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Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome; Adenomas hipofisários não-secretores: avaliações clínica, laboratorial, neuro-radiológica e evolução após tratamento

CURY, Maria Licia Calado de Aguiar Ribeiro; FERNANDES, Juliana Coutinho; MACHADO, Hélio Rubens; ELIAS, Lucila Leico; MOREIRA, Ayrton Custódio; CASTRO, Margaret de
Fonte: Sociedade Brasileira de Endocrinologia e Metabologia Publicador: Sociedade Brasileira de Endocrinologia e Metabologia
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.51%
OBJECTIVE: This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome. DESIGN AND METHODS: Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment. RESULTS: Hypopituitarism and neuro-ophthalmological defects were observed in 89%. We observed GH deficiency (81.4%), hypogonadism (63.3%), adrenal hypofunction (59.5%), hypothyroidism (20.4%), high (38.5%) and low (16.7%) prolactin levels. Preoperative imaging classified 93% of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8%. Varying degrees of visual disturbance were observed in 74%. Primary treatment was transsphenoidal surgery (75%). Clinical control was achieved with one surgery in 37.5 % of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43%. Improvement of neuro-ophthalmological symptoms was observed in 61% of the patients after treatment. CONCLUSIONS: Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common...

Influence of the Fibroblast Growth Factor Receptor 4 Expression and the G388R Functional Polymorphism on Cushing`s Disease Outcome

BRITO, Luciana Pinto; LERARIO, Antonio Marcondes; BRONSTEIN, Marcello Delano; SOARES, Ibere Cauduro; MENDONCA, Berenice Bilharinho; FRAGOSO, Maria Candida Barisson Villares
Fonte: ENDOCRINE SOC Publicador: ENDOCRINE SOC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
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Context: Abnormal FGFR4 expression has been detected in pituitary tumors, especially in larger and invasive adenomas. In addition, the FGFR4 functional polymorphism G388R has been associated with poor outcome in several human malignancies. Then, we hypothesized that FGFR4 expression and genotype could be markers of adverse outcome of Cushing`s disease after transsphenoidal surgery. Objectives: The objective was to investigate whether there is an association between the postoperative outcome of Cushing`s disease (remission/recurrence) and the FGFR4 G388R genotype or the FGFR4 expression in corticotrophinomas. Design and Patients: Clinical, hormonal, and pathological data of 76 patients who underwent the first transsphenoidal surgery were retrospectively reviewed. All patients were genotyped for G388R polymorphism. FGFR4 expression was assessed by real-time PCR in 18 corticotrophinomas. Main Outcome Measures: The outcome measures included the FGFR4 G388R genotype and FGFR4 expression in postoperative remission and recurrence of Cushing`s disease. Results: Homozygosis for FGFR4 glycine (Gly(388)) allele was associated with reduced disease-free survival, in the univariate analysis (hazard ratio of 6.91; 95% confidence interval of 1.14-11.26; P = 0.028). Male gender (P = 0.036)...

Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging assessment, therapeutic management and outcome

Cury,Maria Licia Calado de Aguiar Ribeiro; Fernandes,Juliana Coutinho; Machado,Hélio Rubens; Elias,Lucila Leico; Moreira,Ayrton Custódio; Castro,Margaret de
Fonte: Sociedade Brasileira de Endocrinologia e Metabologia Publicador: Sociedade Brasileira de Endocrinologia e Metabologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2009 EN
Relevância na Pesquisa
46.51%
OBJECTIVE: This study is an updated review of a Southeast Brazilian experience NFPA, emphasizing clinical features, laboratorial and imaging assessment, therapeutic management and outcome. DESIGN AND METHODS: Retrospective study, in which 104 patients with NFPA were evaluated by the same team of endocrinologists and neurosurgeon. Patients underwent biochemical evaluation, radiological studies and visual field assessment. RESULTS: Hypopituitarism and neuro-ophthalmological defects were observed in 89%. We observed GH deficiency (81.4%), hypogonadism (63.3%), adrenal hypofunction (59.5%), hypothyroidism (20.4%), high (38.5%) and low (16.7%) prolactin levels. Preoperative imaging classified 93% of the tumors as macroadenomas. Extra-sellar expansion was observed in 83.8%. Varying degrees of visual disturbance were observed in 74%. Primary treatment was transsphenoidal surgery (75%). Clinical control was achieved with one surgery in 37.5 % of patients. The majority of patients needed a second therapeutic approach, radiotherapy or other surgeries. Immunohistochemistry resulted negative for pituitary hormones in 43%. Improvement of neuro-ophthalmological symptoms was observed in 61% of the patients after treatment. CONCLUSIONS: Our data confirm elevated prevalence of mass effect and hypopituitarism in patients harboring NFPA. Recurrence due to invasion or incomplete resection of the tumor is quite common...

Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

Oya, Soichi; Kumai, Junichiro; Shigeno, Taku
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.51%
The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Primary Closure of a Cerebrospinal Fluid Fistula by Nonpenetrating Titanium Clips in Endoscopic Endonasal Transsphenoidal Surgery: Technical Note

Kobayashi, Hiroyuki; Asaoka, Katsuyuki; Terasaka, Shunsuke; Murata, Jun-ich
Fonte: Thieme Medical Publishers Publicador: Thieme Medical Publishers
Tipo: Artigo de Revista Científica
Publicado em /01/2011 EN
Relevância na Pesquisa
46.78%
Postoperative cerebrospinal fluid (CSF) leakage is one of the most common and aggravating complications in transsphenoidal surgery. Although primary closure of the fistula would be the most desirable solution for an intraoperatively encountered CSF leak, it is difficult to achieve in such a deep and narrow operative field. In this article, the authors report endonasal endoscopic applications of no-penetrating titanium clips to repair a CSF fistula following tumor removal. The AnastoClip Vessel Closure System (VCS; LeMaitre Vascular, Boston, MA) was used for closure of a CSF fistula in endonasal transsphenoidal surgery. In all four patients, CSF leakage was successfully obliterated primarily with two to five clips. There was no postoperative CSF rhinorrhea or complications related to the use of the VCS. Metal artifact by the clips on postoperative images was tolerable. Primary closure of the fistula using the VCS was an effective strategy to prevent postoperative CSF leakage in transsphenoidal surgery. Future application can be expanded to reconstruction of the skull base dura via endonasal skull base approaches.

The use of an early postoperative CRH test to assess adrenal function after transsphenoidal surgery for pituitary adenomas

Kokshoorn, Nieke E.; Romijn, Johannes A.; Roelfsema, Ferdinand; Rambach, Anna H. J. H.; Smit, Johannes W. A.; Biermasz, Nienke R.; Pereira, Alberto M.
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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Transsphenoidal surgery (TS) is the treatment of choice for many pituitary tumors. Because TS may cause pituitary insufficiency in some of these patients, early postoperative assessment of pituitary function is essential for appropriate endocrine management. The aim of our study was to evaluate the clinical relevance of the CRH-stimulation test in assessing postoperative pituitary-adrenal function. We performed a retrospective analysis of 144 patients treated by TS between January 1990 and November 2009, in whom a CRH-test and a second stimulation test was performed to assess adrenal function during follow-up. Patients with Cushing’s disease were excluded. Hydrocortisone substitution was started if peak cortisol levels were <550 nmol/L. The cortisol response was insufficient in 42(29%) and sufficient in 102 patients at the postoperative CRH-test. Thirteen of 42(30%) demonstrated a normal cortisol response during a second cortisol stimulation test. In 75 of the 102 patients with a sufficient response to CRH repeat testing revealed an insufficient cortisol response in 14 patients (14%). All but one had concomitant pituitary hormone deficits. There were no cases of adrenal crises during follow-up. Additional pituitary insufficiency was significantly more present (P < 0.001) in the group of patients with an abnormal response to CRH directly after surgery. In this study a substitution strategy of hydrocortisone guided by the postoperative cortisol response to CRH appeared safe and did not result in any case of adrenal crises. However...

Endovascular Management of Vascular Injury during Transsphenoidal Surgery

Çinar, C.; Bozkaya, H.; Parildar, M.; Oran, I.
Fonte: Centauro S.r.l. Publicador: Centauro S.r.l.
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.65%
Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery.

