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INTRODUCTION: Pituitary apoplexy has historically been considered an emergent condition that necessitates surgical intervention when there is acute symptomatic onset. This potentially serious condition often occurs in the setting of an underlying adenoma, cystic lesion, or other sellar mass. When these mass lesions hemorrhage within the confined space of the sella turcica, the pituitary gland is subjected to hemorrhagic ischemia. Furthermore, critical neurovasculature in close proximity to the sella can sustain collateral damage. In the present study, we investigate whether early versus delayed surgical intervention (in terms of three timelines: before versus after 48 h, 72 h, and 7 days, respectively) results in differences in visual outcomes for patients experiencing pituitary apoplexy with acute onset neurological and/or neuro-opthalmic symptoms. Furthermore, we compare the efficacy of surgical decompression versus expectant management of this condition. METHODS: Accordingly, we queried the PubMed, Scopus, and Embase databases in adherence to PRISMA guidelines. Quantitative meta-analysis was performed according to the Mantel-Haenszel method and forest plots were generated using Review Manager v5.4. P-values  0.05). CONCLUSION: In the present study, timing of surgical intervention for pituitary apoplexy was predictive of visual function recovery only at the 7-day timepoint, as has been reported by previous studies. Ultimately, this suggests that pituitary apoplexy involving severe visual deficits or altered mental status is best addressed within the first seven days post-presentation, and that both surgery and conservative management can offer similar outcomes. When apoplexy is suspected, IV corticosteroids should be administered independent of acuity or severity to prevent secondary adrenal crisis. Subsequently, for patients presenting without severe visual or other neurological deficits, expectant management is recommended. Management should be patient-specific and dependent upon the severity of symptoms present at onset.

Case Presentation: A 22-year-old female presented to the emergency department with a two-month history of worsening fatigue, unintentional weight gain, and progressive facial swelling. Physical examination findings included hirsutism, moon facies, and abdominal striae. Subsequent brain magnetic resonance imaging revealed the presence of a 2.4-centimeter pituitary macroadenoma, confirming the diagnosis of Cushing’s disease. The patient was then admitted for neurosurgical tumor resection.Discussion: Cushing’s disease is exceedingly rare and often presents with symptoms resembling more prevalent disorders, contributing to delays in diagnosis. Therefore, maintaining a high index of suspicion for this disease is crucial for emergency physicians.

Objectives  Pituitary tumor treatment is hampered by the relative rarity of the disease, absence of a multicenter collaborative platform, and limited translational-clinical research partnerships. Prior studies offer limited insight into the formation of a multicenter consortium. Design  The authors describe the establishment of a multicenter research initiative, Registry of Adenomas of the Pituitary and Related Disorders (RAPID), to encourage quality improvement and research, promote scholarship, and apply innovative solutions in outcomes research. Methods  The challenges encountered during the formation of other research registries were reviewed with those lessons applied to the development of RAPID. Setting/Participants  RAPID was formed by 11 academic U.S. pituitary centers. Results  A Steering Committee, bylaws, data coordination center, and leadership team have been established. Clinical modules with standardized data fields for nonfunctioning adenoma, prolactinoma, acromegaly, Cushings disease, craniopharyngioma, and Rathkes cleft cyst were created using a Health Insurance Portability and Accountability Act-compliant cloud-based platform. Currently, RAPID has received institutional review board approval at all centers, compiled retrospective data and agreements from most centers, and begun prospective data collection at one site. Existing institutional databases are being mapped to one central repository. Conclusion  The RAPID consortium has laid the foundation for a multicenter collaboration to facilitate pituitary tumor and surgical research. We sought to share our experiences so that other groups also contemplating this approach may benefit. Future studies may include outcomes benchmarking, clinically annotated biobank tissue, multicenter outcomes studies, prospective intervention studies, translational research, and health economics studies focused on value-based care questions.

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 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]

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]

Objective: Pituitary lesions are rare in the pediatric population. They consist of a heterogenous group of neoplasms including pituitary adenomas (PA) and Rathke cleft cysts (RCC). Their natural history, management strategies, and long-term outcomes are mostly extrapolated from adult experience. Neurosurgical intervention may be necessary for large and/or symptomatic lesions. Of note, the likelihood of their spontaneous regression is uncommon. We report 2 interesting cases of such a phenomenon for these lesions and discuss our findings in corroboration with current literature. Methods and results: Two cases of spontaneous regression of pituitary lesions observed on serial neuroimaging are described. Based on their clinical history and radiological characteristics, the working diagnoses were that of a non-functioning PA and RCC, respectively. A systematic search of relevant publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 14 reported cases (including 1 of our patients) of spontaneous regression of non-functioning PA with good outcomes. Pertaining to RCCs, the limited evidence suggests that the incidence of their spontaneous regression is approximately 30%, similar to what is reported in the adult population. A separate discussion on the possible differential diagnosis of lymphocytic hypophysitis is also highlighted. Conclusion: Pediatric pituitary lesions may present with unpredictable natural histories, as highlighted in our case examples. We advocate an extended period of follow-up by a cohesive multidisciplinary team. In meantime, collaborative efforts should focus on the establishing clinical practice guidelines to optimize the management of pituitary lesions in children. [ABSTRACT FROM AUTHOR]

Purpose: Acromegaly is characterized by an insidious clinical presentation and delayed diagnosis. Longer delays are associated with more comorbidities which can persist after treatment of the growth hormone-secreting pituitary adenoma (GH-PA). Surgery is the primary therapy of GH-secreting PA, which can lead to durable remission. However, approximately 50% of patients require medical treatment postoperatively. Survival normalizes after achieving biochemical control. This mini-review will address ends of the spectrum challenges in acromegaly, including delayed diagnosis and management of the residual tumor and persistent comorbidities. Methods: We synthesize relevant literature and present a case of acromegaly that highlights the complexity of clinical decision-making in the diagnosis and treatment of persistent acromegaly. Results: Despite improved biochemical assays, most patients with acromegaly are diagnosed on average five years after initial symptoms. A high index of suspicion does not rely exclusively on acral enlargement, but also a constellation of manifestations and comorbidities suggestive of acromegaly. Medical therapy is required in patients with persistent biochemical disease. Somatostatin receptor ligands are the cornerstone of medical treatment and can be used alone or in combination with dopamine agonists and growth hormone receptor antagonists. Improved options of medical treatment and careful consideration of comorbidities enables individualized patient management. Reoperation and radiation are considered for tumor progression despite medical therapy. In rare cases of resistant and aggressive tumors, neuro-oncology expertise is required. Conclusions: Increased awareness through education targeting the multifaceted clinical presentation of acromegaly shortens the time to diagnosis and treatment. Multidisciplinary management by specialists increases the likelihood of biochemical and tumor control. [ABSTRACT FROM AUTHOR]

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]

