Objective:To assess the efficacy of "three-step" strategy for preparing autologous pedicled nasal mucosal flaps in repairing cerebrospinal fluid（CSF） leaks following transsphenoidal pituitary adenoma surgery. Methods:A retrospective study was conducted on the clinical data of 25 patients who developed CSF leaks after transsphenoidal pituitary adenoma surgery at the First Affiliated Hospital of Kunming Medical University between July 2012 and June 2022. Surgical repair was selected step by step using nasal septal mucosal flap with either the posterior septal artery or septal branch of the sphenopalatine artery as the pedicle, or a pedicled middle turbinate mucosal flap. All patients underwent ≥2-year endoscopic follow-up to assess flap viability and CSF leak recurrence. Results:The median postoperative hospital stay was 4 days. Five patients developed intracranial infections postoperatively. The follow-up period ranged from 2 to 12 years. Nasal endoscopic examinations showed good mucosal flap growth, with no recurrence of CSF leakage in any of the patients. Conclusion:High-flow cerebrospinal fluid（CSF） leaks following pituitary tumor surgery pose significant challenges for clinical repair. Based on intraoperative nasal septal mucosal preservation and the condition of sellar base CSF leakage, the "three-step" strategy for preparing autologous pedicled nasal mucosal flaps-utilizing posterior septal artery, ethmoidal artery-based, or pedicled middle turbinate mucosal flaps sequentially-is a safe and effective repair method.
Humans ; Retrospective Studies ; Pituitary Neoplasms/surgery* ; Surgical Flaps ; Nasal Mucosa/surgery* ; Cerebrospinal Fluid Leak/surgery* ; Adenoma/surgery* ; Postoperative Complications/surgery* ; Male ; Female ; Middle Aged ; Adult ; Aged

Male patients with prolactinomas usually present with typical hyperprolactinemia symptoms, including sexual dysfunction and infertility. However, clinical factors related to sexual dysfunction and surgical outcomes in these patients remain unclear. This study aimed to investigate the outcomes of male patients with prolactinomas after transsphenoidal surgery and the risk factors affecting sexual dysfunction. This study was conducted on 58 male patients who underwent transsphenoidal surgery for prolactinomas between May 2014 and December 2020 at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. We evaluated the sexual function of patients before and after surgery through International Index of Erectile Function-5 scores, libido, and frequency of morning erection. Of the 58 patients, 48 (82.8%) patients had sexual intercourse preoperatively. Among those 48 patients, 41 (85.4%) patients presented with erectile dysfunction. The preoperative International Index of Erectile Function-5 scores in patients with macroprolactinomas were significantly higher than those in patients with giant prolactinomas (17.63 ± 0.91 vs 13.28 ± 1.43; P = 0.01). Postoperatively, the incidence of erectile dysfunction was 47.9%, which was significantly lower than that preoperatively (85.4%; P = 0.01). Twenty-eight (68.3%) patients demonstrated an improvement in erectile dysfunction. Tumor size and invasiveness were significantly correlated with the improvement of erectile dysfunction. Preoperative testosterone <2.3 ng ml^-1 was an independent predictor of improvement in erectile dysfunction. In conclusion, our results indicated that tumor size and invasiveness were important factors affecting the improvement of sexual dysfunction in male patients with prolactinoma. The preoperative testosterone level was an independent predictor related to the improvement of erectile dysfunction.
Humans ; Male ; Prolactinoma/surgery* ; Erectile Dysfunction/etiology* ; Retrospective Studies ; Sexual Dysfunction, Physiological/complications* ; Testosterone ; Pituitary Neoplasms/pathology*

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

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

ObjectiveTo analyze the clinical characteristics of secondary male hypogonadism induced by sellar space-occupying lesion, explore its pathogenesis, and improve its diagnosis and treatment.

METHODSWe retrospectively analyzed the clinical data about 22 cases of secondary male hypogonadism induced by sellar space-occupying lesion, reviewed related literature, and investigated the clinical manifestation, etiological factors, and treatment methods of the disease. Hypogonadism developed in 10 of the patients before surgery and radiotherapy (group A) and in the other 12 after it (group B). The patients received endocrine therapy with Andriol (n=7) or hCG (n=15).

RESULTSThe average diameter of the sellar space-occupying lesions was significantly longer in group A than in B (［2.35±0.71］ vs ［1.83±0.36］ cm, P<0.05) and the incidence rate of prolactinomas was markedly higher in the former than in the latter group (60% vs 0, P<0.01). The levels of lutein hormone (LH), follicle stimulating hormone (FSH) and testosterone (T) were remarkably decreased in group B after surgery and radiotherapy (P<0.01). Compared with the parameters obtained before endocrine therapy, all the patients showed significant increases after intervention with Andriol or hCG in the T level (［0.78±0.40］ vs ［2.71±0.70］ ng/ml with Andriol; ［0.93±0.44］ vs ［3.07±0.67］ ng/ml with hCG) and IIEF-5 score (5.00±2.61 vs 14.50±3.62 with Andriol; 5.36±1.82 vs 15.07±3.27 with hCG) (all P<0.01). The testis volume increased and pubic hair began to grow in those with hypoevolutism. The patients treated with hCG showed a significantly increased testis volume (P<0.01) and sperm was detected in 7 of them, whose baseline testis volume was markedly larger than those that failed to produce sperm (［11.5±2.3］ vs ［7.5±2.3］ ml, P<0.01). Those treated with Andriol exhibited no significant difference in the testis volume before and after intervention and produced no sperm, either.

