RESUMO
Introducción. Los adenomas gigantes de hipófisis (AGHs) son aquellos tumores con un diámetro máximo ≥4 cm en cualquier dirección, representando del 5% al 14% del total de los adenomas que se tratan quirúrgicamente. Su manejo terapéutico es desafiante ya que, debido a su extensión hacia otras estructuras cerebrales,está asociado a un riesgo mayor de complicaciones quirúrgicas, con una menor tasa de resección total. El objetivo de este trabajo fue evaluar el impacto de la cirugía endoscópica transesfenoidal en AGHs, analizando las variables asociadas a resultados visuales, endocrinológicos y según el grado de resección. Pacientes y Métodos. Se evaluó en 44 pacientes con AGHs(diámetro ≥4 cm y/o volumen ≥10 ml) la presentación visual, endocrinológica e imágenes. Se analizaron estadísticamente resultados visuales, endocrinológicos, grado de resección y complicaciones quirúrgicas. Resultados. Edad promedio de 48.8 años, 24 mujeres y 20 hombres. Presentación: déficit del campo visual (93.1%), hipopituitarismo (61.3%), cefalea (54.5%). Diámetro, volumen y extensión supraselar promedios: 4.8 cm, 20.3 ml, 1.8 cm, respectivamente. Campo visual: mejoría: 83.3%, sin cambios: 9.5%, mayormente en síntomas bilaterales (p<0.0001). Desmejoríavisual: 0%. En resección total: mayor posibilidad de mejoría visual (p=0.040). Buenos resultados endocrinológicos: 85.7%. Tasa de resección total: 52.3%. Resección subtotal: más frecuente con invasión del seno cavernoso (p=0.014). Sin diferencias en el grado de resección según diámetro, volumen, extensión supraselar, forma ni aspecto. Hipopituitarismo: 4.2%. Diabetes insípida: 9.5%, asociada a mayor diámetro (p=0.038) o extensión supraselar (p=0.010) y aspecto sólido (p=0.023). Fístula de LCR: 7.1%. Conclusión. La resección total puede lograrse en la mitad de los casos, siendo la limitante principal el grado de invasión del seno cavernoso y no el aspecto morfológico del AGH per se. Aun así, los resultados visuales y endocrinológicos son muy buenos. En resecciones incompletas se logra el control de la enfermedad mediante tratamientos complementarios
Introduction. Giant pituitary adenomas (sGAs) are those tumors with a maximum diame- ter ≥4 cm in any direction, representing 5% to 14% of all adenomas that are treated surgi- cally. Its therapeutic management is challenging since, due to its extension to other brain structures, it is associated with a higher risk of surgical complications, with a lower rate of total resection. Te objective of this work was to evaluate the impact of transsphenoidal endoscopic surgery on AGHs, analyzing the variables associated with visual and endocri- nological results and according to the degree of resection. Patients and Methods. Visual, endocrinological and imaging presentation were evaluated in 44 patients with sHAA (dia- meter ≥4 cm and/or volume ≥10 ml). Visual and endocrinological results, degree of resection and surgical complications were statistically analyzed. Results. Average age of 48.8 years, 24 women and 20 men. Presentation: visual field deficit (93.1%), hypopituitarism (61.3%), headache (54.5%). Average diameter, volume and suprasellar extension: 4.8 cm, 20.3 ml, 1.8 cm, respectively. Visual field: improvement: 83.3%, no changes: 9.5%, mostly in bilate- ral symptoms (p<0.0001). Visual impairment: 0%. In total resection: greater possibility of visual improvement (p=0.040). Good endocrinological results: 85.7%. Total resection rate: 52.3%. Subtotal resection: more frequent with invasion of the cavernous sinus (p=0.014). No differences in the degree of resection according to diameter, volume, suprasellar exten- sion, shape or appearance. Hypopituitarism: 4.2%. Diabetes insipidus: 9.5%, associated with greater diameter (p=0.038) or suprasellar extension (p=0.010) and solid appearance (p=0.023). CSF fistula: 7.1%. Conclusion. Total resection can be achieved in half of the cases, the main limitation being the degree of invasion of the cavernous sinus and not the morphological appearance of the HGA per se. Even so, the visual and endocrinological results are very good. In incomplete resections, disease control is achieved through com- plementary treatments
Assuntos
Humanos , Hipófise/patologia , Complicações Pós-Operatórias , Adenoma/patologia , Distribuição de Qui-Quadrado , Endoscopia/métodos , Liberação de Cirurgia , Margens de Excisão , Hipofisectomia/métodosRESUMO
