Pituitary最新文献

Pituitary adenomas are prevalent intracranial tumors that, though benign, present surgical challenges due to their anatomy and hormonal behavior. Transsphenoidal surgery is the standard approach, but differentiation between normal gland and adenoma limits complete resection. Traditional imaging methods like MRI and CT are costly and disruptive, while intraoperative ultrasound (IOUS) offers a real-time, practical alternative for enhancing localization and surgical confidence. Recent advances in IOUS technology show promise, yet challenges such as spatial resolution and operator dependency hinder widespread use. This editorial discusses the potential of IOUS as a vital tool for improving safety and outcomes in pituitary adenoma surgeries.

Purpose: To investigate the protein expression levels of circadian clock genes in pituitary adenomas (PAs) using the immunohistochemical staining method.

Methods: Patients who had regular follow-up at the pituitary center, underwent transsphenoidal surgery (TSS) for PA between 8:00 AM and 2:00 PM, and had sufficient clinical data were enrolled. Patients with a known diagnosis of depression, those receiving psychiatric medication or melatonin agonists that may affect the protein expression of circadian clock genes, or those working night shifts during the preoperative period were excluded. Formalin-fixed paraffin-embedded tissue samples from patients with somatotroph, gonadotroph, lactotroph, and corticotroph adenomas were immunohistochemically stained for BMAL1, CLOCK, CRY1, CRY2, and PER2. Non-neoplastic adenohypophysis tissue adjacent to the adenoma in surgical specimens underwent the same staining procedure and served as the control group. Protein expression levels were then evaluated.

Results: A total of 86 PAs and 17 non-neoplastic adenohypophysis tissue samples were evaluated. Total BMAL1 scores tended to be higher in PAs than in control tissues (170.93 ± 59.81 vs. 142.06 ± 47.40; p = 0.064), whereas total CRY2 scores tended to be lower (12.5 [0-59.25] vs. 35 [10-60]; p = 0.053). Total CLOCK scores were lower in patients with recurrent disease compared to those without recurrence (225 [165-270] vs. 250 [212.5-280]; p = 0.038), and preoperative maximum tumor size was negatively correlated with total CRY2 scores (r=-0.463, p < 0.001). Among PA subtypes, CRY2 was the circadian clock gene showing the most prominent differences.

Conclusion: Alterations in the protein expression levels of circadian clock genes may contribute to the development and behavior of PAs.

Purpose: Pituitary adenomas (PAs) are common intracranial tumours with heterogeneous behaviour. Accurate risk stratification is critical for predicting recurrence/progression and for guiding management. The pituitary adenoma nomenclature 3 (PANOMEN 3) classification, introduced in 2024, integrates clinical, radiological, and pathological factors; however, its prognostic utility and histopathological criteria remain uncertain.

Methods: This multicentre retrospective cohort study included 804 patients with PAs surgically treated between January 2010 and December 2023. Patients were classified using the original PANOMEN 3 system and a modified system incorporating silent corticotroph adenomas (SCAs) as high-risk subtypes, revised proliferative activity criteria (Ki-67 ≥ 3%, mitotic index > 2/10 high-power fields, or p53 positivity), and Trouillas clinicopathological grading. Recurrence-free survival was analysed using Kaplan-Meier and Cox regression models. Predictive performance was assessed using receiver operating characteristic curves. Health-related quality of life (HRQoL) was measured using the EuroQol 5 Dimensions-3 Levels (EQ-5D-3 L) and EuroQol Visual Analogue Scale (EQ-VAS) preoperatively and six months postoperatively.

Results: Over a median follow-up of 5.0 years, 169 patients (21.0%) experienced recurrence/progression. The original PANOMEN 3 classification showed moderate predictive accuracy. The modified classification markedly improved predictive performance to match Trouillas' grading. Higher PANOMEN 3 grade was associated with poorer HRQoL outcomes.

Conclusion: The PANOMEN 3 classification provides clinically relevant prognostic value for recurrence/progression and postoperative HRQoL in PAs. The inclusion of SCAs and refined proliferative criteria enhanced predictive accuracy and demonstrated its potential as a comprehensive risk stratification tool. Prospective studies, including non-surgical cohorts, are warranted to confirm its generalisability.

Background: The management of pregnancy in patients with combined pituitary hormone deficiency (CPHD) represents a unique challenge due to the complex interplay of multiple pituitary hormone deficiencies, higher risk of feto-maternal complications, and lack of established evidence-based clinical guidelines. Though improvements in assisted reproductive techniques (ART) and multidisciplinary care over the last decades have increasingly enabled successful pregnancies in hypopituitary women, genetic causes of CPHD are rarely identified and data on pregnancy outcomes in affected women are scarce, underscoring the need for further case documentation to better inform clinical practice.

