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Objective: Preoperative prediction of visual recovery after pituitary adenoma resection surgery remains challenging. This study aimed to investigate the value of clinical and radiological features in preoperatively predicting visual outcomes after surgery. Methods: Patients undergoing endoscopic transsphenoidal surgery (ETS) for pituitary adenoma were included in this retrospective and prospective study. Preoperative MRI, visual acuity, visual field, and postoperative visual recovery data were collected. Logistic regression analysis was used to assess the importance of clinical and MRI features, and a prediction model was developed. Results: The cohort included 198 patients (150 retrospective, 48 prospective). In the retrospective data, visual recovery was observed in 111 patients (74.0%), while non-recovery was observed in 39 patients (26.0%). In the prospective data, visual recovery was observed in 27 patients (56.25%) and non-recovery in 21 patients (43.75%). Blindness, headache, adenoma area, and adenoma upward growth distance were negatively correlated with visual recovery (p < 0.05), while the pituitary gland area was positively correlated (p = 0.001). Logistic regression selected three clinical features: blindness, headache, and visual impairment course. Two additional imaging features, pituitary gland maximum area, and adenoma maximum area, were incorporated into the prediction model. The area under the curve of the prediction model was 0.944 in the retrospective cohort and 0.857 in the prospective cohort. Accuracy was 88% and 81.25%, respectively. Conclusion: This study successfully developed a clinical practical model combining clinical and radiological features to preoperatively predict visual recovery for patients with pituitary adenoma. The model has the potential to provide personalized counseling for individual patients. [ABSTRACT FROM AUTHOR]

Pituitary neuroendocrine tumors (PitNETs) are one of the most common intracranial tumors with diverse clinical manifestations. Current pathological classification systems rely primarily on histological hormone staining and transcription factors (TFs) expression. While effective in identifying three major lineages, molecular characteristics based on hormones and TFs lack sufficient resolution to fully capture the complex tumor heterogeneity. Transcriptional diversity by alternative splicing (AS) offered additional insight to address this challenge. Here, we perform bulk and full-length single-cell RNA sequencing to comprehensively investigate AS dysregulation across all PitNET lineages. We reveal pervasive splicing dysregulations that better depict tumor heterogeneity. Additionally, we delineate fundamental splicing heterogeneity at single-cell resolution, confirming bulk findings and refining splicing dysregulation varying among tumor cell types. Notably, we effectively distinguish the silent corticotroph subtype and define a distinct TPIT lineage subtype, which is associated with worse clinical outcomes and increased splicing abnormalities driven by altered ESRP1 expression. In conclusion, our results characterize the subtype specific AS landscape in PitNETs, enhancing the understanding of the PitNETs subtyping. Current classification systems of pituitary neuroendocrine tumors (PitNETs) rely on histological hormone staining and transcription factors. Here, the authors analyze alternative splicing at bulk and single-cell resolution in PitNETs, revealing additional subtypes associated with worse clinical outcomes and splicing abnormalities. [ABSTRACT FROM AUTHOR]

Background: Surgical management of giant and irregular pituitary neuroendocrine tumors (GIPitNETs) presents a significant challenge in neurosurgery. While endoscopic endonasal surgery (EES) is a widely used approach for PitNETs, GIPitNETs with extensive intracranial extension pose challenges for purely EES. We use simultaneous combined endoscopic endonasal and transcranial surgery (CECS) for the treatment of this type of tumor. Currently, there is limited research comparing CECS to EES for GIPitNETs. This study aims to compare the efficacy and short outcome of CECS and purely EES in the management of GIPitNETs to better understand the advantages and limitations of each surgical approach. Methods: The data of GIPitNETs patients who underwent surgery between March 2018 and May 2023 at a single center were retrospectively reviewed. All included cases were divided into CECS and EES groups according to the treatment modality received. The baseline characteristics and tumor imaging features of patients were compared between the groups, as well as surgical results, perioperative complications, and last follow-up outcomes. Results: A total of 50 patients met the inclusion criteria, with 27 undergoing CECS and 23 EES. CECS achieved a significantly higher GTR rate compared to EES (66.7% vs. 13.0%, p < 0.0001). CECS had longer operation times and hospital stays, but both approaches had similar rates of complications, including intracranial infection, CSF leakage, new pituitary dysfunction, postoperative diabetes insipidus, and vascular infarction. CECS reduces the risk of postoperative bleeding. Tumor recurrence and reoperation were significantly more common in the EES group. Conclusions: CECS is a safe and effective surgical approach for GIPitNETs, leading to higher rates of GTR, comparable complication rates, and reduced risk of postoperative bleeding when compared to purely EES. EES was associated with more tumor recurrence. Further long-term follow-up data is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Non-functioning pituitary adenomas (NFPAs) are a highly heterogeneous group and often show invasion, but few studies have explored the invasion mechanism and biomarkers for specific subtypes. This study was designed to describe the role of HIF1α and its downstreamgenes in specific subtypes of NFPAs. Specimens were classified into two subtypes of NFPAs: 46 null cell adenomas (28 invasive and 18 noninvasive) and 46 oncocytomas (11 invasive and 35 noninvasive). HIF1α, TIMP1, MT6-MMP, ECAD and NCAD were detected by qRT-PCR, western blot or immunohistochemistry in tumor tissue. The transwell assay was performed to measure the effects of HIF1α on tumor cell invasion in GH3 and GT1-1 cells. TIMP1, MT6-MMP, ECAD and NCAD were detected by western blot in HIF1α overexpressed GT1-1 cells. HIF1α mRNA and protein level was significantly upregulated in invasive pituitary null cell adenomas but not in invasive pituitary oncocytoma. The TIMP1 mRNA and protein level was significantly downregulated and MT6-MMP mRNA and protein level was significantly upregulated in invasive pituitary null cell adenomas. Meanwhile, there were no significant differences in epithelial--mesenchymal transition (EMT) markers, ECAD and NCAD, between invasive and noninvasive pituitary null cell adenomas. The overexpression of HIF1α promoted the invasive capability of pituitary adenoma cells in vitro. Regarding the molecular mechanism, HIF1α overexpression could downregulate TIMP1 and upregulate MT6-MMP expression levels but did not affect EMT markers' expression. Our results suggested that HIF1α might contribute to the invasion of pituitary null cell adenomas through activating HIF1α/TIMP1/MT6-MMP pathway but not EMT. [ABSTRACT FROM AUTHOR]

Background/objective: In this radioanatomical study with clinical correlate, we study a variation of the 'extended nasal floor mucosa' (ENFM) free-graft, the purely nasal floor mucosa (PuNFM) free-graft. The objectives of this study are to evaluate the coverage surface area provided by the PuNFM, study the adequacy of the PuNFM in the reconstruction of endoscopic endonasal approach (EEA) transsellar postoperative defects and compare and evaluate this reconstructive technique with current sellar region reconstruction practices. Methods: Dissections were performed on five cadaveric specimens. PuNFM were harvested bilaterally and the area provided for reconstruction was calculated. Twenty-five consecutive cases of pituitary adenomas resected through an EEA were analyzed to estimate the sellar defect surface area (SDSA) after a transsellar EEA and calculate the area of PuNFM bilaterally. Results: The median cadaveric SDSA was 4.77 cm2, with a median left and right side PuNFM area of 5.09 and 5.19 cm2, respectively. Clinically, the median SDSA was 5.36 cm2, and the total radiological PuNFM surface area was 5.46 cm2, with modified Knosp grade >2 tumors having larger SDSA than that of Knosp grade <2 tumors. The PuNFM graft proved to be most effective for covering modified Knosp <2 tumor defects. Conclusions: The PuNFM represents a variation of the ENFM free-graft sellar defect reconstruction technique that provides sufficient surface area to reconstruct the majority of the sellar defects related to transsellar EAA for pituitary adenomas. This technique may positively impact sinonasal function and quality of life. Future prospective clinical studies are needed to verify these findings. [ABSTRACT FROM AUTHOR]

Most pituitary adenoma/neuroendocrine tumours (PitNET) are histologically benign and grow slowly; however, a subset of these tumours exhibit a more aggressive clinical course characterized by local invasiveness and early recurrence. These high-risk PitNETs often require multiple surgeries and radiation over several years and may eventually acquire carcinomatous characteristics, such as metastasis in some cases. Herein, we report a rare case of PitNET causing oculomotor paresis with extremely rapid recurrence only 3 months after initial surgery, followed by lethal liver metastasis. Preoperative magnetic resonance imaging and intraoperative findings were consistent with typical PitNETs, other than moderate invasion of the cavernous sinus. Pathological examination of the specimen obtained from the initial transsphenoidal surgery revealed increased mitosis and elevated rates of cells positive for Ki-67 and p53. Based on the immunohistochemical assessment for transcription factors and pituitary hormones, the diagnosis was determined to be a silent sparsely granulated corticotroph PitNET with focal malignant transformation. Aggressive features represented by Ki-67 and p53 positivity were more robust in recurrent and metastatic specimens, but hormone immunostaining was decreased. Epigenetic analysis revealed methylation of the telomerase reverse transcriptase (TERT) promoter in the tumour, resulting in TERT upregulation. Despite extensive research, markers for distinguishing extremely aggressive PitNETs have not been determined. Although further analysis is needed, our case demonstrates the possible usefulness of assessing TERT promoter methylation status in the stratification of recurrence risk in extremely high-risk variants of PitNET. [ABSTRACT FROM AUTHOR]

