miR-200b-3p accelerates progression of pituitary adenomas by negatively regulating expression of RECK

MicroRNA(miR)-200b-3p has been associated with many tumors,but its involvement in pituitary adenoma is unclear.This study investigated the molecular mechanism underlying miR-200b-3p regulation in pituitary adenomas to provide a theoretical basis for treatment.Bioinformatics was used to analyze pituitary adenoma-related genes and screen new targets related to RECK and miRNA.As well,the relationship between miR-200b-3p and RECK protein was verified using a double-luciferase reporter gene assay.The expression of miR-200b-3p in clinical samples was analyzed by in situ hybridization.Transfection of the miR-200b-3p inhibitor and small interfering-RECK(si-RECK)was verified by qPCR.GH3 cell viability and proliferation were detected using CCK8 and EdU assays.Apoptosis was detected by flow cytometry and western blotting.Wound healing and Transwell assays were used to detect cell migration and invasion.The effects of miR-200b-3p and RECK on GH3 cells were verified using salvage experiments.miR-200b-3p was highly expressed in pituitary tumor tissue.Inhibitors of miR-200b-3p inhibited cell proliferation promoted cell apoptosis,inhibited invasion and migration,and inhibited the expression of matrix metalloproteinases.Interestingly,miR-200b-3p negatively regulated RECK.The expression of RECK in pituitary adenoma tissues was lower than that in neighboring tissues.Si-RECK rescued the function of miR-200b-3p inhibitors in the above cellular behaviors,and miR-200b-3p accelerated the development of pituitary adenoma by negatively regulating RECK expression.In summary,this study investigated the molecular mechanism by which miR-200b-3p regulates the progression of pituitary adenoma through the negative regulation of RECK.The findings provide a new target for the treatment of pituitary adenoma.

Pituitary metastasis from lung adenocarcinoma

Pituitary tumor is a common neuroendocrine tumor,but there are also rare clinical metastases at this site,which are generally transferred from extrabellar tumors.Although the clinical incidence is low,the prognosis is poor.The purpose of this editorial is to discuss further the relevant knowledge of pituitary metas-tases and remind clinicians to prevent missed diagnosis and improve the prog-nosis of these patients.

Pituitary metastasis from lung adenocarcinoma:A case report

BACKGROUND Pituitary gland metastasis is an unusual event,and pituitary metastasis from lung adenocarcinoma is extremely rare and associated with poor prognosis.To date,approximately 15 cases have been reported.CASE SUMMARY Here,we present the case of a 64-year-old woman with pituitary metastasis derived from lung adenocarcinoma,which was difficult to distinguish from other sellar tumors.The patient presented to the neurosurgery clinic with blurred vision and intermittent headache.During hospitalization,brain computed tomography(CT)and magnetic resonance imaging revealed a pituitary macroadenoma.Chest CT revealed irregular nodules in the basal segment of the lower lobe of the left lung,which were likely lung cancer.Positron emission tomography-CT revealed a carbohydrate metabolism tumor in the lungs and sellar region,which was considered malignant.Postoperative pathological examination of the sellar tumor revealed lung adenocarcinoma.CONCLUSION Excision of pituitary metastases combined with radiotherapy and chemotherapy should be a priority treatment for patients with pituitary metastasis.

Pulsatile gonadotropin-releasing hormone therapy induces spermatogenesis in pituitary stalk interruption syndrome:A case report and review of the literature

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare anatomical defect of the pituitary gland falling under the spectrum of holoprosencephaly phenotypes.It is characterized by a deficiency in anterior pituitary hormones,such as growth hormone,gonadotropins,and thyroid hormones.Due to the syndrome's rarity and nonspecific manifestations,there is a lack of standardized treatment strategies.Consequently,early diagnosis through imaging and on-time intervention are crucial for improving patients’outcomes.CASE SUMMARY A 30-year-old man presented with absent secondary sexual characteristics and azoospermia.Laboratory evaluation revealed a deficiency in gonadotropins,while thyroid function was mostly within normal ranges.Magnetic resonance imaging of the pituitary gland showed pituitary stalk agenesis,hypoplasia of the anterior pituitary,and ectopic posterior pituitary,leading to the diagnosis of PSIS.Initially,the patient underwent 6 mo of gonadotropin therapy without significant changes in hormone levels and secondary sexual characteristics.Pulsatile gonadotropin-releasing hormone therapy was then administered,resulting in the detection of sperm in the semen analysis within 3 mo.After 6 mo,routine semen tests showed normal semen quality.The couple faced challenges in conceiving due to abstinence and underwent three cycles of artificial insemination,which was unsuccessful.They also attempted in vitro fertilization,but unfortunately,the woman experienced a miscarriage 10 wk after the embryo transfer.CONCLUSION Early detection,accurate diagnosis,and timely treatment are crucial in improving the quality of life and fertility of PSIS patients.