Predictors of endoscopic transsphenoidal surgery outcome in acromegaly: patient and tumor characteristics evaluated by magnetic resonance imaging

van Bunderen, Christa C.; van Varsseveld, Nadège C.; Baayen, Johannes C.; van Furth, Wouter R.; Aliaga, Esther Sanchez; Hazewinkel, Marieke J.; Majoie, Charles B. L. M.; Freling, Nicole J. M.; Lips, Paul; Fliers, Eric; Bisschop, Peter H.; Drent, Madelein
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.51%
The availability of various first-line treatment modalities for acromegaly and evolving surgical techniques emphasize the need for accurately defined predictors of surgical outcome. We retrospectively analysed the outcome of 30 patients with acromegaly after initial endoscopic transsphenoidal surgery in two university hospitals from 2001 until 2009, and reviewed comparable literature investigating predictive tumor characteristics. Medical records were monitored for patient characteristics. Each pituitary magnetic resonance imaging (MRI) scan was revised independently by two neuroradiologists using a standardised analysis form to record distinctive predefined tumor characteristics. All characteristics were independently analysed as predictors for persistent disease, and a multivariable predictive model was created. Literature from 2000 onwards was searched for studies describing tumor characteristics predictive for surgical outcome. The cohort consisted of 27 macroadenomas with 90 % demonstrating signs of parasellar extension. The surgical cure rate overall was 30 %. Independently, next to male sex and increasing tumor size, infrasellar and parasellar extension based on MRI staging tended to increase the risk of persistent disease. In a multivariable analysis...

Delayed Cavernous Carotid Artery Pseudoaneurysm Caused by Absorbable Plate Following Transsphenoidal Surgery: Case Report and Review of the Literature

Tuchman, Alexander; Khalessi, Alexander A.; Attenello, Frank J.; Amar, Arun P.; Zada, Gabriel
Fonte: Georg Thieme Verlag KG Publicador: Georg Thieme Verlag KG
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.58%
Background Bioabsorbable plates are frequently utilized in the repair of skull base defects following transsphenoidal operations. Traumatic intracranial pseudoaneurysms are a rare complication of transsphenoidal surgery. To date, iatrogenic carotid pseudoaneurysm associated with the use of an absorbable plate has been reported once.

Use of the Hadad-Bassagasteguy flap for repair of recurrent cerebrospinal fluid leak after prior transsphenoidal surgery

Brunworth, Joseph; Lin, Tina; Keschner, David B.; Garg, Rohit; Lee, Jivianne T.
Fonte: OceanSide Publications, Inc. Publicador: OceanSide Publications, Inc.
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
46.97%
The Hadad-Bassagasteguy vascularized nasoseptal pedicled flap (HBF) is an effective technique for reconstruction of skull base defects with low incidence of postoperative cerebrospinal fluid (CSF) leak. Advanced planning is required as posterior septectomy during transsphenoidal surgery can preclude its use due to destruction of the vascular pedicle. We present four cases in which the HBF was successfully used to repair recurrent CSF leaks despite prior posterior septectomy and transsphenoidal surgery. A retrospective chart review was performed on all patients who developed recurrent CSF leak after transsphenoidal surgery over a 7-year period (2006–2013). Data were collected regarding demographics, clinical presentation, intraoperative findings, and surgical outcomes. Four patients who developed recurrent CSF drainage after transsphenoidal surgery were managed with HBF reconstruction during the study period. Two were men and two were women with a mean age of 37 years (range, 24–48 years). All had previously undergone resection of a pituitary macroadenoma via a transsphenoidal approach, with intraoperative CSF leaks repaired using multilayered free grafts. Recurrent CSF rhinorrhea arose 0.37–12 months (mean, 2.98 months) after the initial pituitary surgery. Active CSF drainage could be visualized intraoperatively with posterior septal perforations present. The HBF was successfully used in all cases...

Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist

Fan, Yun-ping; Lv, Ming-hui; Feng, Shao-yan; Fan, Xiang; Hong, Hai-yu; Wen, Wei-ping; Li, Hua-bin
Fonte: Springer India Publicador: Springer India
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.74%
The purpose is to summarize the experience in full endoscopic transsphenoidal resection of pituitary adenoma in 28 patients by rhinologist, and introduce the surgical skill of otolaryngologist, especially skills and cautions when operating inside nose. We removed pituitary adenoma in 28 patients via entirely endoscopic transsphenoidal approach with the help of special-designed instruments; we performed the procedure bloodlessly within limited time. The skill emphasized bilateral nostrils and four hands technique which was as delicate as possible not to scratch nasal mucosa or injure nasal frame. The special instruments included curette with suction, monopolar electrotome and bipolar coagulation forceps with suction, powered surgical equipments (Diamond Bur, Irrigation Tubing for Blades and Burs for nasal endoscopic surgery). Among 28 patients, there were 16 total resections, 8 subtotal resections, 3 partial resections, and 1 only biopsy due to excessive bleeding and hard nature. Of 19 patients with preoperative visual impairment, 12 patients had postoperative improvement in visual acuity and visual field. All the procedures were finished within 60 to 90 min. Complications seldom occurred except transient diabetes insipidus, especially no nasal-related signs or complications but 1 had epistaxis. The full endoscopic transsphenoidal surgery is a promising approach for pituitary adenoma resection. Multidisciplinary collaboration will lead to optimal cure for the patients. New technique and special-designed instruments can facilitate greatly this procedure.

Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

Yoon, Kyeong-Wook; Cho, Chun-Sung; Lee, Sang-Koo
Fonte: The Korean Neurosurgical Society Publicador: The Korean Neurosurgical Society
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.65%
Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complication of cerebral infection after TSS for pituitary macroadenoma.

Detection of recurrent Cushing’s disease: proposal for standardized patient monitoring following transsphenoidal surgery

Ayala, Alejandro; Manzano, Alex J.
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.54%
Transsphenoidal surgery (TSS) is first-line treatment for Cushing’s disease (CD), a devastating disorder of hypercortisolism resulting from overproduction of adrenocorticotropic hormone by a pituitary adenoma. Surgical success rates vary widely and disease may recur years after remission is achieved. Recognizing CD recurrence can be challenging; although there is general acceptance among endocrinologists that patients need lifelong follow-up, there are currently no standardized monitoring guidelines. To begin addressing this need we created a novel, systematic algorithm by integrating information from literature on relapse rates in surgically-treated CD patients and our own clinical experiences. Reported recurrence rates range from 3 to 47 % (mean time to recurrence 16–49 months), emphasizing the need for careful post-surgical patient monitoring. We recommend that patients with post-operative serum cortisol <2 µg/dL (measured 2–3 days post-surgery) be monitored semiannually for 3 years and annually thereafter. Patients with post-operative cortisol between 2 and 5 µg/dL may experience persistent or subclinical CD and should be evaluated every 2–3 months until biochemical control is achieved or additional treatment is initiated. Post-operative cortisol >5 µg/dL often signifies persistent disease and second-line treatment (e.g....

Long-term follow-up on Cushing disease patient after transsphenoidal surgery

Jeong, Insook; Oh, Moonyeon; Kim, Ja Hye; Cho, Ja Hyang; Choi, Jin-Ho; Yoo, Han-Wook
Fonte: The Korean Society of Pediatric Endocrinology Publicador: The Korean Society of Pediatric Endocrinology
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
46.74%
Cushing disease is caused by excessive adrenocorticotropic hormone (ACTH) production by the pituitary adenoma. Transsphenoidal surgery is its first-line treatment. The incidence of Cushing disease in children and adolescents is so rare that long-term prognoses have yet to be made in most cases. We followed-up on a 16-year-old male Cushing disease patient who presented with rapid weight gain and growth retardation. The laboratory findings showed increased 24-hour urine free cortisol and lack of overnight cortisol suppression by low-dose dexamethasone test. The serum cortisol and 24-hour urine free cortisol, by high-dose dexamethasone test, also showed a lack of suppression, and a bilateral inferior petrosal sinus sampling suggested lateralization of ACTH secretion from the right-side pituitary gland. However, after a right hemihypophysectomy by the transsphenoidal approach, the 24-hour urine free cortisol levels were persistently high. Thus the patient underwent a total hypophysectomy, since which time he has been treated with hydrocortisone, levothyroxine, recombinant human growth hormone, and testosterone enanthate. Intravenous bisphosphonate for osteoporosis had been administered for three years. At his current age of 26 years, his final height had attained the target level range; his bone mineral density was normal...