Background We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma. Methods This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the perioperative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression. Results Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.96–0.99, p = 0.029). DI was positively associated with female sex (OR = 2.26, 95% CI: 1.24–4.11, p = 0.008), increase in anteroposterior tumor size (OR = 1.54, 95% CI: 1.11–2.13, p = 0.010), intraoperative cerebrospinal fluid (CSF) leak (OR = 2.29, 95% CI: 1.25–4.19, p = 0.008), and every 100 mL of estimated blood loss (EBL) (OR = 1.18, 95% CI: 1.01–1.39, p = 0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR = 3.56, 95% CI: 1.24–10.21, p = 0.018) on multivariate analysis. Conclusion DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence. [ABSTRACT FROM AUTHOR]

Introduction The first line treatment for prolactinomas is currently dopamine agonists (DAs). Medical management is prolonged, associated with side effects, financial, and psychological burdens. In dedicated centers, pituitary surgery is a low-risk alternative. We evaluated outcome measures of medical and surgical treatment, to assess, if the role of surgery is underestimated. Methods We reviewed the charts of 4,660 pituitary patients, managed at the University of Colorado, from 2004 to 2019. The final analysis included 154 patients with prolactinomas, managed medically, and 120 patients, treated surgically. Primary outcome measures were percentage of tumor volume reduction and prolactin level (ng/mL). Mann–Whitney test was used for quantitative variables, contingency tables, and chi-square tests for qualitative variables. Statistical significance was set at p < 0.05. Results DAs alone were more frequently used for microprolactinomas and Knosp grade 0 adenomas. Surgery was more often performed for macroprolactinomas, giant adenomas, tumors with suprasellar extension, mixed consistency, and sellar floor erosion. Among macroprolactinomas, mean tumor volume reduction after treatment with DAs alone, DAs and surgery, and surgery alone was 53.8, 94.9, and 94.1%, respectively. Prolactin levels after treatment were not significantly different. Continuous DA treatment was required in 94.3% patients in the medical group versus 39.6% in the surgical group. Conclusion Surgery for macroprolactinomas achieved greater tumor volume reduction and dose reduction or discontinuation of DAs. Prolactin levels achieved did not differ significantly between the groups. Over 60% of patients, undergoing surgery, were able to discontinue DAs. The current treatment paradigm may underestimate the role of surgery in the management of prolactinomas. [ABSTRACT FROM AUTHOR]

Background: The types of growth hormone-secreting pituitary adenomas are diverse, we have found that there are significant differences in clinical features and prognosis between PIT-1 single-cell spectrum growth hormone adenomas and growth hormone phenotypic polyhormonal adenomas. Methods: This study examined a cohort of 193 patients with growth hormone-secreting pituitary adenoma (GHPA), stratifying them into two groups: PIT-1 single transcription factor positive growth hormone adenoma (STF-GHPA) and Multiple transcription factor-positive growth hormone-secreting adenomas (MTF-GHPA). The objective was to compare these two groups' clinical characteristics. Within the MTF-GHPA group, we further subtyped them based on transcription factors to evaluate potential variations in clinical manifestations. Logistic regression analyses were employed to develop a risk factor model for investigating factors influencing hormone remission. Results: There were no statistically significant differences in terms of age, gender, serum GH, and IGF-1 levels between patients diagnosed with MTF-GHPA and STF-GHPA. However, patients with MTF-GHPA exhibited a higher proportion of hypopituitarism compared to those with STF-GHPA. Furthermore, MTF-GHPA were characterized by smaller tumor size and less invasiveness, as indicated by lower Knosp classes. However, patients with MTF-GHPA have a lower rate of hormonal remission (30.8%) and more postoperative complications (31.0%), which means that STF-GHPA (hormonal remission:71.6%; postoperative complications:13.4%) has a better endocrine outcome than MTF-GHPA patients. Between the PIT-1 + SF-1+ and PIT-1 + TPIT+ subtypes within MTF-GHPA, significant differences were also observed in tumor size, endocrine outcomes, and postoperative complications. Risk factors influencing hormonal remission for GHPA included preoperative GH level, primary/recurrent, extent of resection, and transcription factor expression. Conclusion: Co-expression of multiple transcription factors is an important factor associated with clinical behavior and endocrine outcomes in patients with GHPA. [ABSTRACT FROM AUTHOR]

Ectopic ACTH syndrome (EAS), in which Cushing syndrome is caused by excessive ACTH secretion from a tumor located outside of the pituitary, is associated with an impaired quality of life and an increased mortality rate. Outcomes can be improved with successful tumor localization and resection, which often proves difficult. In order to distinguish EAS from Cushing disease, a significantly more common condition where excessive ACTH is secreted from a pituitary tumor, bilateral inferior petrosal sinus sampling (IPSS) is often necessary. Correct performance and interpretation of IPSS hence becomes crucial to avoid inappropriate future interventions, including surgical procedures. Once an ectopic source of ACTH is confirmed biochemically, identifying the causative tumor is often challenging since they can be located in unexpected areas and potentially be very small. Additionally, EAS carries a risk of severe hypercortisolism, which sometimes needs urgent treatment to avoid disastrous outcomes. The cases here illustrate pitfalls in diagnostic biochemical testing, describe helpful imaging strategies to improve the chances of tumor detection, and review available options to rapidly normalize severe hypercortisolism in critical situations. [ABSTRACT FROM AUTHOR]

Early diagnosis and proper grouping of tumors in the brain are critical for successful therapy and positive outcomes for patients. This work proposes a complete technique for identifying brain tumors that employ sophisticated artificial intelligence methodologies and achieve an accuracy rate of 97.18%. The work makes use of the brain tumor magnetic resonance imaging (MRI) collection in Kaggle, which has 723 MRI scans classified as glioma, meningioma, pituitary tumor, and no tumor. These images are initially preprocessed, which includes scaling to a homogeneous size normalizing, and removal of noise to ensure uniformity and clarity. To improve the information set, generative adversarial networks (GANs) are used to perform data augmentation, producing artificial pictures that improve the database variety and resilience. To achieve exact cancer localization, the U-Net construction, recognized for its encoder-decoder design and skip links, is used to divide up tumor areas across images generated by MRI. The image segments are then input into gated recurrent units (GRUs), to analyze a collection of features to capture periods and differences between segments. The last classification is accomplished using an entirely linked layer and then a softmax stimulation, which provides the tumors classes. This method helps for medical experiments and clinical methods. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the level of distress and the quality of life of operated and non-operated patients with pituitary tumors. Patients who presented to a neurosurgical center and two endocrinological services for outpatient follow-up after surgical treatment, as well as those under medical therapy or radiological follow-up without treatment, were invited to participate in the study. Sociodemographic, health-related quality of life and clinical data were assessed. Psychosocial factors were measured using the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF-36), and the Sino-nasal outcome test (SNOT). Thirty-two postoperative patients and thirty conservatively managed patients (n = 21 under medical treatment, n = 9 watch and wait), mean age 53, SD 19; 56% female participated in the study. Prolactinomas (35%) and non-functioning pituitary adenomas (21%) were the most common findings. There were no significant differences between conservative and operative groups in mean DT score (4.7 (SD 2.45) vs. 4.9 (SD 3.0), p = 0.61), HADS anxiety score (6.4 (SD 3.9) vs. 6.0 (SD 4.3), p = 0.76) or depression score (5.7 (SD 4.8) vs. 4.6 (SD 3.6), p = 0.50). For patients with ACTH-producing adenomas, the mean anxiety score was significantly higher (10.3 (SD 1.9) vs. 5.9 (SD 4.0), p = 0.03). The SNOT score correlated significantly with the DT, HADS-A, and HADS-D scores and therefore was associated with higher psychological distress. The level of self-reported distress in patients with sellar processes was not associated with a specific treatment strategy. ACTH-producing adenomas and manifest nasal symptoms were associated with higher psychological distress. [ABSTRACT FROM AUTHOR]

