Endoscopic surgery opened new fields in pituitary tumor surgery, not only by direct endonasal access, but also by affording a panoramic view inside the sphenoidal sinus and the sellar turcica. It provides an extremely sharp image with high resolution. We describe our initial experience in using the endonasal endoscopy for the pituitary tumor surgery. Seven operations were performed by the endonasal endoscopy. The endoclinologic diagnosis were prolactinoma in four cases and GH secreating adenoma in three. Four cases were macroadenoma and three were microadenoma. Among the three patients with GH secreting adenomas, two improved clinically with normal serum GH level, one improved clinically with elevated serum GH levels postoperatively. Of the four patients with prolactinomas, all four improved clinically elevated with serum prolactin levels. Two patients developed postoperative complications; one was transient cerebrospinal fluid(CSF) leakage and the other was transient diabetes insipedus(DI). The use of the endoscope allowed close inspection of sella and parasellar structures as well as differentiation between tumor tissue and normal pituitary gland. Gross total removal was possible with the help of angled view of the telescope even in the cases of moderate supra-and parasellar extensions. Although from short and early experience, endoscopic endonasal approach seems to be a valuable and safe procedure for removing pituitary adenomas. With improved techniques and an accumulation in operative experience, endoscopic pituitary surgery will gain in importance and present new horizons in pituitary surgery.
Adenoma ; Diagnosis ; Endoscopes ; Endoscopy ; Humans ; Pituitary Gland ; Pituitary Neoplasms* ; Postoperative Complications ; Prolactin ; Prolactinoma ; Telescopes

Pituitary adenoma with cerebrospinal fluid rhinorrhea is rare clinically. In this paper, through the analysis of a pituitary adenoma patient with initial symptom of cerebrospinal fluid rhinorrhea, we look forward to provide evidence for clinical diagnosis, so that we can avoid misdiagnosis.
Adenoma ; complications ; diagnosis ; Cerebrospinal Fluid Rhinorrhea ; etiology ; Humans ; Pituitary Neoplasms ; complications ; diagnosis

Pituitary adenoma is one of the important etiologies of male infertility. The early diagnosis of pituitary adenoma that caused infertility is not difficult with the help of modem incretion examination and imaging technique. The treatment focused on pituitary adenoma is no doubt the optimal choice of this kind of male infertility.
Growth Hormone-Secreting Pituitary Adenoma ; complications ; therapy ; Humans ; Infertility, Male ; diagnosis ; etiology ; therapy ; Male ; Pituitary Neoplasms ; complications ; therapy

Cushing's disease (CD) is a relatively rare disease,characterized by pathological hypercortisolism secondary to excessive adrenocorticotrophic hormone that is secreted by pituitary adrenocorticotrophic hormone adenoma or hyperplasia. In addition to the typical clinical symptoms such as moon face,buffalo hump,and central obesity,the CD patients may also experience mental disorders and cognitive dysfunction. This review mainly focuses on the cognitive state of CD patients,the mechanisms of cognitive impairment caused by high cortisol levels,and the imaging findings (especially magnetic resonance imaging) for the evaluation of cognitive functions.
Adenoma ; complications ; Cognition ; Cognitive Dysfunction ; complications ; diagnosis ; Cushing Syndrome ; complications ; Humans ; Hyperplasia ; Magnetic Resonance Imaging ; Pituitary ACTH Hypersecretion ; Pituitary Neoplasms ; complications

Aged ; Craniocerebral Trauma ; complications ; Humans ; Magnetic Resonance Imaging ; Male ; Pituitary Apoplexy ; complications ; etiology ; Pituitary Neoplasms ; complications ; diagnosis ; Subarachnoid Hemorrhage ; etiology ; Tomography, X-Ray Computed

Brain ; blood supply ; pathology ; surgery ; Diagnosis, Differential ; Humans ; Middle Aged ; Pituitary Neoplasms ; cerebrospinal fluid ; complications ; diagnosis ; Stroke ; cerebrospinal fluid ; complications ; diagnosis ; Tuberculosis ; cerebrospinal fluid ; complications ; diagnosis

Rathke's Cleft Cyst (RCC), which is located at the intrasellar region, is considered to be the distended remnants of Rathke's pouch, an invagination of the stomodeum. Lined with columnar or cuboidal epithelium of ectodermal origin, RCC usually contains mucoid material and it is found in 13-22% of normal pituitary glands. The cyst rarely leads to the development of symptoms but, when it does, the most common presenting symptoms are headache, visual impairment, hypopituitarism and hypothalamic dysfunction. However, in some cases it presents symptoms of diabetes insipidus, decreased libido and impotence. Recently we experienced a case of RCC inflammation presenting with diabetes insipidus and treated with transsphenoidal surgery. To our knowledge, this is the first report of RCC presenting with symptoms of diabetes insipidus in Korea.
Aged ; Case Report ; Central Nervous System Cysts/complications/*diagnosis/surgery ; Diabetes Insipidus/diagnosis/*etiology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Human ; Pituitary Neoplasms/complications/*diagnosis/surgery

OBJECTIVEPituitary prolactinoma with severe erectile dysfunction (ED) as the initial symptom is often misdiagnosed. This article explores the diagnosis and treatment of severe ED caused by pituitary prolactinoma.

