Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

Jackson A. Gondim, Joao Paulo C. Almeida, Lucas Alverne F. Albuquerque, Michele Schops, Erika Gomes, Tania Ferraz, Wladia Sobreira and Meissa T. Kretzmann

Pituitary

DOI: 10.1007/s11102-010-0280-1

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Abstract

The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

Keywords  Pituitary - Adenoma - Transphenoidal - Endoscopy - Complications

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From http://www.springerlink.com/content/56w8617572673332/

Overactive Adrenal Glands

Adrenal glands are small glands located just on top of a person’s kidneys. These glands are just one of the many glands found in the endocrine system. Sometimes, these glands generate excessive amounts of hormones such as androgenic steroids, corticosteroids and aldosterone. They are then referred to as overactive adrenal glands, a condition also called Cushing's syndrome.

Here are some of the most common signs and symptoms of overactive adrenal glands:
1. Weight gain
One of the primary signs of Cushing’s syndrome is weight gain. A common sign of this condition is your face becoming rounder or more moon-shaped. In some cases, there will also be obesity in the upper body, particularly the upper back and the midsection. You may also begin to gain fat around the neck area.

2. Fragility
While you may be generally gaining weight, you will also experience a general thinning in both your arms and legs. Your fragile skin means that you may bruise easily and be more prone to sores and infection. Healing of bites and wounds take longer than usual. Acne breakouts might occur more frequently.

Red or purple stretch marks tend to develop on your buttocks, stomach, breasts, arms and thighs. In response to overactive adrenal glands, you will also probably experience severe fatigue, feeling very weak and tired most of the time. You may also feel muscle and bone weakness.

3. Reproductive system irregularities
Secreting hormones is just one function of the adrenal glands. Cushing’s syndrome can affect the sexual life and reproductive systems of both men and women. There may be a lower sex drive between both genders. Men may feel a drop in libido, as well as a decrease in fertility.  Women, on the other hand, may experience either irregular menstruation periods or may even stop menstruating. Other women may grow excessive amounts of hair on both the legs and face.

4. Psychological signs
Some individuals with overactive adrenal glands display psychological signs and symptoms. Increased irritability, depression and anxiety are common emotions in people with this condition. These emotions may be displayed for no particular reason. This tends to be an effect of a hormonal imbalance that you are probably experiencing.

Treatment for overactive adrenal glands depends on several factors, including the person’s overall health and medical history.

At times, Cushing’s syndrome can be the result of various medical conditions, such as tumors that have grown on the adrenal or pituitary glands. Remember that the symptoms and signs of overactive adrenal glands vary per person, as well as by the extent to which the glands malfunction. Of course, these signs and symptoms may resemble other medical problems and conditions. It would be best to consult with a medical professional immediately.

 

From http://www.testcountry.org/4-signs-of-overactive-adrenal-glands.htm

Seven Lots of Dexamethasone Injection Recalled

Robert Lowes

Authors and Disclosures

December 27, 2010 — American Regent is voluntarily recalling 7 lots of dexamethasone sodium phosphate injection (USP 4 mg/mL, 30 mL multiple-dose vials) because some vials either contain particulates or have the potential to do so before their expiration dates, the US Food and Drug Administration (FDA) announced today.

A corticosteroid, dexamethasone is used to treat a wide variety of conditions such as severe allergic reactions, arthritis, blood diseases, certain cancers, and breathing disorders. Clinicians also use it to test for Cushing's syndrome and prevent nausea and vomiting in chemotherapy patients. The injectable form of the drug is used when a similar drug cannot be taken orally, or when a patient in a medical emergency needs a rapid response.

The recall pertains to the lots of the product listed in the table.

Table. Recalled Lots

Lot	Expiration Date (Month/Year)
8811	12/2010
9093	02/2011
9195	03/2011
9296	04/2011
9419	06/2011
9505	07/2011
9649	09/2011

American Regent issued the recall on December 20. Hospitals, infusion centers, clinics, and other healthcare facilities should not use any of the recalled lots but should instead quarantine them for return to the company. Anyone with questions about the return process or any other issue can call American Regent at 1-800-645-1706.

