Background: Non-functioning pituitary adenoma (NFPA) is a challenging tumor. It is usually reached to a large size before it is clinically manifested. Operative interference is the first option in treatment of large N...Background: Non-functioning pituitary adenoma (NFPA) is a challenging tumor. It is usually reached to a large size before it is clinically manifested. Operative interference is the first option in treatment of large NFPA causing compressive manifestations but with frequent postoperative residual masses that is usually required additional treatment. Postoperative radiotherapy carried frequent side effects which open the door for postoperative medical treatment with dopamine agonist (DA) drugs based on the fact that these tumors have a variable amount of dopamine receptors. Lack of randomized, placebo-controlled trials prevents any conclusion on the efficacy of this drug. Its role in controlling postoperative proliferation and decreasing the rate of recurrence of NFPA is still questionable. Objective: Efficacy of bromocriptine (dopamine agonist (DA) drug) in reducing or preventing the re-growth of non-functioning pituitary adenoma NFPA after surgery. Methods: In this study, we examined the outcome of treating NFPA after surgery, with bromocriptine (dopamine agonists drug). This study was a retrospective review of consecutive patients that were treated by the authors at Assiut University Hospital between 2012-2018. All patients had postoperative Bromocriptine in a dose of 2.5 mg twice daily. Results: Thirty two patients were included in this study after they had surgery for NFPA. All patients had a residual mass documented by the immediate post operative MRI. After 6 months of postoperative bromocriptine treatment, and with comparing to immediate post operative images, eleven patients (34%) had mass reduction, thirteen patients (41%) of their residual masses remained unchanged and eight patients (25%) of the mass showed slight increase in size but not required re-surgery. After two years and throughout the follow up period, seven patients (22%) (all were males) had complete disappearance of the mass;ten patients (31%) had more reduction of the size of the mass (two of them were males) and four patients (13%) of the mass remained unchanged (none of them were males) and eleven patients (34%) had increase of the mass and they required re-surgery (two of them were males). Conclusion: Bromocriptine (DA drug) can play a role in reducing the size or preventing the re-growth of non-functioning pituitary adenoma after surgical debulking. Males showed noticeable response comparing to females. Its regular use might limit the need for surgery in this type of tumor. Further studies with large number of patients are highly recommended.展开更多
Introduction: Despite the fact that non-functioning pituitary adenomas do not overproduce hormones, many will stain positive for a particular pituitary hormone, which can be used to differentiate these adenomas into s...Introduction: Despite the fact that non-functioning pituitary adenomas do not overproduce hormones, many will stain positive for a particular pituitary hormone, which can be used to differentiate these adenomas into subgroups. If these different sub-groups behave differently in terms of post surgical progression of disease (PSPD) rates or other clinical variables, then better treatment and prognosis could be predicted. Methods: This was a retrospective cohort study. Patients who have undergone surgery for removal of a non-functioning pituitary adenoma at Emory University Hospital served as the source for all data used in this study (n = 184). Data were collected from a database of electronic medical records (EMRs) for these patients in 2010 documenting clinical and demographic variables including treatment and PSPD. Results: Risk for PSPD did not differ by adenoma subtypes: follicle-stimulating hormone (FSH+), luteinizing hormone (LH+), or those that do not stain positive for any hormone (non-functioning, or NF?) (p = 0.971). There were two clinical characteristics statistically related to adenoma subtype: altered mental status and the anterior-posterior (AP) dimension of pre-operative adenomas. PSPD was related to several clinical characteristics, including gender, previous adenoma, post-operative residual, and follow-up time.展开更多
Background Postoperative delayed hyponatremia(PDH)is a major cause of readmission after endoscopic transsphenoidal surgery(eTSS)for pituitary adenomas(PAs).However,the risk factors associated with PDH have not been we...Background Postoperative delayed hyponatremia(PDH)is a major cause of readmission after endoscopic transsphenoidal surgery(eTSS)for pituitary adenomas(PAs).However,the risk factors associated with PDH have not been well established,and the development of a dynamic online nomogram for predicting PDH is yet to be realized.We aimed to investigate the predictive factors for PDH and construct a dynamic online nomogram to aid in its prediction.Methods We analyzed the data of 226 consecutive patients who underwent eTSS for PAs at the Department of Neurosurgery in Jinling Hospital between January 2018 and October 2020.An additional 97 external patients were included for external validation.PDH was defined as a serum sodium level below 137 mmol/L,occurring on the third postoperative day(POD)or later.Results Hyponatremia on POD 1-2(OR=2.64,P=0.033),prothrombin time(PT)(OR=1.78,P=0.008),and percentage of monocytes(OR=1.22,P=0.047)were identified as predictive factors for PDH via multivariable logistic regression analysis.Based on these predictors,a nomogram was constructed with great discrimination in internal validation(adjusted AUC:0.613-0.688)and external validation(AUC:0.594-0.617).Furthermore,the nomogram demonstrated good performance in calibration plot,Brier Score,and decision curve analysis.Subgroup analysis revealed robust predictive performance in patients with various clinical subtypes and mild to moderate PDH.Conclusions Preoperative PT and the percentage of monocytes were,for the first time,identified as predictive factors for PDH.The dynamic nomogram proved to be a valuable tool for predicting PDH after eTSS for PAs and demonstrated good generalizability.Patients could benefit from early identification of PDH and optimized treatment decisions.展开更多
