• Journal of Korean Neurosurgical Society
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• 제44권3호
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• pp.151-155
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• 2008

Objective : Microscopic and endoscopic transsphenoidal approach (TSA) are major surgical techniques in the treatment of pituitary adenoma. Endoscopic endonasal transsphenoidal approach (EETSA) has been increasingly used for pituitary adenomas, however, its surgical outcome particularly in functioning pituitary adenoma has been debated. Here, we investigated the endocrine outcome of the patients with growth hormone (GH) and adrenocorticotropic hormone (ACTH) secreting pituitary adenoma treated by EETSA. Methods : We treated 80 patients with pituitary adenoma by EETSA since 2004, of which 12 patients were affected by functioning pituitary adenomas (9 GH, 3 ACTH, 0 PRL; 9 macro, 3 micro). Surgical outcome of those patients treated by EETSA was compared with that of the 11 functioning pituitary adenoma patients (8 GH, 3 ACTH; 8 macro, 3 micro) who underwent sublabial microscopic TSA between 1997 and 2003. Results : Imaging remission based on postoperative MRI was achieved in 8 (73%) and hormonal remission in 5 (45%) of 11 patients treated by sublabial microscopic TSA. Imaging remission was observed in 10 (83%, p=0.640) and hormonal remission in 10 (83%, p=0.081) of 12 patients by EETSA. CSF leakage was noticed in 2 (17%) of EETSA group and in 2 (18%) of sublabial microscopic TSA group. Panhypopituitarism was observed in 1 (9%) of EETSA group and in 3 (27%) of sublabial microscopic TSA group. Conclusion : EETSA appears to be an effective and safe method for the treatment of functioning pituitary adenomas.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.436-439
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• 2015

Small cell lung cancer (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of an inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH). This paraneoplastic syndrome is known to be a poor prognostic factor in SCLC. The reason for poor survival may be because of a higher risk of infection associated with hypercortisolemia. Therefore, early detection and appropriate treatment for this syndrome is necessary. But the diagnosis is challenging and the source of ACTH production can be difficult to identify. We report a 69-year-old male patient who had severe hypokalemia, metabolic alkalosis, and hypertension as manifestations of an ACTH-secreting small cell carcinoma of the lung. He was treated with ketoconazole and spironolactone to control the ACTH dependent Cushing syndrome. He survived for 15 months after chemotherapy, which is unusual considering the poor outcome of the ectopic ATH syndrome associated with SCLC.

• Radiation Oncology Journal
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• 제3권1호
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• pp.19-28
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• 1985

Twenty-four cases of pituitary adenoma, 13 males and 11 females with the age ranging from 11 to 65 years, received radiation therapy(RT) on the pituitary area with 6MV linear accelerator during past 25 months at the Division of Radiation Therapy, Kangnam St. Mary's Hospital, Catholic Medical College. Of 24 cases of RT, 20 were postoperative and 4 primary. To evaluate the effect of RT, we analysed the alteration of the endocrinologic tests, neurologic abnormalities, major clinical symptoms, endocrinologic changes and improvement in visual problems after RT. The results were as follows ; 1. Major clinical symptoms were headache, visual defects, diabetes insipidus, hypogonadisms and general weakness in decreasing order of frequency. 2. All but the one with Nelson's syndrome showed abnormal neuroradiologic changes in the sella turcica with an invasive tumor mass around supra· and para-sellar area. 3. Endocrinological classifications of the patient were 11 prolactinoma, 4 growth hormone -secreting tumors, 3 ACTH-secreting tumors consisting of one Cushing's disease and two Nelson's syndrome, and 6 nonfunctioning tumors. 4. Eleven of 14 patients, visual problems were improved after treatment but remaining 3 were unchanged. 5. Seven of 11 prolactinomas returned to normal hormonal level after postoperative and primary RT and 3 patients are being treated with bromocriptine (BMCP) but one lost case. 6. Two of 4 growth hormone·secreting tumor returned to normal level after RT but the remaining 2 are being treated with BMCP, as well.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.367-370
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• 2007

