Pituitary最新文献

Purpose: To characterize the clinicopathological features and metabolic profiles of silent growth hormone pituitary adenomas (SGH-PAs).

Methods: The single-center retrospective study identified SGH-PAs from 1387 surgically treated non-functioning PAs at Peking Union Medical College Hospital (2019-2023). Controls included 407 consecutive cases with non-functioning gonadotropin pituitary adenomas (NFG-PAs) and 90 age and gender-matched acromegaly patients. Baseline and postoperative hormonal assessments, pituitary imaging features, pathological classification, metabolic comorbidity, and follow-up outcome were collected and analyzed.

Results: 45 cases of SGH-PA (3.2%) were identified from 1387 non-functioning PAs. The pathological subtypes included 18 (40%) acidophil stem cell adenomas, 11(24%) immature PIT1-lineage tumors, 5 sparsely granulated GH tumors, 5 mammosomatotroph tumors, 4 mature plurihormonal PIT1 lineage tumors, and 2 plurihormonal pituitary tumors. Compared to controls, SGH-PAs showed modestly elevated proliferation (median Ki-67 3% vs. 2% in both acromegaly [p = 0.002] and NFG-PAs [p = 0.011]) without outstanding increases in tumor invasiveness (Knosp 3-4: 20-30% across groups) at baseline or 2-year recurrence. Baseline metabolic comorbidities paralleled NFG-PA profiles for hypertension (22%) and diabetes (8.9%), with reduced dyslipidemia prevalence (17.8% vs. 33.4%, p = 0.049). No case of SGH-PAs transforming into acromegaly was confirmed during 77 person-years of follow-up.

Conclusions: SGH-PAs represent approximately 3% of nonfunctioning PAs undergoing surgery. Multiple anterior pituitary hormones are commonly co-expressed. These tumors may be more proliferative, but the baseline aggressiveness in radiology and short-term recurrence rates are similar.

Introduction: Pituitary adenomas (PAs) are generally benign neoplasms, though in rare cases may exhibit aggressive behavior. In 2024, the PANOMEN-3 workshop released a new clinical-pathological classification. The objective of this study was to examine the potential of the PANOMEN-3 classification to predict prognosis of PAs and guide treatment in our single center cohort of patients with PAs.

Patients and methods: A longitudinal, retrospective, observational study was performed on patients with a PA diagnosis. The PANOMEN 3 classification was applied to each patient 6 months after surgery. Resultant grades were correlated with surgical outcome, disease recurrence or progression.

Results: 289 patients were included. According to the PANOMEN-3 classification, 9 patients (3.1%) were designated as grade 0, 101 patients as grade 1 (34.9%), 140 patients as grade 2 (48.4%) and 39 patients as a grade 3 (13.5%). At last follow-up assessment, 186 patients were found to be disease-free (64.4%), 93 patients (32.5%) exhibited a stable residual, 9 patients (3.1%) had recurrence and/or progression of their PA. The risk of recurrent/residual disease was increased in grade 1 (OR: OR:1.4 95%IC: 1.2-1.7), grade 2 (OR:1.5 95%IC: 1.2-1.9) and grade 3 (OR:5.7 95%IC: 2.7-12.5). Grades 1, 2 and 3 were associated with a shorter disease-free survival interval as compared to those with a grade 0 PANOMEN-3 score.

Conclusion: The PANOMEN-3 score is useful in clinical practice, aiding physicians to better plan patient follow-up, as well as to manage residual disease and treatment strategies post-surgery.

Background: Nelson's syndrome (NS) is an uncommon but serious complication after bilateral adrenalectomy (BA) in patients with Cushing's disease (CD). Stereotactic radiosurgery (SRS) has increasingly been used as a treatment option for NS patients; however, its effectiveness and safety remain uncertain. This meta-analysis aims to assess the role of SRS in NS.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science were searched through June 11, 2025, for studies reporting outcomes of SRS in NS. Pooled estimates were calculated for local control (LC), endocrine remission (ER), new pituitary dysfunction (NPD), salvage treatment (ST), and adverse radiation effects (ARE).

Results: Seven studies with 122 patients were included. Pooled LC was 95% (95% CI: 89-99%), ER was 21% (95% CI: 13-30%), NPD was 20% (95% CI: 11-31%), ST was 4% (95% CI: 0-9%), and ARE was 0% (95% CI: 0-11%). Meta-regression analysis revealed that larger lesion volume, longer interval from prior resection, and higher pre-SRS ACTH levels were significantly associated with an increased risk of ARE.

Conclusion: SRS provides high local control rates and a low safety risk for NS patients, although endocrine remission remains limited. These results support SRS as a viable choice in multidisciplinary management, although further prospective studies are needed.

Objective: Prolactin exerts numerous pleiotropic effects on various tissues, including smooth muscle. Urinary incontinence, particularly the urge subtype, is primarily associated with detrusor overactivity-the involuntary contractions of the bladder's smooth muscle. The aim of this study is to investigate the potential impact of prolactinoma on urinary incontinence (UI) in women.

Methods: This cross-sectional study included 64 patients with prolactinoma and 80 controls. UI was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Based on this instrument, incontinence was categorized into three subtypes: urge urinary incontinence (UUI), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI).

Results: The overall rate of UI was significantly higher in prolactinoma patients, with 20 cases (31.3%), compared to 6 cases (7.5%) in the control group (p < 0.001). Compared to the control group, prolactinoma patients exhibited higher rates of UUI and MUI, while no difference was found in SUI rates (p = 0.012, p = 0.008, and p = 0.839; respectively). Incontinent patients had a higher mean age, a greater frequency of macroadenoma, and a longer disease duration compared to continent patients (p = 0.015, p = 0.038, and p < 0.001; respectively). The logistic regression analysis suggested that the disease duration was the only independent predictor of UI in the prolactinoma patients.

