OBJECTIVE: The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in patients included in the European Registry on Cushing's syndrome (ERCUSYN), compare their clinical characteristics with those who did not develop VTE and identify risk factors for VTE. DESIGN: A retrospective observational cohort study. METHODS: Data extraction from the registry was taken on February, 7, 2022. At the time there were 2174 patients diagnosed with Cushing's syndrome (CS) and 95 VTEs were reported in the database. RESULTS: Of 95 VTE events 70 (74%) were in pituitary-dependent CS patients, 12 (12.5%) in adrenal-dependant CS, 10 (10.5%) in ectopic CS, and 3 (3%) in CS due to other causes. Sex, 24-hour urinary free cortisol (UFC) value at diagnosis, as well as the number of operations remained statistically significant predictors of VTE. Of patients who were treated with at least one surgery, 12 (13%) VTE occurred before and 80 (87%) after the surgery. Nearly half of these VTEs occurred within six months since the operation (36; 45%). Over half of the centers that reported VTE did not routinely anticoagulate CS patients. Anticoagulation schemes varied widely. CONCLUSION: Patients with CS have an elevated risk of developing VTE for an extended period of time. From ERCUSYN cohort patients have higher risk for VTE if they need multiple surgeries to treat CS, are males and have high UFC values at the diagnosis of CS. Since there is no agreement on thromboprohpylaxis, a protocol for VTE prevention that is widely adopted appears to be necessary for patients with CS.

• MeSH
• Cushingův syndrom * komplikace   epidemiologie   chirurgie   MeSH
• hydrokortison MeSH
• hypersekrece ACTH v hypofýze * komplikace   MeSH
• lidé MeSH
• prevalence MeSH
• retrospektivní studie MeSH
• trombóza * MeSH
• žilní tromboembolie * etiologie   komplikace   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

OBJECTIVE: Gamma Knife radiosurgery (GKS) is typically used after failed resection in patients with Cushing's disease (CD) and acromegaly. Little is known about the upfront role of GKS for patients with CD and acromegaly. In this study, the authors examine the outcome of upfront GKS for patients with these functioning adenomas. METHODS: An international group of 7 Gamma Knife centers sent pooled data from 46 patients (21 with CD and 25 with acromegaly) undergoing upfront GKS to the coordinating center of the study for analysis. Diagnosis was established on the basis of clinical, endocrine, and radiological studies. All patients were treated on a common radiosurgical platform and longitudinally followed for tumor control, endocrine remission, and hypopituitarism. Patients received a tumor median margin dose of 25 Gy (range 12-40.0 Gy) at a median isodose of 50%. RESULTS: The median endocrine follow-up was 69.5 months (range 9-246 months). Endocrine remission was achieved in 51% of the entire cohort, with 28% remission in acromegaly and 81% remission for those with CD at the 5-year interval. Patients with CD achieved remission earlier as compared to those with acromegaly (p = 0.0005). In patients post-GKS, the pituitary adenoma remained stable (39%) or reduced (61%) in size. Hypopituitarism occurred in 9 patients (19.6%), and 1 (2.2%) developed third cranial nerve (CN III) palsy. Eight patients needed further intervention, including repeat GKS in 6 and transsphenoidal surgery in 2. CONCLUSIONS: Upfront GKS resulted in good tumor control as well as a low rate of adverse radiation effects in the whole group. Patients with CD achieved a faster and far better remission rate after upfront GKS in comparison to patients with acromegaly. GKS can be considered as an upfront treatment in carefully selected patients with CD who are unwilling or unable to undergo resection, but it has a more limited role in acromegaly.