Liver diseases, including cirrhosis, viral hepatitis, and hepatocellular carcinoma, account for approximately two million annual deaths worldwide. They place a huge burden on the global healthcare systems, compelling researchers to find effective treatment for liver fibrosis-cirrhosis. Portacaval anastomosis (PCA) is a model of liver damage and fibrosis. Arginine vasopressin (AVP) has been implicated as a proinflammatory-profibrotic hormone. In rats, neurointermediate pituitary lobectomy (NIL) induces a permanent drop (80%) in AVP serum levels. We hypothesized that AVP deficiency (NIL-induced) may decrease liver damage and fibrosis in a rat PCA model. Male Wistar rats were divided into intact control (IC), NIL, PCA, and PCA+NIL groups. Liver function tests, liver gene relative expressions (IL-1, IL-10, TGF-ß, COLL-I, MMP-9, and MMP-13), and histopathological assessments were performed. In comparison with those in the IC and PCA groups, bilirubin, protein serum, and liver glycogen levels were restored in the PCA+NIL group. NIL in the PCA animals also decreased the gene expression levels of IL-1 and COLL-I, while increasing those of IL-10, TGF-ß, and MMP-13. Histopathology of this group also showed significantly decreased signs of liver damage with lower extent of collagen deposition and fibrosis. Low AVP serum levels were not enough to fully activate the AVP receptors resulting in the decreased activation of cell signaling pathways associated with proinflammatory-profibrotic responses, while activating cell molecular signaling pathways associated with an anti-inflammatory-fibrotic state. Thus, partial reversion of liver damage and fibrosis was observed. The study supports the crucial role of AVP in the inflammatory-fibrotic processes and maintenance of immune competence. The success of the AVP deficiency strategy suggests that blocking AVP receptors may be therapeutically useful to treat inflammatory-fibrotic liver diseases.
Assuntos
Arginina Vasopressina/deficiência , Cirrose Hepática/patologia , Falência Hepática/imunologia , Hipófise/metabolismo , Receptores de Vasopressinas/metabolismo , Animais , Arginina Vasopressina/sangue , Modelos Animais de Doenças , Humanos , Hipofisectomia , Cirrose Hepática/sangue , Cirrose Hepática/imunologia , Falência Hepática/sangue , Falência Hepática/patologia , Masculino , Hipófise/cirurgia , Derivação Portocava Cirúrgica , Ratos , Ratos Wistar , Transdução de Sinais/imunologiaRESUMO
BACKGROUND: There remains considerable variation in the extent of sinonasal preservation during the approach for endoscopic transsphenoidal hypophysectomy (TSH). We advocate for a minimally destructive approach utilizing turbinate lateralization, small posterior septectomy, no ethmoidectomy, and preservation of nasoseptal flap (NSF) pedicles bilaterally. Due to these factors, this approach may affect the rates of postoperative rhinosinusitis. The objective of this study is to define the rates of postoperative rhinosinusitis in patients undergoing this approach. METHODS: Single institution, retrospective chart review of patients undergoing TSH from 2005 to 2018. RESULTS: A total of 415 patients were identified and 14% developed an episode of postoperative rhinosinusitis within 3 months. These patients were significantly more likely to have had a history of recurrent acute or chronic rhinosinusitis. Most cases were sphenoethmoidal sinusitis managed with 1 to 2 courses of antibiotics. Of patients with postoperative rhinosinusitis, most did not undergo NSF. Average follow-up was 38 months. Six patients (1.4%) underwent post-TSH functional endoscopic sinus surgery (FESS). Average time from TSH to FESS was 26.3 months. Two of these patients had a history of prior chronic rhinosinusitis without polyposis. Two patients underwent revision TSH for recurrent tumor as the primary indication for surgery at time of FESS. Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) scores generally increased immediately postoperatively, but frequently decreased below preoperative level by the time of last follow-up, regardless of whether patients developed rhinosinusitis. CONCLUSION: Sinonasal preservation during TSH is associated with a low rate of postoperative rhinosinusitis requiring FESS and excellent long-term patient reported outcomes. We continue to advocate for sinonasal preservation during pituitary surgery.