METHODSWe retrospectively analyzed the diagnosis and treatment of 4 cases of pituitary prolactinoma with severe ED (IIEF-5 score 5 - 7) as the initial clinical symptom confirmed by MRI.

RESULTSThe 4 cases of pituitary prolactinoma-induced severe ED, with serum prolactin 10 times above the maximum normal level, were misdiagnosed for 2 years. All failed to respond to the PDE5 inhibitor therapy, and then 3 of them underwent transnasal hypophysectomy. Twenty-four months of follow-up found the level of prolactin restored to normal in 1 case (IIEF-5 = 19), and reduced to 600 and 768 IU/L respectively (IIEF-5 = 15) in the other 2. Then administration of the PDE5 inhibitor was followed, which produced satisfactory efficacy. One case was treated with oral bromocriptine, which restored the prolactin level to normal at 12 months (IIEF-5 > 21).

CONCLUSIONProlactin detection and brain MRI can help to confirm pituitary prolactinoma with severe ED at the onset. As for its treatment, in case of an extremely high level of prolactin, simple administration of the PDE5 inhibitor is ineffective. When the prolactin level is reduced after surgery or medication, the symptom of ED can be improved and, in case of no obvious relief, administration of the PDE5 inhibitor can be followed, which may achieve satisfactory results.

Adult ; Erectile Dysfunction ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Pituitary Neoplasms ; complications ; diagnosis ; drug therapy ; Prolactinoma ; complications ; diagnosis ; drug therapy ; Retrospective Studies

OBJECTIVETo investigate the clinical features, diagnosis and treatment in patients with subclinical pituitary adenoma apoplexy (SPAA).

METHODSA retrospective analysis of all operated patients with SPAA was performed. There were 50 male and 80 female patients, ranging from 16 to 65 years (average 39 years). Endocrinological hormones were measured in all patients pre- and post-operatively, and pituitary imaging was obtained by CT scan, MRI or both.

RESULTSTranssphenoidal surgery was achieved in 89 patients, and transcranial surgery was achieved in 41 patients. There was no operative mortality. PRL adenomas were the most common tumor type (56.2%). SPAA usually occurred in patients with big or giant adenomas (97%). Hypertension and diabetes mellitus were the possible predisposing factors. Postoperative follow-up ranged from 0.5 to 6 years (mean 3.2 years). Tumor recurrence happened in 8 patients. Only 12 patients required radiotherapy with tumor residual (4 cases) and recurrence (8 cases) after surgery. Long-term thyroid or steroid hormone replacement was necessary in 25% and 20% of patients, respectively, and long-term desmopressin therapy was necessary in 1% of patients.

CONCLUSIONSThe incidence of SPAA was higher than acute pituitary apoplexy. PRL adenomas are the most common tumor type. MRI is the best investigative modality of choice. Transsphenoidal surgery is a safe and effective method. The rate of long-term endocrinological hormones replacement therapy of SPAA is lower than acute pituitary apoplexy, and the prognosis of SPAA is better than acute pituitary apoplexy. Radiotherapy is indicated if the tumor residual or recurrence are confirmed by CT or MRI after surgery.

Adenoma ; complications ; diagnosis ; therapy ; Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Female ; Hormone Replacement Therapy ; Humans ; Hypophysectomy ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Apoplexy ; diagnosis ; etiology ; therapy ; Pituitary Neoplasms ; complications ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

PURPOSE: We used the Swedish interactive threshold algorithms (SITA) standard strategy of Humphrey perimetry, to analyze the pattern of visual field (VF) defects and evaluate the quantitative correlation between the tumor volume and severity of VF defects in patients with pituitary macroadenoma. METHODS: We reviewed 50 patients with pituitary macroadenoma who received VF test and 11 patients were excluded. VF analysis was performed with Humphrey perimeter using the SITA standard strategy. The tumor volume was assessed radiologically via brain magnetic resonance images and was calculated using Cavalieri's principle. We used the mean deviation (MD) and pattern standard deviation (PSD) of the Humphrey parameter to measure VF defect severity, and then analyzed the correlation of tumor volume with VF defects. RESULTS: Twenty nine patients (74%) showed abnormal VF and bitemporal field changes, which were the most common field defects on presentation. Seven patients (18%) had unilateral VF defects, 22 patients (56%) had bilateral VF defects. The tumor volume of the patients with VF defects was significantly larger than that of patients with normal VF (p = 0.006). The tumor volume exhibited significant negative correlation with MD (r = -0.693; p < 0.001) and significant positive correlation with PSD (r = 0.589; p < 0.001). CONCLUSIONS: In patients with pituitary macroadenoma, there was a variety of VF defects and a high correlation between the tumor volume and the severity of VF defects. SITA standard strategy can be a fast and quantitative method for evaluating central VF defects.
Adenoma/*complications/*diagnosis ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; *Magnetic Re ; Male ; Middle Aged ; Pituitary Neoplasms/*complications/*diagnosis ; Retrospective Studies ; Vision Di ; *Visual Fields ; Young Adult