Lack of effect of a gonadotropin-releasing hormone agonist in a patient with prostate cancer and a gonadotroph adenoma.
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Adenoma↗
Biomedical subjects
K D Post
Publications and source records attributed to K D Post.
Symptoms of pituitary apoplexy rapidly reversed with bromocriptine. Case report.
Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.
Adult↗
Elimination of tinnitus following hearing preservation surgery for acoustic neuromas.
Fifty-one consecutive patients undergoing hearing preservation surgery for acoustic neuromas were evaluated with regard to tinnitus and level of hearing. In 25 patients, hearing was not preserved. In this group, postoperative tinnitus was present in 8 of 13 patients who noted this symptom preoperatively. Four of the remaining 12 patients developed tinnitus following surgery. In 26 patients, useful hearing was preserved (speech reception threshold < 50 dB, speech discrimination score > 60%). Although 10 patients in this group complained of tinnitus preoperatively, only 4 patients noted it following surgery. None of the 16 remaining patients in this group developed tinnitus postoperatively. Overall, only 50% (12/23) of patients who had tinnitus preoperatively complained of it postoperatively, and only 8% (4/51) developed tinnitus as a result of surgery. Our results show that new-onset tinnitus is uncommon following hearing preservation surgery for acoustic neuroma and that it can be reduced or eliminated following surgery, especially if useful hearing is preserved.
Adult↗
Preoperative facial nerve studies predict paresis following cerebellopontine angle surgery.
Facial paresis or paralysis following resection of cerebellopontine angle tumors can occur despite intraoperative cranial nerve monitoring. In an attempt to identify preoperatively those patients at greatest risk for postoperative facial nerve dysfunction, we have prospectively evaluated 30 patients with clinically normal facial function using preoperative facial nerve conduction, electromyography, and the blink reflex. Surgical approach, tumor size, tumor histology, and postoperative facial nerve function were correlated with the preoperative electrophysiologic data to determine the utility of preoperative facial nerve tests as predictors of postoperative facial nerve function. Nineteen patients (Group 1) had normal preoperative facial nerve studies, while 11 patients (Group 2) had abnormal results. Fourteen patients in Group 1 were Grade I immediately after surgery, and five were Grade II. All 19 patients were Grade 1 at 6 months. The 11 patients in Group 2 had immediate postoperative facial nerve function graded as follows: I, three patients; II, five patients; III, one patient; VI, two patients. After 6 months, facial nerve function was graded as follows: I, six patients; II, two patients; III, one patient; VI, two patients. The blink reflex was the single most accurate predictor of facial nerve involvement preoperatively.
Adult↗
Prevention of headache after retrosigmoid removal of acoustic tumors.
OBJECTIVE: To demonstrate a causal relationship between bone dust and the development of headache after retrosigmoid removal of acoustic neuromas. STUDY DESIGN: The study design was both retrospective (group I) and prospective (groups 2 and 3). SETTING: Tertiary Care Referral Center/Outpatient Data Collection. PATIENTS: Eighty-four consecutive patients underwent surgery at the Mount Sinai Medical Center in New York by the same surgical team. INTERVENTION: All patients underwent retrosigmoid removal of acoustic neuromas via the following methods: group 1, standard excision; group 2, excision and cranioplasty; group 3, excision, cranioplasty, and residue trapping. MAIN OUTCOME MEASURE: Presence or absence of postoperative headache. RESULTS: In all, 43 patients (51%) reported postoperative headache. By groups, headache incidence was 64% for group 1 (43% grade 3-4), 81% for group 2 (37% grade 3-4), and 10% (all grade 1) for group 3. Differences with respect to headache incidence and severity were statically significant between groups 1 and 3, and between groups 2 and 3 (p < 0.001). CONCLUSIONS: Free circulation of bone dust into the posterior fossa during intradural drilling of the internal auditory canal may be the most important factor in the development of headache after this surgical procedure.
Adolescent↗
Detection of polyomaviral DNA sequences in normal and adenomatous human pituitary tissues using the polymerase chain reaction.
BACKGROUND: Tumor viruses are known to have a role in the pathogenesis of many types of benign and malignant human tumors. The possible roles of these viruses in the development of human pituitary tumors have not been investigated. METHODS: The polymerase chain reaction was used to screen human pituitary tumors for human papillomaviral (HPV) and Polyomaviral DNA sequences. Sets of consensus primers, which are capable of amplifying HPV Types 16, 18, and 33 and polyomavirus BK, JC, and SV40, were used in these experiments. RESULTS: Amplification products were not detected using HPV consensus primers in 30 tumors. Twenty-six of 30 tumors demonstrated an amplification product with polyomaviral primers that hybridized to SV40 and BK internal probes and was confirmed to be SV40 in one tumor by direct sequencing. Ten normal postmortem pituitary samples then were examined similarly with Polyomaviral consensus primers; 8 of 10 normal samples demonstrated a similar amplification product that also hybridized with SV40 and BK internal probes by Southern blotting. Polyomaviral DNA sequences in normal and tumor samples were not present at levels detectable by genomic Southern blotting. Expressed viral protein (large T antigen) was not demonstrated in positive samples by Western blot analysis. CONCLUSIONS: These findings, that polyomaviral DNA sequences are detectable at low levels in certain normal tissues, are in agreement with those of other groups and, to the authors' knowledge, serve as the first report of polyomaviral latency in human pituitary tissue. A role for polyomaviruses in pituitary tumorigenesis could not be established in this analysis.
Adenoma↗
Differential diagnosis in cushing syndrome. Use of corticotropin-releasing hormone.
Testing with ovine corticotropin-releasing hormone (CRH) has facilitated the differential diagnosis of Cushing syndrome, which is often not straightforward. We provide our experience between January 1989 and August 1993 with 30 patients with Cushing syndrome and describe 4 cases in detail to illustrate how CRH testing can be successfully applied to some of the difficulties encountered in the evaluation. CRH testing proved to be particularly useful in distinguishing cases of Cushing syndrome of adrenal etiology from those of Cushing disease with low or undetectable adrenocorticotropin (ACTH) levels. CRH testing during petrosal sinus sampling was also found to help distinguish the ectopic ACTH syndrome from pituitary-dependent Cushing syndrome. Our cases illustrate the need for careful biochemical evaluation before proceeding to imaging studies. Using CRH testing to evaluate cases of Cushing syndrome in which standard testing was inconclusive can provide useful information and lead to a more rapid determination of etiology and definitive therapy than previously possible.
ACTH Syndrome, Ectopic↗
Symptomatic cavernous malformations affecting the spine and spinal cord.
Ten cases of symptomatic cavernous malformations affecting the spine and spinal cord were retrospectively reviewed. The cases display a spectrum of pathological findings involving the vertebral body, vertebral body with epidural extension, epidural space without bony involvement, intradural extramedullary space, and intramedullary lesions. Lesions at all locations are identical histologically, electron microscopically, and immunohistochemically. This perspective, in which cavernous malformations are envisioned as a single entity arising at numerous locations, runs contrary to the view found in the neurosurgical literature. In most discussions of cavernous malformations, vertebral body lesions are depicted as separate entities from intradural lesions. Cavernous malformations, also called cavernous hemangiomas, are developmental vascular hamartomas that, by definition, do not grow by mitotic activity. Yet, the expansion of these lesions is well documented both in the literature and among our cases. The therapeutic modalities used in our series included observation, embolization, radiation, and surgical resection alone or in combination. All modalities are effective but must be tailored to the specific needs and condition of the patient. The embryology, methods of treatment, and proposed mechanisms of growth, plus similarities and differences between cavernous malformations at each location, are reviewed. Analogies between spinal and intracranial lesions are presented. On the basis of this series and a review of the literature, we conclude that cavernous malformations represent a single entity regardless of location. Segregation based on location, as is prevalent throughout the neurosurgical literature, hinders an overall understanding of these lesions. Cavernous malformations are more appropriately viewed as a single pathological entity arising in a multitude of locations. The difficulties encountered when managing cavernous malformations at various locations are unique to the location and not the lesion.
Adult↗
Hearing preservation in vestibular schwannoma surgery: what factors influence outcome?
The goals in the management of patients with vestibular schwannomas have changed drastically over the past few decades, with preservation of useful hearing representing the newest challenge. The true incidence of preserved useful hearing, however, has become clouded by a lack of uniformity in reporting results. The authors have analyzed 56 consecutive cases, in which directed attempts were made to preserve hearing on the involved side, to understand what factors play a major role in postoperative hearing preservation. Of the 56 cases reviewed, there were 46 patients who had "good" preoperative hearing (pure tone average < 50 dB; speech discrimination score > 50%). We found that, in this group of patients, if the tumor was less than 2 cm in diameter from pons to petrous, there was a 52% (16 of 31 patients) chance of preserving good hearing and if the tumor was 1 cm or less, the chances increased to 83%. Factors such as preoperative hearing status, tumor size and location, tumor consistency, and preoperative and intraoperative brainstem auditory evoked potentials are discussed in detail as they relate to postoperative outcome.
Adult↗
Loss of heterozygosity at the retinoblastoma locus in human pituitary tumors.
BACKGROUND: Recent studies using knockouts of the Retinoblastoma (Rb) gene by homologous recombination in transgenic mice have revealed that a high frequency of heterozygous animals develop pituitary tumors associated with loss of heterozygosity (LOH) at the Rb locus. The authors have determined the frequency of LOH at the Rb locus in 42 benign human pituitary tumors. METHODS: Polymerase chain reaction- (PCR) amplification of polymorphic regions in introns 17 and 20 of the human Rb gene was used to detect heterozygosity in pituitary tumor DNA and matched control DNA samples. RESULTS: The PCR assay was informative in 42 of 48 pituitary tumors examined, and no allelic deletion of Rb was detected in any of the tumors. CONCLUSIONS: These studies confirmed a recent report that LOH at the Rb locus is rare in benign human pituitary tumors.
Base Sequence↗
Cervical transdural intramedullary migration of a sublaminar wire. A complication of cervical fixation.
Wire breakage after a cervical occiput to C2 wire fixation and fusion resulted in the transdural and intramedullary migration of a wire fragment in a patient who remained neurologically intact. The risks of sublaminar wiring fixation are discussed, along with newer techniques for posterior cervical stabilization.
Adult↗
Craniofacial resection. An analysis of 73 cases.
OBJECTIVE: To determine the morbidity and mortality associated with a large series of patients undergoing craniofacial resection at one institution. The series is also analyzed with respect to pathology, disease recurrence, and role of adjuvant therapy. DESIGN: Retrospective review with a mean follow-up of 3 years (range, 6 months to 8 years). SETTING: Tertiary care, urban referral center. PATIENTS: The study included 73 consecutive patients (39 male and 34 female). Ages ranged from 13 to 78 years with a mean of 53.1 years. All patients had benign or malignant tumors of the paranasal sinuses. MAIN OUTCOME MEASURES: Morbidity associated with craniofacial resection was categorized as follows: early (within 30 days of surgery) or late (> 30 days); neurologic, ocular, or infectious. RESULTS: Overall morbidity rate was 63%, and the mortality rate was 2.7%. Of the patients who had complications develop, 26 had development of major morbidities and there were two mortalities. The most common complications were transient alteration in mental status (15 patients), diplopia (11 patients), cerebrospinal fluid leak (10 patients), and osteomyelitis of the frontal bone flap (eight patients). CONCLUSIONS: Craniofacial resection is an effective surgical treatment for paranasal sinus tumors. The mortality rate is acceptable and morbidity appears directly related to experience with the procedure. Infectious complications were the most devastating.
Adolescent↗
Abnormal coagulation profile in brain tumor patients during surgery.
Neurosurgical patients are at high risk for the development of thrombosis and thromboembolism. We compared the perioperative clotting factor and coagulation parameters of 20 patients undergoing elective craniotomy for brain tumors to those of 20 patients undergoing elective abdominal surgery. We also measured the levels of plasma arginine vasopressin to determine if changes in this hormone might be associated with changes in clotting factors, activated partial thromboplastin times, or bleeding times. The results demonstrated a significant reduction in partial thromboplastin times and bleeding times in the neurosurgery group, which began at the initiation of surgery and lasted to the end of the study (12 h postoperatively). Elevations in factor assays and plasma arginine vasopressin occurred in both groups during surgery, but there were no differences between the neurosurgical and abdominal surgical patients, except with Factor IX levels, which were elevated only in the neurosurgical patients. Serum osmolality and hemoglobin levels were significantly higher in the neurosurgical cohort. These results suggest that there are hemostatic differences between neurosurgical patients with brain tumors and abdominal surgery patients that cannot be explained solely by elevations in plasma arginine vasopressin or the clotting factors measured; these differences may be the consequence of perioperative variables such as dehydration and hyperosmolality.
Adult↗
Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives?
Cystic epithelial lesions of the sellar and parasellar region are classified on the basis of histology and location into Rathke's cleft cysts, epithelial cysts, epidermoid cysts, dermoid cysts, and craniopharyngiomas. A retrospective review of the clinical presentation, radiological findings, and histology was performed on 19 such lesions, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of these lesions was conducted. Presentation was nonspecific and not predictive of histology. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. On microscopic examination, most lesions fit into distinct categories; however, overlap was common among all and some could not be definitively categorized by histological criteria. Evidence supportive of an ectodermal ancestry for sellar and parasellar epithelial-lined cystic lesions is presented. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions.
Adolescent↗
Complications of cervical disk surgery.
The common complications of cervical disk surgery using the posterior and the anterior approach are discussed. The advantages and disadvantages of diskectomy with and without fusion are also presented. Complications of cervical disk surgery are a function of the type of procedure, the specific anatomic approach, and the experience of the surgeon. Although the posterior approach may be used for posterolateral or lateral herniated disks and foramenal osteophytes, the anterior approach is safer for central herniated disks and osteophyte formation. At The Mount Sinai Hospital, anterior-approach cervical diskectomy, whether with or without fusion, is preferred to the posterior approach for all herniations.
Cervical Vertebrae↗
Reversible dementia due to macroprolactinoma. Case report.
Subfrontal tumors are an infrequent cause of dementia. Most of those that do cause dementia are meningiomas, and the symptoms may recede when the tumor is resected. A patient with a huge prolactinoma who came to medical attention because of dementia is described. The tumor shrank dramatically after bromocriptine therapy and the patient's mental status returned to normal.
Behavior↗
Comparison of long term results between prolactin secreting adenomas and ACTH secreting adenomas.
A series of 100 prolactin secreting pituitary adenomas was reviewed and demonstrated an early cure rate of 85.2% with a cure rate of 89% if prolactin was less than 200 ng/ml. For macroadenomas the cure rate was 50% giving an overall cure rate of 71% for the entire group. When long term (greater than 5 years) followup was obtained a 17% incidence of recurrence was noted for the microadenoma group with a 20% recurrence rate for the macroadenoma group. Secretory dynamic studies were done shortly after surgery and then after a delay. Many showed a return to normal prolactin secretory dynamic suggesting that the underlying hypothalamic regulation is normal in most patients. Abnormal secretory dynamics at 6 weeks post operative testing were not predictive of which patients would relapse as many patients who had abnormal dynamics early did not relapse even during prolonged followup. Conversely a normal response to provocative testing did not preclude late relapse. A similar series of 40 consecutive patients with Cushing's disease was reviewed. Tumor was found in all but three cases. 84% of patients were cured and thus far only one patient (2.5%) has shown late recurrence with this occurring at 6 2/3 years following surgery with normal stimulatory dynamics present for five years. The implication is that hypothalamic regulation is normal in Cushing's disease as well. The differences in recurrence rates may be reflective of the aggressiveness with which one disease is treated, with the acceptance of a higher incidence of hypopituitarism as a consequence of more radical surgery for Cushing's disease.
Adenoma↗
Pituitary hemorrhage into a Rathke's cleft cyst.
This report describes a case of symptomatic pituitary hemorrhage into a Rathke's cleft cyst in a 25-year-old woman. The literature on pituitary hemorrhage in nonadenomatous sellar tumors is reviewed.
Adult↗