Assuntos
Hipofisectomia/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Rinite/cirurgia , Sinusite/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Rinite/etiologia , Rinite/patologia , Teste de Desfecho Sinonasal , Sinusite/etiologia , Sinusite/patologia , Seio Esfenoidal/cirurgia , Retalhos Cirúrgicos/cirurgia , Resultado do TratamentoRESUMO
Toxocara canis is the helminth causing Toxocariasis, a parasitic disease with medical and veterinary implications. Their final host are members of the family Canidae and as paratenic hosts, most of the mammals are sensitive (man, rat, mouse, among others). It has been reported that a pituitary hormone, prolactin, it is responsible for reactivation and migration of larvae to the uterus and mammary gland during the last third of gestation in bitches. In addition, this hormone has been shown to play an important role in the regulation of the immune response. Thus, the aim of this study, was to evaluate the effect of hypophysectomy in the rat model of Toxocariasis, on the immune response against this parasite during a chronic infection, for which parasite loads were analyzed in different organs (lung and brain). Furthermore, serum specific antibody titers, and percentages of different cells of the immune system were also determined. The results showed a decrease in the number of larvae recovered from lung and brain in the hypophysectomized animals. In this same group of animals, there was no production of specific antibodies against the parasite. As for the percentages of the cells of the immune system, there are differences in some subpopulations due to surgery and others due to infection. Our results demonstrated that the lack of pituitary hormones alters parasite loads and the immune response to the helminth parasite Toxocara canis.
Assuntos
Doença Crônica , Hormônios Hipofisários/imunologia , Toxocara canis/imunologia , Toxocaríase/imunologia , Toxocaríase/fisiopatologia , Animais , Anticorpos Anti-Helmínticos/sangue , Encéfalo/imunologia , Encéfalo/parasitologia , Modelos Animais de Doenças , Hipofisectomia , Larva/crescimento & desenvolvimento , Camundongos , Carga Parasitária , Hormônios Hipofisários/deficiência , Ratos , Toxocara canis/fisiologiaRESUMO
Regulating mechanisms of fibrosis is an important goal in the treatment of fibrosis and liver cirrhosis. The role of arginine vasopressin (AVP) in promoting fibrosis in several organs has been well documented. However, the result of an AVP deficiency during liver fibrosis has not been reported. We herein study the effects of an AVP deficiency, which was induced by neurointermediate pituitary lobectomy (NIL), on liver cirrhosis and liver cirrhosis reversion. Hamsters were intact (control) or underwent CCl4-induced cirrhosis, the latter animals divided into four groups: Cirrhotic, NIL-cirrhotic, Cirrhotic-reversion (R) and NIL-cirrhotic-R. Liver function, liver histopathology (including the fibrosis area and collagen types) and liver expression of MMP-13 and TIMP-2 were assessed. Results show that the AVP deficiency decreased the levels of alkaline phosphatase in serum and the expression of type I collagen and TIMP-2, and increased type III collagen deposition, MMP-13 expression and the size of regeneration nodules in NIL-cirrhotic and NIL-cirrhotic-R animals. A significantly greater recovery was found in the NIL-cirrhotic-R than the Cirrhotic-R group. We conclude that an AVP deficiency participates importantly in hamster liver regeneration by: 1) prompting the fibroblasts to produce type III collagen deposit, 2) influencing the activity of AP from bile duct cells, and 3) inhibiting TIMP-2 expression while favoring the fibrolytic activity of MMP-13.
Assuntos
Arginina Vasopressina/deficiência , Cirrose Hepática/patologia , Regeneração Hepática/fisiologia , Animais , Tetracloreto de Carbono/toxicidade , Cricetinae , Hipofisectomia , MasculinoRESUMO
CONTEXT: Acromegaly is a systemic disorder caused by a GH-secreting pituitary adenoma. As with other rare diseases, acromegaly registries developed in various European countries have provided us with important information. OBJECTIVE: The objective of the study was to analyze the epidemiological, clinical, biochemical, and therapeutic data from the Mexican Acromegaly Registry (MAR). SETTING: The setting of the study was a nationwide patient registry. DESIGN AND METHODOLOGY: The MAR was created in 2009. It gathers data from 24 participating centers belonging to three different institutions using a specifically designed on-line platform. Only patients diagnosed after 1990 were included in the program. RESULTS: A total of 2057 patients (51% female, mean age at diagnosis 41.1 ± 24.5 y) have been registered for an estimated prevalence of 18 cases per 1 million inhabitants. Hypertension, glucose intolerance, diabetes, and dyslipidemia were present in 27%, 18.4%, 30%, and 24% of the patients, respectively. The IGF-1 level at diagnosis and the concomitant presence of hypertension were significantly associated with the development of diabetes. Transsphenoidal surgery was the primary treatment in 72% of the patients. Pharmacological treatment, mostly with somatostatin analogs, was administered primarily and adjunctively in 26% and 54% of the patients, respectively. Treatment choice varied among the three participating institutions, with the predominance of pharmacological therapy in two of them and of radiation therapy in the third. Therapeutic outcomes were similar to those reported in the European registries. CONCLUSIONS: The MAR is the largest and first non-European registry of the disease. Our findings highlight important within-country differences in treatment choice due to variations in the availability of resources.