Background: This study describes the management of patients on oral anticoagulation (OAC) undergoing endoscopic endonasal transsphenoidal surgery (EETS) and analyzes the risk of postoperative hematoma and epistaxis following treatment of pituitary adenoma (PA). Methods: Patients with OAC prior to EETS for PA were analyzed in a single center retrospective case series of consecutive patients with PA, who were treated between December 2008 and July 2022. Patient data (age, sex, clinical, endocrinology, tumor histology) were entered into a SPSS® database. The rate of postoperative hemorrhage (intracranial and epistaxis) and other perioperative complications were assessed. Results: Of 305 patients, 20 patients were on OAC prior to EETS for PA. Indications included non-valvular atrial fibrillation (AF) in 10 patients and previous venous thromboembolic event (VTE) in 8 patients, in 2 patients had overlapping indications. Twelve patients on direct oral anticoagulants (DOAC) paused medication 1–3 days (43.6 ± 23.6 h) before surgery, while phenprocoumon was paused 234 ± 123.55 h (min 6, max 22 days) before surgery. Baseline characteristics such as age, sex, tumor growth direction, tumor volume, and largest diameter showed no significant differences. No significant increase in postoperative hemorrhage was observed in patients with OAC compared to those without. One patient on apixaban paused 48 h before surgery experienced postoperative epistaxis. Among patients without OAC, one experienced intracranial hemorrhage and seven experienced epistaxis. Conclusion: Patients with OAC prior to EETS for PA have no increased risk for postoperative hematoma when OAC is paused based on individual risk assessment and recent general recommendations. [ABSTRACT FROM AUTHOR]

Pituitary neuroendocrine tumors are common, typically benign intracranial neoplasms arising from well-differentiated anterior pituitary cells with prevalence of clinically relevant pituitary tumor of 89 in 100 000 people. Despite the growing number of published studies, there is still a need for diagnostic and predictive biomarkers of pituitary adenomas. Prompt determination of tendency of the tumor for invasive growth and aggressive behavior would allow for earlier and more effective treatment. Extracellular vesicles (EVs), including exosomes, are particles released by cells containing cell-specific cargo including a variety of bioactive molecules, such as DNA, messenger RNA, microRNA, long non-coding RNA, circular RNA, proteins, and lipids surrounded by lipid membranes, which act as mediators of cell to cell communication. The ability of exosomes to reflect the functional state of the tumor, transport informative molecules, and accessibility in body fluids make them promising candidates in the search for biomarkers and new therapeutic methods. This study aims to investigate the involvement of exosomes in the pathology of pituitary adenoma and their potential clinical applications. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of postoperative cerebrospinal fluid (CSF) leaks after endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas without sellar floor reconstruction (SFR). Methods: This retrospective observational study was conducted at Department of Neurosurgery, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan from January, 2018 to December, 2022. It is a non-probability based consecutive case series. A total of 316 patients meeting the inclusion criteria were selected. Results: Among the 316 patients, 102 (32.3%) were male, while 214 (67.7%) were female. Mean age was 40.98±7.8 SD (range 23 to 65 years). Regarding size of pituitary adenomas, 19 (6%) were microadenomas and 297 (94%) were macroadenomas. Overall postoperative CSF (poCSF) leak in our patients was 2.8%. Among cases with poCSF leak, 4 (3.9%) were male and five were female (2.3%) with the P-value of 0.477. Regarding size of pituitary adenomas, only one (5.3%) microadenoma had poCSF leak whereas 8 (2.7%) macroadenomas had poCSF leak with the P-value of 0.432. Conclusion: Pituitary adenomas can be successfully treated with EETS without SFR in patients who do not experience intraoperative CSF leak. [ABSTRACT FROM AUTHOR]

Background: Collision tumors are defined as two or more distinctly bordered, mutually invasive tumors in the same anatomical region. Characterized by low incidence and lack of specificity, they often pose a significant challenge to disease diagnosis. Among these, collision tumors in the sella region are incredibly rare. Case description: On 13 June 2023, the Department of Neurosurgery at Drum Tower Hospital admitted a patient with a pituitary adenoma in the sella region complicated by spindle cell sarcoma. After reviewing the literature, no related cases were reported. A patient presenting with complex clinical symptoms and preoperative imaging showing occupancy in the sella region is considered to have a recurrence of pituitary adenoma. After thorough preoperative evaluation and discussion, a trans-sphenoidal approach (with the aid of an endoscope) was performed to resect the pituitary lesions. Combined with postoperative pathological tissue and imaging, the patient was diagnosed with a pituitary adenoma (postoperative recurrence) in the sella region complicated by spindle cell sarcoma. The patient made a fair recovery and was discharged on the 8th postoperative day. Conclusion: This case report aims to elucidate and discuss the diagnosis and screening of rare collision tumors in the sella region to reduce the misdiagnosis rate and provide accurate treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the application value of radiomics based on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) in non-invasive preoperative prediction of pituitary adenoma consistency. Methods: The clinical and preoperative MRI data of 108 patients with pathologically confirmed pituitary adenoma were retrospectively analyzed. Two neurosurgeons evaluated tumor consistency intraoperatively and categorized them into soft and hard groups. Patients were randomly divided into a training set and a validation set in a 7:3 ratio. Volume of interest (VOI) representing the tumor solid component were manually delineated on T2WI and DWI images. Radiomics features were extracted by FeAture Explorer software. Unsupervised feature selection (UFS) was applied for feature selection. Support vector machine (SVM) was used to conduct the radiomics models. Area under curve (AUC) and calibration curve were used to assess the performance of the models. Results: In the combined T2WI and DWI radiomics model, the AUC for predicting the consistency of pituitary adenoma was 0.89 in the training set and 0.80 in the validation set. The calibration curve showed a good consistency between predicted and actual values. Conclusion: The combined T2WI and DWI radiomics model demonstrates good diagnostic performance and aids in preoperative prediction of the consistency of pituitary adenoma. [ABSTRACT FROM AUTHOR]