Guidance value of MRI for transsphenoidal surgery of pituitary adenomas with cystic degeneration

Xiao, Deyong; Wang, Shousen; Zhao, Lin; Wei, Liangfeng; Hong, Jingfang; Zhong, Qun; Yu, Yinghao; Huang, Yinxing
Fonte: e-Century Publishing Corporation Publicador: e-Century Publishing Corporation
Tipo: Artigo de Revista Científica
Publicado em 15/04/2015 EN
Relevância na Pesquisa
46.65%
Objective: This study is to evaluate the surgical outcomes of transsphenoidal surgery in pituitary adenoma (PA) patients with cystic degeneration by using MRI. Methods: Eighty-three patients with surgically and pathologically confirmed PA were enrolled. They were divided into three groups according to preoperative MR images: substantive adenoma group (n = 40), cystic degeneration without fluid-fluid level group (n = 19), cystic degeneration with fluid-fluid level group (n = 24). The PA was removed by transsphenoidal surgery and the surgical outcomes were retrospectively compared. Results: The number of cases with abundant blood supply was 17 cases (42.5%) in substantive adenoma group, 13 cases (68.4%) in cystic degeneration without fluid-fluid level group and 16 cases (66.7%) in cystic degeneration with fluid-fluid level group. Blood supply in cystic degeneration with fluid-fluid level group was significantly richer than that in substantive adenoma group (P < 0.05). Peritumoral adhesion was significantly greater in cystic degeneration with fluid-fluid level group than in substantive adenoma group. And, PA with fluid-fluid level has significantly lower tumor total resection rate and MVD as well as higher recurrence rate (P < 0.05). Differences in cerebrospinal fluid leakage and postoperative diabetes insipidus were both not significant among the three groups (P > 0.05). Conclusions: Compared with other types of PA...

Endoscopic endonasal transsphenoidal surgery: A mentoring surgical model

Yang, J.; De Ruiter, I.; Parker, A.; Wormald, P.J.; Robinson, S.; Wickremesekera, A.
Fonte: Blackwell Science Asia Publicador: Blackwell Science Asia
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
Relevância na Pesquisa
66.74%
Background:  We report the experience of endoscopic endonasal transsphenoidal surgery (EETS) for resection of pituitary region tumours at Wellington, the central regional referral centre for neurosurgery in New Zealand, and discuss the collaborative mentoring surgical model that enhanced the learning experience. Method:  Between January 2007 and June 2009, a total of 47 operations on 46 patients were performed and reviewed retrospectively. All patients had perioperative clinical assessment, hormonal profile and magnetic resonance imaging studies for residual/recurrent disease. The collaborative model utilized two neurosurgeons with experience in the microsurgical resection of pituitary tumours: an endoscopic skull base fellowship trained rhinologist and an endoscopic skull base rhinologist with more experience who visited twice a year from Adelaide, Australia. Results:  The pathology results included: 30 non-functioning pituitary adenomas, 10 secreting pituitary adenomas, 3 meningiomas, 1 chordoma, 1 anterior skull base adenocarcinoma and 1 clival prostate metastasis. Complete tumour resection was intended and achieved in 38 cases. All 10 patients with secreting adenomas achieved improvement of hormonal profile. Nineteen out of 27 cases demonstrated improvement of vision. Perioperative complications included one epistaxis...

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center; Estratégia cirúrgica na doença de Cushing em pacientes pediátricos: análise de 15 casos consecutivos operados em centro neurocirúrgico especializado

OLIVEIRA, Ricardo Santos de; CASTRO, Margaret de; ANTONINI, Sonir Roberto Rauber; MARTINELLI JÚNIOR, Carlos Eduardo; MOREIRA, Ayrton Custódio; MACHADO, Helio Rubens
Fonte: Sociedade Brasileira de Endocrinologia e Metabologia Publicador: Sociedade Brasileira de Endocrinologia e Metabologia
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
46.84%
OBJECTIVE: The aim of this study was to review the results of surgery for pediatric patients with Cushing's disease who were less than 18 years old and underwent transsphenoidal surgery in a specialized center during a 25-year period. SUBJECTS AND METHODS: Retrospective study, in which the medical records, histology and pituitary imaging of 15 consecutive pediatric patients with Cushing's disease (mean age: 13 years) were evaluated by the same team of endocrinologists and a neurosurgeon from 1982 to 2006. Patients were considered cured when there was clinical adrenal insufficiency and serum cortisol levels were below 1. 8 µg/dL or 50 nmol/L after one, two, three, or seven days following surgery; they therefore required cortisone replacement therapy. Follow-up was for a median time of 11.5 years (range: 2 to 25 years). RESULTS: Clinical and biochemical cure was achieved in 9/15 patients (60%) exclusively after transsphenoidal surgery. Hypopituitarism was observed in four patients; growth hormone deficiency, in two; permanent diabetes insipidus, in one case. CONCLUSIONS: Cushing's disease is rare in children and adolescents. Transsphenoidal surgery is an effective and safe treatment in most of these patients. Plasma cortisol level < 1. 8 µg/dL following surgery is the treatment goal and is a good predictive factor for long-term cure of Cushing's disease.; OBJETIVO: O objetivo deste estudo foi avaliar os resultados cirúrgicos em pacientes pediátricos com doença de Cushing com idade inferior a 18 anos...