Background: Bone-invasive Pituitary Neuroendocrine Tumors (BI PitNETs) epitomize an aggressive subtype of pituitary tumors characterized by bone invasion, culminating in extensive skull base bone destruction and fragmentation. This infiltration poses a significant surgical risk due to potential damage to vital nerves and arteries. However, the mechanisms underlying bone invasion caused by PitNETs remain elusive, and effective interventions for PitNET-induced bone invasion are lacking in clinical practice. Methods: In this study, we performed single-cell (n = 87,287) RNA sequencing on 10 cases of bone-invasive PitNETs and 5 cases of non-bone-invasion PitNETs (Non-BI PitNETs). We identified various cell types and determined their interactions through cell-cell communication analysis, which was further validated experimentally. Results: We identified a novel TNF-α+ TAM macrophage subset. BI PitNETs showed increased IL-34 secretion, impacting TNF-α+ TAMs via the IL34/CSF1R axis, leading to TNF-α production. TNF-α+ TAMs, in turn, communicate with CD14+ monocytes to promote their differentiation into osteoclasts and leading to bone invasion. In addition, we defined a gene signature for TNF-α+ TAM to guide the clinical prognosis prediction of BI PitNETs. Conclusions: Our study elucidates the tumor microenvironment changes in bone invasion and identifies the critical role of TNF-α+ TAMs in promoting bone invasion of PitNETs, laying a foundation for developing new molecular markers or therapeutic agents targeting BI PitNETs. [ABSTRACT FROM AUTHOR]

Pituitary Neuroendocrine Tumors (PitNETs), often treated via endonasal transsphenoidal resection, present a risk for postoperative surgical site infections (SSIs), including intracranial infections such as meningitis. Identifying the risk factors associated with these infections is crucial for improving surgical outcomes and patient care. A retrospective study was conducted at a medical center from June 2020 to June 2023. The study included 20 patients with postoperative intracranial infections and 50 controls without infections. Inclusion criteria involved adult patients diagnosed with PitNETs who underwent standard endonasal transsphenoidal surgery and provided informed consent. Exclusion criteria included previous neurosurgical procedures, preoperative infections, concurrent severe diseases, or alternative surgical approaches. Diagnostic criteria for intracranial infections were based on clinical, hematological, cerebrospinal fluid, radiological, and microbiological findings. Statistical analyses were performed using IBM SPSS, focusing on univariate and multivariate logistic regression analyses. Univariate analysis showed no significant association of intracranial infections with factors like smoking history, previous craniotomy, operation time, hypertension, preoperative sphenoid sinusitis, BMI, and age. However, postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle were significantly associated with infections. Multivariate logistic regression further confirmed these findings, with significant odds ratios for these factors. The study reveals a significant correlation between postoperative CSF leaks, intracranial pneumocephalus, diabetes mellitus, and tumor extension to the third ventricle with the occurrence of SSIs following endonasal transsphenoidal resection of PitNETs. Microbial analysis revealed Escherichia coli as the most prevalent pathogen in post-surgery infections, with notable antibiotic resistance patterns observed in key bacteria, necessitating careful antibiotic selection. Tailored clinical treatment strategies addressing these risk factors are essential to reduce the incidence of postoperative SSIs and enhance patient safety. [ABSTRACT FROM AUTHOR]

\nPlain-language summaryBrain tumors can cause difficulties in normal brain function and are capable of developing in various regions of the brain. Malignant tumours can develop quickly, pass through neighboring tissues, and extend to further brain regions or the central nervous system. In contrast, healthy tumors typically develop slowly and do not invade surrounding tissues. Individuals frequently struggle with sensory abnormalities, motor deficiencies affecting coordination, and cognitive impairments affecting memory and focus. In this research, Utilizing Phase-aware Composite Deep Neural Network Optimized with Coati Optimized Algorithm for Brain Tumor Identification Based on Magnetic resonance imaging (PACDNN-COA-BTI-MRI) is proposed. First, input images are taken from the brain tumour Dataset. To execute this, the input image is pre-processed using Multivariate Fast Iterative Filtering (MFIF) and it reduces the occurrence of over-fitting from the collected dataset; then feature extraction using Self-Supervised Nonlinear Transform (SSNT) to extract essential features like model, shape, and intensity. Then, the proposed PACDNN-COA-BTI-MRI is implemented in Matlab and the performance metrics Recall, Accuracy, F1-Score, Precision Specificity and ROC are analysed. Performance of the PACDNN-COA-BTI-MRI approach attains 16.7%, 20.6% and 30.5% higher accuracy; 19.9%, 22.2% and 30.1% higher recall and 16.7%, 21.9% and 30.8% higher precision when analysed through existing techniques brain tumor identification using MRI-Based Deep Learning Approach for Efficient Classification of Brain Tumor (MRI-DLA-ECBT), MRI-Based Brain Tumor Detection using Convolutional Deep Learning Methods and Chosen Machine Learning Techniques (MRI-BTD-CDMLT) and MRI-Based Brain Tumor Image Detection using CNN-Based Deep Learning Method (MRI-BTID-CNN) methods, respectively.In this research, utilizing a PACDNN-COA-BTI-MRI is proposed. First, input images are taken from the brain tumor dataset. To execute this, input image is pre-processed using Multivariate Fast Iterative Filtering (MFIF) and it reduces the occurrence of over-fitting from the collected dataset; then the feature extraction using Self-Supervised Nonlinear Transform (SSNT) to extract essential features like model, shape, and intensity. Then, the extracted images are fed to PACDNN to detect and classified the brain tumor like pituitary tumors, glioma tumors, meningioma tumors and no tumors. PADDNN generally does not express optimisation algorithms that are tailored to identify the optimal parameters for accurate brain tumour classification. [ABSTRACT FROM AUTHOR]

Objective: The invasiveness of pituitary neuroendocrine tumor is an important basis for formulating individualized treatment plans and improving the prognosis of patients. Radiomics can predict invasiveness preoperatively. To investigate the value of multiparameter magnetic resonance imaging (mpMRI) radiomics in predicting pituitary neuroendocrine tumor invasion into the cavernous sinus (CS) before surgery. Patients and methods: The clinical data of 133 patients with pituitary neuroendocrine tumor (62 invasive and 71 non-invasive) confirmed by surgery and pathology who underwent preoperative mpMRI examination were retrospectively analyzed. Data were divided into training set and testing set according to different field strength equipment. Radiomics features were extracted from the manually delineated regions of interest in T1WI, T2WI and CE-T1, and the best radiomics features were screened by LASSO algorithm. Single radiomics model (T1WI, T2WI, CE-T1) and combined radiomics model (T1WI+T2WI+CE-T1) were constructed respectively. In addition, clinical features were screened to establish clinical model. Finally, the prediction model was evaluated by ROC curve, calibration curve and decision curve analysis (DCA). Results: A total of 10 radiomics features were selected from 306 primitive features. The combined radiomics model had the highest prediction efficiency. The area under curve (AUC) of the training set was 0.885 (95% CI, 0.819-0.952), and the accuracy, sensitivity, and specificity were 0.951,0.826, and 0.725. The AUC of the testing set was 0.864 (95% CI, 0.744-0.985), and the accuracy, sensitivity, and specificity were 0.829,0.952, and 0.700. DCA showed that the combined radiomics model had higher clinical net benefit. Conclusion: The combined radiomics model based on mpMRI can effectively and accurately predict the invasiveness of pituitary neuroendocrine tumor to CS preoperatively, and provide decision-making basis for clinical individualized treatment. [ABSTRACT FROM AUTHOR]

Pituitary adenomas are a diverse group of neoplasms with variable clinical behavior. Despite advances in genetic analysis, understanding the role of epigenetic modifications, particularly DNA methylation, remains an area under investigation. This scoping review aimed to update and synthesize the current body of literature on DNA methylation in pituitary adenomas, focusing on methodological advancements and clinical correlations. A systematic search conducted across multiple databases, including Embase, Scopus, MEDLINE, and CENTRAL, identified 107 eligible studies. Early methods, such as methylation-restricted digestion and methylation-specific PCR (MSP), have evolved into more comprehensive approaches, such as chip-based DNA methylation analysis. Key findings suggest that genes like POMC, SOCS-1, and RASSF1A show a significant association between methylation and clinical behavior. However, methylation patterns alone are insufficient to fully explain tumorigenesis. Emerging data suggest that DNA methylation might serve as a prognostic marker for invasive growth and recurrence, but further longitudinal studies are needed. This review highlights the need for future research to explore the methylome more thoroughly and to better define the clinical impact of epigenetic modifications in pituitary adenomas. [ABSTRACT FROM AUTHOR]

Surgical treatment of complex pituitary adenomas (PAs) presents a significant challenge. Here in, we compared the surgical outcomes between patients undergoing endoscope-assisted transcranial surgery and microscopic regimens to assess the safety and efficacy of endoscope-assisted transcranial surgery in treating complex PA. This retrospective case-control study was conducted at the First Affiliated Hospital of Soochow University, China. Clinical data were retrospectively analysed between January 2018 and January 2023. The primary outcome was gross total resection (GTR), and the secondary outcomes included recurrence, residual tumour volume, and patient status. Propensity score matching was used to account for group differences. We enrolled 73 patients, of whom 29 underwent endoscope-assisted transcranial surgery, and 44 underwent transcranial microscopic surgery. Compared with the microscopic regimen group, the endoscope-assistedgroup had higher postoperative Karnofsky Performance Scale (KPS) scores (p = 0.031), higher GTR rates (GTR: 79.3% vs. 50%, p = 0.023), and smaller tumour residual volume (residual tumour volume: 0.15 vs. 0.94, p = 0.029). After propensity score matching, the endoscope-assistedregimen was associated with increased odds of GTR rate, compared with the microscopic regimen (odds ratio: 3.65, 95% confidence interval: 1.06–12.54, p = 0.040). KPS score improvement at discharge was more evident in the endoscope-assisted group than in non-combined group. The endoscope-assisted transcranial surgery regimen offered increased GTR rates, higher postoperative KPS score, and less residual tumour than the non-combined regimen did, highlighting endoscope-assistedtherapy as the more favourable treatment approach for patients with complex PA. [ABSTRACT FROM AUTHOR]