• MeSH
• akromegalie diagnostické zobrazování   chirurgie   MeSH
• Cushingův syndrom diagnostické zobrazování   chirurgie   MeSH
• dospělí MeSH
• internacionalita * MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• radiochirurgie metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: Targeted stereotactic radiosurgery (SRS) with sparing of the residual pituitary is the traditional radiosurgical method for pituitary adenomas. Whole-sella SRS is an alternative choice for radiologically indeterminate or large adenomas, the safety and efficacy of which has yet to be determined. OBJECTIVE: To determine if whole-sella SRS in acromegaly would have comparable radiographic and biochemical control to targeted SRS. We performed a multicenter, retrospective matched cohort study to compare outcomes between groups. METHODS: We conducted a retrospective review of acromegalic patients who underwent SRS from 1990 to 2016 at 10 centers participating in the International Radiosurgery Research Foundation. Whole-sella and targeted SRS patients were then matched in a 1:1 ratio. RESULTS: A total of 128 patients were eligible for inclusion. Whole-sella patients had a higher pre-SRS random serum growth hormone, larger treatment volume, and higher maximum point dose to the optic apparatus. The rates of initial/durable endocrine remission, new loss of pituitary function, and new cranial neuropathy were similar between groups. Mortality and new visual deficit were higher in the whole-sella cohort, though not statistically significant. CONCLUSION: There was no difference in biochemical remission or recurrence between treatment groups. Although not statistically significant, the higher rates of tumor regression and lower rates of mortality and new visual deficit may suggest consideration of targeted SRS over whole-sella SRS in acromegaly treatment. Further research is needed to determine the association between visual deficits and mortality with whole-sella SRS.

• MeSH
• adenom komplikace   chirurgie   MeSH
• akromegalie etiologie   chirurgie   MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru chirurgie   MeSH
• mladý dospělý MeSH
• nádory hypofýzy komplikace   chirurgie   MeSH
• radiační poranění epidemiologie   etiologie   MeSH
• radiochirurgie škodlivé účinky   metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: Stereotactic radiosurgery (SRS) is used to manage patients with Cushing disease (CD) who have failed surgical/medical management. Because many patients with recurrent/persistent CD lack an identifiable adenoma on neuroimaging, whole-sellar SRS has been increasingly used. Thus, we sought to define the outcomes of patients undergoing whole-sellar SRS. METHODS: An international, multicenter, retrospective cohort design was used to define clinical/endocrine outcomes for patients undergoing whole-sellar SRS for CD. Propensity-score matching was used to compare patients undergoing whole-sellar SRS and patients who underwent discreet adenoma-targeted SRS. RESULTS: A total of 68 patients underwent whole-sellar SRS, with a mean endocrine follow-up of 5.3 years. The mean treatment volume was 2.6 cm3, and the mean margin dose was 22.4 Gy. The 5-year actuarial remission rate was 75.9%, and the median time to remission was 12-months. Treatment volumes >1.6 cm3 were associated with shorter times to remission (P < 0.05). The 5-year recurrence-free survival rate was 86.0%. Decreased margin and maximum treatment doses were associated with recurrence (P < 0.05). New pituitary hormone deficiency occurred in 15 patients (22.7%). An additional 210 patients were identified who underwent adenoma-targeted SRS. There was no difference in remission rate, time to remission, recurrence-free survival or new endocrinopathy development between patients who underwent whole-sellar SRS and those who underwent discreet adenoma-targeted SRS. CONCLUSIONS: Whole-sellar GKRS is effective in controlling CD when an adenoma is not clearly defined on imaging or when an invasive adenoma is suspected at the time of initial surgery. Patients who undergo whole-sellar SRS have outcomes and rates of new pituitary hormone deficiency similar to those of patients who undergo discrete adenoma-targeted GKRS.

