The application of transsphenoidal microsurgery in the management of pituitary microadenoma, long regarded as effective surgical treatment, has had a relatively low mortality and morbidity rate. However early failure and late recurrence has been reported in no small numbers. It has been proposed that stereotactic radiosurgery is an alternative treatment modality. Recent advances in neuroimaging permits precise targeting in radiosurgery of microadenomas. Additionally, a prompt hormonal reduction after the treatment is important for the patients with hormonally active microadenomas. The authors performed Gamma Knife radiosurgery in 27 patients with pituitary adenomas and observed the hormonal changes after radiosurgery in 19 patients with functioning microadenomas (5 with Cushing's disease, 7 with acromegaly, and 7 with prolactinoma). The maximum dose administered ranged from 25 to 75 Gy. The margin of the tumor was encompassed within the 50 to 90% isodose volume. The endocrinological status was assessed pre- and post-operatively. We measured the serum growth hormone and prolactin level, as well as the 24-hour urinary free-cortisol level. Normalization of the hormonal level was achieved in 6 cases, the majority of them within 10 months. The other 6 cases showed marked reduction of hormonal levels (less than 50% of preoperative levels) with a strong possibility of hormonal remission at further follow-up. The remaining 6 were failures. The cure for one case is still pending. It took approximately 1 approximately 3 months after the radiosurgery before the reduction of hormonal secretion began to show up with some improvement of symptoms. When the GKS was successful, hormonal secretion seemed to return to normal within 10 months. Although further follow-up is necessary to evaluate the long-term tumor control rate and hormonal effect, these initial results indicate a potential therapeutic role of radiosurgery in controlling hormone hypersecretion in pituitary microadenomas. Gamma knife radiosurgery is very promising in managing pituitary microadenoma with complementary of the transsphenoidal surgery.
Adenoma/metabolism/*surgery ; Adolescent ; Adult ; Female ; Human ; Male ; Middle Age ; Pituitary Neoplasms/metabolism/*surgery ; *Radiosurgery

Adult ; Estradiol ; blood ; Female ; Gonadotrophs ; metabolism ; pathology ; Humans ; Pituitary Neoplasms ; blood ; diagnosis ; surgery

OBJECTIVETo study the clinical characteristics, diagnosis and surgical effects of thyroid-stimulating hormone pituitary adenomas (TSH-omas).

METHODSThe clinical data of 19 patients (14 female and 5 male) with TSH-omas were analyzed retrospectively in this study from January 2001 to December 2008. The patients ranged from 20 to 70 years old (average 40.5 years old) and had disease histories from 1 to 228 months (average 55 months). Among these patients, 15 of them complained of thyrotoxicosis symptoms, while the other 4 patients' symptoms were associated with headache and/or visual disturbance caused by the tumor mass effect. Initially, 12 of the 15 patients with thyrotoxicosis symptoms were misdiagnosed with Grave's disease. As a result 2 of them received (131) Iodine, and one received subtotal thyroidectomy. All of these patients underwent transsphenoidal microsurgery.

RESULTSAverage follow-up period was 3.6 years (6 months-7 years). Pathological analysis of the surgical specimen showed pituitary adenoma in all patients, immunohistochemistry were positive for TSH in 17 cases, negative for TSH in 2, positive for growth hormone in 2, positive for prolactin in 1, and positive for adrenocorticotrophic hormone in 1. Postoperative MRI revealed that the tumors in 15 patients were removed totally, though 4 patients still had residual tumors. The thyroid hormone level tests suggested that 13 patients could be considered normal 3 months after their tumors were removed, though 2 of patients with normal postoperative MRI and thyroid hormones showed increased levels of TSH. For these 2 patients, tumors did not recur and their thyroid hormone levels returned to normal after pituitary radiotherapy. The cure rate was 11/19 after surgery and 13/19 after surgery plus pituitary radiotherapy.