Background: The overwhelming majority of pituitary tumors consist of pituitary adenomas (PAs), which have recently also been termed pituitary neuroendocrine tumors (PitNETs). Clinically significant PAs occur in approximately one in every 1000 individuals, while other types of pituitary tumors, such as craniopharyngiomas and pituicytomas, are significantly less common. Although PAs are generally benign, a subset of them exhibits malignant‐like biological traits. They tend to infiltrate and grow aggressively into adjacent tissues and organs, including the dura mater, cavernous sinus, and sphenoid sinus. This invasive behavior often results in the destruction of the normal anatomical architecture of the sella turcica and skull base. Clinically, such tumors are classified as invasive PAs (IPAs), emphasizing their aggressive and destructive nature. Objective and Significance: Currently, the diagnostic indicators for IPAs frequently suffer from suboptimal sensitivity and specificity. The invasiveness assessment of PAs lacks a definitive gold standard and instead serves as a predictive tool, with a greater number of indicators met suggesting a higher likelihood of invasiveness. Consequently, a comprehensive approach that integrates imaging, pathological, molecular biological, and other disciplinary metrics is crucial for accurate evaluation. Despite surgery being the primary treatment modality for IPAs, their malignant‐like behavior complicates complete resection, resulting in lower resection rates and heightened postoperative recurrence, necessitating multiple surgeries. Therefore, adjunctive drug therapy is often necessary for IPA patients. Preoperative drug therapy can shrink tumor size, facilitating resection and postoperative recovery, mitigating hormone imbalances, delaying recurrence, and enhancing patients' quality of life. Conclusions: This article comprehensively reviews the diagnostic criteria for assessing the invasiveness of PAs in the domains of imaging, pathology, and molecular biology, provides an overview of the current research status of drug therapy for these conditions, and deepens our insight into the biological and therapeutic aspects of the tumor microenvironment in PAs. [ABSTRACT FROM AUTHOR]

The adenomas in Cushing's disease frequently exhibit mutations in exon 14, within a binding motif for the regulatory protein 14-3-3 located between the catalytic domain (DUB), responsible for ubiquitin hydrolysis, and the WW-like domain that mediates autoinhibition, resulting in constantly active USP8. The exact molecular mechanism of deubiquitinase activity disruption in Cushing's disease remains unclear. To address this, Sanger sequencing of USP8 was performed to identify mutations in corticotropinomas. These mutations were subjected to computational screening, followed by molecular dynamics simulations to assess the structural alterations that might change the biological activity of USP8. Eight different variants of the USP8 gene were identified both within and outside the "hotspot" region. Six of these had previously been reported in Cushing's disease, while two were detected for the first time in our patients with CD. One of the two new variants, initially classified as benign during screening, was found in the neighboring SH3 binding motif at a distance of 20 amino acids. This variant demonstrated pathogenicity patterns similar to those of known pathogenic variants. All USP8 variants identified in our patients caused conformational changes in the USP8 protein in a similar manner. The identified mutations, despite differences in annotation results—including evolutionary conservation assessments, automated predictor data, and variations in localization within exon 14—exhibit similar patterns of protein conformational change. This suggests a pathogenic effect that contributes to the development of CD. [ABSTRACT FROM AUTHOR]

Background/Objectives: Postoperative hemorrhages (POHs) after pituitary adenoma surgery can have devastating consequences for patients. Many patients take acetylsalicylic acid (ASA) for the primary or secondary prevention of cardiovascular or stroke events. However, the impact of continued low-dose ASA use on the risk of postoperative hemorrhage and the frequency of thromboembolic events after discontinuing ASA in these patients remain poorly understood. This study aims to investigate the potential interaction and correlation between low-dose ASA intake and two of the most common complications after neurosurgical surgery—acute postoperative hemorrhage and thromboembolism. Methods: A retrospective study involving 1862 patients who underwent brain tumor surgery over a decade at our neurosurgical institute examined the risk of postoperative hemorrhage and thromboembolic events. The study compared bleeding rates in patients with pituitary adenomas who received low-dose ASA medication to those who did not. Additionally, the study investigated the occurrence of venous thromboembolism (VTE) or arterial pulmonary embolisms (PEs) following surgery, as well as the impact of laboratory parameters, demographic characteristics and intraoperative factors. Results: A total of 108 patients underwent surgery for primary pituitary tumors between January 2008 and January 2018. Only six patients (5.6%) experienced POH. Among those with POH, just two (1.9%) required revision surgery due to neurological decline. Interestingly, none of the 13 patients (12%) taking ASA preoperatively suffered POH. No correlation was found between laboratory results, demographics and postoperative complications. The study also did not find an increase in VTE or PE events. Conclusions: In this analysis, the perioperative intake of low-dose ASA could not be associated with an increased rate of hemorrhagic complications following pituitary adenoma surgery. Low-dose ASA can be safely continued during brain tumor surgery in patients with a high cardiovascular and cerebrovascular risk. [ABSTRACT FROM AUTHOR]

Introduction Pituitary adenoma is the most common disease that affects the gland and may be classified as functional/nonsecretory tumors. Inflammatory/infective causes may also affect the pituitary gland. The 18F-fluorodeoxyglucose positron emission tomography/computed tomography (F18-FDG PET/CT) may have an incremental value in assessing these lesions and in determining their clinical significance. Aim This article assesses the utility of F18-FDG PET/CT in detecting and determining clinical profile of pituitary lesions with abnormal uptake. Methodology Retrospective analysis of all patients who underwent F18-FDG PET/CT from January 2015 to January 2023 was done. Those with abnormal pituitary uptake (standardized uptake value [SUV] > 2.5) were included in the study. SUV value along with relevant anatomical details, biochemical parameters, histopathological details, and follow-up imaging were analyzed. Results Among 15,085 studies, a total of 36 patients (21 males/15 females, average age 47.36 years, range: 17–75 years) with pituitary uptake (0.23%) were included. Out of 36 patients, causes are primary pituitary tumor (21/36, 58%), tubercular hypophysitis (3/36, 8%), lymphocytic hypophysitis (2/36, 6%), lymphomatous involvement (2/36, 6%), autoimmune hypophysitis (1/36, 3%), questionable significance/incidental (4/36, 11%), and metastasis (3/36, 8%)—one each from neuroendocrine tumor ileum, chondrosarcoma, and adenocarcinoma lung. There was no difference in the SUV range between the different etiologies. Among 21 patients with pituitary tumor, biochemical evaluation was done in 19 patients. Two patients were lost to follow-up and did not have biochemical evaluation. Among them, 8 underwent endoscopic transsphenoidal radical excision and 1 patient had PET-CT-guided stereotactic radiosurgery alone. In another 8 patients who had prior endoscopic transsphenoidal radical excision, uptake was noted as residual lesion on PET-CT. Of them, 3 underwent subtotal excision and 5 had PET-CT-guided stereotactic radiosurgery. Biopsy was done in 14 patients, of which 11 were macroadenoma and 3 were microadenoma. Overall, magnetic resonance imaging (MRI) brain was performed in 22 of them and the findings were concordant with F18-FDG PET/CT. Conclusion F18-FDG PET/CT is a useful modality in the evaluation of pituitary uptake. It has an incremental value along with MRI brain and biochemical parameters and is useful for follow-up. Due to its high diagnostic accuracy, it is particularly useful in those with suspected residual/recurrent adenomas. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal Fluid (CSF) leak during endonasal endoscopic pituitary adenoma surgery is an important factor that affects the way of sellar floor closure, postoperative CSF leak rate and postoperative outcome. Our objective is to determine the rate and significance of intraoperative cerebrospinal fluid leak in endoscopic pituitary Adenoma surgery with intrathecal fluorescein administration. Methods: The study focused on 18 patients diagnosed with pituitary adenoma. These patients underwent resection through endonasal transsphenoidal approach with the use of intrathecal fluorescein injection. The rate of intraoperative CSF leak was noted and correlated with tumor size, consistency, extension, extent of resection, postoperative CSF leak and the way of closure of the sellar floor. Results: With the use of intrathecal fluorescein, intraoperative CSF leak appeared to be higher than usual. Intraoperative CSF leak occurred in 15 patients (83.3%). As regard grades of CSF leak, 11 patients had grade 1(61.1%), 3 patients had grade 2(16.7%) and only one patient had grade 3 (5.6 %). Fluorescein injection was done for patients with no CSF leak or suspicion of CSF leak but not done for grade 2 and 3, hence, it was done for 14 patients (77.8%) and in 7 of them (50%), CSF leak appeared only with Fluorescein, in 4 of them (28.5%) suspicious leak was confirmed with Fluorescein and 3 of them (21.5%) had no CSF leak confirmed with no Fluorescein appearance after injection. Postoperative CSF leak occurred in 3 of 18 patients (16.7%) and relieved in all patients after few days with lumbar drain kept in place till CSF leak stopped. Conclusion: The use of intrathecal fluorescein during endoscopic transsphenoidal pituitary surgery is very helpful in identifying intraoperative CSF leak especially G1 leak, resulting in better sellar closure and less postoperative CSF leak. [ABSTRACT FROM AUTHOR]