• MeSH
• adrenokortikotropní hormon metabolismus   MeSH
• dítě MeSH
• dospělí MeSH
• hydrokortison metabolismus   MeSH
• hypersekrece ACTH v hypofýze chirurgie   MeSH
• Kaplanův-Meierův odhad MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezinárodní spolupráce * MeSH
• mladiství MeSH
• mladý dospělý MeSH
• radiochirurgie metody   MeSH
• sella turcica chirurgie   MeSH
• senioři MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Carpal tunnel syndrome (CTS) is neuropathy that occurs due to compression of the median nerve in the carpal tunnel. Acromegaly is one of the important causes of CTS. The aim of this study was to examine median nerve with ultrasound in acromegalic patients and to assess the relationship with activity, duration of disease and body composition parameters. We prospectively examined the cross-sectional area (CSA) of the median nerve with high-resolution ultrasound in 107 acromegalic patients (70 females and 37 males) and 107 healthy controls (70 females and 37 males) matched for age, gender, and BMI. Body composition parameters were assessed by dual-energy X-ray absorptiometry (DXA). The Student t-tests and Pearson correlation were used for data analysis. The cross sectional area of the median nerve was increased in acromegalic patients compared to controls (11.9 ± 4.8 mm2 vs. 7.7 ± 2.4 mm2, P < 0.001). Positive correlation was found between IGF-1 levels and CSA in the acromegalic group (R = 0.400, P < 0.001). Relationship between CSA and duration of acromegaly was not confirmed. In acromegalic patients, BMI correlated with the CSA (R = 0.294, P = 0.002). There was no significant difference in BMI, fat mass between the acromegalic and control group, but lean mass was higher in acromegalic patients compared with controls (54.8 ± 13.3 vs. 51 ± 11.6, P = 0.047). Lean mass and LMI (total body lean mass/height) positively correlated with CSA in acromegalic patients (R = 0.340, P < 0.001; R = 0.424, P < 0.001). No correlation was observed between fat mass and CSA of median nerve in all groups. We confirmed the enlargement of the median nerve in acromegalic patients. This enlargement is proportional to the degree of IGF-1 levels and is not dependent on the duration of the disease. The enlargement of the median nerve in acromegalic patients also depends on lean body mass and is not dependent on fat body mass.

• MeSH
• akromegalie diagnostické zobrazování   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervus medianus diagnostické zobrazování   MeSH
• prospektivní studie MeSH
• senioři MeSH
• složení těla MeSH
• studie případů a kontrol MeSH
• ultrasonografie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We explored the effect of chronically elevated circulating levels of growth hormone (GH)/insulin-like-growth-factor-1 (IGF-1) on mRNA expression of GH/IGF-1/insulin axis components and p85alpha subunit of phosphoinositide-3-kinase (p85alpha) in subcutaneous adipose tissue (SCAT) of patients with active acromegaly and compared these findings with healthy control subjects in order to find its possible relationships with insulin resistance and body composition changes. Acromegaly group had significantly decreased percentage of truncal and whole body fat and increased homeostasis model assessment-insulin resistance (HOMA-IR). In SCAT, patients with acromegaly had significantly increased IGF-1 and IGF-binding protein-3 (IGFBP-3) expression that both positively correlated with serum GH. P85alpha expression in SCAT did not differ from control group. IGF-1 and IGFBP-3 expression in SCAT were not independently associated with percentage of truncal and whole body fat or with HOMA-IR while IGFBP-3 expression in SCAT was an independent predictor of insulin receptor as well as of p85alpha expression in SCAT. Our data suggest that GH overproduction in acromegaly group increases IGF-1 and IGFBP-3 expression in SCAT while it does not affect SCAT p85alpha expression. Increased IGF-1 or IGFBP-3 in SCAT of acromegaly group do not appear to contribute to systemic differences in insulin sensitivity but may have local regulatory effects in SCAT of patients with acromegaly.

