A magnetic resonance imaging‐based classification system for indication of trans‐sphenoidal hypophysectomy in canine pituitary‐dependent hypercortisolism

Sato, Aya; Teshima, Teruki; Ishino, Hirokazu; Harada, Yasuji; Yogo, Takuya; Kanno, Nobuo; Hasegawa, Daisuke; Hara, Yasushi

doi:10.1111/jsap.12474

Cited by 17 publications

(33 citation statements)

References 21 publications

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“…Thus, Sato reported on an MRI-based classification system using the pituitary tumor sizes in PDH cases. 29 The system is used to classify cases to grades I-V based on the size of the pituitary tumor and positional relationships between the pituitary tumor and the cranial structure and to determine whether blood vessels are involved (A or B). Sato et al reported that the pituitary tumor was completely removed in 29 (93.5%) of 31 total PDH cases corresponding to grades I-IIIA.…”

Section: B Amentioning

confidence: 99%

“…6,33,34 Furthermore, plasma ACTH concentration and UCCR are useful not only in clinical diagnosis but also for post-TSS recurrence and post-treatment monitoring. 22,29,35…”

Section: Acthmentioning

confidence: 99%

“…36 In the field of small animal clinical practice, MRI is generally chosen for pituitary gland evaluation owing to its high image resolution. 29,37,38 However, small pituitary gland adenomas can be detected using dynamic CT with contrast agent administration. 39 In PDH cases, the enlargement of the pituitary gland is detected prior to the onset of clinical neurological symptoms.…”

Section: Mrimentioning

confidence: 99%

“…22,24 The PBR of surgical cases in reports that evaluated TSS outcome was as follows: the Netherlands group (n=306), 0.13-1.40 (median, 0.39); 24 US group (n=26), 0.35-1.54 (median, 0.73), 30 and Japan group (n=33), 0.23-0.83. 29 However, successful TSS has been reported in the extraction of massive pituitary tumors measuring 15.0 × 21.4 × 18.3 mm (height × width ×length). 46 Even if complete removal of the massive pituitary tumor was not possible with TSS, the procedure can still be effective as a volume-reduction surgery for intracranial space-occupying lesions.…”

Section: Adenoma Size and Growth Ratementioning

confidence: 99%

“…Thus, TSS should be considered a tumor volume-reduction surgery for cases of Grade ≥3B. 29 Additional care must be given to cases where meningiomas have formed around the pituitary gland. 49 In such cases in canines, Cushing's syndrome is clinically triggered in the early stages.…”

Section: Adenoma Size and Growth Ratementioning

confidence: 99%

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Pituitary-dependent hyperadrenocorticism (PDH) is the cause of approximately 80-85% of naturally occurring cases of hyperadrenocorticism(HAC) in canines and is triggered by an adrenocorticotropic hormone (ACTH)-producing pituitary adenoma or hyperplasia of the corticotroph in the pituitary anterior lobe or intermediate lobe. Transsphenoidal surgery(TSS) is an effective treatment that can directly remove pituitary tumors that cause PDH in canines under a single course of general anesthesia. However, careful evaluations of the definitive diagnosis, adenoma size and growth rate, relationship with surrounding tissue, general condition, and neurosurgical procedural skill involved in each case are important to determine TSS suitability. The basic principle is to confirm that the present HAC case is PDH, that is, an ACTH-producing adenoma or the hyperplasia of the corticotroph originating from either the pituitary anterior or intermediate lobe. Evaluations based on endocrinology, particularly plasma ACTH concentration, and imaging diagnosis, particularly MRI is essential for definitive diagnosis. Enlarged pituitary tumors can shorten the post-TSS survival time, increase the recurrence rate of clinical symptoms, and increase the risk for developing permanent central diabetes insipidus. Therefore, complete removal of adenomas of up to Grade IIIA according to the MRI-based classification system is relatively easy to achieve with TSS, and long-term remission and survival can be expected.

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Section: B Amentioning

confidence: 99%

“…6,33,34 Furthermore, plasma ACTH concentration and UCCR are useful not only in clinical diagnosis but also for post-TSS recurrence and post-treatment monitoring. 22,29,35…”

Section: Acthmentioning

confidence: 99%