Assuntos
Acromegalia/etiologia , Adenoma/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Hipófise/fisiopatologia , Acromegalia/prevenção & controle , Adenoma/epidemiologia , Adenoma/fisiopatologia , Adenoma/terapia , Adulto , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Adenoma Hipofisário Secretor de Hormônio do Crescimento/epidemiologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Adenoma Hipofisário Secretor de Hormônio do Crescimento/terapia , Terapia de Reposição Hormonal/efeitos adversos , Hospitais Públicos , Humanos , Hipofisectomia/efeitos adversos , Masculino , México/epidemiologia , Hipófise/efeitos dos fármacos , Hipófise/efeitos da radiação , Hipófise/cirurgia , Padrões de Prática Médica , Prevalência , Radioterapia/efeitos adversos , Sistema de Registros , Estudos Retrospectivos , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Resultado do TratamentoRESUMO
Yokenella regensburgei es un bacilo Gram negativo de la familia Enterobacteriaceae, que puede encontrarse en agua de pozos, alimentos y en el tubo digestivo de insectos y reptiles. Aunque se ha aislado de muestras provenientes de seres humanos, pocas veces se ha reportado como causante de infección y, en tales casos, especialmente en pacientes inmunosuprimidos. Se presenta aquí el primer caso de osteomielitis secundaria a una infección por Y. regensburgei en una paciente inmunocompetente después de un procedimiento quirúrgico.
The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.
Assuntos
Idoso , Feminino , Humanos , Osteomielite/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Osso Temporal/microbiologia , Craniotomia , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Osteomielite/etiologia , Osteomielite/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Prolactinoma/cirurgia , Tomografia Computadorizada por Raios X , Drenagem , Hospedeiro Imunocomprometido , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/etiologia , Infecções por Enterobacteriaceae/diagnóstico por imagem , Hipofisectomia , Antibacterianos/uso terapêuticoRESUMO
It is well known that sex hormones play an important role during Taenia solium infection; however, to our knowledge no studies exist concerning the immune response following complete or lobe-specific removal of the pituitary gland during T. solium infection. Thus, the aim of this work was to analyze in hamsters, the effects of lack of pituitary hormones on the duodenal immune response, and their impact on T. solium establishment and development. Thus, in order to achieve this goal, we perform anterior pituitary lobectomy (AL, n = 9), neurointermediate pituitary lobectomy (NIL, n = 9) and total hypophysectomy (HYPOX, n = 8), and related to the gut establishment and growth of T. solium, hematoxylin-eosin staining of duodenal tissue and immunofluorescence of duodenal cytokine expression and compared these results to the control intact (n = 8) and control infected group (n = 8). Our results indicate that 15 days post-infection, HYPOX reduces the number and size of intestinally recovered T. solium adults. Using semiquantitative immunofluorescent laser confocal microscopy, we observed that the mean intensity of duodenal IFN-γ and IL-12 Th1 cytokines was mildly expressed in the infected controls, in contrast with the high level of expression of these cytokines in the NIL infected hamsters. Likewise, the duodenum of HYPOX animals showed an increase in the expression of Th2 cytokines IL-5 and IL-6, when compared to control hamsters. Histological analysis of duodenal mucosa from HYPOX hamsters revealed an exacerbated inflammatory infiltrate located along the lamina propria and related to the presence of the parasite. We conclude that lobe-specific pituitary hormones affect differentially the T. solium development and the gut immune response.
Assuntos
Citocinas/metabolismo , Duodeno/parasitologia , Hipófise/fisiologia , Taenia solium/fisiologia , Teníase/imunologia , Teníase/metabolismo , Animais , Cricetinae , Duodeno/imunologia , Duodeno/patologia , Feminino , Hipofisectomia , Imuno-Histoquímica , Interferon gama/metabolismo , Interleucina-12/metabolismo , Interleucina-5/metabolismo , Interleucina-6/metabolismo , Mucosa Intestinal/imunologia , Mucosa Intestinal/parasitologia , Mucosa Intestinal/patologia , Mesocricetus , Hipófise/cirurgia , Taenia solium/imunologiaRESUMO
The gram-negative bacillus Yokenella regensburgei (of the Enterobacteriaceae family) can be found in groundwater and foodstuffs, as well as the digestive tracts of insects and reptiles. Although it has been isolated from humans since its original description, it has rarely been reported as a cause of infection, and then, only in immunosuppressed patients. We report the first case of post-surgical secondary osteomyelitis due to Y. regensburgei in an immunocompetent woman who had undergone a craniotomy.
