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Cushing disease and acromegaly are common endocrine disorders caused by excessive cortisol and growth hormone production, respectively. Both conditions can co-occur due to functioning pituitary adenomas, which are typically benign pituitary gland tumors. This report discusses a 30-year-old woman with hyperpituitarism leading to treatment-resistant Cushing disease and acromegaly caused by a functional pituitary macroadenoma. A 30-year-old woman presented with a history of excessive weight gain, facial puffiness, fatigue, persistent headaches, and visual disturbances. Clinical examination revealed features consistent with Cushing disease and acromegaly, including a moon face, central obesity, and large hands and feet—the ophthalmologic evaluation identified bitemporal hemianopia, suggesting optic chiasm compression. Laboratory results showed elevated ACTH, IGF-1, and prolactin levels, alongside confirmed hypercortisolism. The patient also had secondary diabetes mellitus and galactorrhea—initial treatment with octreotide provided limited benefit, with persistent hormone elevations and insufficient symptom control. The patient underwent endonasal endoscopic transsphenoidal resection of the pituitary macroadenoma, leading to marked symptomatic and hormonal improvements. This underscores the diagnostic challenge and treatment complexity of such cases. Early diagnosis is critical for optimizing outcomes in patients with hyperpituitarism and mitigating complications. This case highlights the importance of multidisciplinary management and the necessity of long-term follow-up to monitor for recurrence and ensure sustained remission.

Acromegaly is a clinical syndrome with isolated cases globally. Patients may remain undiagnosed for several years after the onset of initial signs and symptoms. Timely diagnosis and initiation of its treatment play a crucial role in patients with acromegaly. In this article, we present physical, biochemical, and radiological characteristics in a set of 6 cases that may aid in prompt diagnosis and appropriate management of acromegaly. [ABSTRACT FROM AUTHOR]

Abstract Background Pituitary adenomas are benign brain tumors that cause considerable morbidity and neurological symptoms. SOX9 as a regulatory transcriptional mediator affects normal and tumor cell growth with an undefined role in pituitary adenomas pathogenesis. Thus, in the present study, the expression pattern of SOX9 in GH-secreting pituitary tumors and normal pituitary tissues is investigated. Methods The SOX9 gene expression level was evaluated in 60 pituitary tissues including different types of GH-secreting adenomas and normal pituitary tissues through Real-Time PCR. The protein level of SOX9 was assessed using immunohistochemistry. The correlations of SOX9 gene and protein expression level with the patient’s clinical and pathological features were considered. Results The SOX9 over-expression was detected in GH-secreting adenomas tumor tissues compared to normal pituitary tissues which were accompanied by overexpression of SOX9 protein in tumor tissues. The over-expression of SOX9 had a significant impact on GH-secreting adenomas tumor incidence with the odds ratio of 8.4 and the diagnostic value of SOX9 was considerable. The higher level of SOX9 expression was associated with invasive and macro tumors in GH-secreting pituitary adenoma patients. The positive correlation of SOX9 gene and protein level was observed and the tumor size and tumor invasive features were valuable in predicting SOX9 expression level in GH-producing pituitary tumors. Conclusion The study provided the first shreds of evidence regarding the expression pattern of SOX9 in the GH- secreting pituitary adenomas at both gene and protein levels which may emphasize the possible involvement of SOX9 as a mediator in pituitary adenoma tumor formation also open up new intrinsic molecular mechanism regarding pituitary adenoma pathogenesis.