The genetic landscape of corticotroph tumours of the pituitary gland has dramatically changed over the last 10 years. Somatic changes in the USP8 gene account for the most common genetic defect in corticotrophinomas, especially in females, while variants in TP53 or ATRX are associated with a subset of aggressive tumours. Germline defects have also been identified in patients with Cushing's disease: some are well-established (MEN1, CDKN1B, DICER1), while others are rare and could represent coincidences. In this review, we summarise the current knowledge on the genetic drivers of corticotroph tumorigenesis, their molecular consequences, and their impact on the clinical presentation and prognosis. [ABSTRACT FROM AUTHOR]

Objectives: The Pituitary Tumor Registry intends to provide a platform for clinical research and basic sciences, with an emphasis on disease outcomes. Methods: In this retrospective cohort study, all patient data, including demographics, vital signs, symptoms and signs, medical history, medications, past drug history, paraclinical data, treatment modalities, post-surgery follow-up, treatment responsiveness, and pathology reports, have been gathered from the electronic patient records of the Endocrinology and Metabolism Research Center affiliated with Tehran University of Medical Sciences. Results: A total of 200 patients with pituitary adenoma were identified. Acromegaly was the most prevalent adenoma, accounting for 35% (n = 70) of cases, followed by clinically nonfunctional pituitary adenoma (CNFPA) at 28.5% (n = 57), prolactinoma at 23% (n = 46), and Cushing disease at 13.5% (n = 27). All of the patients with Cushing disease had surgery, with trans-sphenoidal surgery accounting for 92.59%. Prolactinoma was mostly treated with medication (82.60% of cases). Post-operative complications were reported, including cerebrospinal fluid (CSF) leakage in CNFPA cases (24.13%, n = 7) and diabetes insipidus (DI) in acromegaly (13.46%, n = 7). Unfortunately, 5 patients died: two with acromegaly, two with CNFPA and one with Cushing disease. Conclusions: This registry permits a comprehensive management, long term follow up and treatment outcomes of patients with pituitary adenomas. [ABSTRACT FROM AUTHOR]

Pituitary adenomas (PA) represent the most common type of sellar neoplasm. Extracting relevant information from radiological images is essential for decision support in addressing various objectives related to PA. Given the critical need for an accurate assessment of the natural progression of PA, computer vision (CV) and artificial intelligence (AI) play a pivotal role in automatically extracting features from radiological images. The field of "Radiomics" involves the extraction of high-dimensional features, often referred to as "Radiomic features," from digital radiological images. This survey offers an analysis of the current state of research in PA radiomics. Our work comprises a systematic review of 34 publications focused on PA radiomics and other automated information mining pertaining to PA through the analysis of radiological data using computer vision methods. We begin with a theoretical exploration essential for understanding the theoretical background of radionmics, encompassing traditional approaches from computer vision and machine learning, as well as the latest methodologies in deep radiomics utilizing deep learning (DL). Thirty-four research works under examination are comprehensively compared and evaluated. The overall results achieved in the analyzed papers are high, e.g., the best accuracy is up to 96% and the best achieved AUC is up to 0.99, which establishes optimism for the successful use of radiomic features. Methods based on deep learning seem to be the most promising for the future. In relation to this perspective DL methods, several challenges are remarkable: It is important to create high-quality and sufficiently extensive datasets necessary for training deep neural networks. Interpretability of deep radiomics is also a big open challenge. It is necessary to develop and verify methods that will explain to us how deep radiomic features reflect various physics-explainable aspects. [ABSTRACT FROM AUTHOR]

Background: Pituitary adenoma (PA), though rare, has seen increased incidence with widespread MRI use, enabling incidental diagnosis. Prevalence is approximately 1 case per 1000 in the general population. PAs are benign neoplasms, constituting 10 to 20% of intracranial tumours. Ectopic pituitary adenoma developed outside the sella turcica is exceptional. It may be hormonally active or not. These are called nonfunctional pituitary adenomas. Methods: Here is reported a case of a man in his eighties with a nasopharyngeal ectopic pituitary adenoma treated by robot-assisted excision using a combined route. CARE guidelines have been respected. Results: A man in his eighties, asymptomatic, underwent an MRI for dizziness, revealing a nasopharyngeal mass. Despite being asymptomatic, nasofibroscopy revealed a reddish oval-shaped tissue mass attached to the roof of the nasopharynx. Biopsy identified a neuroendocrine tumor G1/G2. Imaging showed no local invasion or distant metastases. A multidisciplinary team decided on a robot-assisted surgical excision through the mouth, coupled with nasal endoscopy. The procedure achieved complete excision with clear margins and no adverse event has occurred. Conclusions: This unique case involved the successful transoral robot-assisted excision of a nasopharyngeal ectopic pituitary adenoma, highlighting an innovative surgical approach. [ABSTRACT FROM AUTHOR]