Pituitary neuroendocrine tumors remain one of the most common intracranial tumors. While radiomic research related to pituitary tumors is progressing, public data sets for external validation remain scarce. We introduce an open dataset comprising high-resolution T1 contrast-enhanced MR scans of 136 patients with pituitary tumors, annotated for tumor segmentation and accompanied by clinical, radiological and pathological metadata. This diverse dataset captures variations in tumor size, location, and pathological activity, essential for understanding this complex condition. Expert annotations of both the tumor and adjacent carotid arteries ensure precise delineation, facilitating the development of automated segmentation algorithms. Our initiative addresses the need for standardized data in pituitary oncology, fosters collaboration and innovation, and enables the development and benchmarking of workflows that utilize pituitary radiomics for treatment planning and outcome prediction. [ABSTRACT FROM AUTHOR]

Invasiveness of pituitary adenoma is the main cause of its poor prognosis, mechanism of which remains largely unknown. In this study, the differential proteins between invasive and non-invasive pituitary tumors (IPA and NIPA) were identified by TMT labeled quantitative proteomics. The differential metabolites in venous bloods from patients with IPA and NIPA were analyzed by untargeted metabolomics. Proteomic data showed that the top five up-regulated proteins were AD021, C2orf15, PLCXD3, HIST3H2BB and POU1F1, and the top five down-regulated proteins were AIPL1, CALB2, GLUD2, SLC4A10 and GTF2I. Metabolomic data showed that phosphatidylinositol (PI) was most remarkably up-regulated and melibiose was most obviously down-regulated. Further investigation demonstrated that PI stimulation increased the expression of PITPNM1, POU1F1, C2orf15 and LDHA as well as the phosphorylation of AKT and ERK, and promoted the proliferation, migration and invasion of GH3 cells, which were blocked by PITPNM1knockdown. Inhibiting AKT phosphorylation reduced the expression of POU1F1, C2orf15 and LDHA in PI-stimulated cells while activating AKT increased their expression in PITPNM1-silencing cells, which was similar to the function of ERK. POU1F1 silence suppressed the expression of LDHA and C2orf15. Luciferase report assay and ChIP assay demonstrated that POU1F1 positively regulated the transcription of LDHA and C2orf15. In addition, PI propelled the metastasis of GH3 cells in vivo, and elevated the expression of PITPNM1, POU1F1, C2orf15 and LDHA. These results suggested that elevated serum PI might contribute to the proliferation and invasion of pituitary adenoma by regulating the expression of PITPNM1/AKT/ERK/POU1F1 axis. [ABSTRACT FROM AUTHOR]

Currently, the direct endonasal approach is widely used in endoscopic endonasal surgery (EES) for pituitary neuroendocrine tumor. However, a large posterior septal perforation is inevitable. We routinely utilize a modified para/transseptal approach using the combination of a Killian and a contralateral rescue flap incision (PTSA with K-R incision). Especially, rescue flap incision is used on ipsilateral side of the tumor extension to facilitate lateral expansion of the anterior sphenoidotomy and tumor resection. One hundred eighty-nine patients underwent EES using PTSA with K-R incision in Tsukuba university hospital. Gross total resection (GTR) was achieved in 146 (77.2%) patients. Even in cases of significant lateral tumor extension (Knosp 3 or 4), GTR was achieved in 56 of 90 (62.2%) patients. Among the 168 patients with available rhinological follow-up data, postoperative anterior and posterior septal perforation occurred in six (3.6%) and 18 (10.7%) patients, respectively. Surgical intervention was required in one (0.6%) patient with anterior septal perforation. Thus, PTSA with K-R incision was effective in preserving the nasal septal mucosa on one side and gaining a sufficient surgical corridor with lateral expansion of the anterior sphenoidotomy on the other side. Our strategy may be preferable to improve maneuverability of instruments during tumor resection. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate machine learning (ML) models to predict the occurrence of delayed hyponatremia after transsphenoidal surgery for pituitary adenoma. We retrospectively collected clinical data on patients with pituitary adenomas treated with transsphenoidal surgery between January 2010 and December 2020. From January 2021 to December 2022, patients with pituitary adenomas were prospectively enrolled. We trained seven ML models to predict delayed hyponatremia using the clinical variables in the training set. The final model was internally validated using a test set and a prospective dataset. The SHapley Additive exPlanations (SHAP) algorithm was used to determine the significance of each variable in the occurrence of delayed hyponatremia. In the training dataset, the best predictive performance was observed for XGBoost (area under the ROC curve; AUC = 0.821), followed by Random Forest (AUC = 0.8), Logistic Regression (AUC = 0.793), Support Vector Machine (AUC = 0.776), naïve Bayes (AUC = 0.774), K-Nearest Neighbors (AUC = 0.742), and Decision Tree (AUC = 0.717). The AUC of the XGBoost model for the test and prospective datasets are 0.831 and 0.785, respectively. The differences in pituitary stalk deviation angle, the "measurable pituitary stalk" length before and after surgery, and blood sodium concentration between preoperative and postoperative day 2 were important variables for predicting delayed hyponatremia as determined by the SHAP algorithm. The XGBoost model was best able to predict delayed hyponatremia after transsphenoidal surgery for pituitary adenomas. The differences in pituitary stalk deviation angle, pre- versus postoperative "measurable pituitary stalk" length, and pre- versus postoperative day 2 blood sodium concentrations were important variables for predicting delayed hyponatremia. [ABSTRACT FROM AUTHOR]

Prolactinomas are the most prevalent subtype of pituitary adenomas and represent one of the leading etiological factors responsible for amenorrhea and infertility in women. The primary therapeutic approach entails the use of dopamine agonists, which effectively restore fertility. In cases of microprolactinomas, the likelihood of experiencing a symptomatic enlargement of the tumor during pregnancy is exceptionally low, estimated at a mere 2.4%. Consequently, once pregnancy is successfully achieved, the administration of dopamine agonists is discontinued, with ongoing clinical monitoring of the patient's condition. The incidence of pituitary apoplexy during pregnancy is exceedingly rare. We present a case of a 29‐year‐old patient with microprolactinoma, treated with cabergoline, which was discontinued upon achieving pregnancy. However, at the 16th week of gestation, she presented with persistent headaches and compromised visual acuity, manifesting as left temporal hemianopia. A noncontrast magnetic resonance imaging (MRI) revealed an enlargement of the adenoma, accompanied by evidence of hemorrhage. She was referred to our hospital at 26 weeks of gestation. Cabergoline treatment was reinstated and well tolerated by the patient. Doses were increased to 2 mg per week because bitemporal hemianopia was not improving. A subsequent noncontrast MRI scan performed at 35 weeks of gestation demonstrated a further increase in adenoma size, measuring 17 × 21 × 13 mm, with signs of intratumoral bleeding. A planned cesarean section was performed at 39 weeks of gestation, without encountering maternal–fetal complications. Breastfeeding was not initiated due to the adenoma's compression of the chiasm. Accordingly, dopamine agonist therapy was continued. During the postpartum follow‐up, the patient experienced a resumption of menstrual cycles, normalization of prolactin levels, and a reduction in tumor size. Ultimately, the diagnosis was established as a microprolactinoma, which had enlarged during pregnancy due to a pituitary tumor apoplexy. Although microprolactinomas typically carry a low risk of symptomatic tumor growth during pregnancy, this case emphasizes the critical importance of vigilant clinical monitoring to swiftly detect and manage this rare complication. This instance serves as an educational example of an uncommon event—a microprolactinoma experiencing apoplexy during pregnancy. [ABSTRACT FROM AUTHOR]

Craniopharyngioma is a rare, benign tumor that originates from the pituitary stalk and extends along the pituitary-hypothalamic axis. It can have serious effects due to its location, affecting hormone regulation, vision, and other neurological functions. It is particularly rare and challenging to manage it during pregnancy due to the potential impacts on both maternal and fetal health, requiring careful, individualized treatment. We reported a 26-year-old pregnant woman at 27 weeks with recurrent craniopharyngioma who presented with worsening consciousness and hydrocephalus. Despite recommendations to terminate the pregnancy for tumor resection, she chose to continue. We performed an endoscopic endonasal tumor resection with pituitary transposition to preserve pituitary function, and at 32 weeks, she delivered a healthy baby via cesarean section. We provided a detailed account of the perioperative complications and their management, addressing endocrine, temperature, and fluid regulation challenges. Throughout the process, the medical team maintained open communication with the patient and her family, respecting their desire to continue the pregnancy and exemplifying patient-centered, compassionate care. [ABSTRACT FROM AUTHOR]