• MeSH
• akromegalie metabolismus   MeSH
• dospělí MeSH
• fosfatidylinositol-3-kinasy třídy Ia krev   MeSH
• IGFBP-3 metabolismus   MeSH
• insulinu podobný růstový faktor I metabolismus   MeSH
• inzulin krev   MeSH
• inzulinová rezistence * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidský růstový hormon krev   sekrece   MeSH
• messenger RNA metabolismus   MeSH
• podkožní tuk metabolismus   MeSH
• studie případů a kontrol MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Cieľ: Cieľom štúdie bolo vyšetriť plochu priečneho rezu (cross-sectional area; CSA) nervus medianus pomocou UZ u akromegalických pacientov a posúdiť vzťah medzi CSA nervus medianus a aktivitou, trvaním akromegálie ako aj vekom pacientov. Materiál a metódy: Prospektívne sme vyšetrili CSA nervus medianus u 107 akromegalických pacientov (70 žien a 37 mužov) a u 77 zdravých kontrol (51 žien a 26 mužov) zodpovedajúcich veku, pohlaviu a indexu telesnej hmotnosti. Na analýzu údajov sme použili Studentov t-test a Pearsonovu koreláciu. Výsledky: CSA nervus medianus bola signifikantne väčšia u akromegalických pacientov v porovnaní so zdravými kontrolami (0,12 ± 0,005 cm2 vs. 0,078 ± 0,003 cm2; p < 0,001). Priemerná dĺžka trvania akromegálie bola 11 rokov, priemerná sérová hladina inzulínu podobného rastového faktora 1 (insulin-like growth factor 1; IGF-1) bola 249,9 ng/ml a rastového hormónu (RH) bola 2,63 ng/ml. Potvrdili sme pozitívnu koreláciu medzi sérovými hladinami IGF-1 a CSA nervus medianus u akromegalických pacientov (r = 0,400, p < 0,001). Nepotvrdili sme vzťah medzi CSA nervus medianus a sérov hladinou RH, dĺžkou ochorenia a vekom pacientov. Záver: V našej štúdii sme potvrdili zväčšenie nervus medianus u pacientov s akromegáliou. Toto zväčšenie je úmerné hladinám IGF-1 a nezávisí od dĺžky trvania ochorenia a veku pacientov.

Aim: The aim of this study was to examine the cross-sectional area (CSA) of the median nerve using ultrasound in acromegalic patients and to assess the relationship between the CSA of the median nerve and the activity, duration of acromegaly and age of patients. Materials and methods: We prospectively examined the CSA of the median nerve in 107 acromegalic patients (70 women and 37 men) and in 77 healthy controls (51 women and 26 men) matched for age, sex and body mass index. The Student t-test and Pearson correlation were used for data analysis. Results: The CSA of the median nerve was significantly greater in acromegalic patients compared with healthy controls (0.12 ± 0.005 cm2 vs. 0.078 ± 0.003 cm2; P < 0.001). The average duration of acromegaly was 11 years, average serum insulin-like growth factor 1 (IGF-1) level was 249.9 ng/mL and average growth hormone (RH) level was 2.63 ng/mL. We confirmed a positive correlation between the serum levels of IGF-1 and CSA of the median nerve in acromegalic patients (R = 0.400, P < 0.001). We did not confirm a relationship between CSA of the median nerve and serum levels of GH, duration of acromegaly and age of patients. Conclusion: In our study, we confirmed enlargement of the median nerve in patients with acromegaly. This enlargement depends on IGF-1 levels and is not depend on the duration of acromegaly and age of the patients.

• MeSH
• akromegalie * patologie   terapie   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• nervus medianus * patologie   MeSH
• růstový hormon analýza   MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

The aim of the study was to propose a multilocus calibrator containing seven specific sequences of SSTR1-SSTR5, D2R, ER1 genes and the GUS house-keeping reference gene. For preparation, gene synthesis and gene assembly technique were used. The experimental group consisted of 44 pituitary adenomas with overproduction of growth hormone leading to acromegaly. The gene expression was investigated using the real-time PCR. We revealed highest numbers of SSTR2 and D2R transcripts, lower numbers of SSTR1, SSTR3, SSTR5 and ER1 trans¬cripts, and the lowest transcription of the SSTR4 gene. The use of the multicalibrator ensured a high comparability of the results obtained for the tested genes.