Assuntos
Craniotomia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/isolamento & purificação , Osteomielite/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Osso Temporal/microbiologia , Idoso , Antibacterianos/uso terapêutico , Drenagem , Farmacorresistência Bacteriana Múltipla , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/diagnóstico por imagem , Infecções por Enterobacteriaceae/etiologia , Feminino , Humanos , Hipofisectomia , Hospedeiro Imunocomprometido , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Neoplasias Hipofisárias/cirurgia , Prolactinoma/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate expression of somatostatin receptor subtypes 2 and 5 (SSTR 2 and 5) by RT/PCR and immunohistochemistry (IHC) in GH-secreting adenomas, seeking correlations with response to octreotide. METHODS: SSTR2 and 5 expression was tested by IHC (n=37), RT/PCR (n=36) or both (n=13) in GH-secreting adenomas from 60 patients with acromegaly who had undergone pituitary surgery; 36 had been treated preoperatively with octreotide LAR for 3-6 months, and were categorized as responders (achievement of GH <2.5ng/mL and a normal age-adjusted IGF-1), partial responders (GH and IGF-1 reduction >50% and >30%, respectively) or non-responders. IHC was performed on a tissue microarray using specific antibodies directed to the carboxyl terminus of SSTR2 and 5. RESULTS: SSTR5 was the predominantly expressed receptor subtype by both IHC and RT/PCR in all tumors tested, regardless of whether they came from octreotide-naïve, octreotide-responsive, or octreotide-resistant patients. Immunostaining was concentrated in the cytoplasm. Neither SSTR2 nor SSTR5 expression correlated with baseline or post-octreotide GH or IGF-1 levels or tumor volume by either method. The agreement rate between RT/PCR and IHC was 77% in all 13 adenomas in which both methods were used. CONCLUSION: Expression of these receptors does not guarantee an adequate response to somatostatin analogs; other functional aspects of this interaction, such as receptor homo- and heterodimerization, and the resulting signaling cascade, probably play a role in determining whether a patient will respond or not to these agents.
Assuntos
Adenoma/química , Adenoma Hipofisário Secretor de Hormônio do Crescimento/química , Hormônio do Crescimento Humano/metabolismo , Proteínas de Neoplasias/biossíntese , Octreotida/uso terapêutico , Receptores de Somatostatina/biossíntese , Acromegalia/etiologia , Adenoma/complicações , Adenoma/tratamento farmacológico , Adenoma/cirurgia , Antineoplásicos Hormonais/uso terapêutico , Terapia Combinada , Resistencia a Medicamentos Antineoplásicos , Regulação Neoplásica da Expressão Gênica , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/tratamento farmacológico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/cirurgia , Hormônio do Crescimento Humano/análise , Humanos , Hipofisectomia , Fator de Crescimento Insulin-Like I/análise , Proteínas de Neoplasias/genética , Reação em Cadeia da Polimerase em Tempo Real , Receptores de Somatostatina/genética , Análise Serial de TecidosRESUMO
El abordaje quirúrgico de la patología selar ha sufrido importantes cambios desde sus primeras descripciones. Inicialmente de manejo neuroquirúrgico, hoy en día el abordaje hipofisiario transeptoesfenoidal se ha transformado en una de las vías de acceso más utilizadas por el otorrinolaringólogo para lesiones a nivel de silla turca. Esta publicación describe un tipo de acceso transeptoesfenoidal utilizado por el otorrinolaringólogo en el Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA) en el abordaje de lesiones selares, tanto en cirugía primaria de hipófisis, cirugía secundaria o en casos con alteraciones anatómicas del septum nasal posterior.
The surgical approach to the sellar pathology has undergone significant changes since its first descriptions. Initially addressed by neurosurgical management, today the transseptosphenoidal pituitary approach has become one of the most used pathways by the otolaryngologist to reach sellar lesions. This publication describes one of the transseptosphenoidal approach used by the otolaryngologist at the Instituto de Neurocirugía Dr. Alfonso Asenjo (INCA) in addressing sellar lesions and its variations in primary pituitary surgery, secondary surgery, multiple interventions and in cases of anatomical variations of the posterior nasal septum.
Assuntos
Humanos , Sela Túrcica/cirurgia , Hipofisectomia/métodos , Osso Esfenoide/cirurgia , Seio Esfenoidal/anatomia & histologiaRESUMO
The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.