A 47-year-old man presented with a large midline skull base lesion, with panclival erosion leading to a very rare event of CV junction instability causing severe neck pain and movement restriction as the predominant symptom presented. Sub-total excision of the lesion through the endonasal endoscopic transsphenoidal transclival approach followed by occiput-C2-C3 fixation was successfully performed as a one-stage procedure. Although the initial hormonal evaluation showed normal values, serial dilution confirmed very high prolactin levels. Careful evaluation for instability and the importance of the serial dilution method for prolactin levels is emphasized for proper treatment. We present an extremely rare scenario of invasive giant pituitary adenoma and review the pertinent literature. [ABSTRACT FROM AUTHOR]

Objective: To use machine learning tool to predict visual outcomes. Methods: A retrospective cohort of 284 consecutive pituitary adenoma patients with preoperative visual deficit was used. Patient variables were collected. Preprocessing and classification was done in the open source ML tool box Weka (Ver 3.8.4). Four algorithms were used for classification—the J48 trees, LMT algorithm, the REP tree algorithm, and the Random Forest. Results: The study included a total of 284 patients. The mean duration of visual symptoms was 10.09 ± 4.3 months. There were 24 patients with uniocular involvement and 260 patients with binocular visual impairment: Vision improved in 89.78% patients, remained same in 9.86% and deteriorated in 0.3% patients and were same in 9.86% patients and deteriorated in 0.3% patient. Factors like extent of resection, preoperative visual acuity, tumor volume, and duration of symptoms were found to have statistically significant effect on postoperative visual outcome. The model predicting visual improvement had an AUC of 0.846; 88.94% accuracy, 78.4% specificity, and 93.7% sensitivity; 90.5% and 85.04% positive and negative predictive value, respectively; an F1 score of 0.921; and a Brier score of 0.291. Conclusions: Postoperative visual outcomes of pituitary adenoma surgery and factors affecting it can be predicted with 88.94% accuracy using a machine learning approach. Based on this preliminary evaluation, ML appears promising in predicting visual outcomes after endoscopic resection of pituitary adenomas, thus improving patient-tailored care and counselling. [ABSTRACT FROM AUTHOR]

Background: Long-term functional and tumor outcomes in patients undergoing endoscopic surgery for non-functioning pituitary adenomas (NFPA) are not well documented. Objective: To study factors influencing the extent of resection (EOR) and long-term visual, hormonal, and tumor outcomes following uni-nostril endoscopic surgery in patients with nonfunctioning pituitary adenomas. Methods: In total 172 patients, with ≥1 year follow-up, operated between 2005 and 2018 were included in this retrospective study. Risk factors were analyzed, with logistic regression analysis, for EOR and long-term visual and hormonal outcomes. Recurrence rates were correlated with EOR and adjuvant radiation therapy (RT). Results: Gross total resection (GTR) or near total resection (NTR) was achieved in 120 (69.7%) patients. Higher Knosp grade and previous surgery were associated with lower EOR (P = 0.02 and 0.004, respectively). On long-term follow-up (mean, 72.5 months), visual impairment score improved in 59.4% and remained the same in 38.5% of patients. The hormonal axis remained the same in 55.8% and worsened in 39.5% of patients. The 10-year recurrence rate for patients who had NTR of the tumor was 0% with RT and 63.2% without RT. Overall, the 10-year recurrence rate in the non-RT group was higher (51.2%) than the RT group (3.2%) (P = 0.001). Conclusion: Long-term visual outcome following uni-nostril surgery for NFPA is excellent or good in over 80% of patients but most patients need life-long hormonal replacement therapy. RT following surgery is associated with excellent tumor control in patients undergoing less than a GTR, but it leads to higher rates of pituitary dysfunction. [ABSTRACT FROM AUTHOR]

Immunohistochemistry (IHC) of somatostatin receptor subtype 2 can predict response to first-generation somatostatin receptor ligands (fg-SRLs) in acromegaly. Recently, we validated an open-source digital image analysis (DIA) to quantify somatostatin receptor subtype 2 (SSTR2) expression. We aimed to validate the DIA also on somatostatin receptor subtype 5 (SSTR5) in a new cohort of growth hormone (GH)-secreting pituitary tumors, with IHC performed in a different laboratory, and to correlate fg-SRL response with SSTs expression. Somatostatin receptor subtype 2 and SSTR5 were assessed in 42 GH-secreting pituitary tumors, using a semiquantitative immunoreactivity score (IRS) and the DIA by use of the open-access software CellProfiler. The DIA calculates the staining intensity and the percentage of positive cells (%PC). We found a good correlation between IRS and DIA for both SSTR2 and SSTR5 (P <.001), demonstrating the reliability of the DIA in this setting. Response to fg-SRL treatment correlated with SSTR2, but not SSTR5, expression. Somatostatin receptor subtype 2 expression predicted response to fg-SRL. In particular, the identified cut-offs were IRS ≥ 5 (area under the curve [AUC] 0.763; sensitivity 77%; specificity 83%); intensity/area ≥0.106 (AUC 0.833; sensitivity 92%; specificity 83%); and %PC-DIA ≥63.7% (AUC 0.917; sensitivity 92%; specificity 83%). The SSTR2 %PC correlated with treatment response only when evaluated using the DIA, showing a better performance of this method. [ABSTRACT FROM AUTHOR]

Simple Summary: This study explores the use of pre-trained deep learning models for classifying brain MRI images into four categories: Glioma, Meningioma, Pituitary, and No Tumor. The study uses a publicly available Brain Tumor MRI dataset and applies transfer learning to improve diagnostic accuracy and efficiency by fine-tuning pre-trained models. Xception achieved the highest performance with a weighted accuracy of 98.73%. While the models showed promise in addressing class imbalances, challenges in improving recall for certain tumor types remain. The study highlights the potential of deep learning in transforming medical imaging and clinical diagnostics. Background/Objectives: Brain tumor classification is a crucial task in medical diagnostics, as early and accurate detection can significantly improve patient outcomes. This study investigates the effectiveness of pre-trained deep learning models in classifying brain MRI images into four categories: Glioma, Meningioma, Pituitary, and No Tumor, aiming to enhance the diagnostic process through automation. Methods: A publicly available Brain Tumor MRI dataset containing 7023 images was used in this research. The study employs state-of-the-art pre-trained models, including Xception, MobileNetV2, InceptionV3, ResNet50, VGG16, and DenseNet121, which are fine-tuned using transfer learning, in combination with advanced preprocessing and data augmentation techniques. Transfer learning was applied to fine-tune the models and optimize classification accuracy while minimizing computational requirements, ensuring efficiency in real-world applications. Results: Among the tested models, Xception emerged as the top performer, achieving a weighted accuracy of 98.73% and a weighted F1 score of 95.29%, demonstrating exceptional generalization capabilities. These models proved particularly effective in addressing class imbalances and delivering consistent performance across various evaluation metrics, thus demonstrating their suitability for clinical adoption. However, challenges persist in improving recall for the Glioma and Meningioma categories, and the black-box nature of deep learning models requires further attention to enhance interpretability and trust in medical settings. Conclusions: The findings underscore the transformative potential of deep learning in medical imaging, offering a pathway toward more reliable, scalable, and efficient diagnostic tools. Future research will focus on expanding dataset diversity, improving model explainability, and validating model performance in real-world clinical settings to support the widespread adoption of AI-driven systems in healthcare and ensure their integration into clinical workflows. [ABSTRACT FROM AUTHOR]

Pituitary gigantism (PG) is a rare endocrine disorder that may present with multiple pituitary hormone abnormalities in pediatric patients. A hallmark presentation is accelerated growth due to growth hormone (GH) excess. Current treatment modalities include surgery, radiation, and medical therapy. We describe a 14-year-old girl who presented with recurrent slipped capital femoral epiphysis with GH excess and multiple other hormonal abnormalities. A sellar mass was identified on magnetic resonance imaging of the brain and was surgically resected. The pathology report was consistent with pituitary gland adenoma with mammosomatotrophs hyperplasia. Post surgery, serial laboratory results showed persistently elevated growth factor and GH levels, and residual tumor was reported on follow-up imaging. Even though we found limited data on the efficacy and safety of a long-acting somatostatin analogue, lanreotide, in the treatment of PG, a total of 4 doses of lanreotide successfully reduced growth factor and GH levels to normal ranges in our patient. Repeat imaging 5 weeks post discontinuation of lanreotide showed reduction of residual tumor volume. This case reveals that a short course of lanreotide may be used as an effective medical treatment in pediatric patients with PG who have residual disease after surgical intervention. [ABSTRACT FROM AUTHOR]

