Wyniki leczenia neurochirurgicznego gruczolaków kortykotropowych przysadki w zespole Nelsona — pułapki terapeutyczne

Zieliński, Grzegorz; Witek, Przemysław; Maksymowicz, Maria

doi:10.5603/ep.2015.0062

Cited by 8 publications

(11 citation statements)

References 23 publications

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“…In these cases, combined therapy may be the only way to attain partial remission, which was defined by the authors as a distinct improvement in the clinical course of NS, with reduced size of the pituitary tumor and decreased -but still exceeding the upper limit of normal -plasma ACTH levels. Similarly, Zielinski et al, recommend the transsphenoidal approach in the pre-invasive phase and the transcranial approach in invasive tumors (65). Our consensus panel emphasized transsphenoidal surgery as the preferred technique in the majority of the cases, depending mostly on tumor localization and growth direction, similar to the approach in other subtypes of pituitary tumors.…”

Section: Transsphenoidal Vs Transcranial Approachmentioning

confidence: 76%

“…Wilson and coworkers reported that none of the 10 patients with macroadenomas had normalized plasma ACTH levels after neurosurgery (59). In Zielinski's report, all cases that did not achieve remission after surgery were grade IV tumors (according to the Knosp scale) with infiltration of the cavernous sinus (65,68). The extent of parasellar growth, as measured by the Knosp scale, was established as the main factor influencing the effectiveness of surgical treatment.…”

Section: Remission Rates Of Surgerymentioning

confidence: 99%

“…Considering that tumors in patients with CTP-BADX/ NS in historic series were mainly macroadenomas, visual field alterations secondary to optic chiasm compression occurred in 10-51% of cases (58,59,60,61,62,63,65,66,67). Neurosurgery can achieve improvement in visual defects through decompression of the optic chiasm (58,61,63,65).…”

Section: Remission Rates Of Surgerymentioning

confidence: 99%

“…Pituitary surgery in CTP-BADX/NS is associated more frequently with side effects than primary TSS, since patients are more often subjected to repeated interventions. Still, cerebrospinal fluid leak (CSF) and meningitis have been rarely reported as complications (61,65). Hypopituitarism or the onset of new pituitary deficits is reported in 5-30% of cases (58,60,62,64,65).…”

Section: Side Effects Of Surgerymentioning

confidence: 99%

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Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome): systematic review and expert consensus recommendations

Reincke

Albani

Assié

et al. 2021

European Journal of Endocrinology

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BACKGROUND: Corticotroph tumor progression (CTP) leading to Nelson’s syndrome (NS) is a severe and difficult-to-treat complication subsequent to bilateral adrenalectomy (BADX) for Cushing’s disease. Its characteristics are not well described, and consensus recommendations for diagnosis and treatment are missing. METHODS: A systematic literature search was performed focusing on clinical studies and case series (≥5 patients). Definition, incidence, treatment and long-term outcomes of CTP/NS after BADX were analyzed using descriptive statistics. The results were presented and discussed at an interdisciplinary consensus workshop attended by international pituitary experts in Munich on October 28th, 2018. RESULTS: Data covered definition and incidence (34 studies, 1275 patients), surgical outcome (12 studies, 187 patients), outcome of radiation therapy (21 studies, 273 patients), and medical therapy (15 studies, 72 patients). CONCLUSIONS: We endorse the definition of CTP-BADX/NS as radiological progression or new detection of a pituitary tumor on thin-section MRI. We recommend surveillance by MRI after 3 months and every 12 months for the first 3 years after BADX. Subsequently, we suggest clinical evaluation every 12 months and MRI at increasing intervals every 2-4 years (depending on ACTH and clinical parameters). We recommend pituitary surgery as first-line therapy in patients with CTP-BADX/NS. Surgery should be performed before extrasellar expansion of the tumor to obtain complete and long-term remission. Conventional radiotherapy or stereotactic radiosurgery should be utilized as second-line treatment for remnant tumor tissue showing extrasellar extension.

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Section: Transsphenoidal Vs Transcranial Approachmentioning

confidence: 76%

Section: Remission Rates Of Surgerymentioning

confidence: 99%

Section: Remission Rates Of Surgerymentioning

confidence: 99%

Section: Side Effects Of Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome): systematic review and expert consensus recommendations

Reincke

Albani

Assié

et al. 2021

European Journal of Endocrinology

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“…Secondary empty sella syndrome may be a consequence of pituitary adenoma apoplexy, neurosurgery, radiotherapy, or pharmacotherapy [58][59][60]. Lymphocytic hypophysitis and Sheehan's syndrome are rare causes of secondary empty sella syndrome.…”

Section: Etiopathogenesismentioning

confidence: 99%

Zmiany torbielowate okolicy siodłowo-nadsiodłowej — diagnostyka i leczenie

Andrysiak‐Mamos

Sagan

et al. 2018

Endokrynologia Polska

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The differentiation of cystic lesions located in the sellar-suprasellar region is a significant problem in clinical practice because of the similarities in their clinical, radiological, and even histopathological picture. Arriving at the right diagnosis is vital for taking appropriate therapeutic decisions. The most frequent clinical manifestation of lesions located in the sellar-suprasellar region is headache. It often co-exists with symptoms of anterior pituitary gland insufficiency or hyperprolactinaemia caused by compression of the pituitary stalk. Diabetes insipidus, obe-sity, mental disorders, and circadian rhythm disorders may be associated with lesions penetrating the suprasellar space. It is extremely important to rule out the possible coexistence of pituitary microadenoma and Rathke's cleft cyst, which became possible with the use of ¹¹C-methionine positron emission tomography/computed tomography (C-MET PET/CT). Reports from literature indicate that pituitary microadenoma may coexist with Rathke's cleft cyst in 10% of patients. Cystic lesions of the sellar-suprasellar region should also be differentiated from a cystic pituitary adenoma or abscess. The first-choice therapy in symptomatic cystic lesions of the sellar-suprasellar region is neurosurgery, which usually relieves headache and improves vision impairment, while less frequently restores normal pituitary function. In suprasellar lesions, neurosurgery may trig-ger or aggravate pre-existing symptoms of damage to the hypothalamus. Patients undergoing neurosurgery for cystic lesions located in the sellar-suprasellar region should be monitored for a few years due to their high recurrence rate, potential malignant transformation of these lesions, and possible adenoma development through metaplasia. The advent of targeted therapy of the BRAF/MEK pathway is associated with new therapeutic opportunities for patients with craniopharyngiomas.

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Influence of gender and sexual hormones on outcomes after pituitary surgery: a systematic review and meta-analysis

Theiler,

Hegetschweiler,

Staartjes

et al. 2023

Acta Neurochir

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Background Although there is an increasing body of evidence showing gender differences in various medical domains as well as presentation and biology of pituitary adenoma (PA), gender differences regarding outcome of patients who underwent transsphenoidal resection of PA are poorly understood. The aim of this study was to identify gender differences in PA surgery. Methods The PubMed/MEDLINE database was searched up to April 2023 to identify eligible articles. Quality appraisal and extraction were performed in duplicate. Results A total of 40 studies including 4989 patients were included in this systematic review and meta-analysis. Our analysis showed odds ratio of postoperative biochemical remission in males vs. females of 0.83 (95% CI 0.59–1.15, P = 0.26), odds ratio of gross total resection in male vs. female patients of 0.68 (95% CI 0.34–1.39, P = 0.30), odds ratio of postoperative diabetes insipidus in male vs. female patients of 0.40 (95% CI 0.26–0.64, P < 0.0001), and a mean difference of preoperative level of prolactin in male vs. female patients of 11.62 (95% CI − 119.04–142.27, P = 0.86). Conclusions There was a significantly higher rate of postoperative DI in female patients after endoscopic or microscopic transsphenoidal PA surgery, and although there was some data in isolated studies suggesting influence of gender on postoperative biochemical remission, rate of GTR, and preoperative prolactin levels, these findings could not be confirmed in this meta-analysis and demonstrated no statistically significant effect. Further research is needed and future studies concerning PA surgery should report their data by gender or sexual hormones and ideally further assess their impact on PA surgery.

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Wyniki leczenia neurochirurgicznego gruczolaków kortykotropowych przysadki w zespole Nelsona — pułapki terapeutyczne

Cited by 8 publications

References 23 publications

Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome): systematic review and expert consensus recommendations

Corticotroph tumor progression after bilateral adrenalectomy (Nelson’s syndrome): systematic review and expert consensus recommendations

Zmiany torbielowate okolicy siodłowo-nadsiodłowej — diagnostyka i leczenie

Influence of gender and sexual hormones on outcomes after pituitary surgery: a systematic review and meta-analysis

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