Assuntos
Adenoma/complicações , Aneurisma Roto/complicações , Aneurisma Intracraniano/complicações , Neoplasias Hipofisárias/complicações , Hemorragia Subaracnóidea/etiologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/cirurgia , Cegueira/etiologia , Confusão/etiologia , Transtornos da Cefaleia Primários/etiologia , Hemodinâmica , Humanos , Hipofisectomia/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias , Reoperação , Ruptura Espontânea , Estresse Mecânico , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Ao longo dos anos, a cirurgia minimamente invasiva avançou com a contribuição importante dos neurocirurgiões sobre a melhor opção para a abordagem terapêutica de tumores da região selar, partindo-se de uma cirurgia extremamente prejudicial, com alta morbidade e mortalidade, até a evolução de técnicas mais modernas, as quais dispõem de materiais mais adequados, que permitem ressecções completas com menor agressão às estruturas neurovasculares. Para praticá-las, é necessário um grupo de trabalho que envolva diferentes especialidades, como endocrinologia, oftalmologia, otorrinolaringologia, neurocirurgia e radioterapia, a fim de oferecer aos pacientes as melhores opções, garantindo atendimento individualizado, resolutivo e pouco agressivo. Há necessidade de um planejamento pré-operatório cuidadoso, com o uso de exames complementares avançados como ressonância magnética, tomografia computadorizada dos seios da face, dosagem sérica dos hormônios hipofisários e campimetria visual. Ainda, durante o procedimento cirúrgico, pode-se dispor de neuronavegação, tornando a cirurgia mais segura, especialmente nas reoperações. Por essas vantagens, a cirurgia transesfenoidal por microscopia convencional e por endoscopia é o procedimento atual de escolha para tratar tumores selares e fornecer adequada descompressão de estruturas neurais, com recuperação favorável mais rápida no pós-operatório em comparação com a abordagem transcraniana convencional.
Over the years, minimally invasive surgery has advanced with the important contribution of neurosurgeons for the best option for the therapeutic approach of sellar tumors. Starting from an extremely harmful surgery with high morbidity and mortality until the evolution of techniques modern, which have the most suitable materials, which allow complete resections with less aggression to the neurovascular structures. To do them, is necessary a working group involving different specialities, such as endocrinology, ophthalmology, otolaryngology, neurosurgery and radiotherapy in order to offer patients the best options, ensuring individualized care, resolute and less aggressive. It?s necessary a careful preoperative planning, using advanced exams such as MRI, CT scan of the sinuses, serum levels of pituitary hormones and visual perimetry. Still, the surgical procedure can be increased with the neuronavigation, making surgery more safer, especially in reoperations. Thus, because of these advantages, transphenoidal surgery for conventional microscopy and for endoscopy is the current procedure of choice for treating parasellar tumors, and provide adequate decompression of the neural structures with a favorable and faster recovery after surgery compared to the approach transcranial conventional.
Assuntos
Humanos , Neoplasias Hipofisárias/cirurgia , Endoscopia , HipofisectomiaRESUMO
Sleep is characterized by a reduced response to external stimuli and a particular form of electroencephalographic (EEG) activity. Sleep is divided into two stages: REM sleep, characterized by muscle atonia, rapid eye movements, and EEG activity similar to wakefulness, and non-REM sleep, characterized by slow EEG activity. Around 80% of total sleep time is non-REM. Although it has been intensely studied for decades, the function (or functions) of sleep remains elusive. Sleep is a highly regulated state; some brain regions and several hormones and cytokines participate in sleep regulation. This mini-review focuses on how pituitary hormones and cytokines regulate or affect sleep and how sleep modifies the plasma concentration of hormones as well as cytokines. Also, we review the effects of hypophysectomy and some autoimmune diseases on sleep pattern. Finally, we propose that one of the functions of sleep is to maintain the integrity of the neuro-immune-endocrine system.