Lymphocytic infundibuloneurohypophysitis (LINH) is a disease with an etiology involving an autoimmune mechanism, characterized by lymphocytic inflammation of the posterior pituitary and infundibular stalk, resulting in arginine vasopressin deficiency. It is difficult to distinguish from pituitary neoplasm or infiltrative diseases, and biopsy is necessary for a definitive diagnosis, but this is highly invasive. In children, it is especially important to distinguish LINH from tumors such as germ cell tumors. Recently, the usefulness of anti-rabphilin-3A antibody as a serum marker for LINH has been reported. To date, only a limited number of pediatric cases have been reported. We present a 4-year-old boy with arginine vasopressin deficiency. Magnetic resonance imaging of the head showed thickening of the pituitary stalk without a posterior pituitary bright spot, and anti-rabphilin-3A antibody was positive. Consequently, pituitary biopsy was not performed because of the strong suspicion of LINH. Five months after symptom onset, the pituitary stalk thickening had resolved. This case represents the first report of probable or definitive LINH with anti-rabphilin-3A antibody positivity in a 4-year-old child, making it the youngest positive case reported to date. Our case highlights the importance of noninvasive approaches and careful follow-up to avoid invasive interventions for children with LINH. [ABSTRACT FROM AUTHOR]

Background: Endoscopic pituitary surgery might yield better endocrine outcomes compared to microscopic resection. We conducted a prospective, randomized, single-blinded study to compare the endocrine outcome and quality of life (QoL) of patients with newly diagnosed pituitary adenoma who underwent either endoscopic or microscopic transsphenoidal surgery (NCT03515603). Methods: Due to slow recruitment, this study had to be stopped prematurely. Out of 170 transsphenoidal pituitary surgeries performed during the study period, 36 patients were enrolled in this study. The primary endpoint was based on the development of a new hypopituitarism. Secondary endpoints included the extent of resection, complications, and QoL. Results: Endoscopic surgery was performed in 47.2% (n = 17). A new hypopituitarism was found in 8.3% (n = 3). All these cases underwent microscopic resection. Arginine vasopressin deficiency was found in 2.7% (n = 1) after microscopic resection. Gross total resection was achieved in 94.4% (n = 34). No surgical complications or new neurological deficits were observed. QoL improved significantly after the surgery, as measured by EQ-VAS (p = 0.003). According to EQ-5D3L, QoL improved or remained unchanged in almost all patients. No significant difference was found in QoL between the endoscopic and microscopic groups. Conclusion: The endoscopic technique appears to offer benefits in the treatment of pituitary adenomas, particularly in terms of achieving a favorable endocrine outcome. [ABSTRACT FROM AUTHOR]

Purpose: Achieving endocrine remission by gross total resection is challenging in pituitary neuroendocrine tumours (PitNETs) with cavernous sinus invasion. This study aims to assess the safety, feasibility, and optimal dose for intraoperative fluorescence imaging as an added instrument to discriminate PitNET from surrounding tissue using bevacizumab-800CW, targeting vascular endothelial growth factor A (VEGF-A). Methods: In part I, dose-escalation (0–4∙5-10-25 mg) was performed in 4 groups of 3 patients with PitNETs Knosp grade 3–4. In part II, after interim analysis, the 10 mg and 25 mg groups were expanded to a total of 6 patients. Quantitative fluoroscence molecular endoscopy consisted of wide field fluorescence molecular endoscopy and multi-diameter single fiber reflectance / single fiber fluorescence spectroscopy. Mean fluorescence intensity (MFI) of the fresh surgical specimen was calculated and VEGF-staining was performed. Results: Eighteen patients were included. All doses were well tolerated. Three serious adverse events were registered, but none were tracer-related. Part I showed an adequate in-vivo tumour-to-background ratio for both 10 mg (TBR 2∙00 [1∙86, 2∙19]) and 25 mg (TBR 2∙10, [1∙86, 2∙58]). Part II revealed a substantially higher MFI in the 25 mg group. With both 10 mg and 25 mg a statistically significant difference between tumour and surrounding tissue was detected (p < 0∙0001). All surgical specimens had VEGF-A expression. Conclusion: This study demonstrates the safety and feasibility of quantitative fluorescence molecular endoscopy during PitNET surgery. Both 10 mg and 25 mg bevacizumab-800CW result in clear differentiation in-vivo, with improved contrast ex-vivo (MFI) in the 25 mg group. Trial registration: NCT 04212793 / Study Details| Detection of PitNET Tissue During TSS Using Bevacizumab800CW| ClinicalTrials.gov. [ABSTRACT FROM AUTHOR]

Background: Endoscopic endonasal transsphenoidal surgery is widely used to resect pituitary adenomas, yet its impact on olfactory function after resection of the posterosuperior nasal septum remains a concern. To optimize surgical techniques to preserve olfactory function, it is essential to understand the relationship between the extent of septal resection and olfactory outcomes. Methods: This retrospective study analyzed 295 patients who underwent pituitary adenoma surgery. The extent of nasal septum resection was quantified and its impact on olfactory function was assessed using the Cross-Cultural Smell Identification Test (CCSIT), Sino-Nasal Outcome Test-22 (SNOT-22), and a Visual Analog Scale (VAS) for olfactory loss. Preoperative and 6-month postoperative scores were compared to evaluate changes in olfactory function. Results: There was a significant correlation between larger septal resections and greater reductions in CCSIT scores, indicating a decline in olfactory function. Furthermore, patients with more extensive septal resections reported increased discomfort and olfactory loss, as evidenced by higher SNOT-22 and VAS scores. These findings highlight the importance of the nasal septum in maintaining laminar airflow and its role in olfactory function. Conclusion: Study underscores the adverse effects of extensive posterior septectomy on olfactory outcomes. Minimizing the extent of septal resection may help preserve olfactory function, suggesting a need for surgical strategies that maintain septum integrity to reduce the risk of postoperative olfactory impairment. [ABSTRACT FROM AUTHOR]

The evolution of classification systems of pituitary adenomas (now PitNETs) has culminated in the use of transcription factor (TF) immunohistochemistry (IHC), forming a cell lineage‐based system. However, several issues remain to be addressed, including the additional financial and logistic burden of undertaking the complete array of anterior pituitary hormones and TF IHC. To that end, several groups have suggested algorithms to minimise the number of tests performed, with varying levels of diagnostic accuracy. Although the proportion of null cell tumours has decreased following the use of TFs, "multilineage" tumours have been reported and characterised using transcriptomic signatures, most prominently the PIT1‐SF1 co‐expressing PitNETs, which do not bear a position in the present system of classification. In this review, we examine the proposed practical approaches to the diagnosis of PitNETs. We review the literature on reported PitNET types that challenge the existing classification system, such as those that express multiple TFs, with their potential clinical implications. Finally, we assess limitations in the present system, such as the lack of a standardised system for IHC interpretation, that need to be addressed in the future. [ABSTRACT FROM AUTHOR]

Non‐neuroendocrine tumors account for around 10% of all primary neoplasms of the sella. If meningiomas, craniopharyngiomas, and germ cell tumors are excluded, the remaining lesions include a broad spectrum of uncommon, benign, and aggressive, often diagnostically challenging lesions. This review aims to summarize the essential clinicopathological features of tumors of the posterior pituitary gland, infundibulum spectrum expressing thyroid transcription factor 1, and primary sellar atypical rhabdoid teratoid tumor, and provide the criteria for their diagnosis and management. [ABSTRACT FROM AUTHOR]

The vast majority of pituitary neuroendocrine tumors (PitNETs) are benign and slow growing with a low relapse rate over many years after surgical resection. However, about 40% are locally invasive and may not be surgically cured, and about one percentage demonstrate an aggressive clinical behavior. Exceptionally, these aggressive tumors may metastasize outside the sellar region to the central nervous system and/or systemically. The 2017 (4th Edition) WHO Classification of Pituitary Tumors abandoned the terminology "atypical adenoma" for tumors previously considered to have potential for a more aggressive behavior since its prognostic value was not established. The 2022 (5th Edition) WHO Classification of the Pituitary Tumors emphasizes the concept that morphological features distinguish indolent tumors from locally aggressive ones, however, the proposed histological subtypes are not consistent with the real life clinical characteristics of patients with aggressive tumors/carcinomas. So far, no single clinical, radiological or histological parameter can determine the risk of growth or malignant progression. Novel promising molecular prognostic markers, such as mutations in ATRX, TP53, SF3B1, and epigenetic DNA modifications, will need to be verified in larger tumor cohorts. In this review, we provide a critical analysis of the WHO guidelines for prognostic stratification and diagnosis of aggressive and metastatic PitNETs. In addition, we discuss the new WHO recommendations for changing ICD‐O and ICD‐11 codes for PitNET tumor behavior from a neoplasm either "benign" or "unspecified, borderline, or uncertain behavior" to "malignant" neoplasm regardless of the clinical presentation, histopathological subtype, and tumor location. We encourage multidisciplinary initiatives for integrated clinical, histological and molecular classification, which would enable early recognition of these challenging tumors and initiation of more appropriate and aggressive treatments, ultimately improving the outcome. [ABSTRACT FROM AUTHOR]