Objectives The lateral supraorbital (LSO) approach is a less-invasive alternative to the pterional craniotomy that provides rapid transsylvian access. Establishing familiarity with the LSO technique and its features as compared with other anterolateral approaches is an important component of advanced skull base training. We present a step-by-step demonstration of the LSO approach using cadaveric dissection in a manner that is digestible for trainees at various levels. Design This is anatomic step-by-step dissection and representative case series. Setting This study was carried out in the cadaveric dissection laboratory. Participants A formalin-fixed, latex-injected cadaveric head specimen was dissected under microscopic magnification by a neurosurgery resident under faculty supervision. Following dissection, representative case applications were reviewed. Main Outcome Measures Dissection and case illustration were the main outcome measures. Results A single-layer myocutaneous flap is developed, and a single-burr-hole technique is used, followed by extensive drilling of the sphenoid wing. The dura is opened in a C-shaped fashion centered on the Sylvian fissure, exposing the inferior frontal and superior temporal lobes. Labeled photographs of dissections with pertinent anatomical structures are presented. Three case examples illustrating the versatility of the LSO approach, including the resection of a large pituitary adenoma, an inferior frontal melanoma metastasis presenting to the Sylvian surface, and a frontoinsular low-grade glioma, are reviewed. Conclusion As compared with the pterional craniotomy, the LSO approach involves a shorter incision, smaller craniotomy, and faster exposure; it can be conveniently tailored to various indications. Understanding the step-by-step dissection and indications of the LSO approach is of paramount importance to neurosurgery trainees. [ABSTRACT FROM AUTHOR]

Context Few data exist about the clinical course of acromegaly, surgical and medical outcomes in patients with GH- and prolactin cosecreting pituitary adenomas (GH&PRL-PAs). Nevertheless, some series described a more aggressive clinic-radiological behavior than in growth hormone–secreting pituitary adenomas (GH-PAs). Objective This work aims to evaluate differences in clinical presentation and in surgical outcomes between GH-PAs and GH&PRL-PAs. Methods A multicenter retrospective study was conducted of 604 patients with acromegaly who underwent pituitary surgery. Patients were classified into 2 groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal (ULN) and IHC for GH and PRL was positive or PRL levels were greater than 100 ng/dL and PRL IHC was not available (n = 130) and b) GH-PA patients who did not meet the previously mentioned criteria (n = 474). Results GH&PRL-PAs represented 21.5% (n = 130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P <.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs 77.4%; P =.001) and tended to be more invasive (33.6% vs 24.7%; P =.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (odds ratio 2.8; 95% CI, 1.83-4.38). Insulin-like growth factor ULN levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [interquartile range (IQR) 1.73-3.29] vs 2.7 [IQR 1.91-3.67]; P =.023). There were no differences in the immediate (41.1% vs 43.3%; P =.659) or long-term postsurgical acromegaly biochemical cure rate (53.5% vs 53.1%; P =.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs 2.4%; P =.011) in GH&PRL-PA patients. Conclusion GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger, and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently. [ABSTRACT FROM AUTHOR]

TSH-secreting pituitary adenoma (TSHoma) is the rarest functioning pituitary tumor, with an increasing incidence over the last decades. Diagnosis is often delayed, exposing patients to a high risk of developing chronic complications of long-standing hyperthyroidism. Although thyroid hormone excess is a recognized cause of secondary osteoporosis, very few studies have investigated skeletal damage in patients with TSHoma, with data limited to bone turnover markers (BTM) and a study on the prevalence of radiological vertebral fractures (VFs) incidentally detected on chest X-ray, whereas data on bone mineral density (BMD) are anecdotal. Bone resorption is increased in TSHoma compared to controls, whereas few case reports described osteoporosis and spine fractures as early complications of TSHoma. A high prevalence of morphometric VFs was described in TSHoma compared to nonfunctioning pituitary adenoma (NFPA). Patients with fracture were older and had higher free thyroxine (fT4) levels than patients without fracture. In this specific setting, treatment with somatostatin receptor ligands seems to have a protective role on fracture risk. Based on this evidence, a comprehensive osteometabolic evaluation should be performed in all patients with TSHoma, including assessment of BTM, measurement of BMD, and morphometric evaluation of VFs, both at diagnosis and then during follow-up, particularly in patients at high risk for fragility fractures. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic caused significant disruption to the surgical care of patients. The aim of this study was to analyze the impact of the pandemic on endoscopic endonasal surgery (EES) for patients with a pituitary adenoma. Methods: Patients from 2015 to 2022 that had EES for a pituitary adenoma were included in this study. Patients were separated into pre-COVID (January 2015-March 2020) and COVID (March 2020-September 2022) groups. Univariate analysis was done using chi-square, fisher exact tests, and t-tests to compare groups. Results: This study included 492 patients that had EES for their pituitary adenoma. There were 314 patients in the pre-COVID group and 178 patients in the COVID group. Patients in the COVID group had a higher risk analysis index (RAI) frailty score (15 ± 10 pre-COVID vs. 20 ± 9 COVID, P < 0.001) and a higher American Society of Anesthesiology (ASA) physical status score (3 or 4) (72.0% pre-COVID vs. 81.9% COVID, P = 0.02). There were significantly more macroadenoma cases (87.6% pre-COVID vs. 94.4% COVID, P = 0.02) and extrasellar surgical approaches (45.2% pre-COVID vs. 61.2% COVID, P < 0.001) during COVID. There was no significant difference in length of stay (LOS) and readmission rates between groups. Conclusions: Patients that presented during the pandemic tended to be more frail, have more comorbidities, and require additional extrasellar surgical approaches. Despite changes in clinical presentation and operative management, the LOS and readmission rate remained stable during COVID, supporting the safety of this procedure during the recent pandemic. [ABSTRACT FROM AUTHOR]

Tumors of adenohypophysial hormone-secreting cells, now classified as pituitary neuroendocrine tumors (PitNETs), have been subclassified based on cell differentiation. Normal adenohypophysial cells have three lineages of differentiation driven by the transcription factors PIT1, TPIT, and SF1 which are responsible for the regulation of hormone gene expression; PIT1 drives expression of GH, PRL, and TSH, TPIT is required for POMC expression that gives rise to ACTH, and SF1 is the transcription factor responsible for FSH and LH expression. The vast majority of PitNETs follow these three lineage differentiation pathways but rare PitNETs show either no lineage differentiation or express biomarkers of more than one lineage. The recent WHO classification continued the terminology "plurihormonal" for tumors that have features of more than one lineage but a better term is "multilineage" since some tumors may express more than one lineage-specific transcription factor without the hormones that are driven by those factors. Recent data indicate that tumors with expression of PIT1 and SF1 are the most common multilineage PitNETs. Here we report the existence of rare PitNETs that express TPIT and SF1. The 6 patients (5 female, 1 male; mean age 54.8 years; range 35–84 years) represent less than 1% of patients in our series of PitNETs. Most patients had clinically silent tumors with no evidence of hormone excess and variable degrees of hypopituitarism; two had Cushing disease. All patients had macrotumors with a mean tumor size of 2.46 cm (range 1.1–5.0 cm). Crooke's hyaline change was identified in the nontumorous adenohypophysis of the two patients with Cushing disease. The mean Ki67 labeling index was 2.91% (range 2.03–3.94%). All tumors were negative for PIT1 and PIT1-lineage hormones (GH, PRL, and TSH). TPIT was focal in one tumor, and the remaining tumors had diffuse reactivity in more than 50% of tumor cells. SF1 expression was focal in 5 tumors and diffuse in one. Three tumors had variable expression of at least one gonadotropin (FSH or LH). GATA3 was expressed in two tumors. Variable ER-alpha expression was noted in three tumors. CAM5.2 was positive in all tumors. With the exception of two tumors causing Cushing disease, p27 expression was intact. Our study confirms that multilineage PitNETs expressing TPIT and SF1 occur but are extremely rare; they can be clinically non-functional or can cause Cushing disease. Irrespective of functional status of a PitNET, routine application of pituitary transcription factors is warranted to identify these tumors. Data on the molecular correlates and clinical significance are still needed for these rare multilineage PitNETs. [ABSTRACT FROM AUTHOR]