Surgical management of pediatric Cushing's disease: an analysis of 15 consecutive cases at a specialized neurosurgical center

Oliveira,Ricardo Santos de; Castro,Margaret de; Antonini,Sonir Roberto Rauber; Martinelli Júnior,Carlos Eduardo; Moreira,Ayrton Custódio; Machado,Helio Rubens
Fonte: Sociedade Brasileira de Endocrinologia e Metabologia Publicador: Sociedade Brasileira de Endocrinologia e Metabologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2010 EN
Relevância na Pesquisa
46.84%
OBJECTIVE: The aim of this study was to review the results of surgery for pediatric patients with Cushing's disease who were less than 18 years old and underwent transsphenoidal surgery in a specialized center during a 25-year period. SUBJECTS AND METHODS: Retrospective study, in which the medical records, histology and pituitary imaging of 15 consecutive pediatric patients with Cushing's disease (mean age: 13 years) were evaluated by the same team of endocrinologists and a neurosurgeon from 1982 to 2006. Patients were considered cured when there was clinical adrenal insufficiency and serum cortisol levels were below 1. 8 µg/dL or 50 nmol/L after one, two, three, or seven days following surgery; they therefore required cortisone replacement therapy. Follow-up was for a median time of 11.5 years (range: 2 to 25 years). RESULTS: Clinical and biochemical cure was achieved in 9/15 patients (60%) exclusively after transsphenoidal surgery. Hypopituitarism was observed in four patients; growth hormone deficiency, in two; permanent diabetes insipidus, in one case. CONCLUSIONS: Cushing's disease is rare in children and adolescents. Transsphenoidal surgery is an effective and safe treatment in most of these patients. Plasma cortisol level < 1. 8 µg/dL following surgery is the treatment goal and is a good predictive factor for long-term cure of Cushing's disease.

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero,Alicia Del Carmen Becerra; Nora,Joaquim Enseñat; Topczewski,Thomaz Eduardo; Aguiar,Paulo Henrique Pires de; Alobid,Isam; Rodriguéz,Enrique Ferrer
Fonte: Academia Brasileira de Neurologia - ABNEURO Publicador: Academia Brasileira de Neurologia - ABNEURO
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2010 EN
Relevância na Pesquisa
46.86%
BACKGROUND: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery. OBJECTIVE: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. METHOD: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. RESULTS: Six patients (8.2%) had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. CONCLUSION: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report.

Transsphenoidal surgery for Cushing's disease.

Fahlbusch, R; Buchfelder, M; Müller, O A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /05/1986 EN
Relevância na Pesquisa
46.54%
A series of 101 patients with Cushing's disease underwent transsphenoidal surgery. Diagnosis was fundamentally based on dynamic testing, mainly on the dosage-dependent suppression of cortisol after dexamethasone. The effect of surgery was monitored by intraoperative ACTH measurements. In 96 out of 101 patients a microadenoma of the pituitary was identified and removed selectively. In 74% of patients there was a clinical and endocrinological remission of Cushing's disease. Four 'operative failures' after selective adenomectomy underwent hypophysectomy in a second operation and each remitted. Thus the overall remission rate was 77%. In general, bilateral adrenalectomy was performed in patients who had failed to remit after selective adenomectomy. Although there is a considerable mortality and morbidity in patients with Cushing's syndrome, complications attributed to surgery were low. Two patients died postoperatively. In general, an improvement of disturbed pituitary function was noted after selective adenomectomy.