Pituitary adenoma/pituitary neuroendocrine tumors (PitNETs) are the second most common primary intracranial tumor and the most frequent neuroendocrine tumors/neoplasms of the human body. Thus, they are one of the most frequent diagnoses in neuropathologist's practise. 2022 5th edition WHO Classification of Endocrine and Neuroendocrine Tumors does not support a grading and/or staging system for PitNETs and argues that histological typing and subtyping are more robust than proliferation rate and invasiveness to stratify tumors. Numerous studies suggest the existence of clinically relevant molecular subgroups encouraging an integrated histo‐molecular approach to the diagnosis of PitNETs to deepen the understanding of their biology and overcome the unresolved problem of grading system. The present review illustrates the main issues involved in establishing a grading and a staging system, as well as alternative systems validated by independent series to date. The state of art of the current histological and molecular markers is detailed, demonstrating that a standardized and reproducible clinico‐pathological approach, combined with the integration of molecular data may help build a workflow to refine the definition of PitNETs with 'malignant potential' and most importantly, avoid delay in patient treatment. Next molecular studied are needed to validate an integrated histo‐molecular grading for PitNETs. [ABSTRACT FROM AUTHOR]

There are five subtypes of somatostatin receptors (SST1‐5), which are expressed in several types of solid neoplasms, neuroendocrine tumors, and pituitary adenomas. Most commonly, SST2 and SST5, are of interest regarding diagnostic, treatment, and prognostic purposes. In this article the basic biological characteristics of SST are briefly reviewed, and focus given to the immunohistochemical evaluation of SST2 and SST5 in growth hormone (GH)‐secreting pituitary tumors, and their quantification as predictors of response to treatment with somatostatin receptor ligands (SRL), the mainstay of the pharmacological therapy available for these tumors. Although many different scoring systems for SST2 immunohistochemistry showing correlation with SRL response have been reported, among which the immunoreactivity score (IRS) has been the most consistently used, a universally validated immunohistochemical technique and scoring scheme is lacking. Efforts should be made on collaborative multicenter studies aiming at validating homogeneous immunostaining protocols and a scoring system for SST2 and SST5 expression, to help clinicians to define the optimal therapeutic strategy for the patients with somatotroph tumors. [ABSTRACT FROM AUTHOR]

The article published in Brain Pathology discusses the assessment of Ki-67 and mitoses in pituitary neuroendocrine tumors, emphasizing the importance of consistent scoring approaches to clarify controversies in this area. The study highlights the variability in Ki-67 proliferation index based on the number of tumor cells assessed and the need for accurate quantification methods. While the results suggest an inverse relationship between the number of cells assessed and Ki-67 PI obtained, the clinical value of digital Ki-67 PI and mitotic counts remains limited. The study underscores the necessity for consistent Ki-67 scoring approaches and re-evaluation of the recommended Ki-67 PI 3% cut-off to enhance the understanding of this complex topic. [Extracted from the article]

Purpose: The endoscopic endonasal approach (EEA) has become the preferred treatment for pituitary tumors, with minimal sinonasal morbidity. However, patients with Cushing's disease (CD) may represent a subgroup with prolonged impairment of sinonasal quality of life (QOL). Methods: We retrospectively identified patients with CD who underwent EEA at our institution. Control patients with non-functional tumors were matched by age, gender, and extent of EEA. The primary outcome was post-operative 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Results: Ten patients with CD met the selection criteria and 20 controls were selected for comparison. Nine of the CD patients achieved persistent endocrinologic remission post-operatively. Comparing the CD and control groups, there was no difference in post-operative SNOT-22 score at 1 or 3 months. At 6 months, SNOT-22 scores were significantly worse in the CD group (27.4 ± 21.6 vs. 2.8 ± 2.3, P =.039). SNOT-22 scores improved to normal from 1 to 6 months in the control cohort (P =.007), but not in the Cushing's group (P =.726). Morbidity was present across all SNOT-22 domains, but was highest in the sleep domain (P =.023). Only morbidity in the facial domain improved over time (P =.032). Conclusions: Patients with CD have significantly prolonged postoperative sinonasal QOL impairment following EEA compared to patients with non-functioning tumors, who normalize within 6 months. In CD patients, only morbidity in the facial domain, likely related to post-operative pain and nasal packing, improved over time, while the sleep domain was the most affected. [ABSTRACT FROM AUTHOR]

The long-term hypercortisolemia of Cushing disease (CD) may lead to hemodynamic disorders by increasing subclinical cardiac and vascular dysfunction. The purpose of this observational cohort study was to assess the relationship between hemodynamic parameters evaluated via impedance cardiography (ICG) and echocardiographic parameters reflecting left ventricular function in 54 patients newly diagnosed with CD. The parameters assessed via ICG included stroke volume index (SI), cardiac index (CI), acceleration index (ACI), velocity index (VI), systemic vascular resistance index (SVRI), total artery compliance index (TACI). The echocardiographic parameters included left ventricular mass index (LVMI) and left ventricular systolic and diastolic parameters. Higher LVMI values were associated with lower SI (p = 0.003), CI (p = 0.001), VI (p = 0.048), TACI (p < 0.001), and with higher SVRI (p < 0.001). Poorer parameters of left ventricular diastolic function corresponded to the parameters assessed via ICG: (1) lower ratio E/A was associated with lower SI (p = 0.002), VI (p = 0.001), ACI (p = 0.01), TACI (p = 0.001); (2) lower average e' was associated with lower SI (p = 0.017), CI (p = 0.009), VI (p = 0.004), TACI (p = 0.001), and with higher SVRI (p = 0.002); (3) higher ratio E/e' corresponded to lower TACI (p = 0.01). Decreased global longitudinal strain corresponded to lower TACI (p = 0.046). CD is associated with impaired pumping function of the heart and higher afterload. [ABSTRACT FROM AUTHOR]

The correction notice in Acta Neuropathologica addresses formatting errors in Table 2 of the original article "Genome-wide methylation profiling differentiates benign from aggressive and metastatic pituitary neuroendocrine tumors." The incorrect and correct versions of Table 2 are provided in the correction, highlighting significantly enriched gene sets associated with different tumor types. The correction ensures accuracy in the presentation of data for research on pituitary neuroendocrine tumors. [Extracted from the article]

Context.--PIT1 and SF1-multilineage pituitary neuroendocrine tumors (PitNETs) have been defined since the classifi- cation of adenohypophysial tumors based on the PIT1, SF1, and TPIT transcription factors. Objective.--To describe the clinicopathologic features of PIT1 and SF1-multilineage PitNETs and to contribute to the pituitary pathology practice by questioning the expression of NKX2.2 in PitNETs. Design.--We reviewed 345 PitNETs and described the clinicopathologic features of 8 PIT1 and SF1-multilineage tumors. NKX2.2 positivity and staining pattern were compared to those of 45 PitNETs from the control group. Results.--PIT1 and SF1-multilineage PitNET patients had a mean age of 41.13 (range, 14--58 years) and a mean tumor diameter of 14.0 mm (range, 8--20 mm). The most common clinical presentation was acromegaly (6 of 8), and postoperative remission was achieved in all patients. On histomorphologic examination, a pseudopapillary pattern was seen in 5 of the tumors, either focally or diffusely. In addition to PIT1 and SF1, there was a diffuse staining with growth hormone and a predominantly perinuclear staining with cytokeratin 18. With NKX2.2, all multilineage tumors were positive, of which 5 were diffuse and 3 were focal. In the control group, 8 tumors (8 of 45) were positive, of which only 1 was diffuse and 7 were focal. Conclusions.--In conclusion, NKX2.2 is a transcription factor that can be used as an additional tool in pituitary pathology, and PIT1 and SF1-multilineage PitNETs are specific tumors that usually present with acromegaly, show signs of a nonaggressive clinical course, have a pseudopapillary histomorphology, and express NKX2.2. [ABSTRACT FROM AUTHOR]

Background: Skull base tumors represent a small subset of intracranial neoplasm. Due to their proximity to critical neurovascular structures, their resection often leads to morbidity. As a result, surgical interventions can exacerbate symptoms or cause new deficits, thereby impacting the patients' perceived quality of life (QoL). The factors influencing QoL in patients with skull base tumors remain underexplored. This systematic review aims to synthesize current research on QoL outcomes and identify potential factors influencing QoL in these patients. Methods: A systematic literature review was conducted in PubMed using the keywords "Skull Base" AND "Quality of Life." A total of 815 studies published up to January 31, 2024, were screened. After abstract review, 656 studies were excluded, and 159 studies underwent full-text review. The wide variability in study methodologies and utilized QoL instruments made only a descriptive comparison possible. Results: In total, 113 studies were systematically reviewed. Publications focusing on the same tumor type or localization were compared. The majority of studies addressed tumors of the anterior skull base, with pituitary adenomas, meningiomas and vestibular schwannomas being the most commonly represented. The impact of surgery on QoL is often underestimated by caregivers and has a more profound effect on patients than expected by surgeons. A transient decline in QoL after surgery was observed across almost all studies regardless of localization and entity. Factors influencing QoL included age, gender, tumor localization, surgical approach, tumor type, extent of resection, preoperative clinical status and neurological deficits. Radiotherapy and recurrent surgeries were predictors of poorer QoL. Early psychological intervention in complex tumors appears to enhance QoL. Some successful sealing techniques, such as nasoseptal flaps and lumbar drains, affected QoL. However, variability in study methodologies reduced the validity of the findings. Conclusion: This review highlights the significant impact of skull base tumor surgery on patients' QoL. Given the major oncological and surgical challenges presented by skull base tumors, their treatment significantly affects QoL, and gross total resection (GTR) should not always be the primary goal. Additionally, recognizing and addressing the modifiable and non-modifiable factors influencing QoL is crucial for improving patient outcomes and providing personalized care. [ABSTRACT FROM AUTHOR]