The company reminds clinicians that as a matter of standard practice, they should visually inspect parenteral drugs for particulate matter and discoloration before administration, whenever the solution or container permits.

More information about today's announcement is available on the FDA Web site.

To report adverse events related to injectable dexamethasone, contact MedWatch, the FDA's safety information and adverse event reporting program, by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to MedWatch, FDA, 5600 Fishers Lane, Rockville, Maryland 20852-9787.

From http://www.medscape.com/viewarticle/734851

Pegylated Long-Acting Human Growth Hormone Possesses a Promising Once-Weekly Treatment Profile, and Multiple Dosing Is Well Tolerated in Adult Patient

Esben Søndergaard, Marianne Klose, Mette Hansen, Birgit Sehested Hansen, Marianne Andersen, Ulla Feldt-Rasmussen, Torben Laursen, Michael Højby Rasmussen*, and Jens Sandahl Christiansen

Aarhus University Hospital (E.S., T.L., J.S.C.), DK-8000, Aarhus C, Denmark; Rigshospitalet (M.K., U.F.-R.), Copenhagen University, DK-2100, Copenhagen, Denmark; Odense University Hospital (M.H., M.A.), DK-5000, Odense, Denmark; and Global Development (B.S.H., M.H.R.), Novo Nordisk A/S, DK-2880 Bagsvaerd, Denmark

* To whom correspondence should be addressed. E-mail: mhr@novonordisk.com.

Background: Recombinant human GH (rhGH) replacement therapy in children and adults currently requires daily sc injections for several years or lifelong, which may be both inconvenient and distressing for patients. NNC126-0083 is a pegylated rhGH developed for once-weekly administration.

Objectives: Our objective was to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of multiple doses of NNC126-0083 in adult patients with GH deficiency (GHD).

Subjects and Methods: Thirty-three adult patients with GHD, age 20–65 yr, body mass index 18.5–35.0 kg/m2, and glycated hemoglobin of 8.0% or below. Fourteen days before randomization, subjects discontinued daily rhGH. NNC126-0083 (0.01, 0.02, 0.04, and 0.08 mg/kg) was given sc once weekly for 3 wk (NNC126-0083 for six subjects and placebo for two subjects). Blood samples were collected up to 168 h after the first and up to 240 h after the third dosing. Physical examination, antibodies, and local tolerability were assessed.

Results: NNC126-0083 was well tolerated with no difference in local tolerability compared with placebo and with no signs of lipoatrophy. A more than dose-proportional exposure was observed at the highest NNC126-0083 dose (0.16 mg protein/kg). Steady-state pharmacokinetics seemed achieved after the second dosing. A clear dose-dependent pharmacodynamic response in circulating IGF-I levels was observed [from a predose mean (SD) IGF-I SD score of -3.2 (1.7) to peak plasma concentration of -0.5 (1.3), 1.6 (1.3), 2.1 (0.5), and 4.4 (0.9) in the four dose groups, respectively].

Conclusion: After multiple dosing of NNC126-0083, a sustained pharmacodynamic response was observed. NNC126-0083 has the potential to serve as an efficacious, safe, and well-tolerated once-weekly treatment of adult patients with GHD.


From http://jcem.endojournals.org/cgi/content/abstract/jc.2010-1931v1

UK guidelines for the management of pituitary apoplexy

Authors: Rajasekaran, Senthil¹; Vanderpump, Mark²; Baldeweg, Stephanie³; Drake, Will⁴; Reddy, Narendra¹; Lanyon, Marian⁵; Markey, Andrew⁶; Plant, Gordon⁵; Powell, Michael⁷; Sinha, Saurabh⁸; Wass, John⁹

Source: Clinical Endocrinology, Volume 74, Number 1, January 2011 , pp. 9-20(12)