CONCLUSIONSThe screening test for hyperthyroidism patients with high TSH levels is a key point to improve the accuracy rate in early diagnoses of TSH-omas. The transsphenoidal microsurgery is first choice to treat TSH-omas, while pituitary radiotherapy and somatostatin analogs are beneficially adjunctive therapies.

Adult ; Aged ; Female ; Humans ; Hyperthyroidism ; metabolism ; Male ; Middle Aged ; Pituitary Neoplasms ; diagnosis ; metabolism ; surgery ; Retrospective Studies ; Thyrotropin ; metabolism ; Young Adult

Amyloid ; metabolism ; Humans ; Male ; Middle Aged ; Pituitary Neoplasms ; metabolism ; pathology ; surgery ; Plaque, Amyloid ; pathology ; Prolactin ; secretion ; Prolactinoma ; metabolism ; pathology ; surgery ; Synaptophysin ; metabolism

In this study, we examined patients with functioning pituitary adenoma that underwent Gamma Knife radiosurgery (GKS). In particular, we assessed the effects of GKS on the growth and endocrinological response of the functioning pituitary adenoma. Forty-two cases of functioning pituitary adenoma treated with GKS were analyzed. The mean follow-up duration was 42.5 months (range 6 - 98), and the mean tumor volume was 1.4 cm3 (range 0.1 - 3.8). Multiple isocenters, ranging from 1 to 6 in number (mean 2.7), were used. The tumor margin was covered by an isodose ranging from 50 to 90%. The margin dose was 18 to 40 Gy (mean 28.5) and the maximum dose varied from 35 to 80 Gy (mean 54.1). Tumor growth was controlled in 96.9% of the cases and tumor shrinkage occurred in 40.6% of the cases. Hormonal response was observed in 35 of the 42 (83.3%) patients after GKS, with a mean duration of 6.8 months. Sixteen of the 42 (38.1%) patients showed hormonal normalization, with a mean duration of 21 months. In our multivariate analysis, high integral dosage (p=0.005) and maximum dosage (p=0.001) correlated significantly with hormonal normalization. For patients with functioning pituitary adenoma, GKS can be effective in controlling tumor growth and inducing hormonal normalization, especially if patients are reluctant to undergo surgical resection, or are not able to undergo microsurgery under general anesthesia. It appears that early hormonal normalization can be induced by high maximum dosage (at least 50 Gy) and broad coverage of the target volume within the isodose curve, while keeping the maximum dose to the visual pathways below 9 Gy.
Adenoma/*diagnosis/metabolism/*surgery ; Adult ; Female ; Hormones/*metabolism ; Human ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pituitary Neoplasms/*diagnosis/metabolism/*surgery ; *Radiosurgery

It has been suggested that the patients with Cushing's disease secondary to pituitary macroadenomas (>10 mm) have higher basal adrenocorticotropic hormone (ACTH) levels, which are less suppressible on high-dose dexamethasone suppression tests (HDDST). We compared the clinical and biochemical characteristics of patients with macroadenomas (N=7) and microadenomas (N=23) who were diagnosed at Samsung Medical Center in Korea between 1996 and 2006. Basal morning plasma ACTH levels were 101.5+/-23.2 pg/mL for macroadenoma patients and 83.6+/-11.1 pg/mL for microadenoma patients (mean+/-SEMs) (p=0.44). Morning serum cortisol levels were 26.8+/-3.2 microgram/dL for macroadenoma patients and 29.5 +/-2.9 microgram/dL for microadenoma patients (p=0.77). The proportion of patients who showed suppressibility on HDDST was almost identical in the two groups (71.4% [5/7] for macroadenoma patients vs. 72.7% [16/22] for microadenoma patients, p=1.00). Furthermore, the remission rate with trans-sphenoidal surgery was similar between the two groups (100% [5/5] for macroadenoma patients vs. 73.3% [11/ 15] for microadenoma patients, p=0.53). Thus, tumor size is not a major determinant of hormone secretion or clinical outcomes in patients with Cushing's disease.
Adenoma/complications/*metabolism/surgery ; Adolescent ; Adrenocorticotropic Hormone/blood/*secretion ; Adult ; Aged ; Dexamethasone/metabolism ; Female ; Humans ; Hydrocortisone/blood/*secretion ; Male ; Middle Aged ; Pituitary ACTH Hypersecretion/*diagnosis/etiology ; Pituitary Neoplasms/complications/*metabolism/surgery ; Retrospective Studies

OBJECTIVETo investigate the growth of craniopharyngioma involving the third ventricular floor with regard to the hypothalamus by detecting expressions of leukocyte common antigen (CD45) and intercellular adhesion molecule (ICAM-1) in the tumor tissue.

METHODSThe expressions of CD45 and ICAM-1 proteins in 30 craniopharyngioma samples with third ventricular floor involvement were detected by SP immunohistochemistry.

RESULTSThe inflammations labeled by CD45 were identified commonly in the craniopharyngioma tissues involving the third ventricular floor. The expression of ICAM-1 was mainly in the inner tumor cells and interstitial cells, but not detected in the basilar tumor cells growing toward the third ventricular floor. Adamantinomatous craniopharyngiomas showed markedly higher CD45 and ICAM-1 expressions than squamous papillary tumors (P<0.05).

CONCLUSIONInflammatory adhesion largely characterizes the growth of the craniopharyngioma tissues involving the third ventricular floor toward the hypothalamus without the tendency of invasion. The difference in the inflammation between the two types of craniopharyngioma may affect the prognosis of the patients.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; metabolism ; secondary ; Child ; Craniopharyngioma ; metabolism ; pathology ; surgery ; Female ; Humans ; Hypothalamus ; metabolism ; pathology ; Immunohistochemistry ; Intercellular Adhesion Molecule-1 ; biosynthesis ; Leukocyte Common Antigens ; biosynthesis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pituitary Neoplasms ; metabolism ; pathology ; surgery ; Third Ventricle

Intrasellar location of schwannoma is extremely rare, although intracranial schwannomas account for up to 8% of all primary brain tumors. An unusual case of an intrasellar schwannoma radiographically and clinically simulating a pituitary adenoma is reported. A 39-yr-old man presented a 10-month history of visual disturbance and decreased libido. Neurological examination showed poor visual acuity of both eyes with bitemporal hemianopsia. Computed tomography and magnetic resonance imaging showed a sellar tumor with suprasellar extension. Pituitary adenoma was considered as a preoperative diagnosis. The tumor was removed through a trans-sphenoidal approach. Microscopic examination of the tumor revealed schwannoma.
Adult ; Brain Neoplasms/diagnosis/metabolism/*pathology/surgery ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Neurilemmoma/diagnosis/metabolism/*pathology/surgery ; Pituitary Neoplasms ; Prolactinoma ; Tomography, X-Ray Computed ; Visual Fields

Adenoma ; pathology ; Brain Neoplasms ; secondary ; Chromogranin A ; metabolism ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Pituitary Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Reoperation ; Synaptophysin ; metabolism ; Temporal Lobe ; pathology

Total excision is a treatment of choice in preventing the relapse of craniopharyn-gioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retro-spective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed. The shrinkage and/or stabiliza-tion of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleo-mycin injection for cystic craniopharyngioma, although does not appear to eradi-cate the tumor, decreases and stabilizes the tumor size, when used as an adju-vant therapy in young patients.
Adolescent ; Adult ; Aged ; Antibiotics, Antineoplastic/administration & dosage/adverse effects/*therapeutic use ; Bleomycin/administration & dosage/adverse effects/*therapeutic use ; Brain/radiation effects ; Child ; Child, Preschool ; Craniopharyngioma/*drug therapy/radiography/surgery ; Female ; Follow-Up Studies ; Humans ; Injections ; L-Lactate Dehydrogenase/metabolism ; Male ; Middle Aged ; Pituitary Neoplasms/*drug therapy/radiography/surgery ; *Postoperative Care ; Retrospective Studies ; Tomography, X-Ray Computed/methods