Pituitary stalk interruption syndrome complicated with liver cirrhosis:A case report

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare disorder,often characterized by delayed growth and development,short stature,and hypogonadism as the main clinical manifestations.It is not clear whether PSIS can lead to liver cirrhosis.CASE SUMMARY This paper reported a case of liver cirrhosis of unknown origin.The patient was admitted to Beijing Ditan Hospital Affiliated to Capital Medical University in November 2023.The diagnosis of PSIS complicated with liver cirrhosis was established after a series of blood tests and pituitary magnetic resonance imaging examination.CONCLUSION We also reviewed the literature from both domestic and international sources to deepen the clinical understanding of PSIS in conjunction with liver cirrhosis among medical practitioners.

Clinical application of reserved gastric tube in neuroendoscopic endonasal surgery for pituitary tumor

BACKGROUND The neuroendoscopic approach has the advantages of a clear operative field,convenient tumor removal,and less damage,and is the development direction of modern neurosurgery.At present,transnasal surgery for sphenoidal pituitary tumor is widely used.But it has been found in clinical practice that some patients with this type of surgery may experience post-operative nausea and vomiting and other discomforts.AIM To explore the effect of reserved gastric tube application in the neuroendoscopic endonasal resection of pituitary tumors.METHODS A total of 60 patients who underwent pituitary adenoma resection via the endoscopic endonasal approach were selected and randomly divided into the experimental and control groups,with 30 in each group.Experimental group:After anesthesia,a gastric tube was placed through the mouth under direct vision using a visual laryngoscope,and the fluid accumulated in the oropharynx was suctioned intermittently with low negative pressure throughout the whole process after nasal disinfection,during the operation,and when the patient recovered from anesthesia.Control group:Given the routine intraoperative care,no gastric tube was left.The number of cases of nausea/vomiting/aspiration within 24 h post-operation was counted and compared between the two groups;the scores of pharyngalgia after waking up,6 h post-operation,and 24 h postoperation.The frequency of postoperative cerebrospinal fluid leakage and intracranial infection were compared.The hospitalization days of the two groups were statistically compared.RESULTS The times of postoperative nausea and vomiting in the experimental group were lower than that in the control group,and the difference in the incidence of nausea was statistically significant(P<0.05).After the patient woke up,the scores of sore throat 6 h after the operation and 24 h after operation were lower than those in the control group,and the difference was statistically significant(P<0.05).The number of cases of postoperative cerebrospinal fluid leakage and intracranial infection was higher than that of the control group,but there was no statistically significant difference from the control group(P>0.05).The hospitalization days of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).CONCLUSION Reserving a gastric tube in the endoscopic endonasal resection of pituitary tumors,combined with intraoperative and postoperative gastrointestinal decompression,can effectively reduce the incidence of nausea,reduce the number of vomiting and aspiration in patients,and reduce the complications of sore throat The incidence rate shortened the hospitalization days of the patients.

Simultaneous rectal neuroendocrine tumors and pituitary adenoma:A case report and review of literature