文摘Background: Non-functioning pituitary adenoma (NFPA) is a challenging tumor. It is usually reached to a large size before it is clinically manifested. Operative interference is the first option in treatment of large NFPA causing compressive manifestations but with frequent postoperative residual masses that is usually required additional treatment. Postoperative radiotherapy carried frequent side effects which open the door for postoperative medical treatment with dopamine agonist (DA) drugs based on the fact that these tumors have a variable amount of dopamine receptors. Lack of randomized, placebo-controlled trials prevents any conclusion on the efficacy of this drug. Its role in controlling postoperative proliferation and decreasing the rate of recurrence of NFPA is still questionable. Objective: Efficacy of bromocriptine (dopamine agonist (DA) drug) in reducing or preventing the re-growth of non-functioning pituitary adenoma NFPA after surgery. Methods: In this study, we examined the outcome of treating NFPA after surgery, with bromocriptine (dopamine agonists drug). This study was a retrospective review of consecutive patients that were treated by the authors at Assiut University Hospital between 2012-2018. All patients had postoperative Bromocriptine in a dose of 2.5 mg twice daily. Results: Thirty two patients were included in this study after they had surgery for NFPA. All patients had a residual mass documented by the immediate post operative MRI. After 6 months of postoperative bromocriptine treatment, and with comparing to immediate post operative images, eleven patients (34%) had mass reduction, thirteen patients (41%) of their residual masses remained unchanged and eight patients (25%) of the mass showed slight increase in size but not required re-surgery. After two years and throughout the follow up period, seven patients (22%) (all were males) had complete disappearance of the mass;ten patients (31%) had more reduction of the size of the mass (two of them were males) and four patients (13%) of the mass remained unchanged (none of them were males) and eleven patients (34%) had increase of the mass and they required re-surgery (two of them were males). Conclusion: Bromocriptine (DA drug) can play a role in reducing the size or preventing the re-growth of non-functioning pituitary adenoma after surgical debulking. Males showed noticeable response comparing to females. Its regular use might limit the need for surgery in this type of tumor. Further studies with large number of patients are highly recommended.
文摘Introduction: Despite the fact that non-functioning pituitary adenomas do not overproduce hormones, many will stain positive for a particular pituitary hormone, which can be used to differentiate these adenomas into subgroups. If these different sub-groups behave differently in terms of post surgical progression of disease (PSPD) rates or other clinical variables, then better treatment and prognosis could be predicted. Methods: This was a retrospective cohort study. Patients who have undergone surgery for removal of a non-functioning pituitary adenoma at Emory University Hospital served as the source for all data used in this study (n = 184). Data were collected from a database of electronic medical records (EMRs) for these patients in 2010 documenting clinical and demographic variables including treatment and PSPD. Results: Risk for PSPD did not differ by adenoma subtypes: follicle-stimulating hormone (FSH+), luteinizing hormone (LH+), or those that do not stain positive for any hormone (non-functioning, or NF?) (p = 0.971). There were two clinical characteristics statistically related to adenoma subtype: altered mental status and the anterior-posterior (AP) dimension of pre-operative adenomas. PSPD was related to several clinical characteristics, including gender, previous adenoma, post-operative residual, and follow-up time.
基金supported by Jiangsu Provincial Department of Science and Technology of China(grant no.BE2022821)the China Scholarship Council(CSCgrant no.202206090022)
文摘Background Postoperative delayed hyponatremia(PDH)is a major cause of readmission after endoscopic transsphenoidal surgery(eTSS)for pituitary adenomas(PAs).However,the risk factors associated with PDH have not been well established,and the development of a dynamic online nomogram for predicting PDH is yet to be realized.We aimed to investigate the predictive factors for PDH and construct a dynamic online nomogram to aid in its prediction.Methods We analyzed the data of 226 consecutive patients who underwent eTSS for PAs at the Department of Neurosurgery in Jinling Hospital between January 2018 and October 2020.An additional 97 external patients were included for external validation.PDH was defined as a serum sodium level below 137 mmol/L,occurring on the third postoperative day(POD)or later.Results Hyponatremia on POD 1-2(OR=2.64,P=0.033),prothrombin time(PT)(OR=1.78,P=0.008),and percentage of monocytes(OR=1.22,P=0.047)were identified as predictive factors for PDH via multivariable logistic regression analysis.Based on these predictors,a nomogram was constructed with great discrimination in internal validation(adjusted AUC:0.613-0.688)and external validation(AUC:0.594-0.617).Furthermore,the nomogram demonstrated good performance in calibration plot,Brier Score,and decision curve analysis.Subgroup analysis revealed robust predictive performance in patients with various clinical subtypes and mild to moderate PDH.Conclusions Preoperative PT and the percentage of monocytes were,for the first time,identified as predictive factors for PDH.The dynamic nomogram proved to be a valuable tool for predicting PDH after eTSS for PAs and demonstrated good generalizability.Patients could benefit from early identification of PDH and optimized treatment decisions.
