Pituitary tumors: epidemiology and clinical presentation spectrum

Araujo‐Castro, Marta; Berrocal, Víctor Rodríguez; Pascual‐Corrales, Eider

doi:10.1007/s42000-019-00168-8

Cited by 48 publications

(29 citation statements)

References 75 publications

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“…This can lead to symptoms such as weakness of muscles of the eye, blurred or double vision, blindness, headaches, facial numbness or dizziness [3]. Macroadenomas and pituitary carcinomas may also press on and destroy the normal parts of the pituitary gland leading to deficiency of one or more pituitary hormones [20]. Low levels of some body hormones such as cortisol, thyroid hormone, and sex hormones may cause symptoms.…”

Section: Clinical Presentation Of Pituitary Adenomasmentioning

confidence: 99%

Pituitary Adenomas: Insights into the Recent Trends

Kabel¹

2020

JCRT

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Pituitary adenoma is a type of pituitary neoplasms that is typically a benign, slow-growing tumor that arises from cells in the pituitary gland. Pituitary adenomas are classified according to their secretory products into functioning (Endocrine-active) tumors that represent almost 70% of pituitary tumors, and non-functioning adenomas (Endocrine-inactive). Because of physiologic effects of excess hormones, the functioning tumors present earlier than non-functioning adenomas. Patients with pituitary adenomas usually present with symptoms related to hormonal disturbances. However, pressure symptoms, such as headache, visual field defects, cranial nerve palsies and hypopituitarism may occur due to the mass effect of large tumors. Treatment of pituitary adenomas include transsphenoidal surgery and adjunctive therapy including supervoltage radiation and pharmacologic agents. This review throws light on pituitary adenoma regarding its prevalence, predisposing factors, types, clinical presentation, diagnosis and possible lines of management in view of the recent trends.

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Section: Clinical Presentation Of Pituitary Adenomasmentioning

confidence: 99%

Pituitary Adenomas: Insights into the Recent Trends

Kabel¹

2020

JCRT

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“…Pituitary adenomas (PA) are among the most common intracranial neoplasms, an can become symptomatic due to endocrine and mass effect manifestations [1]. Transsphenoidal surgery (TSS), either endoscopic or microsurgical, represents the standard of care for those patients requiring treatment, except for prolactinomas which can often be managed medically [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Impact of intraoperative magnetic resonance imaging on gross total resection, extent of resection, and residual tumor volume in pituitary surgery: systematic review and meta-analysis

et al. 2021

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Background Residual tumor tissue after pituitary adenoma surgery, is linked with additional morbidity and mortality. Intraoperative magnetic resonance imaging (ioMRI) could improve resection. We aim to assess the improvement in gross total resection (GTR), extent of resection (EOR), and residual tumor volume (RV) achieved using ioMRI. Methods A systematic review was carried out on PubMed/MEDLINE to identify any studies reporting intra- and postoperative (1) GTR, (2) EOR, or (3) RV in patients who underwent resection of pituitary adenomas with ioMRI. Random effects meta-analysis of the rate of improvement after ioMRI for these three surgical outcomes was intended. Results Among 34 included studies (2130 patients), the proportion of patients with conversion to GTR (∆GTR) after ioMRI was 0.19 (95% CI 0.15–0.23). Mean ∆EOR was + 9.07% after ioMRI. Mean ∆RV was 0.784 cm3. For endoscopically treated patients, ∆GTR was 0.17 (95% CI 0.09–0.25), while microscopic ∆GTR was 0.19 (95% CI 0.15–0.23). Low-field ioMRI studies demonstrated a ∆GTR of 0.19 (95% CI 0.11–0.28), while high-field and ultra-high-field ioMRI demonstrated a ∆GTR of 0.19 (95% CI 0.15–0.24) and 0.20 (95% CI 0.13–0.28), respectively. Conclusions Our meta-analysis demonstrates that around one fifth of patients undergoing pituitary adenoma resection convert from non-GTR to GTR after the use of ioMRI. EOR and RV can also be improved to a certain extent using ioMRI. Endoscopic versus microscopic technique or field strength does not appear to alter the impact of ioMRI. Statistical heterogeneity was high, indicating that the improvement in surgical results due to ioMRI varies considerably by center.

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“…Functioning and non-functioning hypophyseal adenomas represent 15% of all intra-cranial tumors, being considered one of the most frequent intra-cranial neoplasia (6). Their associated co-morbidities due to the tumor itself and due to hypersecretion/hyposecretion involve a relatively high rate of morbidity and mortality (7).…”

Section: Introductionmentioning

confidence: 99%

Aggressive prolactinoma (Review)

et al. 2021

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Aggressive prolactinoma (APRL) is a subgroup of aggressive pituitary tumors (accounting for 10% of all hypophyseal neoplasia) which are defined by: invasion based on radiological and/or histological features, a higher proliferation profile when compared to typical adenomas and rapidly developing resistance to standard medication/protocols in addition to an increased risk of early recurrence. This is a narrative review focusing on APRL in terms of both presentation and management. Upon admission, the suggestive features may include increased serum prolactin with a large tumor diameter (mainly >4 cm), male sex, early age at diagnosis (<20 years), and genetic predisposition [multiple endocrine neoplasia type 1 (MEN1), aryl hydrocarbon receptor interacting protein (AIP), succinate dehydrogenase (SDHx) gene mutations]. Potential prognostic factors are indicated by assessment of E-cadherin, matrix metalloproteinase (MMP)-9, and vascular endothelial growth factor (VEGF) status. Furthermore, during management, APRL may be associated with dopamine agonist (DA) resistance (described in 10-20% of all prolactinomas), post-hypophysectomy relapse, mitotic count >2, Ki-67 proliferation index ≥3%, the need for radiotherapy, lack of response in terms of controlling prolactin levels and tumor growth despite multimodal therapy. However, none of these as an isolated element serves as a surrogate of APRL diagnosis. A fourth-line therapy is necessary with temozolomide, an oral alkylating chemotherapeutic agent, that may induce tumor reduction and serum prolactin reduction in 75% of cases but only 8% have a normalization of prolactin levels. Controversies surrounding the duration of therapy still exist; also regarding the fifth-line therapy, post-temozolomide intervention. Recent data suggest alternatives such as somatostatin analogues (pasireotide), checkpoint inhibitors (ipilimumab, nivolumab), tyrosine kinase inhibitors (TKIs) (lapatinib), and mTOR inhibitors (everolimus). APRL represents a complex condition that is still challenging, and multimodal therapy is essential.

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Pituitary tumors: epidemiology and clinical presentation spectrum

Cited by 48 publications

References 75 publications

Pituitary Adenomas: Insights into the Recent Trends

Pituitary Adenomas: Insights into the Recent Trends

Impact of intraoperative magnetic resonance imaging on gross total resection, extent of resection, and residual tumor volume in pituitary surgery: systematic review and meta-analysis

Aggressive prolactinoma (Review)

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