"Micromegaly": an update on the prevalence of acromegaly with apparently normal GH secretion in the modern era.

Purpose: Approximately 25 % of cases of clinically active acromegaly cases treated in our academic center between 1996 and 2000, were diagnosed in patients who had elevated plasma IGF-1 levels, but apparently "normal" 24-h mean plasma GH levels. The current study served to update the data for patients with acromegaly referred to our facility, after increasing awareness of this "normal" GH subpopulation throughout the medical community.

Methods: A retrospective chart review was conducted on 157 patients with acromegaly who underwent resection of a confirmed somatotroph pituitary adenoma at the University of Michigan Health System between the dates of 1 Jan 2001 to 23 Sept 2015.

Outcome of Transsphenoidal Surgery for Cushing Disease: A Single-Center Experience Over 32 Years.

Background: Transsphenoidal surgery is the standard approach for treating Cushing disease. Evidence is needed to document effectiveness.

Objective: To analyze results of transsphenoidal surgery in 276 consecutive patients, including 19 children.

Gene expression changes in subcutaneous adipose tissue due to Cushing's disease.

Glucocorticoids have major effects on adipose tissue metabolism. To study tissue mRNA expression changes induced by chronic elevated endogenous glucocorticoids, we performed RNA sequencing on the subcutaneous adipose tissue from patients with Cushing's disease (n=5) compared to patients with nonfunctioning pituitary adenomas (n=11). We found a higher expression of transcripts involved in several metabolic pathways, including lipogenesis, proteolysis and glucose oxidation as well as a decreased expression of transcripts involved in inflammation and protein synthesis.

Gene Expression Signature in Adipose Tissue of Acromegaly Patients.

To study the effect of chronic excess growth hormone on adipose tissue, we performed RNA sequencing in adipose tissue biopsies from patients with acromegaly (n = 7) or non-functioning pituitary adenomas (n = 11). The patients underwent clinical and metabolic profiling including assessment of HOMA-IR. Explants of adipose tissue were assayed ex vivo for lipolysis and ceramide levels.

Repeat endoscopic transsphenoidal surgery for acromegaly: remission and complications.

Reported biochemical remission rates following surgical intervention for acromegaly range from 38 to 83%. In patients not achieving surgical remission, few options remain, mostly limited to medical management and radiation therapy. There is debate over whether or not to offer reoperation to patients in whom surgical remission is not achieved with initial resection.

Prevalence and natural history of pineal cysts in adults.

Object: We reviewed our experience with pineal cysts to define the natural history and clinical relevance of this common intracranial finding.

Methods: The study population consisted of 48,417 consecutive patients who underwent brain MR imaging at a single institution over a 12-year interval and who were over 18 years of age at the time of imaging. Patient characteristics, including demographic data and other intracranial diagnoses, were collected from cases involving patients with a pineal cyst.

Clinical problem solving: monster on the hook--case problems in neurosurgery.

Background And Objective: Nonfunctioning and functioning pituitary tumors can present in numerous ways. They may be difficult to diagnose correctly and, even with proper treatment, may lead to complications.

Methods: We present the case of a patient who presented with a large, invasive sellar mass and underwent both medical and surgical treatment for this lesion.

Langerhans cell histiocytosis of the optic chiasm: case report.

Background And Importance: Langerhans cell histiocytosis (LCH) is an uncommon disease, usually affecting the cranium and peripheral bones. We present a rare case of isolated optic chiasm involvement by LCH to highlight the importance of considering LCH in the differential diagnosis of optic chiasm lesions.

Clinical Presentation: A 71-year-old woman presented with a 6-week history of worsening peripheral vision, headaches, weakness, cold sensitivity, and fatigue.

Dysphagia due to anterior cervical hyperosteophytosis.

Background: Anterior cervical hyperosteophytosis describes the excessive formation of osteophytes along the ventral spine. Dysphagia due to ACH is considered an uncommon entity described mainly in case reports. Symptomatic ACH has been attributed to multiple etiologies including DISH, trauma, postlaminectomy syndromes, and cervical spondylosis.

Intraoperative acquisition of three-dimensional imaging for frameless stereotactic guidance during transsphenoidal pituitary surgery using the Arcadis Orbic System.