Assuntos
Citocinas/metabolismo , Hipofisectomia/efeitos adversos , Sistema Imunitário/fisiologia , Hormônios Hipofisários/metabolismo , Sono/fisiologia , Animais , Doenças Autoimunes/fisiopatologia , Citocinas/imunologia , Eletroencefalografia , Movimentos Oculares/fisiologia , Humanos , Hormônios Hipofisários/imunologia , Ratos , Transtornos do Sono-Vigília/fisiopatologia , Sono REM/fisiologia , Vigília/fisiologiaRESUMO
Both stiffness and strength of bones are thought to be controlled by the "bone mechanostat". Its natural stimuli would be the strains of bone tissue (sensed by osteocytes) that are induced by both gravitational forces (body weight) and contraction of regional muscles. Body weight and muscle mass increase with age. Biomechanical performance of load-bearing bones must adapt to these growth-induced changes. Hypophysectomy in the rat slows the rate of body growth. With time, a great difference in body size is established between a hypophysectomized rat and its age-matched control, which makes it difficult to establish the real effect of pituitary ablation on bone biomechanics. The purpose of the present investigation was to compare mid-shaft femoral mechanical properties between hypophysectomized and weight-matched normal rats, which will show similar sizes and thus will be exposed to similar habitual loads. Two groups of 10 female rats each (H and C) were established. H rats were 12-month-old that had been hypophysectomized 11 months before. C rats were 2.5-month-old normals. Right femur mechanical properties were tested in 3-point bending. Structural (load-bearing capacity and stiffness), geometric (cross-sectional area, cortical sectional area, and moment of inertia), and material (modulus of elasticity and maximum elastic stress) properties were evaluated. The left femur was ashed for calcium content. Comparisons between parameters were performed by the Student's t test. Average body weight, body length, femur weight, femur length, and gastrocnemius weight were not significantly different between H and C rats. Calcium content in ashes was significantly higher in H than in C rats. Cross-sectional area, medullary area, and cross-sectional moment of inertia were higher in C rats, whereas cortical area did not differ between groups. Structural properties (diaphyseal stiffness, elastic limit, and load at fracture) were about four times higher in hypophysectomized rats, as were the bone material stiffness or Young's modulus and the maximal elastic stress (about 7×). The femur obtained from a middle-aged H rat was stronger and stiffer than the femur obtained from a young-adult C rat, both specimens showing similar size and bone mass and almost equal geometric properties. The higher than normal structural properties shown by the hypophysectomized femur were entirely due to changes in the intrinsic properties of the bone; it was thus stronger at the tissue level. The change of the femoral bone tissue was associated with a high mineral content and an unusual high modulus of elasticity and was probably due to a diminished bone and collagen turnover.
Assuntos
Envelhecimento , Fêmur/química , Hipófise/fisiologia , Animais , Fenômenos Biomecânicos , Diáfises/química , Diáfises/crescimento & desenvolvimento , Diáfises/metabolismo , Módulo de Elasticidade , Feminino , Fêmur/crescimento & desenvolvimento , Fêmur/metabolismo , Hipofisectomia/efeitos adversos , Minerais/análise , Hipófise/crescimento & desenvolvimento , Ratos , Ratos Sprague-Dawley , Aumento de Peso , Suporte de CargaRESUMO
INTRODUCTION: Brain tumors are present in 2.9 per 100,000 newborn. Craniopharyngioma is a benign and slow growing brain tumor, frequently localized in the sellar and suprasellar region. There are few reports of pituitary tumor detected prenatally. CASE REPORT: We report a neonate with a craniopharyngioma detected prenatally as a pituitary tumor. In a 23 year old mother, second gestation, with no important history, was detected a sellar tumor at 31 gestation weeks, the obstetric ultrasound reported a suprasellar tumor of 2 per 3 cm diameter. Pregnancy ended in a vaginal delivery at 39 weeks, and obtained a 3.9 kg female, with cephalic diameter of 37.5 cm, the Apgar score was 8-9 at 1st and 5th minutes. In early neonatal period was scanned and confirmed a 3.2/2.3/2.9 cm suprasellar tumor with calcium deposits. The Paediatric Oncology department suggested a surgery and was realized a craniotomy at 3rd week of age. The surgery allowed to obtain 30% of the tumor and confirmed by histology craniopharyngioma. Patient had favourable evolution and was discharged at 3 months of age. CONCLUSIONS: We report a neonate in who was detected by prenatal ultrasound the presence of a suprasellar solid tumor, scan and magnetic resonance images in neonatal period defined its size and location and a craniopharyngioma was confirmed by histology. Patient had a satisfactory postsurgical evolution and was discharged at 3 months of age.
Assuntos
Craniofaringioma/congênito , Neoplasias Hipofisárias/congênito , Ultrassonografia Pré-Natal , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/embriologia , Craniofaringioma/cirurgia , Craniotomia , Feminino , Humanos , Hipofisectomia/métodos , Recém-Nascido , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/embriologia , Neoplasias Hipofisárias/cirurgia , Indução de Remissão , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
OBJECTIVE: To evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. MATERIALS AND METHODS: In five years 51 functioning adenomas were operated (31 GH-secreting, 14 ACTH-secreting, 5 PRL-secreting and 1 TSH-secreting). Hormonal control was defined as GH < 2,5 ng/mL, normal free-urinary cortisol, lower prolactin and normal T3 and FT4. RESULTS: Control rates were 36% in acromegaly, and 57% in Cushing's disease. Two prolactinomas normalized prolactin levels. Thyroid hormone levels were normalized in the TSH-secreting adenoma. Control of hypercortisolism was positively correlated with years of experience (p = 0.01). CONCLUSION: Our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. During these years, there was a significant improvement in initial post surgery urinary cortisol levels in Cushing's disease as a function of surgical experience.