Aims: We describe the case of a woman with genetically confirmed PROP1-related CPHD who achieved and completed a successful pregnancy through ART and tailored endocrine management throughout gestation and the postpartum period. This case report highlights the importance of preconception counseling, careful hormone replacement, and close monitoring and collaboration among expert endocrinologists, obstetricians, and neonatologists to optimize maternal and fetal outcomes in women with genetic CPHD. Furthermore, we provide a comprehensive literature review exploring key issues related to the main clinical and therapeutic challenges in the management of hypopituitarism during pregnancy, and particularly in the context of CPHD.

Purpose: Growth hormone (GH) and insulin-like growth factor-1 (IGF-1) influence erythropoiesis; however, data on the prevalence and determinants of anemia in acromegaly are limited. This study aimed to investigate the frequency, characteristics, and risk factors of anemia in patients with acromegaly.

Methods: We retrospectively reviewed medical records of 381 patients with acromegaly followed at a tertiary referral center. Clinical, hormonal, radiological, and hematological data were analyzed.

Results: Anemia was identified in 219 of 381 patients with acromegaly (57.5%). Most cases were normocytic (67%) and of mild severity (45%), while moderate and severe anemia accounted for 11.3% and 0.8%, respectively. Iron deficiency anemia was present in 41 of 219 anemic patients (18.7%) more frequently in women than men (27/120 [22.5%] vs. 14/98 [14.3%]), and thalassemia minor was detected in 4% of cases. No folate- or vitamin B12-deficiency anemia was observed. The majority of anemic cases (77.3%) remained unexplained. Sex-specific analyses showed that microcytic anemia was predominantly seen in women (49/73, 67.1%), whereas normocytic anemia displayed a nearly equal distribution between men (74/145, 51.0%) and women (71/145, 49.0%). Compared with non-anemic patients, those with anemia more frequently had macroadenomas with invasive features, residual tumor on postoperative imaging, and hypopituitarism, together with higher postoperative GH, IGF-1, and prolactin levels (all p < 0.05). They required more intensive treatment, including somatostatin receptor ligands (SRLs) (71.1% vs. 49.7%), dopamine agonists (18.8% vs. 10.4%), and radiotherapy (29.8% vs. 9.2%). Cancer prevalence was also higher in anemic patients (17% vs. 10.4%), although not statistically significant. Multivariate analysis identified macroadenoma, SRL therapy, and L-thyroxine use as independent predictors of anemia.

Conclusion: Anemia is a frequent and clinically relevant comorbidity in acromegaly, associated with tumor burden, hypopituitarism, treatment intensity. These findings highlight the need for systematic evaluation of anemia in acromegalic patients and underscore the importance of future prospective studies to clarify its complex pathophysiology.

Purpose: Factors related to the development of new pituitary hormone deficiencies following transsphenoidal surgery for non-functioning pituitary adenomas are multifactorial and remain poorly understood. We explored associations with brain injury biomarkers and investigated intraoperative hypotension (IOH) as a potential mediator.

Methods: This prospective study included 100 patients undergoing endoscopic transsphenoidal surgery. Two individual outcomes at 12-months postsurgery were analysed: new anterior pituitary hormone deficiency (APH-D) and new arginine vasopressin deficiency (AVP-D). Plasma concentrations of glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau were measured preoperatively and on postoperative days 1 and 5. IOH was assessed using two definitions: duration below an absolute MAP threshold of 65 mmHg and duration below a relative threshold of 20% below preoperative MAP. Associations between new deficiency and biomarkers were assessed using mixed-effects models, and associations with IOH were evaluated using the Mann-Whitney U test.

Results: Elevated postoperative GFAP, NfL, and tau were associated with new APH-D, with GFAP also linked to new AVP-D. Patients who experienced new APH-D demonstrated longer durations of relative IOH (median [IQR] 155 min [54-216] vs. 82 min [20-154]; p = 0.03). There was no difference in relative or absolute IOH for those with new AVP-D.

Conclusion: Elevated postoperative plasma GFAP, NfL, and tau might indicate increased risk of long-term postoperative pituitary hormone deficiency. Relative IOH may also contribute to these deficiencies.