Objective: Pituitary adenomas are common neurological lesions believed to account for 10% to 15% of all primary brain tumors. There can be diagnostic confusion due to discordance of the preoperative endocrine and the postoperative immunohistochemical diagnosis. In this study, the rate of discordance between preoperative and postoperative findings and their clinical implications were investigated. Methods: From March 2005 to March 2006, 26 patients who underwent surgery for a pituitary adenoma were enrolled in this study. The preoperative pituitary hormone level and postoperative immunohistochemical results were compared and analyzed. Results: The median age of the patients was 38 years [range 15-66 years]. The male to female ratio was 8 to 18. The endocrine evaluation showed 16 hormonally-active and 10 hormonally-inactive adenomas. The immunohistochemical findings showed : 13 prolactin-positive, 1 GH-positive, 1 FSH-positive, 8 pleurihormone-positive and 3 stain-negative adenomas. The percentage of discordance observed between the preoperative endocrine and postoperative immunohistochemical diagnosis was 54%. Nine of 10 endocrine non-functioning adenomas showed : 3 PRL positive, 1 GH positive, 2 PRL+GH positive, 1 TSH+FSH positive, 1 FSH+ACTH+PRL positive and 1 FSH+LH+PRL positive adenomas by immunohistochemistry. Three endocrine PRL+GH secreting adenomas showed 2 PRL positive and 1 FSH+GH positive by immunohistochemistry. One endocrine PRL secreting and 1 GH secreting adenoma showed 1 PRL+ TSH positive and 1 GH+PRL positive by immunohistochemistry, respectively. The diagnosis of the other 12 pituitary adenomas showed concordance. Conclusion : The results of this study showed 54% discordance rate between the preoperative endocrine and postoperative immunohistochemical diagnosis for pituitary adenomas.

• Radiation Oncology Journal
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• 제9권2호
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• pp.185-195
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• 1991

가톨릭의대 강남성모병원 방사선치료실에서는 1983년 3월부터 1990년 4월 사이 7년여 동안에 뇌하수체선종으로 확진되었던 74명의 환자($7\~65$세, 평균 37세, 남:여=39:35)에 대하여 뇌하수체부위에 외부방사선치료를 하였다. 방사선치료는 6 MV 선형 가속기를 사용하여 선원중심축거리 80 cm, $4{\times}4{\times}4\~8{\times}8{\times}8cm^3$ 조사야로 3문조사하였다(180cGy/일, 5회/주, $20\~65$Gy). 5예에서는 정위다방향고선량단일조사($15\~25$ Gy/l회)를 실시하였다. 이 환자들의 수술전후 및 방사선치료 후에 복합뇌하수체자극검사를 실시하여 종양의 호르몬분비에 따른 분류와 방사선치료가 호르몬분비에 미치는 영향을 추적조사하였다. 호르몬분비에 따른 뇌하수체선종의 분류는 프로랙틴종 23예($29\%$), 성장호르몬분비종 20예($26\%$), 부신피질자극호르몬분비종 6예 ($8\%$) (쿠싱병 4예와 넬슨증후군 2예)였으며 4예 ($5\%$)에서는 프로랙틴과 성장호르몬을 동시에 분비하였다. 한편, 호르몬분비기능없는 종양이 29예($37\%$)였다. 23예의 프로랙틴종 중 15예 ($65\%$)와 20예의 성장호르몬분비종 중 3예 ($15\%$)에서는 방사선치료$2\~3$년 후 정상 호르몬 수치로 전환되었다. 부신피질자극호르몬분비종은 6예 중 1예를 제외한 전예에서 치료 후 모두 정상이되었다. 방사선치료에 따른 부작용으로서 범하수체기능저하증 및 갑상선기능저하증이 각각 7예($9\%$)씩 그리고 성선기능저하증 2예 ($3\%$) 등이 관찰되었다. 전예 중 15예 ($20\%$)에서는 정기적인 호르몬 추적검사를 실시하지 못하였다.

• Journal of Korean Neurosurgical Society
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• 제43권5호
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• pp.246-249
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• 2008

Cause of pituitary apoplexy has been known as hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or adjacent tissues of pituitary gland. However, pituitary apoplexy caused by pure infarction of pituitary adenoma has been rarely reported. Here, we present the two cases pituitary apoplexies caused by pituitary adenoma infarction that were confirmed by transsphenoidal approach (TSA) and pathologic reports. Pathologic report of first case revealed total tumor infarction of a nonfunctioning pituitary macroadenoma and second case partial tumor infarction of ACTH secreting pituitary macroadenoma. Patients with pituitary apoplexy which was caused by pituitary adenoma infarction unrelated to hemorrhage or hemorrhagic infarction showed good response to TSA treatment. Further study on the predisposing factors of pituitary apoplexy and the mechanism of infarction in pituitary adenoma is necessary.