BACKGROUND Neuroendocrine tumors(NET)are rare heterogeneous tumors that arise from neuroendocrine cells throughout the body.Acromegaly,a rare and slowly progressive disorder,usually results from a growth hormone(GH)-secreting pituitary adenoma.CASE SUMMARY We herein describe a 38-year-old patient who was initially diagnosed with diabetes.During colonoscopy,two bulges were identified and subsequently removed through endoscopic submucosal dissection.Following the surgical intervention,the excised tissue samples were examined and confirmed to be grade 2 NET.^(18)F-ALF-NOTATATE positron emission tomography-computed tomography(PET/CT)and 68Ga-DOTANOC PET/CT revealed metastases in the peri-intestinal lymph nodes,prompting laparoscopic low anterior resection with total mesorectal excision.The patient later returned to the hospital because of hyperglycemia and was found to have facial changes,namely a larger nose,thicker lips,and mandibular prognathism.Laboratory tests and magnetic resonance imaging(MRI)suggested a GH-secreting pituitary adenoma.The pituitary adenoma shrunk after treatment with octreotide and was neuroendoscopically resected via a trans-sphenoidal approach.Whole-exome sequencing analysis revealed no genetic abnormalities.The patient recovered well with no evidence of recurrence during follow-up.CONCLUSION ^(18)F-ALF-NOTATE PET/CT and MRI with pathological analysis can effectively diagnose rare cases of pituitary adenomas complicated with rectal NET.

Morphological comparison and gonadotropins cell localization of mature female turbot and mouse pituitary

Reproduction is subtlety regulated by the hypothalamic-pituitary-gonad(HPG)axis in vertebrates.Pituitary gland is the center of the HPG axis,while pituitary gonadotropins follicle stimulating hormone(FSH)and luteinizing hormone(LH)were identified the key elements of the HPG axis in teleost and mammal.Morphology,cell lines,and gonadotropins cell localization of female turbot and mouse pituitary were determined at mature stage to illustrate the anatomical difference and cell characteristics in this study.Results show that turbot pituitary is chicken heart-shaped,dorsoventral,located on the ventral surface of the diencephalon.The mouse pituitary is oval,located in the pituitary fossa of the sella turcica at the skull base.Two well-distinguished areas adenohypophysis(AH)and neurohypophysis(NH)in pituitary were identified in turbot and mouse.Turbot AH comprised the rostral pars distalis(RPD),proximal pars distalis(PPD),and pars intermedia(PI).NH was not pronounced and with finger-like protrusions into PPD.However,mouse AH only comprised the pars distalis(PD)and PI.NH distribution was semicircular.Three main types of cells(acidophilic,basophilic,and chromophobic cells)were distributed in the mouse PD region,whereas appeared in the turbot PPD,RPD,and PI.Moreover,the percentage of mouse chromophobic and basophilic cells was higher and lower than that of turbot,respectively.The diameter of the aforementioned three cells in the mouse was significantly higher than turbot.fshβ-and lhβ-immunoreactive signals were identified in turbot-distinct pituitary cells that primarily occupied the peripheral and central regions of AH.However,mouse fsh-and lh-immunoreactive cells were expressed in the same cells and present in the PD.These results demonstrate the significantly difference of pituitary morphology,cell lines and gonadotropins(fshβand lhβ)location in female turbot and mouse.These differences help for fully understand the evolution and endocrinological functions of pituitary.

Surgical management of pituitary adenoma during pregnancy

BACKGROUND Although conservative treatment is typically recommended for pregnant patients with pituitary adenoma(PA),surgical treatment is occasionally necessary for those with acute symptoms.Currently,surgical interventions utilized among these patients is poorly studied.AIM To evaluate the surgical indications,timing,perioperative precautions and postoperative complications of PAs during pregnancy and to provide comprehensive guidance.METHODS Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 were recruited for this study.Another 35 pregnant patients who were profiled in the literature were included in our analysis.RESULTS The 41 enrolled patients had acute symptoms including visual field defects,severe headaches or vision loss that required emergency pituitary surgeries.PA apoplexies were found in 23 patients.The majority of patients(55.9%)underwent surgery in the second trimester of pregnancy.A multidisciplinary team was involved in patient care from the preoperative period through the postpartum period.With the exception of 1 patient who underwent an induced abortion and 1 fetus that died due to a nuchal cord,39 patients delivered successfully.Among them,37 fetuses were healthy until the most recent follow-up.CONCLUSION PA surgery during pregnancy is effective and safe during the second and third trimesters.Pregnant patients requiring emergency PA surgery require multidisciplinary evaluation and healthcare management.

Pituitary apoplexy secondary to dengue fever-induced-thrombocytopenia:A case report and review of literature

Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.