Assuntos
Hipofisectomia/métodos , Neoplasias Hipofisárias/cirurgia , Acromegalia/sangue , Adulto , Idoso , Síndrome de Cushing/sangue , Síndrome de Cushing/urina , Feminino , Hormônio do Crescimento Humano/metabolismo , Humanos , Hidrocortisona/urina , Fator de Crescimento Insulin-Like I/metabolismo , Masculino , Pessoa de Meia-Idade , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia , Prolactinoma/sangue , Prolactinoma/cirurgia , Estatísticas não Paramétricas , Tireotropina/sangue , Fatores de Tempo , Adulto JovemRESUMO
OBJETIVO: Avaliar os resultados iniciais de uma equipe cirúrgica no controle hormonal dos adenomas hipofisários secretores. MATERIAIS E MÉTODOS: Em cinco anos, foram operados 51 adenomas secretores (31 GH, 14 ACTH, 5 prolactina, 1 TSH). O controle hormonal foi GH basal < 2,5 ng/dL, cortisol livre urinário normal, redução dos níveis de prolactina, e T3 e T4 livre normais. RESULTADOS: As taxas de controle foram 36 por cento na acromegalia e 57 por cento no Cushing. Dois prolactinomas (40 por cento) normalizaram a prolactina. Os hormônios tiroidianos normalizaram no adenoma secretor de TSH. O controle do hipercortisolismo correlacionou-se com o tempo de experiência da equipe (p = 0,01). CONCLUSÃO: Nossos resultados, limitados aos primeiros anos de experiência cirúrgica, situam-se abaixo da variação reportada em grandes casuísticas com maior tempo de experiência. Ao longo do tempo, observou-se melhora progressiva nos níveis de cortisol urinário no pós-operatório inicial da doença de Cushing em função da experiência cirúrgica.
OBJECTIVE: To evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. MATERIALS AND METHODS: In five years 51 functioning adenomas were operated (31 GH-secreting, 14 ACTH-secreting, 5 PRL-secreting and 1 TSH-secreting). Hormonal control was defined as GH < 2,5 ng/mL, normal free-urinary cortisol, lower prolactin and normal T3 and FT4. RESULTS: Control rates were 36 percent in acromegaly, and 57 percent in Cushing's disease. Two prolactinomas normalized prolactin levels. Thyroid hormone levels were normalized in the TSH-secreting adenoma. Control of hypercortisolism was positively correlated with years of experience (p = 0.01). CONCLUSION: Our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. During these years, there was a significant improvement in initial post surgery urinary cortisol levels in Cushing's disease as a function of surgical experience.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hipofisectomia/métodos , Neoplasias Hipofisárias/cirurgia , Acromegalia/sangue , Síndrome de Cushing/sangue , Síndrome de Cushing/urina , Hormônio do Crescimento Humano , Hidrocortisona/urina , Fator de Crescimento Insulin-Like I , Hormônios Hipofisários/sangue , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias , Prolactinoma/sangue , Prolactinoma/cirurgia , Estatísticas não Paramétricas , Fatores de Tempo , Tireotropina/sangueRESUMO
Iodide is a trace element and a key component of thyroid hormones (TH). The availability of this halogen is the rate-limiting step for TH synthesis; therefore, thyroidal iodide uptake and recycling during TH synthesis are of major importance in maintaining an adequate supply. In the rat, the thyroid gland co-expresses a distinctive pair of intrathyroidal deiodinating enzymes: the thyroid iodotyrosine dehalogenase (tDh) and the iodothyronine deiodinase type 1 (ID1). In the present work, we studied the activity of these two dehalogenases in conditions of hypo- and hyperthyroidism as well as during acute and chronic iodide administration in both intact and hypophysectomized (HPX) rats. In order to confirm our observations, we also measured the mRNA levels for both dehalogenases and for the sodium/iodide symporter, the protein responsible for thyroidal iodide uptake. Our results show that triiodothyronine differentially regulates tDh and ID1 enzymatic activities, and that both acute and chronic iodide administration significantly decreases rat tDh and ID1 activities and mRNA levels. Conversely, both enzymatic activities increase when intrathyroidal iodide is pharmacologically depleted in TSH-replaced HPX rats. These results show a regulatory effect by iodide on the intrathyroidal dehalogenating enzymes and suggest that they contribute to the iodide-induced autoregulatory processes involved in the Wolff-Chaikoff effect.