INTRODUCTION: Functioning pituitary adenomas lead to substantial morbidity and increased mortality associated with typical endocrine syndromes. Surgical therapy is an integral part of the management of these tumours. The aim of this study was to evaluate the results of surgical transnasal procedures in patients with functioning pituitary adenomas who underwent the surgery at the Department of Neurosurgery, University Hospital Olomouc. METHODS: Patients with functioning pituitary adenoma (ACTH, GH, PRL) were indicated for surgery. All patients underwent preoperative and postoperative endocrinological examination and laboratory tests to assess excessive or deficient hormonal production and imaging examination. RESULTS: The cohort consisted of 58 patients, 33 of whom were women and 25 men. The age range was 12-77 years (mean age 47.6 years). Microadenoma was diagnosed in 58.6% of patients and macroadenoma in 41.4% of patients. The most common hypersecretory syndrome was excessive production of growth hormone (56.9%), followed by excessive production of adrenocorticotropic hormone (24.1%) and prolactin (12.1%). In the group with excessive production of ACTH, complete remission was achieved after the first surgery in 78.6% of cases (72.8% for microadenomas (8) and 100% (3) cases in macroadenomas); in the group with excessive GH production in 51.4% (63.2% (7) in microadenomas and 46.2% (12) cases in macroadenomas). In the group with excessive production of PRL, it was 57.1% (100% (2) in microadenomas and 40% (2) cases in macroadenomas). CONCLUSION: Surgical therapy in the presented cohort led to the normalisation of hormonal excessive production in 58.6% of cases. A combination of drug therapy and radiotherapeutic methods was necessary in the remaining cases to achieve hormonal remission.

• MeSH
• Adenoma * surgery   MeSH
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pituitary Neoplasms * surgery   MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort. METHODS: The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications. RESULTS: Among 63 patients included in the study (median tumor volume: 1.5 cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10 Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63). CONCLUSION: SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.

• MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Pituitary Neoplasms * mortality   radiotherapy   secondary   MeSH
• Radiosurgery * adverse effects   methods   statistics & numerical data   MeSH
• Retrospective Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

Kromě hypogonadizmu jsou s mužskou sexuální dysfunkcí spojena i další endokrinní onemocnění. V našem článku se zabýváme úlohou hypofyzárního hormonu prolaktinu při mužských sexuálních dysfunkcích, zvláště pak při erektilní dysfunkci. Erektilní dysfunkce je u mužů s hyperprolaktinémií častá. Léčba této primární příčiny může ovlivnit normální erektilní funkci. V souboru našich pacientů došlo po léčbě hyperprolaktinémie (medikamentózní i operační) k normalizaci hladiny prolaktinu u všech léčených pacientů. Erektilní dysfunkce byla u všech mužů léčena některým typem inhibitoru 5 fosfodiesterázy – tedy sildenafilem, tadalafilem, vardenafilem, avanafilem. Po zaléčení primární příčiny erektilní dysfunkce pak došlo i ke zlepšení IIEF-5 (International Index of Erectile Function) skóre, a tedy i erektilní funkce všech našich pacientů.

In addition to hypogonadism, other endocrine dis­eases are associated with male sexual dysfunction. In this article, we review the role of the pituitary hormone prolactin in male sexual dysfunction, and in particular in erectile dysfunction. Erectile dysfunction is common in men with hyperprolactinemia. Treatment of this primary cause may affect normal erectile function. In our patient cohort, after treatment of hyperprolactinemia (medical and surgical), prolactin levels normalized in all treated patients. Erectile dysfunction in all men was treated with some type of phosphodiesterase 5 inhibitor - i.e. sildenafil, tadalafil, vardenafil, avanafil. After the treatment of the primary cause of erectile dysfunction, there was then also an improvement in IIEF-5 (International Index of Erectile Function) score and therefore erectile function in all our patients.

• MeSH
• Erectile Dysfunction etiology   therapy   MeSH
• Hyperprolactinemia * diagnosis   etiology   drug therapy   complications   MeSH
• Phosphodiesterase 5 Inhibitors therapeutic use   MeSH
• Humans MeSH
• Pituitary Neoplasms surgery   diagnosis   complications   MeSH
• Prolactin blood   MeSH
• Prolactinoma MeSH
• Check Tag
• Humans MeSH

BACKGROUND: We report four pediatric subjects with Cushing's disease (CD) diagnosed in the Czech Republic. We focus on initial symptoms of Cushing's syndrome (CS) which can lead to early diagnosis, on typical symptoms of CS in children, their age and sex distribution, the mean length of symptoms prior to diagnosis, indication for examination, post-cure growth, sexual development and pituitary function in our four CD patients after transsphenoidal pituitary surgery (TSS). We describe the diagnostic process leading to confirmation of CD and we emphasize the biochemical and radiological diagnostic difficulties. CONCLUSIONS: Pediatric CD has a number of features distinct from adult CD. Our retrospective analysis confirmed the presence of growth retardation and change in facial appearance with development of moon face as the first symptoms of CS. According to our observation, growth retardation is prior to development of moon face. The other typical symptoms frequently seen in pediatric patients are pseudo-precocious puberty in both sexes, hirsutism in pubertal girls due to excessive adrenal androgen secretion and pubertal delay. A corticotropin-releasing hormone (CRH) test and especially bilateral inferior petrosal sinus sampling for ACTH (BIPSS) contribute to confirming the diagnosis of CD and excluding ectopic ACTH syndrome in children with unvisible adenoma on pituitary magnetic resonance imaging (MRI).