La hiperprolactinemia es un diagnóstico frecuente en la consulta de endocrinología y de los adenomas hipofisarios los prolactinomas son el subtipo más frecuente causantes de hiperprolactinemia. Se revisó pacientes con hiperprolactinemia idiopática y prolactinomas evaluados en el servicio de endocrinología del Centro Médico Docente La Trinidad. Se realizó un estudio descriptivo, retrospectivo, de carácter observacional en el que se explorararon posibles relaciones estadísticamente significativas, entre la presencia de hiperprolactinemia idiopática versus tumores hipofisiario (prolactinoma) e hiperprolactinemia y características demográficas o de presentación y presentació clínica. Se encontró: predominio de hiperprolactinemia en el sexo femenino, con una proporción de 4:2, pacientes con prolactinomas la proporción fue 3 mujeres por cada hombre afectado, el promedio de edad al momento del diagnóstico en las mujeres resultó 37 años y 45 años en los hombres. Los prolactinomas eran responsables de la hiperprolactinemia en un 67.44 %, siendo los microadenomas los tumores más frecuentes con un 68,9 %. Los macroadenomas se presentaron en 9 pacientes (31,03 %) de los cuales 8 fueron tratados con neurocirugía. Las manifestaciones clínicas y comorbilidades en los 43 pacientes con hiperprolactinemia principales fueron trastornos menstruales, dislipidemia y sobrepeso. La concentración media de prolactina estuvo directamente relacionada con las dimensiones de los tumores. Por último, se observó que la totalidad de los pacientes recibió tratamiento con cabergolina y 8 ameritaron neurocirugía, presentando déficits secuelares más inherentes al tumor que a la cirugía.

Objective  Pituitary adenomas are historically classified into microadenoma or macroadenomas based on size less than or greater than/equal to 1c m. "Giant" adenomas describe tumors ≥4 cm. The aim of this study is to present an evidence-based approach to size classification based on national trends. Design  The design involved is multi-institutional retrospective study. Participants  A total of 29,651 patients were studied from National Cancer Institute's SEER program from 2004 to 2016 across the United States. Main Outcome Measures  The main outcome measures include demographics, treatment characteristics, and overall survival in the population. Results  At the 20-mm threshold, the likelihood of operation exceeds the likelihood of nonoperative management. Patients with adenoma size 1 to 19 mm had significantly longer overall survival compared with 20 to 50 mm (Log rank: p  < 0.0001). No survival difference was found between size 20 to 29 mm and larger. There was no significant difference in the rate of surgery between 30 to 39 mm and 40 to 50 mm tumors(p  = 0.5035). Surgery group had a higher overall survival compared with nonsurgically managed patients (Log rank: p  < 0.0001). Conclusion  Microadenoma has classically been used to describe pituitary tumors less than 1 cm, though no clinical significance of this threshold has been demonstrated. The current study suggests a size cut-off of 20 or 30 mm as more clinically relevant. Still, future studies are warranted to examine the significance of this classification by specific tumor type, and subclassified as appropriate. There is no difference in the rate of surgery or survival for adenomas between 30 and 50 mm, challenging the 4-mm cutoff threshold for "giant" adenoma. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to assess clinical characteristics of apoplexy of pituitary microadenomas compared to macroadenomas. Methods: We retrieved clinical records of patients > 18 years old, hospitalized in Rambam hospital between January 2001 and October 2017, with pituitary apoplexy and follow-up of at least one year. We compared clinical course and outcomes of apoplexy between patients with microadenomas and macroadenomas, and between patients who received conservative or surgical treatment. Statistical analysis was done using Fisher's exact and Mann–Whitney tests. Results: Twenty-seven patients with pituitary apoplexy were included in the final analysis: mean age was 40.7 ± 12.5 years, 13(48%) were female, 7(26%) had microadenomas, and 21(78%) harbored clinically nonfunctioning pituitary adenomas. Upon admission, hyponatremia, random cortisol level of < 200 nmol/L, and secondary hypothyroidism, were evident in 6/20, 8/18, and 4/18 patients with macroadenoma and 1/5, 2/5, and 1/6 patients with microadenoma, respectively (P = 1.0). Hypogonadotropic hypogonadism was evident in 9/12 men with macroadenoma. In 12 macroadenoma patients, the tumor abutted the optic chiasm, of whom eight had visual field defects. Fifteen patients with macroadenoma and two with microadenoma underwent transsphenoidal surgery. Median follow-up was 3 years. At last follow-up visit, patients with microadenoma had lower rates of corticotropic deficiency or secondary hypothyroidism compared to macroadenoma patients (1/7 vs. 13/20 respectively, p = 0.033). Only two patients with macroadenomas had persistent visual field defects. Outcomes were comparable between conservative and surgical treatment groups. Conclusions: Long term pituitary hormone deficiencies are more common in pituitary apoplexy patients with macroadenomas. Apoplexy of pituitary microadenoma carries a more favorable prognosis. [ABSTRACT FROM AUTHOR]

Background: Pituitary adenomas are benign brain tumors that cause considerable morbidity and neurological symptoms. SOX9 as a regulatory transcriptional mediator affects normal and tumor cell growth with an undefined role in pituitary adenomas pathogenesis. Thus, in the present study, the expression pattern of SOX9 in GH-secreting pituitary tumors and normal pituitary tissues is investigated. Methods: The SOX9 gene expression level was evaluated in 60 pituitary tissues including different types of GH-secreting adenomas and normal pituitary tissues through Real-Time PCR. The protein level of SOX9 was assessed using immunohistochemistry. The correlations of SOX9 gene and protein expression level with the patient's clinical and pathological features were considered. Results: The SOX9 over-expression was detected in GH-secreting adenomas tumor tissues compared to normal pituitary tissues which were accompanied by overexpression of SOX9 protein in tumor tissues. The over-expression of SOX9 had a significant impact on GH-secreting adenomas tumor incidence with the odds ratio of 8.4 and the diagnostic value of SOX9 was considerable. The higher level of SOX9 expression was associated with invasive and macro tumors in GH-secreting pituitary adenoma patients. The positive correlation of SOX9 gene and protein level was observed and the tumor size and tumor invasive features were valuable in predicting SOX9 expression level in GH-producing pituitary tumors. Conclusion: The study provided the first shreds of evidence regarding the expression pattern of SOX9 in the GH- secreting pituitary adenomas at both gene and protein levels which may emphasize the possible involvement of SOX9 as a mediator in pituitary adenoma tumor formation also open up new intrinsic molecular mechanism regarding pituitary adenoma pathogenesis. [ABSTRACT FROM AUTHOR]

Purpose: To report the results of a series of patients undergoing the endoscopic subperichondrial transseptal (STRAS) approach for pituitary surgery and to evaluate the efficiency and the safety of this approach. Methods: This is a single-centre retrospective study including all patients undergoing pituitary lesion resection through the STRAS approach from January 2002 to December 2017 by a multidisciplinary surgical team (ENT and neurosurgeon). Demographic data, tumour type, complication rate and pre- and post-operative visual, endocrine and tumour status were retrospectively analysed. Results: 119 patients were included in the study, 80 (67%) presenting macroadenoma, 24 (20%) microadenoma (20%) and 6 (5%) giant adenoma. 61 (51%) patients had secreting adenoma and 51 (42%) patient had non-functioning adenoma. The STRAS approach allowed a good visualization of intrasphenoidal and intrasellar anatomical landmarks in all cases and no patient needed turbinate resection. No patient died or had neurological deficit. Endocrine remission or control was achieved in 90.5% of hormone-secreting microadenomas and in 84.2% of hormone-secreting macroadenomas. Gross-total resection was achieved for 39 patients (48.8%) of the 80 macroadenomas. Nasal complication rate was very low, with no septal perforation and two epistaxis (1.7%) medically treated. Conclusion: The STRAS approach is an elegant approach to the sphenoid sinus that enables a good exposure of the intrasphenoidal anatomical landmarks with a maximal preservation of the nasal mucosa. This approach allows an intrasellar work with great comfort and safety for the surgeon using a two-hand or a four-hand technique. [ABSTRACT FROM AUTHOR]

Hypogonadism is a result of testicular/ovarian failure and/or insufficient pituitary stimulation. Various hypothalamo-pituitary abnormalities or lesions can contribute to hypogonadism. Benign or malign tumoural lesions of cellar or paracellar region, may lead to hypogonadism. Therefore, pituitary magnetic resonance imaging (MRI) is needed in patients with hypogonadism. In our study, we aimed to investigate our hypothalamo-pituitary MRI findings of hypogonadal patients. We evaluated 42 isolated hypogonadal patients followed in our clinic. These patients pituitary MRI findings were analyzed retrospectively. 80.9 % of isolated hypogonadotrophic patients were male, 19.1 % were female. Pituitary MRI findings of isolated hypogonadotrophic patients revealed that; 59.5% (n=25) were normal, 16.7 % (n=7) pituitary microadenoma, 11.9% (n=5) partial empty sella, 4.7% (n=2) pituitary macroadenoma, 2.4% empty sella (n=1), 2.4% (n=1) ectopic neuropituitary, and 2.4% (n=1) empty sella plus ectopic neuropituitary together. In half of the patients with isolated hypogonadotrophic hypogonadism, pituitary MRI findings may be normal. In these patients, if clinic and laboratory results are harmonious, to determine the diagnosis dynamic tests are required and appropriate therapy must be done, even if pituitary MRI is normal. [Med-Science 2015; 4(4.000): 2857-68]