Publisher: Wiley-Blackwell

Abstract:

Summary

Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving. It is a clinical syndrome characterized by the sudden onset of headache, vomiting, visual impairment and decreased consciousness caused by haemorrhage and/or infarction of the pituitary gland. It is associated with the sudden onset of headache accompanied or not by neurological symptoms involving the second, third, fourth and sixth cranial nerves. If diagnosed patients should be referred to a multidisciplinary team comprising, amongst others, a neurosurgeon and an endocrinologist. Apart from patients with worsening neurological symptoms in whom surgery is indicated, it is unclear currently for the majority of patients whether conservative or surgical management carries the best outcome. Post apoplexy, there needs to be careful monitoring for recurrence of tumour growth. It is suggested that further trials be carried out into the management of pituitary apoplexy to optimize treatment.

Document Type: Research article

DOI: 10.1111/j.1365-2265.2010.03913.x

Affiliations: 1: Churchill Hospital, Oxford 2: Royal Free Hospital, London 3: University College Hospital, London and Trustee and member of the Medical Committee -The Pituitary Foundation 4: St. Bartholomew's Hospital, London and Society for Endocrinology 5: University College Hospital, London 6: The Lister Hospital, London 7: National Hospital for Neurology, London and Society of British Neurosurgeons 8: Royal Hallamshire Hospital, Sheffield 9: Churchill Hospital, Oxford and Royal College of Physicians

From http://www.ingentaconnect.com/content/bsc/cend/2011/00000074/00000001/art00002

Happy Holidays!

 

No matter what your beliefs may be,
we wish the very best holiday season,
full of family, friends and better health.

Help Give Back to Cushing’s Help – At No Cost to You!

From iGive.com:

We're celebrating with a challenge for Cushings Help!

What are we celebrating?
    1) The end of a tough year;
    2) Our web search is new and improved (using Microsoft Bing) and;
    3) iGive members have helped donate over $5,000,000 to causes so far.

You are invited to participate in our celebration --  it's free and definitely easy.

Here's the challenge:

iGive.com is going to attempt to donate $5,000 in just 27 hours to Cushings Help and other causes.

For each person who joins iGive using the special link below and does just one qualified web search on our site between Thursday at 9.a.m. CST and 12:00 Noon CST Friday, we'll give Cushings Help a dollar. 5,000 new members, $5,000 donated.  No purchase necessary.

 

Of course, if they search more (or buy something) they'll earn even more money for Cushings Help.  Right now, we're donating $.02 per search and a bonus $5 for a new member's first purchase (plus the usual percentage).

Here's where you come in.  The only way Cushings Help will get new supporters and that free $1 (or more) is if they're invited.  Send your supporters, friends, family, and colleagues the following link in an e-mail, tweet it, chirp it, do a Facebook posting, put up posters, shout from mountain tops (you know the drill) and let the world know you think Cushings Help is pretty cool and deserves their support, especially since it's free!  You can even just forward this e-mail.

This is the link:

http://www.igive.com/welcome/warm_reg_promo.cfm?c=17825

We're really proud of our improved search capability, powered by Bing.  We want lots of people to try it out and see if they like it as much as we do.  If they keep on searching or shopping after checking us out, so much the better for Cushings Help and iGive.com.

The details:

• Offer active between 9 a.m. Thursday, December 9, 2010 and 11:59 a.m., Friday, December 10, 2010 (Chicago time).
  
• New members only (never have been an iGive member previously).  All the normal rules of membership, searching, and  purchasing apply, our site has the details. 
  
• Real people only, who sign themselves up. (It's not fair to hire a room full of elves who sign people up, the new member has to sign him or herself up.)
  
• Once we've given away $5,000, the offer ends.  That's $5,000 to all causes, not just yours, so it's a bit of a race.
  
• The special link is important.  No link, no $1.
  
• A web search is a search from the WEB tab on our site.  Qualified searches are explained on our site, but basically means NOT a search for a store or a site name.

Thanks so much for reading and helping out!