CONCLUSIONSHypothyroidism might be attributed to surgery- or radiotherapy-induced damage to the pituitary tissue, space-occupying effect of sellar lesion, and hyperprolactinemia. Both Andriol and hCG can improve the T level and erectile function, but the former does not help spermatogenesis.

Adult ; Chorionic Gonadotropin ; therapeutic use ; Follicle Stimulating Hormone ; blood ; Humans ; Hypogonadism ; diagnosis ; etiology ; therapy ; Luteinizing Hormone ; blood ; Male ; Pituitary Neoplasms ; blood ; complications ; pathology ; therapy ; Prolactinoma ; blood ; complications ; pathology ; therapy ; Retrospective Studies ; Sella Turcica ; Spermatogenesis ; Spermatozoa ; Testis ; anatomy & histology ; drug effects ; Testosterone ; analogs & derivatives ; blood ; therapeutic use ; Tumor Burden

PURPOSE: Our objective was to estimate the maximum color contrast sensitivity (MCCS) thresholds in individuals with chiasma opticum damage. METHODS: The pilot study tested 41 people with pituitary adenoma (PA) and 100 age- and gender-matched controls. Patients were divided into two groups according to PA size, PA ≤1 cm or PA >1 cm. A new MCCS test program was used for color discrimination. RESULTS: The mean total error score (TES) of MCCS was 1.8 in the PA ≤1 cm group (standard deviation [SD], 0.38), 3.5 in the PA >1 cm group (SD, 0.96), and 1.4 in the control group (SD, 0.31; p < 0.001). There was a positive correlation between tumor size and MCCS result (r = 0.648, p < 0.01). In the group that had PA-producing hormones, the TES was 2.5 (SD, 1.09), compared to 4.2 value in the non-functioning PA group of patients that did not have clinically significant hormone excess (SD, 3.16; p < 0.01). In patients with normal visual acuity (VA) or visual field MCCS, the TES was 3.3 (SD, 1.8), while that in patients with VA <0.00 was 4.6 (SD, 2.9). CONCLUSIONS: Results of the MCCS test TES were 1.9 times better in patients with PA ≤1 cm compared to patients with PA >1 cm (p < 0.01). In PA patients with normal VA, the TES was 2.35 times worse than that of healthy persons (p < 0.01).
Adenoma/*complications/diagnosis ; Adolescent ; Adult ; Aged ; Color Perception/physiology ; Color Perception Tests/*methods ; Contrast Sensitivity/*physiology ; *Early Diagnosis ; Female ; Humans ; Male ; Middle Aged ; *Optic Chiasm ; Pilot Projects ; Pituitary Neoplasms/*complications/diagnosis ; Time Factors ; Vision Disorders/*diagnosis/etiology/physiopathology ; Visual Fields ; Young Adult

OBJECTIVE: To investigate the feasibility and efficacy of CO2 laser assisted posterior cordotomy for patients with bilateral paralysis of the vocal cord. METHOD: Twenty-one patients with bilateral paralysis of the vocal cord underwent CO2 laser assisted posterior cordotomy in our hospital from Jul. 2009 to Jun. 2015. The causes of the bilateral paralysis of the vocal cord were thyroidectomy in 15 cases, cervical trauma in 2 cases, resection of pituitary tumor in 1 case, inflammation in 1 case and without cause in 2 cases. Ten patients underwent tracheotomy before the operation; 9 patients underwent tracheotomy after the operation; 2 cases without tracheotomy. RESULT: The tracheotomy tube was plugged next day after posterior cordotomy. Lots of patients were breathing well without any effort. A few patients were breathing hard, so the tracheotomy tube was plugged discontinuously. Seventeen patients were decannulated 1 year after operation. Two patients were failed to decannulated. The patients were followed up for 3 months 6 years after operation, and all of them were breathing well. CONCLUSION Our limited experience showed that CO2 laser assisted posterior cordotomyis an effective and reliable surgical procedure for patients with bilateral paralysis of the vocal cord.
Cordotomy ; methods ; Humans ; Inflammation ; complications ; Laser Therapy ; Lasers, Gas ; Neck Injuries ; complications ; Pituitary Neoplasms ; complications ; surgery ; Thyroidectomy ; adverse effects ; Tracheotomy ; Treatment Outcome ; Vocal Cord Paralysis ; surgery ; Vocal Cords ; physiopathology

