Diagnosis and management of prolactin-secreting pituitary adenomas: a Pituitary Society international Consensus Statement

Nature Reviews Endocrinology, Journal Year: 2023, Volume and Issue: 19(12), P. 722 - 740

Published: Sept. 5, 2023

Language: Английский

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Acromegaly: pathogenesis, diagnosis, and management

The Lancet Diabetes & Endocrinology, Journal Year: 2022, Volume and Issue: 10(11), P. 804 - 826

Published: Oct. 6, 2022

Language: Английский

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Diagnosis and Management of Pituitary Adenomas

JAMA, Journal Year: 2023, Volume and Issue: 329(16), P. 1386 - 1386

Published: April 25, 2023

Importance Pituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by secretion hormones, nonfunctioning tumors. Clinically evident occur in approximately 1 1100 persons. Observations classified as either macroadenomas (≥10 mm) (48% tumors) or microadenomas (<10 mm). Macroadenomas may cause mass effect, such visual field defects, headache, and/or hypopituitarism, which about 18% to 78%, 17% 75%, 34% 89% patients, respectively. Thirty percent adenomas, do not produce hormones. Functioning tumors those that an excess normally produced hormones prolactinomas, somatotropinomas, corticotropinomas, thyrotropinomas, prolactin, growth hormone, corticotropin, thyrotropin, Approximately 53% can hypogonadism, infertility, galactorrhea. Twelve acromegaly adults gigantism children, 4% secrete corticotropin autonomously, resulting hypercortisolemia Cushing disease. All patients with require endocrine evaluation for hormone hypersecretion. Patients additionally compressing optic chiasm should be referred ophthalmologist formal testing. For requiring treatment, first-line therapy is usually transsphenoidal surgery, except medical therapy, bromocriptine cabergoline, first line. Conclusions Relevance manifest affect people complicated syndromes well defects hypopituitarism from effect larger First-line prolactinomas consists surgery other treatment.

Language: Английский

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Cushing Syndrome

JAMA, Journal Year: 2023, Volume and Issue: 330(2), P. 170 - 170

Published: July 11, 2023

Importance Cushing syndrome is defined as a prolonged increase in plasma cortisol levels that not due to physiological etiology. Although the most frequent cause of exogenous steroid use, estimated incidence endogenous overproduction ranges from 2 8 per million people annually. associated with hyperglycemia, protein catabolism, immunosuppression, hypertension, weight gain, neurocognitive changes, and mood disorders. Observations characteristically presents skin changes such facial plethora, easy bruising, purple striae metabolic manifestations excess fat deposition face, back neck, visceral organs. disease, which corticotropin produced by benign pituitary tumor, occurs approximately 60% 70% patients production. Evaluation possible begins ruling out use. Screening for elevated performed 24-hour urinary free test or late-night salivary evaluating whether suppressed morning after an evening dexamethasone dose. Plasma can help distinguish between adrenal causes hypercortisolism (suppressed corticotropin) corticotropin-dependent forms (midnormal levels). Pituitary magnetic resonance imaging, bilateral inferior petrosal sinus sampling, whole-body imaging identify tumor sources hypercortisolism. Management surgery remove source production followed medication includes steroidogenesis inhibitors, pituitary-targeted drugs, glucocorticoid receptor blockers. For responsive medication, radiation therapy adrenalectomy may be appropriate. Conclusions Relevance The First-line causative tumor. Many will require additional treatment medications, radiation, adrenalectomy.

Language: Английский

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Consensus on criteria for acromegaly diagnosis and remission

Pituitary, Journal Year: 2023, Volume and Issue: unknown

Published: Nov. 3, 2023

Abstract Purpose The 14th Acromegaly Consensus Conference was convened to consider biochemical criteria for acromegaly diagnosis and evaluation of therapeutic efficacy. Methods Fifty-six experts from 16 countries reviewed discussed current evidence focused on assays; the role imaging, pathology, clinical assessments; consequences diagnostic delay; remission recommendations follow up; value assessment monitoring in defining disease progression, selecting appropriate treatments, maximizing patient outcomes. Results In a with typical features, insulin-like growth factor (IGF)-I > 1.3 times upper limit normal age confirms diagnosis. Random hormone (GH) measured after overnight fasting may be useful informing prognosis, but is not required For patients equivocal results, IGF-I measurements using same validated assay can repeated, oral glucose tolerance testing might also useful. Although primary treatment outcome, findings should interpreted within context acromegaly. Follow up assessments effectiveness, imaging studies evaluating residual/recurrent adenoma mass, signs symptoms acromegaly, its complications, comorbidities. Referral multidisciplinary pituitary center considered biochemical, or at diagnosis, insufficiently responsive standard approaches. Conclusion highlight new understandings disordered GH importance expert management this rare disease.

