与术前肿瘤体积呈正线性关系(r2=0.41,p&llt;0.02),DCI/VS组与对照组之间的斜率存在显著差异对照组(y=x(5.0×10−3),r2=0.76 vs y=x(7.4×10−4),r2=0.07,p<;肿瘤PACAP表达水平的升高与垂体手术后的DCI/VS相关,并且可能在肿瘤生长中起作用。PACAP信号可能在DCI的发展中发挥作用,但还需要进一步的研究。
Delayed cerebral ischemia associated with surgery for pituitary macroadenomas that express elevated levels of PACAP
Delayed cerebral ischemia (DCI) and cerebral vasospasm (VS) are rare but serious post-operative complications after surgery for pituitary macroadenomas; the mechanism of which are poorly understood. Pituitary adenylate cyclase-activating polypeptide (PACAP) is a vasoactive neuropeptide expressed in pituitary adenomas and may play a role in DCI/VS. The aim of this case-control study was to investigate the association between tumor expression of PACAP and DCI/VS following pituitary surgery. Tumor tissue from five patients with DCI/VS following pituitary surgery and nine matched controls were evaluated for PACAP expression by immunohistochemistry. Nuclear PACAP expression was significantly elevated in patients with DCI/VS following pituitary surgery compared to controls (0.396 ± 0.0.16 a.u. vs 0.093 ± 0.04 a.u, p < 0.0001). There was a positive linear relationship between nuclear PACAP expression and pre-operative tumor volume (r2 = 0.41, p < 0.02) with a significant difference in slopes between the DCI/VS group compared to controls (y = x(5.0 × 10−3), r2 = 0.76 vs y = x(7.4 × 10−4), r2 = 0.07, p < 0.05). Elevated levels of tumor PACAP expression is associated with DCI/VS following pituitary surgery and may have a role in tumor growth. PACAP signaling may play a role the development of DCI, but further studies are needed.