To explore the influence of preventive use of vasopressin tannate on diabetes insipidus and serum sodium at the early postoperation of craniopharyngioma.
 Methods: The data of 83 patients, who underwent unilateral sub-frontal approach resection of craniopharyngioma between 2010 and 2014 by the same senior neurosurgeon, were retrospectively analyzed. The patients were divided into a vasopressin tannate group (used group) and a control group. The diabetes insipidus and serum sodium changes were compared between the two groups.
 Results: Compared with the control group, the incidence of diabetes insipidus decreased at the early postoperation in the vasopressin tannate group (P<0.05). There was high incidence of diabetes insipidus in patients with pituitary stalk excision and tumor close adhesion to the third ventricle floor at the early postoperation (P<0.05). Under such conditions, the incidence of diabetes insipidus in the vasopressin tannate group was decreased compared with the control group (P<0.05). Postoperative hypernatremia occurred in 37 patients (44.6%), and hyponatremia occurred in 60 patients (72.3%), the average time of the occurrence of hpernatremia and hyponatremia was 1.4 and 3.7 days after surgery. Postoperative high serum sodium and low serum sodium appeared alternately in 19 patients (22.9%). There was significant difference in the serum sodium distribution in the first day after surgery in both groups (P<0.05), and the percent of hpernatremia in the vasopressin tannate group was significantly less than that in the control group (P<0.05).
 Conclusion: Preventive use of vasopressin tannate can effectively reduce diabetes insipidus and hypernatremia incidence at the early postoperative stage after microsurgery for craniopharyngioma.
Arginine Vasopressin ; therapeutic use ; Craniopharyngioma ; complications ; surgery ; Diabetes Insipidus ; prevention & control ; Female ; Humans ; Hypernatremia ; epidemiology ; prevention & control ; Hyponatremia ; epidemiology ; Incidence ; Male ; Microsurgery ; adverse effects ; Pituitary Gland ; surgery ; Pituitary Neoplasms ; Postoperative Complications ; prevention & control ; Postoperative Period ; Retrospective Studies

OBJECTIVETo study the expression of nNOS and ultrastructural changes in the penile tissue of rats with prolactinoma-induced erectile dysfunction (ED).

METHODSWe established the model of prolactinoma in 20 male Westar rats by peritoneal injection of diethylstilbestrol (DES) and treated the control rats with normal saline (n = 10) or sterilized arachis oil (n = 10). After 8 weeks, we performed the apomorphine test and measured the weight of the pituitary gland and the levels of serum prolactin (PRL) and testosterone (T) to confirm the successful construction of the prolactinoma-induced ED model. Then we determined the expression of nNOS in the penile tissue by immunohistochemistry and examined the ultrastructural changes of the penile cavernosum under the transmission electron microscope.

RESULTSThe prolactinoma-induced ED model was successfully established in 15 rats. The weight of the pituitary gland was significantly increased in the rats treated with DES as compared with the normal saline and sterilized arachis oil controls ([46.7 ± 15.5] vs [11.7 ± 2.4] and [12.4 ± 2.3] mg, both P < 0.05). The level of serum PRL was markedly higher while that of T remarkably lower in the former than in the latter two groups ([1,744.9 ± 304.5] vs [11.5 ± 2.4] and [10.6 ± 1.9] ng/ml, both P < 0.0l; [1.54 ± 0.46] vs [3.11 ± 1.08] and [3.04 ± 1.11] ng/ml, both P < 0.05). The rate of penile erection was significantly reduced in the prolactinoma-induced ED model rats in comparison with the normal saline and arachis oil controls (16.7% vs 100% and 87.5%, both P < 0.05), and so was the expression of nNOS in the penile tissue (0.024 ± 0.011 vs 0.066 ± 0.019 and 0.058 ± 0.021, both P < 0.05). Transmission electron microscopy manifested significant ultrastructural changes in the endothelial and smooth muscle cells of the cavernous tissue in the prolactinoma-induced ED models.

CONCLUSIONThe ultrastructural changes of the penile cavernous tissue and the reduced expression of nNOS in penile tissue may be the most important mechanisms of prolactinoma-induced ED in rats.

Animals ; Apomorphine ; Carcinogens ; Diethylstilbestrol ; Erectile Dysfunction ; etiology ; Humans ; Male ; Myocytes, Smooth Muscle ; ultrastructure ; Nitric Oxide Synthase Type I ; metabolism ; Organ Size ; Penile Erection ; Penis ; enzymology ; ultrastructure ; Pituitary Neoplasms ; chemically induced ; complications ; Prolactin ; blood ; Prolactinoma ; chemically induced ; complications ; Rats ; Rats, Wistar ; Testosterone ; blood

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery.
Cardiopulmonary Bypass ; Hemodynamics ; Hemorrhage ; Heparin ; Humans ; Infarction ; Mitral Valve Insufficiency ; Pituitary Apoplexy* ; Pituitary Neoplasms ; Postoperative Complications ; Thoracic Surgery