Language: Английский

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Hypopituitarism

The Lancet, Journal Year: 2024, Volume and Issue: 403(10444), P. 2632 - 2648

Published: May 9, 2024

Language: Английский

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Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers

Pituitary, Journal Year: 2023, Volume and Issue: 26(5), P. 583 - 596

Published: Aug. 28, 2023

The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria Tumor Centers of Excellence (PTCOEs) based on expert consensus. Aim study was to validate those previously proposed through collection evaluation self-reported activity several internationally-recognized tertiary pituitary centers, thereby transforming 2017 definition into a validated quantitative one, which could serve as basis future objective PTCOE accreditation.An ad hoc prepared database distributed nine chosen by Project Scientific Committee comprising worldwide repute, agreed provide information derived from registries related years 2018-2020 completing within 60 days. database, provided each center composed Excel® spreadsheets with requested specific leading supporting teams, reviewed two blinded referees all 9 candidate centers satisfied overall definition, according referees' evaluations. To obtain numerical criteria, median values activity/parameter were considered preferred target, whereas low limit range selected acceptable target respective parameter.Three dedicated neurosurgeons are preferred, one surgeon is acceptable. Moreover, 100 surgical procedures per year while results indicated that 50 surgeries Acute post-surgery complications, including mortality readmission rates, should preferably be negligible or nonexistent, but criterion rate lower than 10% patients complications requiring 30 days after surgery. Four endocrinologists devoted diseases in total population followed not less 850. It appears at least dedicated/expert present neuroradiology, pathology, ophthalmology groups, radiation oncologists needed.This is, our knowledge, first survey evaluate relevant number high-volume field. This effort, internally reviewers, allowed transformation formulated theoretical precise definitions real-life evidence. application synopsis used independent bodies accreditation PTCOEs.

Language: Английский

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An individualized approach to the management of Cushing disease

Nature Reviews Endocrinology, Journal Year: 2023, Volume and Issue: 19(10), P. 581 - 599

Published: Aug. 3, 2023

Language: Английский

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Single-cell sequencing identifies differentiation-related markers for molecular classification and recurrence prediction of PitNET

Cell Reports Medicine, Journal Year: 2023, Volume and Issue: 4(2), P. 100934 - 100934

Published: Feb. 1, 2023

Pituitary neuroendocrine tumor (PitNET) is one of the most common intracranial tumors with variable recurrence rate. Currently, prediction unsatisfying and can be improved by understanding cellular origins differentiation status. Here, to comprehensively reveal origin PitNET, we perform comparative analysis single-cell RNA sequencing data from 3 anterior pituitary glands 21 PitNETs. We identify distinct genes representing major subtypes well poorly differentiated PitNETs in each lineage. To further verify predictive value biomarkers, include an independent cohort 800 patients average follow-up 7.2 years. In both PIT1 TPIT lineages, groups show significantly higher rates while well-differentiated SF1 Our findings possible status PitNET based on which new classification proposed verified predict recurrence.

Language: Английский

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Standards of care for medical management of acromegaly in pituitary tumor centers of excellence (PTCOE)

Pituitary, Journal Year: 2024, Volume and Issue: 27(4), P. 381 - 388

Published: June 4, 2024

Abstract Purpose A series of consensus guidelines on medical treatment acromegaly have been produced in the last two decades. However, little information is available their application clinical practice. Furthermore, international standards care not published. The aim our study was to report current for therapy acromegaly, using results collected through an audit performed validate criteria definition Pituitary Tumor Centers Excellence (PTCOE). Methods Details approaches were voluntarily provided by nine renowned centers that participated this audit. For period 2018–2020, we assessed overall number patients under treatment, distribution different modalities, biochemical control rate with therapy, and specific rates options. Results Median total median new managed annually endocrinology units 206 16.3, respectively. percentage 48.9%. Among first-generation somatostatin receptor ligand (SRL) monotherapy used a 48.7%, followed combination therapies 29.3%. Cabergoline 6.9% patients. Pegvisomant 7 pasireotide 5 centers, 7.9% 6.3%, Conclusions Current PTCOEs include use SRLs as first option about 50% patients, recommended guidelines. some are kept despite inadequate suggesting cost-effectiveness, availability, patient preference, side effects, therapeutic inertia may play possible role also PTCOE. Moreover, at odds guidelines, other monotherapies appear marginal compared extrapolated from PTCOE practice data. Presence uncontrolled each category suggest further optimization well tools such radiosurgery be needed.

Language: Английский

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