Effect of Single Nostril Transsphenoidal Resection of Pituitary Adenoma under Neuroendoscope on Hospitalization Time and Bleeding Volume in Patients with Pituitary Adenoma

Objective:This study mainly discusses the clinical effect of treating pituitary adenoma by using single nostril transsphenoidal resection of pituitary adenoma under neuro-endoscope,and analyzes the influence on hospitalization time and bleeding volume.Methods:A total of 335 patients with pituitary adenoma treated in our hospital from January 2017 to January 2019 were randomly selected for study.The patients were divided into two groups by number table method.167 patients in the reference group underwent single nostril transsphenoidal resection of pituitary adenoma under microscope.Also,168 patients in the study group underwent single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope.The hospitalization time and bleeding volume and other surgical treatment effects were observed and compared.Results:There was no significant difference in the levels of prolactin(PRL),adrenocorticotropic hormone(ACTH)and thyroid stimulating hormone(TSH)between the two groups before operation(P>0.05);After surgical treatment,the levels of PRL,ACTH and TSH in the study group were lower than those in the control group(P<0.05);In terms of surgical indexes,the operation time and hospital stay in the study group were shorter than those in the reference group,and the amount of surgical bleeding was less than that in the reference group(P<0.05);The total tumor resection rate in the study group was higher than that in the reference group,and the incidence of complications such as nasal septal defect,cerebrospinal fluid leakage and diabetes insipidus in the study group was lower than that in the reference group(P<0.05).Conclusion:For pituitary adenoma diseases,using single nostril transsphenoidal resection of pituitary adenoma under neuroendoscope can improve the tumor resection rate,reduce the bleeding volume and shorten postoperative hospitalization time.

Cold exposure alters proteomic profiles of the hypothalamus and pituitary in female rats

Objective:Studies have shown that both short-term and long-term cold exposures disturb the biological process.The aim of the present study is to investigate the effects of intermittent cold exposure on proteomic profiles in the hypothalamus and pituitary of female Sprague-Dawley(SD)rats.Materials and methods:The rats were exposed to-10°C in a cabin for 4 h per day,and the treatment lasted for 14 days.The comparative label-free LC-MS/MS analysis was performed to investigate the changes of proteomic profiles in the hypothalamus and pituitary.ELISA analysis was used to validate the expression of differential proteins.Results:22 differential proteins in the hypothalamus and 75 differential proteins in the pituitary were identified by the label-free proteomic analysis.Gene ontology annotation and enrichment analysis indicated that cold exposure disrupted protein phosphorylation,filopodium assembly,intracellular protein transport,peripheral nervous system neuron axonogenesis,spinal cord development,Golgi organization,positive regulation of pseudopodium assembly,and cell-cell adhesion.Three proteins(Cdc42,Ptprs,and Setd7)were down-regulated in the cold exposure group.Conclusion:The results indicate that intermittent cold exposure alters the proteomic profiles of hypothalamus and pituitary in female rats.

Advances in the mechanism of action of metformin in pituitary tumors

Pituitary tumors are common intracranial tumors,but when faced with drugresistant or aggressive tumors,existing medical measures may not provide good control,leading to progression and deterioration.Metformin,a traditional hypoglycemic drug,has recently been discovered to have multiple functions including antitumor effects.There have been studies on the mechanism of metformin for the treatment of pituitary tumors,but it is uncertain whether it will provide new adjuvant or alternative therapies for the treatment of these tumors.We analyzed the potential mechanisms of action of metformin with respect to the inhibition of pituitary tumor growth and hormone secretion by reviewing the available literature.

Steroid-induced psychosis related to pituitary adenoma status post trans-sphenoid excision and a history of psychiatric illness:A case

BACKGROUND Steroid-induced psychosis is a common adverse effect of steroid exposure.Reported cases were mostly related to rheumatologic disease.Despite its high incidence,there is only one case reported related to perioperative steroid replacement for pituitary adenoma surgery.This manuscript presents the second case of such and compared the two with the latest literature review of steroidinduced psychosis.CASE SUMMARY This is a case of an adult male with a chief complaint of auditory hallucinations and was referred by Neurosurgery to Psychiatry Out-patient department.He was diagnosed with pituitary adenoma who underwent trans-sphenoid excision of the mass from which steroid exposure led to steroid-induced psychosis.Also,patient had a history of psychiatric illness of severe depressive episode.At the out-patient department,patient was started on antipsychotic,Risperidone,which led to eventual improvement of his symptoms.CONCLUSION The two cases of pituitary adenoma surgery with steroid-induced psychosis had almost similar clinical profile with the latest literature review of steroid-induced psychosis.However,the present case highlights the association of psychiatric illness in predisposing an individual in developing it.Also,this manuscript emphasizes that early recognition of steroid-induced psychosis leads to better prognosis.Multispecialty treatment is vital in the holistic management of the patient with timely referral and close coordination.