Conclusion: Prolactinoma, particularly in the later stages of the disease, may influence detrusor muscle activity in female patients and contribute to an increased prevalence of UI.

Purpose: Hypothalamic obesity is a severe complication of craniopharyngioma, marked by hyperphagia and rapid weight gain. Glucagon-like peptide-1 receptor agonists such as semaglutide have shown promising effects on weight reduction, but long-term data on weight outcomes, metabolic parameters and quality-of-life remain limited.

Methods: Four female patients with hypothalamic obesity following craniopharyngioma treatment received semaglutide for 24 months. Assessments included DXA scans, metabolic biomarkers, and The Three-Factor Eating Questionnaire at baseline, 6, 12, and 24 months. Interviews at 24 months explored hunger, side effects and quality of life.

Results: After 24 months, median weight loss was 16% (95% CI: 8 to 34%, p = 0.004), with maximal loss of 17% at 6 months. Emotional and uncontrolled eating scores (range: 0-100) decreased by 44 (95% CI: - 69 to - 19, p = 0.011) and 27 units (95% CI: - 63 to 9, p = 0.097), respectively. Interviews revealed reduced hunger, improved self-confidence, less isolation, and higher productivity. Treatment was well tolerated; side effects were mainly mild GI symptoms. Fat and lean mass decreased by 10% (95% CI: 2 to 44%, p = 0.016) and 19% (95% CI: 14 to 26%, p < 0.001), respectively, with stable bone mineral content. Hemoglobin A1c and LDL cholesterol declined by 6.4 mmol/mol (95% CI: 2.3 to 9.9, p = 0.016) and 0.5 mmol/L (95% CI: 0.3 to 0.7, p = 0.012).

Conclusion: Semaglutide is a safe treatment that led to long-term sustained improvements in eating behavior, weight control, and improved metabolic health. Patients reported an improved quality of life, which persisted after body weight stabilization.

Background: The Pituitary Society established criteria to develop Pituitary Tumor Centers of Excellence (PTCOE) for optimization of patient care. These criteria were later transformed into quantitative standards based on real-life data from accredited pituitary centers worldwide. The aim of this study was to evaluate the pituitary tumor care capacity at our institute and compare it with the PTCOE criteria.

Method: We retrospectively reviewed the data of patients who underwent sellar, suprasellar, or parasellar surgery during 2021-2023 at Taipei Veterans General Hospital. Adults older than 18 years who were diagnosed with pituitary tumors were included. We collected data regarding baseline patient and tumor characteristics, the surgical method, complications, and activity volumes across involved departments. The relevant data were compared with those of the PTCOE standards.

Results: In total, 182 patients with pituitary tumors underwent surgery via the endoscopic endonasal approach during 2021-2023. Their median age was 51 (range, 20-91) years. Among them, 90.7% had macroadenomas. Functional remission rates were 55.6% for acromegaly, 69.2% for prolactinoma, and 93.3% for Cushing's disease. Our institute met the acceptable PTCOE criteria for the number of pituitary interventions, postoperative readmissions for complications, dynamic endocrine tests, neuroradiologists, and neuro-oncologists. Further, we met the preferred PTCOE criteria for mortality rate and the numbers of dedicated surgeons, endocrinologists, trained nurses, neuropathologists, and neuro-ophthalmologists.

Conclusion: Most indicators in our study met the acceptable standards for a PTCOE. During the study period, the multidisciplinary team at our institute collaborated closely to provide comprehensive care for patients with pituitary adenomas.

Purpose: Pituitary adenomas (PAs) constitute a rare pediatric diagnosis and their pathogenetic mechanisms are not clearly understood. The aim of this study was to evaluate the prevalence of genetic defects in pediatric PAs through germline and tumor testing, and to describe genotype-phenotype correlations.

Methods: Fifty-four pediatric patients with PAs and available germline and/or tumor samples were studied. Germline and/or tumor sequencing were reviewed for variants in genes previously associated with pituitary tumorigenesis.

Results: Germline genetic testing revealed a pathogenic variant in AIP gene in 2 patients with growth hormone excess (GHE) and a likely pathogenic variant in CDKN2A in a patient with Cushing's disease (CD). Somatic gene sequencing identified pathogenic variants in GNAS in 4/7 patients (57.1%) with GHE. 6/38 patients (15.8%) with CD had pathogenic variants in USP8 gene, and in one tumor pathogenic variants in PRKAR1A, TP53 and MEN1 genes were identified. Overall, pathogenic/likely pathogenic germline or somatic variants were identified in 14/54 patients (25.9%). When evaluating the genotype-phenotype correlations in patients with CD, patients with somatic USP8 pathogenic variants had larger tumors (median size: 9.5 mm [6.5, 13.3] vs. 6 mm [4.0, 7.0], p = 0.048), trend towards higher incidence of cavernous sinus invasion (50% vs. 12.5%, p = 0.06), and higher risk of non-remission after surgery (33.3% vs. 0%, p = 0.021) compared to patients without USP8 variants.

Conclusions: Somatic USP8 pathogenic variants correlate with worse tumor behavior and patient outcomes in pediatric-onset CD. Unlike GH-secreting PAs, the genetic basis of the majority of pediatric corticotroph PAs remains unclear. Further studies are needed to explore the genetic drivers of pediatric CD.

Clinicaltrials:

Gov id: NCT00001595, NCT03206099.