Background This study investigated the outcome of transsphenoidal surgery (TSS) for Cushing disease (CD) and the influence of our surgical strategy on remission rates and postoperative pituitary function. Patients and Methods We retrospectively reviewed data from 71 patients with CD who underwent microscope navigation TSS (MN-TSS) in Saint-Luc Hospital between 1996 and 2017. True remission was defined as normal fasting cortisol level, normal 24-hour urinary free cortisol, or continued need for hydrocortisone replacement for 1 year after surgery. Results Overall remission rate after 1 or repeated MN-TSS was 83%. Highest remission rate was found in patients with macroadenomas (92%). Successful first MN-TSS was correlated with a high final remission rate (95%), whereas failed first MN-TSS was correlated with a low final remission rate (36%). Although day 1 cortisol levels were significantly lower in patients with long-term remission, high levels were still observed in a few patients, especially those who had had CD for many years. We found a low rate of postoperative pituitary long-term hypofunction (9.7%). Conclusions MN-TSS is a safe and effective procedure to treat CD, allowing remission rates of 83%. One-year remission period after first surgery is correlated with a final remission rate of 95%. Although day 1 morning cortisol value is the most significant predictor for long-term remission, some patients with CD for many years may keep high postoperative cortisol levels and be in later remission, likely because of secondary adrenal hyperplasia. Our focused approach with microscope navigation resulted in low rates of postoperative pituitary hypofunction and kept a recurrence rate comparable to that in the literature. Highlights • The overall remission rate in our center (mainly 1 surgeon) was 83%. Highest remission rate in patients with macroadenomas (92%). • Successful first MN-TSS was correlated with a high final remission rate (95%), failed first MN-TSS remained associated with a low final remission rate (36%) even after additional surgery. • For patients with CD for many years, a high-level day 1 cortisol level was regularly observed even if followed by long-term remission. • Less than 10% of postoperative pituitary long-term hypofunction. [ABSTRACT FROM AUTHOR]

BackgroundThe aim of this study was to assess the clinical differences between acromegalic patients with microadenoma and patients with macroadenoma, and to evaluate the predictive value of growth hormone (GH) levels for early detection of macroadenoma.MethodsWe performed a retrospective analysis of 215 patients diagnosed with a GH-secreting pituitary adenoma. The patients were divided into two groups: the microadenoma group and the macroadenoma group, and the clinical parameters were compared between these two groups. The most sensitive and specific GH values for predicting macroadenoma were selected using receiver operating characteristic (ROC) curves.ResultsCompared with the microadenoma group, the macroadenoma group had a significantly younger age, higher body mass index, higher prevalence of hyperprolactinemia and hypogonadism, and a lower proportion of positive suppression to octreotide. However, there were no significant differences in the gender or in the prevalence of diabetes between the two groups. The tumor diameter was positively correlated with all GH values during the oral glucose tolerance test (OGTT). All GH values were significantly higher in the macroadenoma group than the microadenoma group. Cut-off values for GH levels at 0, 30, 60, 90, and 120 minutes for optimal discrimination between macroadenoma and microadenoma were 5.6, 5.7, 6.3, 6.0, and 5.8 ng/mL, respectively. ROC curve analysis revealed that the GH value at 30 minutes had the highest area under the curve.ConclusionThe GH level of 5.7 ng/mL or higher at 30 minutes during OGTT could provide sufficient information to detect macroadenoma at the time of diagnosis.