Object: Intraoperative fluoroscopy has long been used for anatomical localization in transsphenoidal pituitary surgery. More recently, frameless stereotaxy has been used to supplement 2D sagittal radiographs with 3D multiplanar reconstructions. Use of Arcadis Orbic allows both conventional fluoroscopic views and multiplanar reconstructions to be acquired intraoperatively without need for preoperative planning studies.

Treatment of pituitary tumors: a surgical perspective.

Surgical intervention is a necessary part of a multimodal approach to pituitary lesions. This article summarizes the surgical approach to different neoplastic processes affecting the sellar region.

Changes in the utilization of spinal fusion in the United States.

Objective: Several reports suggest that spine surgery has experienced rapid growth in the past decade. Limited data exist, however, documenting the increase in spinal fusion. The objective of this work was to quantify and characterize the contemporary practice of spinal fusion in the United States.

The role of endogenous growth hormone-releasing hormone in acromegaly.

Context: Some indirect evidence suggests hypothalamic control of GH secretion in acromegaly.

Objective: The objective of the study is to examine whether GH secretion in acromegaly is dependent on endogenous GHRH.

Patients And Study Design: We studied eight patients with untreated acromegaly due to a GH-producing pituitary tumor.

Phase II study of 9-nitro-camptothecin in patients with advanced chordoma or soft tissue sarcoma.

Purpose: The purpose of this trial was to assess the objective clinical response, toxicity, and time to progression of treatment with 9-Nitro-Camptothecin (9-NC) in patients with advanced chordoma, soft tissue sarcoma (STS), and gastrointestinal stromal tumor (GIST).

Patients And Methods: Patients with locally advanced and/or metastatic chordoma, STS, or GIST received 9-NC 1.25 mg/m2 orally for 5 consecutive days followed by 2 days of rest.

Clinically silent somatotropinomas may be biochemically active.

The diagnosis of acromegaly is suspected based on the typical clinical presentation and is subsequently confirmed biochemically by elevated GH and IGF-I concentrations. We report three female patients with pituitary tumors who presented without any signs or symptoms of acromegaly but with elevated IGF-I levels. Plasma GH was measured every 10 min for 24 h, and an oral glucose tolerance test was performed.

The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas.

Objective: Radiotherapy after aggressive surgical resection of nonfunctional macroadenoma (NFA) of the pituitary remains controversial. Historically, immediate postoperative radiotherapy has been recommended to decrease risk of recurrence. With the availability of high-resolution imaging, most neurosurgeons now withhold radiation until recurrence.

Management options for persistent functional tumors.

This article describes in detail the current management of patients with functional pituitary tumors that demonstrate persistent function after surgical intervention. After providing a clear definition of "persistent function" for each specific type of tumor, the medical, surgical, and radiation options for each type are provided. Functional tumors include those that produce growth hormone, adrenocorticotrophic hormone, prolactin, and thyroid stimulating hormone.

Acromegaly with apparently normal GH secretion: implications for diagnosis and follow-up.

The biochemical diagnosis of acromegaly is conventionally based on elevated plasma GH levels that fail to suppress after an oral glucose load. We studied 16 newly diagnosed patients with acromegaly with normal mean plasma GH but elevated age and gender-adjusted plasma IGF-I concentrations (476 +/- 29 microg/liter, mean +/- SE). Plasma GH was sampled every 10 min for 24 h, and an oral glucose tolerance test was performed.

Localization of basic fibroblast growth factor (bFGFJ) protein and mRNA in human pituitaries: regulation of bFGF mRNA by gonadotropin-releasing hormone.

Distribution of basic fibroblast growth factor (bFGF) in non-neoplastic and adenomatous human pituitaries was analyzed by immunohistochemistry, in situ, and Northern hybridization analyses. Basic FGF protein and mRNA were present in most hormone-producing cells of the non-neoplastic pituitary and in all pituitary adenomas examined. Northern hybridization analysis revealed 7.

Corticotroph (Basophil) invasion of the pars nervosa in the human pituitary: Localization of proopiomelanocortin peptides, galanin and peptidylglycine α-amidating monooxygenase-like immunoreactivities.

Corticotroph (basophil) invasion or the migration of corticotroph cells into the pars nervosa of the human pituitary gland was found in 35 of 767 (4.4%) consecutive pituitaries obtained at autopsy. The degree of invasion increased with patient age and extensive invasion was more common in men than in women.