• Journal of Korean Neurosurgical Society
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• 제30권5호
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• pp.611-621
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• 2001

Objective : We analyzed the clinical and endocrinological results of the transsphenoidal microsurgery for ACTH secreting pituitary adenomas. Marerials and Methods : From October 1995 to August 2000, 18 patients underwent transsphenoidal microsurgery for Cushing's disease. We analyzed the surgical results of 17 patients, one patient who was previously operated from other hospital was excluded. Age of the patients were 18 to 61 years old(mean 37.7), male to female ratio was 1 : 3.3, and follow-up period was 3 to 50 months(mean 20.3). The selection of candidates for transsphenoidal exploration was based on endocrinologic criteria. Magnetic resonance imaging was the preferred radiologic test. Selective inferior petrosal sinus sampling of adrenocorticotropic hormone futher refined the diagnosis when endocrinologic and radiologic procedures were not definitive. Results : Results of the preoperative endocrinological test were : level of serum ACTH 29.4 to $225{\mu}g/dL$(mean $93.88{\mu}g/dL$) ; serum cortisol 11.9 to $47.5{\mu}g/dL$(mean $27.49{\mu}g/dL$) ; 24-hour urine free cortisol 235 to $1019{\mu}g/day$(mean $571.0{\mu}g/day$). Inferior petrosal sinus sampling for ACTH was performed in 11 patients and all were confirmed by Cushing's disease and we could predict the laterality of the tumor in 9 of 11 patients. We performed transsphenoidal selective adenomectomy in 5 patients, adenomectomy and subtotal hypophysectomy in 2 patients, adenomectomy and partial hypophysectomy in 9 patients, and in the remaining one patient, hemihypophysectomy followed by total hypophysectomy due to remission failure. Fifteen of 17 patients(88.2%) showed endocrinological remission. Glucocorticoid replacement therapy was performed in all the patients who showed remission for 1 to 24 months(mean 5.9 months), and 6 patients received steroid over 6 months. Conclusion : We conclude that the direct demonstration of a tumor in the pituitary gland by MRI is the most important and definitive diagnostic tool and the location of a mass should be confirmed with increased level of ACTH by the inferior petrosal sinus sampling. Transsphenoidal microsurgery is effective treatment modality for Cushing's disease and the immediate postoperative evaluation of the surgical resection of the tumor is very important. The patients should show hypocortisolism, decreased, subnormal serum ACTH and cortisol levels and 24-hours urine free cortisol. We performed 18 transsphenoidal microsurgery for Cushing's disease in 17 patients and 15 patients(88.2%) showed endocrinological remission.

• 한국임상수의학회지
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• 제26권3호
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• pp.268-272
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• 2009

An-11-year-old male Shih-tzu was admitted to emergency care unit of Haemaru Referral Animal Hospital with signs of dyspnea, anuria and depression. There were abnormalities on complete blood count and serum chemistry included leukocytosis with mild left shift, mild azotemia, and increased ALT activity. Fluid therapy(0.9% saline, 40 ml/hr) and antibiotics were immediately initiated. The patient began to vomit after 5 hours' rest and pale mucous membrane, bradycardia, and hypertension were noted. Abdominal ultrasonography revealed enlarged left adrenal gland and thrombus in caudal vena cava(CVC). Result of ACTH stimulation test was normal. Cytology of ultrasound-guided FNA smears showed numerous naked nuclei, which was suggestive of adrenal medullar tumor. Concentrations of 24 hour urine metanephrine and normetanephrine was moderately increased compared to those of a control dog. Adrenal mass was surgically removed, and biopsy of the CVC mass was obtained. After surgery the patient began to recover but the dog acutely developed cardiopulmonary arrest and died. On histopathology the adrenal mass and biopsy of the CVC mass were consistent with pheochromocytoma. On electron microscopic view norepinephrine specific granules were found in the cytoplasm of tumor cells.