Background: Pituitary adenomas (PAs) often require adjuvant Gamma Knife radiosurgery (GKRS) due to partial resection or postoperative recurrence. The purpose of this study was to evaluate the long-term efficacy of GKRS for such cases. Methods: Population-based, observational cohort study of patients who underwent GKRS for postoperative residual or recurrent PAs between 1999 and 2020. We assessed long-term progression-free survival (PFS), identified predictors of tumor growth, and documented adverse radiation events (AREs). Results: 147 patients were included, with a median follow-up time of 8.1 years. Following GKRS, the 5-year and 10-year PFS was 86% and 68%, respectively, with a median PFS of 18.7 years. Somatotrophic adenomas showed a significantly lower risk of tumor progression in the regression analysis (OR 0.11, p = 0.003). Hypopituitarism was the most common ARE, affecting 32% of patients. Conclusion: GKRS is an effective treatment option for recurrent or residual PAs, offering substantial long-term control. However, the risk for AREs, particularly hypopituitarism, is not negligeable. [ABSTRACT FROM AUTHOR]

To determine the effects of Peplau's theory of interpersonal relations during the perioperative period among patients with pituitary adenomas (PAs). One hundred patients with PAs from June 2021 to June 2022 were randomized into experimental and control groups (50 patients in each group). The patients in the control group were provided conventional nursing services after admission, while patients in the experimental group were provided nursing services based on Peplau's theory of interpersonal relations. The patients' levels of anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). The quality of life was assessed based on the 36-Item Short Form Health Survey questionnaire (SF-36). The measurements were taken on day 4 after the intervention. The intervention group included 50 participants, and the control group included 50 participants. Primary outcome data were obtained for 100 participants, and 50 participants in the intervention arm completed taken on day 4 after the intervention. Patients in the experimental group had a significantly lower incidence of postoperative complications, anxiety and depression than the control group in the same cycle (P < 0.05). The levels of anxiety and depression in the experimental group were statistically lower than those in the control group (P < 0.05). Furthermore, the experimental group showed statistically superior than the control group in quality of life. The application of Peplau's theory of interpersonal relations during the perioperative period of patients with PAs can significantly reduce the occurrence of common complications and eliminate the psychological barriers to improve their quality of life. [ABSTRACT FROM AUTHOR]

Non-Functioning Pituitary Adenomas (pituitary neuroendocrine tumours) (NFPA) have a profound detrimental effect of patient-reported health-related quality of life (QOL). Elucidating the underlying mechanisms by which NFPA influence patients' emotional physical and psychosocial wellbeing would provide the foundation for therapeutic strategies to optimise patient outcomes. A systematic review of the literature was performed in accordance with the PRISMA statement. Studies that utilised validated metrics to report QOL in NFPA were included. Patients with NFPA exhibit worse QOL than healthy controls across both mental and physical domains. Surgery provides significant improvements in QOL within 3 months, and QOL can normalise years after successful treatment. Compared with functioning adenomas, QOL is favourable. The underlying mechanisms for QOL detriment in NFPA is multifactorial and includes visual failure, hypopituitarism, headache, sleep dysfunction, pain, the sick role, treatment-related anxiety, and the morbidity of surgical and radiotherapy treatment. The effects of NFPA on QOL are global, with deficits in physical, psychosocial, and cognitive function. With successful treatment, QOL can return to that of the general population. Targeting hypopituitarism, sleep dysfunction, headache, pain, and disease-related anxiety are paths to improve QOL in NFPA. [ABSTRACT FROM AUTHOR]

Aggressive pituitary neuroendocrine tumors (PitNETs)/adenomas are characterized by progressive growth despite surgery and all standard medical therapies and radiotherapy. A subset will metastasize to the brain and/or distant locations and are termed metastatic PitNETs (pituitary carcinomas). Studies of potential prognostic markers have been limited due to the rarity of these tumors. A few recurrent somatic mutations have been identified, and epigenetic alterations and chromosomal rearrangements have not been explored in larger cohorts of aggressive and metastatic PitNETs. In this study, we performed genome-wide methylation analysis, including copy-number variation (CNV) calculations, on tumor tissue specimens from a large international cohort of 64 patients with aggressive (48) and metastatic (16) pituitary tumors. Twelve patients with non-invasive pituitary tumors (Knosp 0–2) exhibiting an indolent course over a 5 year follow-up served as controls. In an unsupervised hierarchical cluster analysis, aggressive/metastatic PitNETs clustered separately from benign pituitary tumors, and, when only specimens from the first surgery were analyzed, three separate clusters were identified: aggressive, metastatic, and benign PitNETs. Numerous CNV events affecting chromosomal arms and whole chromosomes were frequent in aggressive and metastatic, whereas benign tumors had normal chromosomal copy numbers with only few alterations. Genome-wide methylation analysis revealed different CNV profiles and a clear separation between aggressive/metastatic and benign pituitary tumors, potentially providing biomarkers for identification of these tumors with a worse prognosis at the time of first surgery. The data may refine follow-up routines and contribute to the timely introduction of adjuvant therapy in patients harboring, or at risk of developing, aggressive or metastatic pituitary tumors. [ABSTRACT FROM AUTHOR]

Background/Objectives: Neoplasms are one of the three most common causes of death in patients with acromegaly. Our study aimed to assess the incidence of benign and malignant neoplasms among patients with acromegaly and the associations between this prevalence and the disease activity, the time of acromegaly diagnosis, and the time of its first symptoms. The correlation between neoplasm occurrence and pituitary somatotropic axis hormone levels was also studied, and the prevalence of different types of neoplasms was compared between the patients with acromegaly and the Polish population. Methods: A retrospective study included a statistical analysis of the medical documentation of 230 patients with acromegaly diagnosed and treated in the Department of Endocrinology, Diabetes, and Isotope Therapy in Wrocław (Poland) between 1976 and 2023. Results: We observed 171 cases of neoplasms (144 benign and 27 malignant). All types of neoplasms and benign tumors were diagnosed more frequently, in both the short and long term, after a diagnosis of acromegaly, but, after a long time, only malignant neoplasms were more frequently diagnosed. In the cases of controlled acromegaly, all types of neoplasms and benign neoplasms were more common than in cases of cured acromegaly. The incidence of neoplasms was higher, regardless of type, in patients with active acromegaly compared to the cured disease. Malignant neoplasms of the thyroid, renal, and stomach type were more common among our subjects compared to the Polish population. Conclusions: This study confirms the association between acromegaly, as well as its activity level and the time from its diagnosis, and the prevalence of neoplasms. [ABSTRACT FROM AUTHOR]