Reduction in growth hormone (GH) signaling throughout life is known to extend lifespan and enhance healthspan in mice, and congenital GH receptor (GHR) mutations in both mice and humans confer protection against age-related diseases such as cancer, diabetes, and cognitive decline. To explore the health effects of disrupting GH action during adulthood, we previously generated adult-onset GHR knockout (6mGHRKO) mice by ablating GHR at 6 months of age. Both male and female 6mGHRKO mice exhibited reduced oxidative stress, with males showing improved insulin sensitivity and resistance to cancer, while females demonstrated extended lifespan. In the current study, we performed RNA sequencing on subcutaneous adipose tissue (Subq AT) from 6mGHRKO and control mice to investigate molecular mechanisms underlying these health benefits. Differential gene expression, gene ontology, pathway enrichment, and upstream regulator analyses revealed that GHR ablation predominantly downregulated gene expression, particularly in males. Sex-specific gene expression differences were more pronounced in control mice than in 6mGHRKO counterparts. Among the enriched processes, pathways related to extracellular matrix (ECM) organization emerged as differentially regulated between sexes and genotypes. These transcriptomic findings are exploratory and hypothesis-generating, highlighting ECM remodeling as a potential area for future mechanistic validation.

Purpose: Detection of pituitary incidentalomas is increasing in frequency with the use of advanced imaging techniques. As an adjunct to publication of consensus guidelines on management of pituitary incidentalomas, the Pituitary Society sought to understand patient perceptions of their diagnosis, prognosis, and follow-up.

Methods: An electronic survey developed in English and translated into Japanese and Portuguese was sent to the World Alliance of Pituitary Organizations, Australian Pituitary Foundation, Pituitary Foundation UK, Associação Brasileira Addisoniana, Instituto Vidas Raras, and Pituitary Patient Advocacy Group Japan. These organizations subsequently disseminated the survey to their patient members. Survey responses were analyzed using a mixed-methods approach to capture qualitative and quantitative data.

Results: 275 patients responded to the survey, primarily from the United Kingdom (31%), Australia (20%), Japan (18%), and Brazil (15%). Respondents were mostly aged 30-69 years, although distribution differed significantly between the English-, Japanese-, and Portuguese-language surveys (p = 0.003). Only 44% of all respondents reported learning of the incidentaloma from a specialist in neurologic disorders or endocrinology. 60% were told they had a tumor and only 38% were told it was benign or noncancerous. 58% said they were worried about the treatment or long-term complications and 26% said they were scared about having cancer or about dying. 17% received little or no specific information about what was likely to happen to the incidentaloma over time.

Conclusion: Results from this survey highlight gaps in physician-patient communication about pituitary incidentalomas. Our findings underscore the need for enhanced education to improve patient perceptions of their disease.

Background: Craniopharyngioma is a rare, parasellar tumor of low histological malignancy (WHO grade 1) arising from remnants of the Rathke pouch, which can disrupt hypothalamic modulation. Sleep disturbances, including excessive daytime sleepiness (EDS), are commonly reported in patients with craniopharyngioma, although findings have been inconsistent. This systematic review and meta-analysis was conducted to aggregate prior sleep-related findings in craniopharyngioma patients, with the aim of determining the prevalence and severity of sleep disorders, as well as quantifying alterations in sleep structure and sleep breathing.

Method: Databases including PubMed, Web of Science, EBSCO, and Cochrane library were searched up through April 8, 2025, to identify studies investigating sleep disturbances in craniopharyngioma patients. Random-effect meta-analysis was employed to calculate the pooled proportion of patients with sleep disorders, pooled means of sleep scale and polysomnography parameters, and the standard mean difference in sleep parameters between craniopharyngioma patients and control group.

Results: A total of 22 studies, encompassing 1137 patients and 370 matched controls, were included. The meta-analysis revealed that the pooled mean score of Pittsburgh sleep quality index in craniopharyngioma patients was 6.76 (95% CI: 6.17-7.35). The overall prevalence of EDS was 50% (95% CI: 40%-61%), with a higher estimate from the multiple sleep latency test (MSLT) (55%, 95% CI: 43%-67%) and a lower estimate from Epworth sleepiness scale (ESS) (36%, 95% CI: 25%-48%). The prevalence of narcolepsy and obstructive sleep apnea were 27% (95% CI: 21%-33%) and 14% (95% CI: 5%-24%), respectively. The periodic limb movements index was obviously abnormal across age subgroups in craniopharyngioma. Compared to healthy controls, patients with craniopharyngioma exhibited significantly reduced rapid eye movement sleep; and compared to obese controls, craniopharyngioma patients showed shorter sleep onset latency but no reduction in non-rapid eye movement stage 3. Additionally, the pooled mean sleep latency for patients with craniopharyngioma on the MSLT was 8.45 min, significantly shorter than in healthy and obese controls.

Conclusions: Our findings imply sleep-related impairments in patients with craniopharyngioma during both of diurnal and nocturnal phases, particularly the daytime hypersomnolence and narcolepsy. Discrepancies between subjective ESS and objective MSLT of EDS assessments underscore the need for the MSLT in pediatric patients. These results suggest that the tumor and/or its treatment may affect the coordination of hypothalamic sleep-wake regulatory nuclei or orexin neurons.