Profile of Pituitary Adenomas in Senegal: Epidemiological, Clinical and Therapeutic Aspects about 241 Collected Cases

Introduction: in adults, adenomas are the most frequent causes of pituitary tumours. The objective was to characterize its epidemiological and clinical aspects, as well as its therapeutic modalities in Senegal. Methodology: this was a multicenter, retrospective, descriptive and analytical study carried out from the Senegalese register of pituitary adenomas (2008-2022). Results: 242 patients were collected with an average age of 42.4 ± 13 years and a sex ratio (M/F) of 0.91. The mean consultation time was 19.7 ± 23 months. The circumstances of discovery were pituitary apoplexy (11 cases, 4.54%), tumor syndrome (176 cases, 72.72%), gonadal manifestations (103 cases, 42.56%), dysmorphic syndrome (21 cases, 8.68%), hypercorticism (15 cases, 6.19%). Morphologically, it was a macroadenoma (197 cases, 81.40%), an extensive adenoma (22 cases, 9.10%). The hormonal profile was lactotropic hypersecretion (80 cases, 33.05%), somatotropic (13 cases, 5.39%), corticotropic (14 cases, 5.78%), mixed (9 cases, 3.71%). The factors significantly associated with prolactinoma were young age (p = 0.000), female sex (p = 0.000), long consultation delay (p = 0.000) and microadenoma (p = 0.001). Only arterial hypertension was associated with acromegaly (p = 0.000). We found a significant correlation between Cushing’s disease and microadenomas (p = 0.000). Non-secreting adenomas were significantly associated with advanced age (p = 0.000), long delay in consultation (p = 0.000), male gender (p = 0.000), tumor syndrome (p = 0.001) and macroadenomas (p = 0.000). Pituitary surgery was effective in 173 patients (71.49%) including 166 cases (68.59%) by transphenoidal approach. Postoperative incidents were transient diabetes insipidus in 82 cases (47.39%), cerebrospinal fluid leak (20 cases, 11.56%). Death was observed in 18 patients in the entire series (7.44%). The latter had a tumor syndrome (88.88%), a macroadenoma (83.33%) and had undergone pituitary surgery (72.22%). Conclusion: pituitary pathology has become a reality with clinical and secretory polymorphism. The diagnostic delay explains the predominance of macroadenomas which are sources of pre and post-operative complications.

Pituitary Adenoma Complicated by Acute Bacterial Meningitis in a Patient in Kara (Togo)

Introduction: In the context of pituitary adenoma, bacterial meningitis is a possible complication of surgical or medical treatment. The occurrence of meningitis before any treatment is exceptional, explained by the existence of an osteomeningeal breach caused by the adenoma whose main symptom is rhinorrhea. Case Report: We report a case of bacterial meningitis complicating a prolactin pituitary macroadenoma. The patient had been referred for jet vomiting in a febrile context preceded by headaches and visual blurring. There was no rhinorrhea. The examination revealed a meningeal syndrome and the diagnosis of acute bacterial meningitis was made. The isolated germ was the pneumococcus. Faced with headaches and visual blurring, a cerebral scan revealed a pituitary macroadenoma and pituitary hormone dosage had shown hyperprolactinemia. The meningitis was sterilized and the prolactinoma was treated with dopaminergic agonists. This allowed the normalization of prolactinemia and the disappearance of symptoms. Conclusion: The pituitary adenoma was complicated by bacterial meningitis without treatment and the presence of a meningeal breach. Hormonal and bacterial treatments have been successful.