Pituitary adenomas (PAs) are tumors originating in the pituitary gland, a small gland located at the base of the brain. They are the most common type of pituitary tumor, affecting approximately 1 in 10 people over their lifetime. Common symptoms include headaches, vision problems, hormonal imbalances, and weight changes. Treatment options depend on the type and size of the adenoma and may consist of medication, surgery, radiation therapy, or a combination. PAs are typically benign and slow-growing, but they can cause significant health issues if left untreated. Proper diagnosis and management by an experienced multidisciplinary team is important for achieving the best outcomes. Natural compounds like celastrol, curcumin, quercetin, apigenin, resveratrol, epigallocatechin gallate (EGCG), and genistein have shown the ability to inhibit cell growth, promote cell death, and suppress hormone activity in pituitary tumor cells, suggesting their potential as alternative or complementary treatments for PAs. MicroRNAs (miRNAs) are a kind of tiny RNA molecules that do not code for proteins and have a vital function in controlling gene expression. These 21–23 nucleotide-long molecules regulate gene expression by binding to complementary sequences in mRNA molecules, leading to mRNA degradation. miRNAs participate in a wide range of biological activities, including apoptosis, metastasis, differentiation, and proliferation. The research indicates that miRNAs play a crucial role in the pathogenesis, therapeutic approaches, diagnosis, and prognosis of PAs. This review article will provide a comprehensive analysis of the current understanding of the efficacy of naturally derived anti-cancer agents in the treatment of PAs. Furthermore, the study provides a comprehensive assessment of the miRNAs in PAs, their role in the development of PAs, and their potential application in the treatment of the condition. [ABSTRACT FROM AUTHOR]

Objective: This study aims to define a set of related anatomical landmarks based on preoperative Magnetic Resonance Imaging (MRI) of patients with pituitary adenomas (PAs). It explores the impact of the dynamic relationships between different anatomical landmarks and the tumor on the resection rate and tumor progression/recurrence during the endoscopic endonasal approach (EEA). Methods: A single-center institutional database review was conducted, identifying patients with PAs treated with EEA from December 2018 to January 2023. Clinical data were reviewed, and anatomical landmarks were categorized into two regions: the suprasellar region and the cavernous sinus region. Following basic statistical and univariate logistic regression analyses, patients were randomly divided into training and validation sets. A nomogram was then established through the integration of least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The clinical prediction model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Kaplan-Meier curves were plotted for survival analysis. Results: A total of 626 patients with PAs were included in the study, with gross total resection (GTR) achieved in 570 cases (91.05%). Significant differences were observed in the distribution of age, Knosp grade, and tumor size between the GTR and near total resection (NTR) groups. LASSO regression identified 8 key anatomical landmarks. The resulting model demonstrated an AUC of 0.96 in both the training and validation sets. Calibration curves indicated a strong agreement between the nomogram model and actual observations. Survival analysis revealed that the extent of resection (EOR), age, Knosp grade, tumor size, and PAs extending beyond several anatomical landmarks identified were significantly associated with the progression or recurrence of PAs. Conclusion: This study proposes a model for adaptively assessing the resection rate of PAs by delineating relevant anatomical landmarks. The model comprehensively considers instrument manipulation angles, surgical accessibility during EEA procedures, anatomical variations, and the displacement of related anatomical structures in pathological states. This approach can assist neurosurgeons in preoperative planning and developing personalized surgical strategies. [ABSTRACT FROM AUTHOR]

Surgical resection of non-functioning pituitary neuroendocrine tumors (NF-PitNET) is associated with new onset hormonal axis (HA) dysfunction, and factors predicting HA dysfunction are controversial, especially in large and giant NF-PitNET. Thus, we evaluated the postoperative hormonal function and assessed factors affecting HA dysfunction in patients with NF-PitNET. This prospective observational study involved 50 patients who underwent endoscopic surgical resection of NF-PitNET in the Department of Neurosurgery (April 2023–March 2024). The preoperative tumor diameter and volume were calculated radiologically. Hormonal evaluation was performed preoperatively, and again postoperatively at 7-days and 90-days. At 90-days, 36% patients recovered HA function, 34% remained unchanged, while 30% worsened. Serum cortisol (p < 0.0001), adrenocorticotropic hormone (p = 0.012), growth hormone (p = 0.013), and luteinizing hormone (p = 0.020) levels increased significantly; serum prolactin (p = 0.016) decreased significantly; while serum thyroid-stimulating hormone, follicle-stimulating hormone, and testosterone levels remained unchanged (all p > 0.05). Overall, there was no significant change in grade of HA dysfunction (p > 0.05). Male sex (OR:5.630, 95%CI:1.648–19.232; p = 0.006), tumor volume (OR:3.511, 95%CI:1.308–9.423; p = 0.013) and tumor diameter (OR:9.489, 95%CI:2.916–30.878; p < 0.0001) were significantly associated with postoperative HA dysfunction. Tumor volume and diameter (cut-off: 8.87 cm3 and 2.95 cm, respectively) predicted postoperative HA dysfunction with a sensitivity of 96.0% and 92.0%, and a specificity of 88.0% and 76.0%, respectively. New-onset diabetes insipidus (30%) was the predominant complication. Tumor diameter and volume are significant predictors of postoperative HA dysfunction. More than one third of patients improved their HA function, while it worsened in less than a third of patients. [ABSTRACT FROM AUTHOR]

Introduction: Tumorous growths in the sellar region pose significant clinical challenges due to their proximity to critical visual structures such as the optic chiasm and optic nerves. Given their proximity to the optic system, these tumors are often diagnosed due to a progressive decrease in visual acuity. Thus, surgical intervention is crucial to prevent irreversible damage, as timely decompression can halt the progression of edema and subsequent optic atrophy. Although Quantitative Pupillometry (QP) has been employed in various clinical settings, its application in patients with sellar region neoplasms remains unexplored. This study aims to evaluate the utility of QP to enhance treatment approaches in patients undergoing surgical resection of these tumors. Methods: Pupillometry assessments were conducted prospectively using the automated NPi 200® Pupillometer on 45 patients who underwent surgical resection of tumors in the sellar region at our institution. The Neurological Pupil Index (NPi) was measured pre- and post-operatively, with a focus on correlations with visual acuity and tumor volume. Concurrently, MRI findings were analyzed to assess optic chiasm compression. Results: Of the patients, 73.3% were diagnosed with pituitary tumors, 22.2% with tuberculum sellae meningiomas, and 4.4% with craniopharyngiomas. 66.7% of patients presented with decreased visual acuity, and 42.2% demonstrated paresis of the third cranial nerve (CN III). Compression of the optic chiasm was noted in 55.6% of cases. Patients with visual disturbances and CN III paresis exhibited significantly reduced NPi scores compared to unaffected individuals. In patients with pituitary adenomas, pathological NPIs were observed exclusively in cases of optic chiasm compression; compression of cranial nerve III (CN III) did not significantly affect the NPIs. Conversely, in patients with tuberculum sellae meningiomas, pathological NPIs were associated specifically with CN III compression, while optic chiasm compression tended to show a difference, however the results are not significant. Postoperatively, NPi values normalized among those who had presented with decreased visual acuity. Conclusions: This study contributes to the field of skull base surgery by evaluating the utility of QP as a diagnostic tool for neurological assessment in patients with sellar region tumors. The findings suggest that QP may help in assessing the extent of tumor-related compression on the optic system. It particularly points to differences in the effects of optic chiasm and CN III compression, with observed variations in NPI scores corresponding to the type of compression in specific tumors, such as pituitary adenomas and tuberculum sellae meningiomas. By providing rapid and non-invasive assessments, QP supports enhanced correlation with clinical and radiological evaluations, potentially improving targeted interventions for these complex conditions. [ABSTRACT FROM AUTHOR]

Although pituitary tumors (PTs) are mostly benign, some PTs are characterized by low surgical resection rates, high recurrence rates, and poor response to conventional treatments and profoundly affect patients' quality of life. Everolimus (EVE) is the only FDA-approved mTOR inhibitor, which can be used for oral treatment. It effectively inhibits tumor cell proliferation and angiogenesis. It has been administered for various neuroendocrine tumors of the digestive tract, lungs, and pancreas. EVE not only suppresses the growth and proliferation of APT cells but also enhances their sensitivity to radiotherapy and chemotherapy. This review introduces the role of the PI3K/AKT/mTOR pathway in the development of APTs, comprehensively explores the current status of preclinical and clinical research of EVE in APTs, and discusses the blood-brain barrier permeability and safety of EVE. [ABSTRACT FROM AUTHOR]