Purpose: To investigate microvascular changes in the macular and peripapillary area in prolactinoma patients by using optical coherence tomography angiography (OCTA). Design: A retrospective study. Methods: This study included 40 patients with treatment-naive prolactinoma and 42 healthy controls. Participants underwent comprehensive ophthalmic examinations, visual field testing, and optical coherence tomography (OCT) assessments, including retinal nerve fiber layer (RNFL) thickness, macular, and peripapillary region OCTA by using the Topcon DRI OCT Triton Swept Source-OCT system. The OCTA results were evaluated between groups and then correlated with PRL levels. Results: The differences in best-corrected visual acuities were statistically significant among the groups. The RNFL thickness in the superior and nasal quadrants was significantly lower in the prolactinoma group. The prolactinoma group showed significant reductions in macular vessel density (VD) across all layers than the control group, except in the deep retinal capillary plexus temporal quadrants. The radial peripapillary capillary (RPC) temporal VD in the prolactinoma group was significantly lower. In patients with optic neuropathy, correlations were observed between the RPC temporal and RNFL temporal sectors (r = 0.650, P = 0.03), and between the RPC inferior and RNFL inferior sectors (r = −0.612, P = 0.045). Between PRL levels and OCTA parameters, negative correlations were observed (RPC inferior: r = −0.452, P = 0.003; DCP superior: r = −0.379, P = 0.016). Conclusion: Our study revealed reduced VD in the macula and RPC temporal regions in patients with treatment-naive prolactinoma. OCTA holds significant importance in detecting potential retinopathies and vasculopathies. Future research should focus on examining pre- and post-treatment changes in treatment-naive patients without ON to better understand the impact of prolactinoma. [ABSTRACT FROM AUTHOR]

Postoperative cerebrospinal fluid (CSF) leakage is the leading adverse event in transsphenoidal surgery. Intraoperative CSF (ioCSF) leakage is one of the most important predictive factors for postoperative CSF leakage. This systematic review and meta-analysis aimed to evaluate the effectiveness of artificial intelligence (AI) models in predicting ioCSF. Literature records were retrieved on June 13, 2024, using the relevant key terms without filters in PubMed, Embase, Scopus, and Web of Science. Records were screened according to the eligibility criteria, and the data from the included studies were extracted. The quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies–2 tool. The meta-analysis, sensitivity analysis, and meta-regression were conducted using R software. Our results demonstrate that the AI models achieved a pooled sensitivity of 93.4% (95% confidence interval [CI]: 74.8%–98.6%) and specificity of 91.7% (95% CI: 75%–97.6%). The subgroup analysis revealed that the pooled sensitivities in machine learning and deep learning were 86.2% (95% CI: 83%–88.8%) and 99% (95% CI: 93%–99%), respectively (P < 0.01). The subgroup analysis demonstrated a pooled specificity of 92.1% (95% CI: 63.1%–98.7%) for machine learning and 90.6% (95% CI: 78.2%–96.3%) for deep learning models (P = 0.87). The diagnostic odds ratio meta-analysis revealed an odds ratio 114.6 (95% CI: 17.6–750.9). The summary receiver operating characteristic curve demonstrated that the overall area under the curve of the studies was 0.955, which is a considerable performance. AI models have demonstrated promising performance for predicting the ioCSF leakage in pituitary surgery and can optimize the treatment strategy. [ABSTRACT FROM AUTHOR]

To objectively correlate distortions of optic apparatus morphology in patients with pituitary adenomas undergoing trans-sphenoidal surgery. In this retrospective analysis, visual acuity (VA), visual field (VF), and total visual (TV) function were objectively scored in patients selected from an institutional cohort of pituitary adenomas. The following imaging measures of optico-chiasmatic morphology were recorded preoperatively, and at 3 months after surgery: chiasm area, mid-chiasm height (CH), optic nerve-canal bending angle (BA), and optic nerve kinking angle (ONKA). Receiver operator characteristic analysis was performed to establish optimal thresholds for achieving a "normal" TV score of 200 at 1-year follow-up. Seventy-one eyes were individually studied. VA, VF, and TV scores significantly improved after surgery, both at the 3-month and at the 1-year follow-up visits (P < 0.001). Cranio-caudal tumor dimension was significantly associated with VA, VF, and TV scores, both preoperatively and postoperatively. There were significant changes in CH (P < 0.001), BA (P < 0.001), and ONKA (P < 0.001) at 3 months after surgery, but not in chiasm area (P = 0.061). Baseline VA, VF, and TV scores were positively correlated with preoperative CH and ONKA, while VF and TV scores also demonstrated significant negative correlations with preoperative BA. VF scores at 1-year follow-up were significantly correlated with preoperative and change in BA values, as well as with preoperative and change in ONKA values. Receiver operator characteristic analysis revealed that only the preoperative ONKA was found to have acceptable discrimination (area under the curve >0.7) for predicting "normal" TV score. Chiasm sag was noted in 45.8% of patients at 1-year follow-up, but was not associated with delayed visual deterioration in any case. Anatomic realignment of the optic apparatus 3 months following trans-sphenoidal surgery predicts VF scores, but not VA or TV scores at 1-year follow-up. Patients with preoperative ONKA values of more than 139.3° have a 76% chance of achieving normal TV scores 1 year after surgery. Postoperative chiasm sag appears to be clinically irrelevant at short-term follow-up. [ABSTRACT FROM AUTHOR]