Management of prolactinoma in pregnancy is a big challenge for the treating obstetrician as prolactin levels are normally raised in pregnancy and this creates a possibility of missing the diagnosis of prolactinoma. Women with micro adenomas and intrasellar macro adenomas do not require serial magnetic resonance imaging (MRI) or visual field testing as required in macro adenomas with extrasellar extension. A strict and vigil monitoring during each trimester for any clinical signs and symptoms related to tumor will suffice for the diagnosis of enlarging prolactinoma and for any active intervention required thereof. Dopamine agonists are the first choice of drugs to treat these tumors during pregnancy. Cabergoline is reported to be more effective and better tolerated as compared to traditional bromocriptine, with minimal risk of spontaneous abortion, congenital malformations or menstrual abnormalities. We are reporting a patient with macro prolactinoma who was treated successfully throughout her pregnancy with cabergoline. We achieved a very good control of prolactinoma without any significant alteration of dose and also without any adverse effects. We convey that cabergoline can be a first choice drug to treat macro prolactinomas in pregnancy also.

Objective: The purpose of the study was to find MRI findings in patients with Prolactin levels above 1000mIU/L. Methodology: This Retrospective study was conducted in Radiology Department, Rehman Medical Institute, Peshawar, from December 2009 to October 2012. A total of 86 patients, aged 16-48 years with high Prolactin levels, were screened with MRI for pituitary gland abnormalities. Only new undiagnosed patients were considered for the study. Children and patients with known causes for hyperprolactinaemia were excluded. Results: The most common abnormality on MRI was microadenoma (n=34, 39.5%) followed by macroadenoma (n=14, 16.3%). 12(7%) cases of complete/partial empty sella syndrome were seen. Macroadenoma was more common in males (n=6 out of 14, 42.3%) while microadenoma was more common in females (n=32 out of 72, 44.4%). Conclusion: Majority of Patients had an abnormal MRI finding, showing that MRI screening should be recommended for Prolactin levels above 1000mIU/L. Microadenoma was the most common abnormality, having higher incidence in female patients. [ABSTRACT FROM AUTHOR]

Prolactinomas commonly cause infertility and treatment usually restores ovulation and fertility. The dopamine agonists are the preferred mode of treatment, with cabergoline generally being preferred to bromocriptine because of its higher therapeutic ratio. Experience with both drugs shows no increase in spontaneous abortions, preterm deliveries, multiple births, or congenital malformations, compared to what is expected in the normal population but the experience with bromocriptine is approximately 10-fold greater than with cabergoline. Clinically significant tumor growth may occur in 2.7% of those with microadenomas, 22.9% in those with macroadenomas without prior ablative treatment and 4.8% of those with macroadenomas with prior ablative treatment. Patients with macroadenomas should have visual fields assessed periodically during gestation. Should symptomatic tumor growth occur, reinstitution of the dopamine agonist is usually successful in shrinking the tumor but delivery if the pregnancy is sufficiently advanced is also an option and transsphenoidal debulking is rarely necessary. [ABSTRACT FROM AUTHOR]

Management of prolactinoma in pregnancy is a big challenge for the treating obstetrician as prolactin levels are normally raised in pregnancy and this creates a possibility of missing the diagnosis of prolactinoma. Women with micro adenomas and intrasellar macro adenomas do not require serial magnetic resonance imaging (MRI) or visual field testing as required in macro adenomas with extrasellar extension. A strict and vigil monitoring during each trimester for any clinical signs and symptoms related to tumor will suffice for the diagnosis of enlarging prolactinoma and for any active intervention required thereof. Dopamine agonists are the first choice of drugs to treat these tumors during pregnancy. Cabergoline is reported to be more effective and better tolerated as compared to traditional bromocriptine, with minimal risk of spontaneous abortion, congenital malformations or menstrual abnormalities. We are reporting a patient with macro prolactinoma who was treated successfully throughout her pregnancy with cabergoline. We achieved a very good control of prolactinoma without any significant alteration of dose and also without any adverse effects. We convey that cabergoline can be a first choice drug to treat macro prolactinomas in pregnancy also. [ABSTRACT FROM AUTHOR]

To observe the maternal and perinatal outcome in pituitary tumor (macro- and micro-adenoma) during pregnancy. A retrospective analysis of a total of 19 cases of pituitary tumor group 1 (10 macroadenoma), and group 2 (9 microadenoma), during pregnancy over last 3 years in our unit were evaluated for pregnancy outcome, comparing maternal and perinatal outcome in the two groups using statistical analysis (Chi square test and Fischer exact t test). The mean age was 27.1 years in group 1 (macroadenoma), 29.2 years in group, parity was 0.2 and 0.55, respectively, in the two groups. Mean pituitary size 14.85 cm3 in group 1 and 0.22 cm3 in group 2. While there was no significant difference in infertility, menstrual disorder in the two groups, galactorrhea, headache, seizures and blurring of vision were more common in macroadenoma group. More patients required medications (cabergoline/bromocriptine) in group 1 with significantly more women had worsening of their symptoms (raised intracranial tension, seizures) in group 1 than in group 2. Mean gestation and birthweight were better in group 2 (37.6 vs. 36.1 weeks and 2,849 vs. 2,401 g). While vaginal delivery could be achieved in 88.8% women in microadenoma group (group 2), 80% women required cesarean delivery in macroadenoma group (group 1), a highly significant difference ( P value 0.005), there were no perinatal death in any group. Pituitary tumor during pregnancy if properly treated is associated with excellent maternal and perinatal outcome but macroadenoma is associated with lower gestation, birth weight and increased cesarean delivery rate. [ABSTRACT FROM AUTHOR]

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Abstract: Objective: Although numerous studies have shown that transsphenoidal surgery is the best initial treatment for Cushing disease offering 59–95% of success, fewer information is available on the long-term outcome in the subgroup of patients harboring ACTH-secreting macroadenomas. The aims of this study were to analyze our 10-year experience with transsphenoidal surgery in Cushing''s disease and to examine whether remission rates were different between micro- and macroadenomas. Patients and methods: Forty consecutive patients with proven Cushing''s disease (28 microadenomas, 12 macroadenomas [diameter: 10–25mm], 3 patients with no visible adenoma at MRI) underwent transsphenoidal surgery (TSS) assisted by neuronavigation in our center between 1996 and 2007. The diagnosis was made using standard endocrinological criteria including bilateral inferior petrosal sinus sampling (BIPSS) with CRH stimulation in all patients with discordant or equivocal biochemical and radiological testing. Morning serum cortisol was measured during the first week postoperatively, and a complete endocrine evaluation was made in all patients at 6–8 weeks. Remission at follow-up was defined as a normal postoperative 24-h urinary free cortisol (UFC) or continued need for glucocorticoid hormone replacement after TSS. Results: Overall, 32/40 patients (80%) were in remission after one or more TSS. Interestingly, a very good remission rate (92%) was observed in the subset of macroadenomas, similar to that found in the group of microadenomas (84%, NS), while no post-surgical remission was observed in the 3 patients with no visible adenoma at MRI (p <0.01). Of the 8 patients not in remission after repeated TSS surgery, 3 underwent radiation therapy and three had bilateral adrenalectomy, allowing remission of their hypercortisolism. There was minor morbidity and no death. Conclusion: While our overall results are in accordance with other published series, we show here that ACTH-secreting pituitary macroadenomas are usually not associated with a bad outcome, in contrast with patients with no visible adenoma at preoperative MRI. [Copyright &y& Elsevier]

Lanreotide is an eight-amino acid peptide, which is an analog of the native somatostatin peptide, physiological inhibitor of growth hormone (GH). The drug shows high binding affinity for somatostatin receptors, SSTR2 and SSTR5, which is the primary mechanism considered to be responsible for decreasing GH secretion and GH cell proliferation in acromegaly. Two different formulations of lanreotide are currently available: lanreotide slow release, which requires intramuscular injection every 7–14 days, and lanreotide autogel, which requires deep subcutaneous injection every 4–8 weeks. Several studies have been published to date on the use of lanreotide in acromegaly. Antisecretory efficacy has been reported in 35%–70% of cases; this huge variability is probably explained by different indications (eg, primary or adjunctive postsurgical treatment), or the fact that some studies were based on patients known to be responders to somatostatin analogs. As a primary treatment, antisecretory efficacy was very similar, confirming the possibility of lanreotide as an option in cases of unsuccessful surgery, contraindication, or surgery refusal. Lanreotide also has antitumoral effects as it induces a decrease in tumor volume of 〉25% in 30%–70% of patients. This could be beneficial before transsphenoidal surgery, as a pretreatment, to decrease tumor volume and ease surgery; however, to date, advantages in terms of final remission or uncured status remain a matter of debate. Side effects are rare; the most frequent being gastrointestinal discomfort and increased risk of gallstone formation, and glucose metabolism modifications. Comparison with the other somatostatin analog, octreotide, tends to show identical levels of efficacy between both drugs. Lanreotide thus seems to be an effective treatment in acromegaly. To date, however, lanreotide is still considered as only suspending GH secretion, thus requiring prolonged and costly treatment. [ABSTRACT FROM AUTHOR]

Hyperprolactinaemia is a common condition with varied aetiology. It is more frequent in women, but also seen in men and even in adolescence and childhood. Prolactin is mainly a lactogenic hormone but has other actions. Most cases present with amenorrhoea and infertility and are managed by gynaecologists. However, multidisciplinary involvement may be required in some cases. Evidence relating to aetiology, clinical features, pathogenesis and management has been discussed. [ABSTRACT FROM AUTHOR]

The transphenoidal procedure has become the preferred approach in the surgical management of sellar/parasellar tumors. Nevertheless, specific indications remain for the transcranial approach and the objective of this review is to evaluate the available data on outcomes following transcranial or transphenoidal approaches to sellar/parasellar tumors. We assess the indications used for each approach and parameters that favor one over the other. Factors such as tumor size, consistency and configuration are important variables in choosing the transcranial approach. Other important considerations include persistent visual loss after incomplete decompression via the transphenoidal route, ectatic midline carotid arteries, co-existent intracranial aneurysms and sphenoid sinusitis. We review the data on visual and endocrinological outcomes following the transcranial or transphenoidal approach and provide an argument that, while there appears to be a trend towards greater visual improvement after transcranial surgery for large-to-giant pituitary adenomas, this benefit is offset by a greater risk of postoperative pituitary dysfunction. There is no difference in the rate of recurrence between the two procedures in the published literature. Overall, craniotomies will continue to play a role in the management of patients with sellar/parasellar tumors, although patient selection and careful preoperative evaluation are key elements in choosing the most appropriate approach. [ABSTRACT FROM AUTHOR]

The management of adrenocorticotropic hormone (ACTH)-dependent Cushing's disease implies difficulties in the differential diagnosis, in the detection of minute pituitary adenomas, as well as in the radical removal of invasive adenomas. Magnetic resonance imaging (MRI) is unspecific and often negative in minute adenomas of three or less millimeters diameter. The trias of detectable ACTH, suppression of cortisol in the high-dose dexamethasone test, and stimulation in the corticotropin-releasing-hormone (CRH)-test has a high accuracy to prove pituitary dependency. In unclear cases, the use of inferior petrosal sinus sampling (IPSS) or cavernous sinus sampling (CSS) for the exclusion of ectopic ACTH-syndrome is currently advised especially in cases where cranial MRI is negative. The reliability of these methods to localize the mostly lateralized microadenomas is still discussed. Transsphenoidal microsurgical adenomectomy, the accepted primary therapy of Cushing's disease, has been published from experienced pituitary centers with remission rates ranging from 70% to 98% in the last decade. False diagnosis (pseudo-Cushing, ectopic ACTH-syndrome), incorrect adenoma localization by IPSS or CSS, and the rate of minute or non-resectable invasive tumors influence the results. The handling of minute specimen implies problems for surgeon and pathologist. Intraoperative tumor localization was improved by ACTH measurement from the cavernous sinus and the adenoma itself, by cytology, and frozen sections. The histology of the anterior lobe (rate of Crooke's cells) bears information of clinical relevance. Invasive macroadenomas may deserve repeat microsurgery, medical treatment, and radiosurgery. [ABSTRACT FROM AUTHOR]

We report a 27-year-old woman with amenorrhea and galactorrhea with mildly elevated serum prolactin levels. Her MRI demonstrated a cystic macroadenoma in the left aspect of the sella and a small microadenoma in the right aspect of the sella. Endoscopic transsphenoidal resection of the tumors revealed two histologically distinct tumors. The left tumor was consistent with a silent corticotroph macroadenoma and the right tumor was a prolactin producing microadenoma. Isolated double pituitary adenomas that are clearly separated by normal pituitary gland tissue are extremely rare. The incidence is approximately 0.37–2.6%. The coexistence of double adenomas can pose diagnostic and management challenges for the pituitary neuroendocrine team. [ABSTRACT FROM AUTHOR]