Relationship Between Histopathology and Clinical Prognosis of Invasive Pituitary Adenoma

Objective: To study the relationship between histopathology and clinical prognosis of invasive pituitary adenoma subjected to transsphenoidal surgery. Methods: The enrolled were 82 patients with invasive pituitary adenomas undergoing transsphenoidal surgery during Jan. 2000 - May 2003 in our department with full MR imaging findings, pathology data and follow-up information. The follow-up duration was 5-30 months. Results: MR imaging findings of invasive pituitary adenoma included: depression of the sellar floor, involvement of sphenoid sinus and cavernous sinus, breakthrough of diaphragma sellae, encasement of internal carotid artery, etc. Pathological examination revealed that the invasion rate of dura in sella turcica was the highest among the structures around tumor. Pituitary adenoma apoplexy was found in 20 cases (24.4%). The total removal rate for PRL-secreting adenomas was significantly lower than that for non-secreting adenomas (P<0.01), but non-, GH-, ACTH-secreting adenomas had no significant differences. The recurrence rate of PRL-secreting adenomas was higher than that of non- and GH-secreting adenomas (P<0.05). Conclusion: Among invasive pituitary adenomas, the therapeutic effects of non-and GH-secreting pituitary adenomas are better than that of PRL-secreting adenomas. Invasive biological behaviors of invasive pituitary adenomas result in radical operation failure and postoperative recurrence.

Secondary diabetes due to different etiologies:Four case reports

BACKGROUND As research on diabetes continues to advance,more complex classifications of this disease have emerged,revealing the existence of special types of diabetes,and many of these patients are prone to misdiagnosis and underdiagnosis,leading to treatment delays and increased health care costs.The purpose of this study was to identify four causes of secondary diabetes.CASE SUMMARY Secondary diabetes can be caused by various factors,some of which are often overlooked.These factors include genetic defects,autoimmune disorders,and diabetes induced by tumours.This paper describes four types of secondary diabetes caused by Williams–Beuren syndrome,Prader–Willi syndrome,pituitary adenoma,and IgG4-related diseases.These cases deviate significantly from the typical progression of the disease due to their low incidence and rarity,often leading to their neglect in clinical practice.In comparison to regular diabetes patients,the four individuals described here exhibited distinct characteristics.Standard hypoglycaemic treatments failed to effectively control the disease.Subsequently,a series of examinations and follow-up history confirmed the diagnosis and underlying cause of diabetes.Upon addressing the primary condition,such as excising a pituitary adenoma,providing glucocorticoid supplementation,and implementing symptomatic treatments,all patients experienced a considerable decrease in blood glucose levels,which were subsequently maintained within a stable range.Furthermore,other accompanying symptoms improved.CONCLUSION Rare diseases causing secondary diabetes are often not considered in the diag-nosis of diabetes.Therefore,it is crucial to conduct genetic tests,antibody detection and other appropriate diagnostic measures when necessary to facilitate early diagnosis and intervention through proactive and efficient management of the underlying condition,ultimately improving patient outcomes.

The Observation of Pituitary Function in Patients with Acute Pituitary Apoplexy before and after Transsphenoidal Surgery

Objective： To explore the pituitary function of acute pituitary apoplexy and its effect by transsphenoidal surgery. Methods： The clinical data and endocrine hormones level of 25 patients with acute pituitary apoplexy who underwent transsphenoidal surgery from Jan. 2002 to June 2004 were retrospectively analyzed. Results： 13 cases underwent surgery within 3 days after admission and 22 cases within 1 week. Of the 25 cases, 9 patients suffered the impairment of pituitary-thyroidal function, 14 cases of pituitary-adrenal function and 11 cases of pituitary-gonadal function before surgery. After surgery, 5/9, 8/14 and 7/11 were recovered from the corresponding hypopituitarism. Conclusion： Hypopituitarism is a major manifestation of acute pituitary apoplexy. Urgent surgery decompression contributed to the improvement of pituitary function. Patients with hypopituitarism after surgery required the corresponding hormones replacement therapy.

Systemic low-grade inflammation associated with specific depressive symptoms:insights from network analyses of five independent NHANES samples

To the editor:Major depressive disorder(MDD)is a heterogeneous disorder with varying symptom presentations and underlying biological mechanisms.1 The mainstream neurobiological hypotheses of depression involve monoamine neurotransmitters,hypothalamic-pituitary-adrenal axis,immune-inflammation and the glutamate system.