• MeSH
• Diagnosis, Differential MeSH
• Child MeSH
• Adult MeSH
• Pituitary ACTH Hypersecretion * diagnosis   MeSH
• Humans MeSH
• Pituitary Neoplasms * MeSH
• Growth Disorders MeSH
• Retrospective Studies MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: A higher risk of secondary brain tumor, carotid stenosis, and stroke has been reported after conventional sella irradiation for pituitary neuroendocrine tumors (PitNET). Stereotactic radiosurgery (SRS), which is a more focused approach, is now increasingly used instead. The aim was to assess the risk of secondary brain tumor, carotid stenosis/occlusion, and stroke after SRS. METHODS: In this multicentric retrospective study, 2254 patients with PitNET were studied, 1377 in the exposed group, and 877 in the control group. RESULTS: There were 9840.1 patient-years at risk for the SRS and 5266.5 for the control group. The 15-year cumulative probability of secondary intracranial tumor was 2.3% (95% CI: 0.5%, 4.1%) for SRS and 3.7% (95% CI: 0%, 8.7%) for the control group (P = .6), with an incidence rate of 1.32 per 1000 and 0.95 per 1000, respectively. SRS was not associated with an increased risk of tumorigenesis when stratified by age (HR: 1.59 [95% CI: 0.57, 4.47], Pp = .38). The 15-year probability of new carotid stenosis/occlusion was 0.9% (95% CI: 0.2, 1.6) in the SRS and 2% (95% CI: 0, 4.4) in the control group (P = .8). The 15-year probability of stroke was 2.6% (95% CI: 0.6%, 4.6%) in the SRS and 11.1% (95% CI: 6%, 15.9%) in the control group (P < .001). In Cox multivariate analysis stratified by age, SRS (HR 1.85 [95% CI:0.64, 5.35], P = .26) was not associated with risk of new stroke. CONCLUSIONS: No increased risk of long-term secondary brain tumor, new stenosis or occlusion, and stroke was demonstrated in the SRS group compared to the control in this study with imaging surveillance.

• MeSH
• Stroke * etiology   epidemiology   MeSH
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pituitary Neoplasms * epidemiology   MeSH
• Brain Neoplasms epidemiology   etiology   MeSH
• Follow-Up Studies MeSH
• Prognosis MeSH
• Radiosurgery * adverse effects   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Neoplasms, Second Primary etiology   epidemiology   pathology   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Carotid Stenosis * etiology   epidemiology   MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections. METHODS: Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism. RESULTS: Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm 3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P -value = .004). CONCLUSION: For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection.

• MeSH
• Adenoma * surgery   radiotherapy   MeSH
• Adult MeSH
• Hypopituitarism MeSH
• Middle Aged MeSH
• Humans MeSH
• Pituitary Neoplasms * surgery   radiotherapy   MeSH
• Radiosurgery * methods   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

Nádory hypofýzy jsou běžné intrakraniální tumory dospělé populace. Naprostá většina nádorů hypofýzy je představována pituitárními neuroendokrinními tumory (PitNETy, dříve adenomy), které lze klasifikovat v závislosti na linii diferenciace nádorových buněk, jež odráží buněčné populace normální hypofýzy. Příslušnost k různým subpopulacím je řízena jedním či více transkripčními faktory (Pit1, Tpit, SF1 a GATA3), které regulují mimo jiné též hormonální produkci v normálních i nádorových buňkách hypofýzy. Tento přehledový článek v krátkosti z perspektivy diagnostické patologie shrnuje novinky ve WHO klasifikaci PitNETů a dále se zabývá vzácnějšími lézemi hypofýzy, jmenovitě kraniofaryngiomy, pituicytomy a sekundárními nádory sellární oblasti.

Pituitary tumors are common intracranial tumors in adults. Pituitary neuroendocrine tumors (PitNETs, formerly adenomas) represent a vast majority of pituitary lesions. These tumors can be classified according to the lineage of differentiation in tumor cells that corresponds to cellular subpopulations of normal pituitary. These cell lineages are determined by one or more transcription factors (Pit1, Tpit, SF1 and GATA3) that also regulate hormonal production in both normal pituitary cells and their neoplastic counterparts. This review article summarizes briefly current approach in histopathological diagnosis of PitNETs according to the latest WHO classification. Furthermore, rarer entities, including pituictyomas and craniopharyngiomas are discussed, as well as secondary tumors of sellar region.

• MeSH
• Histological Techniques MeSH
• Craniopharyngioma diagnosis   pathology   MeSH
• Humans MeSH
• Pituitary Neoplasms * diagnosis   pathology   MeSH
• Neuroendocrine Tumors MeSH
• Transcription Factors genetics   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

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.

• MeSH
• Adenoma * diagnostic imaging   MeSH
• Deep Learning MeSH
• Humans MeSH
• Pituitary Neoplasms * diagnostic imaging   MeSH
• Image Processing, Computer-Assisted methods   MeSH
• Radiomics MeSH
• Machine Learning MeSH
• Artificial Intelligence MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Systematic Review MeSH

• MeSH
• Bariatric Surgery methods   MeSH
• Energy Metabolism MeSH
• Hypoglycemic Agents pharmacology   classification   therapeutic use   MeSH
• Craniopharyngioma * diagnosis   complications   MeSH
• Humans MeSH
• Medication Therapy Management MeSH
• Hypothalamic Neoplasms diagnosis   classification   complications   MeSH
• Obesity * diagnosis   etiology   drug therapy   metabolism   MeSH
• Octreotide pharmacology   therapeutic use   MeSH
• Sleep Wake Disorders etiology   drug therapy   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

• MeSH
• Early Diagnosis MeSH
• Mental Disorders diagnosis   etiology   classification   MeSH
• Craniopharyngioma * diagnosis   complications   MeSH
• Humans MeSH
• Hypothalamic Neoplasms classification   complications   MeSH
• Neurology MeSH
• Oxytocin MeSH
• Signs and Symptoms * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH