Pituitary adenomas: results of 684 surgically treated patients and review of the literature

Oruçkaptan, Hakan; Şenmevsim, Özcan; Özcan, Osman; Özgen, Tunçalp

doi:10.1016/s0090-3019(00)00171-3

Cited by 95 publications

(62 citation statements)

References 35 publications

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“…Surgical debulking may be employed to induce rapid optic decompression and visual improvement, or to prevent pituitary apoplexy in patients refractory to dopamine agonists (14). However, complete surgical removal of giant tumors that extend into the suprasellar, parasellar, and infrasellar areas is difficult, and biochemical cure is rare even after extensive tumor removal (15)(16)(17). After surgery, most patients still require medical therapy (1,15,16), as occurred in two of our patients as well.…”

Section: Discussionmentioning

confidence: 74%

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Shimon¹,

Benbassat²,

Hadani³

2007

eur j endocrinol

101

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Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24-52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393G14 579 ng/ml (range 2047-55 033 ng/ml; normal 5-17 ng/ml). Following treatment, levels normalized in ten men within 1-84 months (mean, 25.3 months) and decreased in the other two to 2-3 times of normal. Tumor diameter, which measured 40-70 mm at diagnosis, showed a mean maximal decrease of 47G21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.European Journal of Endocrinology 156 225-231

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Section: Discussionmentioning

confidence: 74%

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Shimon¹,

Benbassat²,

Hadani³

2007

eur j endocrinol

101

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“…There are well-known risks of radiation to this area, including macular ischemia, vasculopathy and even optic neuropathy. Furthermore, radiotherapy is not very effective in tumor control for tumors of the pituitary fossa [50], and so likewise, is probably not effective in ectopic foci either. Therefore, in selected cases, if the tumors are large or incompletely excised, post operative radiotherapy may be indicated for tumor control, although not cure [4].…”

Section: Treatment and Prognosismentioning

confidence: 99%

Ectopic Sphenoid Sinus Pituitary Adenoma (ESSPA) with Normal Anterior Pituitary Gland: A Clinicopathologic and Immunophenotypic Study of 32 Cases with a Comprehensive Review of the English Literature

Thompson

Seethala

Müller

2012

Head and Neck Pathol

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Ectopic sphenoid sinus pituitary adenoma (ESSPA) may arise from a remnant of Rathke's pouch. These tumors are frequently misdiagnosed as other neuroendocrine or epithelial neoplasms which may develop in this site (olfactory neuroblastoma, neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, paraganglioma, melanoma). Thirty-two patients with ESSPA identified in patients with normal pituitary glands (intact sella turcica) were retrospectively retrieved from the consultation files of the authors' institutions. Clinical records were reviewed with follow-up obtained. An immunohistochemical panel was performed on available material. Sixteen males and 16 females, aged 2-84 years (mean, 57.1 years), presented with chronic sinusitis, headache, obstructive symptoms, and visual field defects, although several were asymptomatic (n = 6). By definition, the tumors were centered within the sphenoid sinus and demonstrated, by imaging studies or intraoperative examination, a normal sella turcica without a concurrent pituitary adenoma. A subset of tumors showed extension into the nasal cavity (n = 5) or nasopharynx (n = 9). Mean tumor size was 3.4 cm. The majority of tumors were beneath an intact respiratory epithelium (n = 22), arranged in many different patterns (solid, packets, organoid, pseudorosetterosette, pseudopapillary, single file, glandular, trabecular, insular). Bone involvement was frequently seen (n = 21). Secretions were present (n = 16). Necrosis was noted in 8 tumors. The tumors showed a variable cellularity, with polygonal, plasmacytoid, granular, and oncocytic tumor cells. Severe pleomorphism was uncommon (n = 5). A delicate, salt-and-pepper chromatin distribution was seen. In addition, there were intranuclear cytoplasmic inclusions (n = 25) and multinucleated tumor cells (n = 18). Mitotic figures were infrequent, with a mean of 1 per 10 HPFs and a\1% proliferation index (Ki-67). There was a vascularized to sclerotic or calcified stroma. Immunohistochemistry highlighted the endocrine nature of the tumors, with synaptophysin (97%), CD56 (91%), NSE (76%) and chromogranin (71%); while pan-cytokeratin was positive in 79%, frequently with a dot-like Golgi accentuation (50%). Reactivity with pituitary hormones included 48% reactive for 2 or more hormones (plurihormonal), and 33% reactive for a single hormone, with prolactin seen most frequently (59%); 19% of cases were non-reactive. The principle differential diagnosis includes olfactory neuroblastoma, neuroendocrine carcinoma, melanoma, and meningioma. All patients were treated with surgery. No patients died from disease, although one patient died with persistent disease (0.8 months). Surgery is curative in the majority of cases, although recurrence/persistence was seen in 4 patients (13.8%). In conclusion, ESSPAs are rare, affecting middle aged patients with nonspecific symptoms, showing characteristic light microscopy and immunohistochemical features of their intrasellar counterparts. When encountering a tumor within the sphenoid sinus, ectopic...

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“…Regarding the differential diagnosis, invasive pituitary adenoma is an important consideration. Initial intrasellar localization of a pituitary adenoma with a following localized or diffuse destruction of sellar floor and extension into the sphenoid sinus -grade 3 and 4 in modified Hardy's system -is expected in 35% and 10% of cases, respectively [13]. Although MRI may help to confirm the integrity of sellar dura and sellar floor [4,10,12,19], the gold standard is an intraoperative verification [2,5,6,[9][10][11]15].…”

Section: Discussionmentioning

confidence: 99%

Three cases of ectopic sphenoid sinus pituitary adenoma

Bobeff¹,

Wiśniewski²,

Papierz³

et al. 2017

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Pituitary adenomas: results of 684 surgically treated patients and review of the literature

Cited by 95 publications

References 35 publications

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

Ectopic Sphenoid Sinus Pituitary Adenoma (ESSPA) with Normal Anterior Pituitary Gland: A Clinicopathologic and Immunophenotypic Study of 32 Cases with a Comprehensive Review of the English Literature

Three cases of ectopic sphenoid sinus pituitary adenoma

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