Almost all postoperative assessments for pituitary patients are performed in clinical settings under the supervision of medical providers. With the emergence of telemedicine, however, there are opportunities to monitor these patients remotely. The potential for use of such technologies is inconsistently described in the brain tumor literature, especially for patients with pituitary adenomas. In this comprehensive narrative review, we present the literature for the use of mobile applications (apps) for monitoring of postoperative symptomatology that is specific to patients undergoing pituitary surgery. Our primary research question was: "Which smartphone apps exist in the literature to monitor parameters associated with common complications of pituitary surgery?" Specifically, we search for apps in the literature that facilitate the measurement of parameters associated with adrenal insufficiency, disorders of water imbalance, and visual changes—3 common complications of pituitary surgery. Twenty-six apps were identified. Fourteen apps pertained to monitoring of visual changes, followed by 9 apps for monitoring water and electrolyte imbalances and 3 apps for monitoring adrenal dysfunction. Novel technologies that were integrated into these apps included digital image-based colorimetry, sonouroflowmetry, visual contrast sensitivity, and lateral flow immunoassays, among others. Due to advancing capabilities of smartphone apps, the potential of telemedicine may extend beyond patient appointments. We show that by integrating novel advances in medical technologies from a variety of specialties, it is possible to develop smartphone-based protocols for remote monitoring of patients after pituitary surgery. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: The endoscopic approach to skull base lesions is widely regarded as less invasive and associated with reduced morbidity, offering favorable outcomes, particularly in terms of short-term quality of life (QOL). However, to date, long-term assessments of both nasal function and tumor-related QOL remain limited. To evaluate patients' long-term nasal- and tumor-related QOL after endoscopic endonasal resection of pituitary tumors and to detect predictors for poor postoperative QOL. Study Design: This study was a prospective cohort study. Methods: All patients with pituitary adenomas who underwent trans-sphenoidal surgery at Tel Aviv Sourasky Medical Center between 2014 and 2021 were recruited. Recruited patients completed the Anterior Skull Base Disease-Specific QOL (ASBS-Q) questionnaire and the Sinonasal Outcome Test 22 (SNOT-22) questionnaire before surgery and 1, 2, and 3–5 years after surgery. Clinical data were collected and analyzed. Results: The study included 43 patients (18 women). No significant decrease was observed in tumor-related quality of life (QOL) scores, measured by ASBS-Q and SNOT-22, throughout the 5-year follow-up period. SNOT-22 score differences from the preoperative baseline at years 1, 3, and 5 were 0.81 [−4.84–6.58], 3.35 [−4.32–11.02], and 3.73 [−2.22–9.68], respectively, with no statistically significant changes. ASBS-Q scores similarly showed no significant changes over time. Subgroup analyses revealed that tumor characteristics (secreting vs. non-secreting, size), surgical factors (intraoperative cerebrospinal fluid leak, gross tumor resection, use of nasoseptal flap), and endocrine remission did not significantly impact QOL (p > 0.05 for all variables). Conclusions: Our study demonstrated that patients who underwent endoscopic pituitary lesion resection maintained high nasal- and tumor-related quality of life over a 5-year follow-up period. However, given the limitations of our study, further multi-center studies with larger patient populations are warranted to validate these results. [ABSTRACT FROM AUTHOR]

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Background: Currently, endoscopic transsphenoidal surgery is the primary approach for treating pituitary tumors. While endoscopic surgery offers numerous advantages, it also comes with a series of potential surgical complications. Postoperative hypokalemia is a common complication, with mild cases presenting with atypical symptoms such as dizziness, headache, fatigue, and constipation, while severe cases can lead to arrhythmias, rhabdomyolysis, and even death. Therefore, early identification of risk factors for postoperative hypokalemia is crucial. This study aims to analyze the risk factors for hypokalemia after endoscopic pituitary tumor resection. Methods and Materials: This study included 168 patients who underwent endoscopic resection of pituitary tumors between 2019 and 2023. Patients were divided into hypokalemia group and non-hypokalemia group based on whether their postoperative serum potassium concentration was less than 3.0 mEq/L. Identifying independent risk factors through binary logistic regression analysis. Results: Among the 168 patients, 18 (10.7%) cases experienced postoperative hypokalemia, with the majority occurring on the fourth day after surgery. The majority of patients did not exhibit clinical symptoms related to hypokalemia. The binary logistic regression analysis revealed that age (OR 1.09; 95% CI [1.03–1.15]; P = 0.001) and postoperative hypoalbuminemia on the first day (OR, 4.35; 95% CI [1.38–13.75]; P = 0.012) were associated with postoperative hypokalemia. Conclusions: Patients aged ≥50 years and those presenting with hypoalbuminemia on the first postoperative day were more likely to develop postoperative hypokalemia. Therefore, electrolyte monitoring should be enhanced in such patients postoperatively, especially to actively prevent hypokalemia on the 4th–5th postoperative day. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aims to investigate whether Signal Transducer and Activator of Transcription 4 (STAT4) influences the anti-tumor immune response and is possibly involved in the initiation or relapse of pituitary adenomas (PAs) by examining STAT4 polymorphisms and serum levels. This research seeks to uncover potential connections that could inform future therapeutic strategies and improve our understanding of PA pathogenesis. Materials and Methods: This study was conducted at the Laboratory of Ophthalmology, Lithuanian University of Health Sciences. DNA was extracted from peripheral venous blood samples, and the genotyping of four STAT4 SNPs (rs7574865, rs10181656, rs7601754, and rs10168266) was performed using real-time PCR with TaqMan® Genotyping assays. The serum STAT4 levels were measured via ELISA, and the optical density was read at 450 nm. Genotype frequencies, allele distributions, and serum STAT4 levels were statistically analyzed to assess associations with pituitary adenoma occurrence. Results: A binary logistic regression revealed that the STAT4 rs7574865 GT + GG genotypes vs. TT were associated with 1.7-fold increased odds of PA occurrence under the dominant genetic model (p = 0.012). The stratification by gender showed no significant associations in females; however, in males, the STAT4 rs10168266 CC + CT genotypes compared to TT were linked to 2.5-fold increased odds of PA under the dominant genetic model (p = 0.005). STAT4 rs10181656, rs7574865, rs7601754, and rs10168266 were analyzed to evaluate the associations with the pituitary adenoma size. We found that the STAT4 rs7574865 GG genotype was statistically significantly less frequent in the macro PA group compared to in the reference group (p = 0.012). For PA relapse, the rs7574865 G allele was less frequent in the PA group without relapse (p = 0.012), and the GT + GG genotypes were associated with a 1.8-fold increase in the PA group without relapse occurrence (p = 0.008). The serum STAT4 levels were higher in the PA patients compared to those of the reference group (p < 0.001). Elevated STAT4 serum levels were observed in PA patients with the STAT4 rs10181656 CC or CG genotypes (CC: p = 0.004; CG: p = 0.023), and with the rs7574865 GG or GT genotypes (GG: p = 0.003; GT: p = 0.021). The PA patients with the STAT4 rs7601754 AA genotype exhibited higher serum levels compared to those of the reference group (p < 0.001). Similarly, higher serum levels were found in the PA patients with the STAT4 rs10168266 CC or CT genotypes (CC: p = 0.004; CT: p = 0.027). A haplotype frequency analysis revealed no statistically significant results. Conclusions: The STAT4 genotypes were significantly associated with the PA occurrence, size, and relapse. Elevated serum STAT4 levels were observed in the PA patients, highlighting its potential role in PA pathogenesis. [ABSTRACT FROM AUTHOR]