• MeSH
• akromegalie * etiologie   genetika   MeSH
• biopsie MeSH
• dospělí MeSH
• exprese genu MeSH
• genetická transkripce MeSH
• insulinu podobný růstový faktor I sekrece   MeSH
• kalibrace * MeSH
• kvantitativní polymerázová řetězová reakce MeSH
• lidé středního věku MeSH
• lidé MeSH
• multilokusová sekvenční typizace MeSH
• nádory hypofýzy * genetika   MeSH
• receptory dopaminové * analýza   MeSH
• receptory somatostatinu * analýza   MeSH
• růstový hormon sekrece   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH
• práce podpořená grantem MeSH

GH-secreting pituitary adenomas can be hypo-, iso- or hyper-intense on T2-weighted MRI sequences. We conducted the current multicenter study in a large population of patients with acromegaly to analyze the relationship between T2-weighted signal intensity on diagnostic MRI and hormonal and tumoral responses to somatostatin analogs (SSA) as primary monotherapy. Acromegaly patients receiving primary SSA for at least 3 months were included in the study. Hormonal, clinical and general MRI assessments were performed and assessed centrally. We included 120 patients with acromegaly. At diagnosis, 84, 17 and 19 tumors were T2-hypo-, iso- and hyper-intense, respectively. SSA treatment duration, cumulative and mean monthly doses were similar in the three groups. Patients with T2-hypo-intense adenomas had median SSA-induced decreases in GH and IGF-1 of 88% and 59% respectively, which were significantly greater than the decreases observed in the T2-iso- and hyper-intense groups (P < 0.001). Tumor shrinkage on SSA was also significantly greater in the T2-hypo-intense group (38%) compared with the T2-iso- and hyper-intense groups (8% and 3%, respectively; P < 0.0001). The response to SSA correlated with the calculated T2 intensity: the lower the T2-weighted intensity, the greater the decrease in random GH (P < 0.0001, r = 0.22), IGF-1 (P < 0.0001, r = 0.14) and adenoma volume (P < 0.0001, r = 0.33). The T2-weighted signal intensity of GH-secreting adenomas at diagnosis correlates with hormone reduction and tumor shrinkage in response to primary SSA treatment in acromegaly. This study supports its use as a generally available predictive tool at diagnosis that could help to guide subsequent treatment choices in acromegaly.

• MeSH
• adenom hypofýzy vylučující růstový hormon diagnóza   farmakoterapie   patologie   MeSH
• adenom diagnóza   farmakoterapie   patologie   sekrece   MeSH
• akromegalie diagnóza   farmakoterapie   metabolismus   patologie   MeSH
• insulinu podobný růstový faktor I metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidský růstový hormon metabolismus   MeSH
• magnetická rezonanční tomografie * metody   MeSH
• oktreotid terapeutické užití   MeSH
• prognóza MeSH
• somatostatin analogy a deriváty   MeSH
• tumor burden účinky léků   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

INTRODUCTION: We continuously look for new techniques to improve the radicality of resection and to eliminate the negative effects of surgery. One of the methods that has been implemented in the perioperative management of Cushing's disease was the combination of three magnetic resonance imaging (MRI) sequences: SE, SPGR and fSPGR. MATERIAL AND METHODS: We enrolled 41 patients (11 males, 30 females) diagnosed with Cushing's disease. A 3D tumour model with a navigation console was developed using each SPGR, fSPGR and SE sequence. The largest model was then used. In all cases, a standard four-handed, bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up evaluation using morning cortisol sampling was performed for 6-34 months in our study. RESULTS: In total, 36 patients (88%) were disease-free following surgery. Our results indicate we achieved 100% sensitivity of MR. Overall, the conformity of at least one donor site, as compared with the places designated on MR, was in 78% of patients. We searched the place of compliance in individual locations. There is a consensus in individual locations in 63 of the 123 cases (or 56%). The correlation gamma function at a 5% significance level was then 0.27. DISCUSSION: The combination of MR sequences (SE, SPGR, fSPGR), neuronavigation system and iMRI led to increased sensitivity of up to 100%. Specificity reached 56% in our study. CONCLUSION: We found a high success rate in surgical procedure in terms of the correlation between MR findings and histology, which leads to remission of Cushing's disease.

• MeSH
• dítě MeSH
• dospělí MeSH
• hypersekrece ACTH v hypofýze diagnostické zobrazování   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   normy   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• neuronavigace metody   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• transanální endoskopická chirurgie metody   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH