Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery
Purpose To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients. Methods Seventy-eight patients, newly diagnosed with acromegaly who underwent...
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| Veröffentlicht in: | Pituitary 2017-08, Vol.20 (4), p.403-408 |
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| creator | Sasagawa, Yasuo Hayashi, Yasuhiko Tachibana, Osamu Oishi, Masahiro Fukui, Issei Iizuka, Hideaki Nakada, Mitsutoshi |
| description | Purpose
To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients.
Methods
Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging.
Results
Twelve patients (15.4%), predominantly female (10 women,
p
= .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm,
p
= .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients
(p
= .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8
%, p
= .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7
%, p
= .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (
p
= .248).
Conclusions
Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear. |
| doi_str_mv | 10.1007/s11102-017-0798-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1872578161</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1918299054</sourcerecordid><originalsourceid>FETCH-LOGICAL-c416t-62d45d49b1dea755b0008d5f6ea506a014095e29b56baaf077b42a98ed88296f3</originalsourceid><addsrcrecordid>eNp1kU2LFDEQhoMo7of-AC8S8OKltSqdrz7KsLrCghcFbyGdTs9k6e60Sdpl_r0ZZhURPFWgnvetSr2EvEJ4hwDqfUZEYA2gakB1upFPyCUK1TaKQ_u0vlstm5bj9wtylfM9QFW1_Dm5YJq1LXK4JD93U1iCsxN1B5usKz6FXILLNI7UuhRnv7dTcHS1JfilZPoQyoH6eS1Hmv00WWqXgZaDD4nGrbgqyHSM0xQfwrKnJdkl5_XglxiGOiVvae_T8QV5Ntop-5eP9Zp8-3jzdXfb3H359Hn34a5xHGVpJBu4GHjX4-CtEqIHAD2IUXorQFqoX-iEZ10vZG_tCEr1nNlO-0Fr1smxvSZvz75rij82n4uZQ3antRcft2xQKyaURokVffMPeh-3tNTtDHZY7ToQvFJ4puppck5-NGsKs01Hg2BOoZhzKKaGYk6hGFk1rx-dt372wx_F7xQqwM5Arq2l3uev0f91_QU87Zkx</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1918299054</pqid></control><display><type>article</type><title>Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Sasagawa, Yasuo ; Hayashi, Yasuhiko ; Tachibana, Osamu ; Oishi, Masahiro ; Fukui, Issei ; Iizuka, Hideaki ; Nakada, Mitsutoshi</creator><creatorcontrib>Sasagawa, Yasuo ; Hayashi, Yasuhiko ; Tachibana, Osamu ; Oishi, Masahiro ; Fukui, Issei ; Iizuka, Hideaki ; Nakada, Mitsutoshi</creatorcontrib><description>Purpose
To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients.
Methods
Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging.
Results
Twelve patients (15.4%), predominantly female (10 women,
p
= .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm,
p
= .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients
(p
= .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8
%, p
= .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7
%, p
= .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (
p
= .248).
Conclusions
Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.</description><identifier>ISSN: 1386-341X</identifier><identifier>EISSN: 1573-7403</identifier><identifier>DOI: 10.1007/s11102-017-0798-6</identifier><identifier>PMID: 28233140</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Acromegaly ; Acromegaly - diagnostic imaging ; Acromegaly - surgery ; Adenoma ; Aged ; Cerebrospinal fluid ; Empty Sella Syndrome - diagnostic imaging ; Empty Sella Syndrome - surgery ; Endocrinology ; Female ; Human Physiology ; Humans ; Leakage ; Magnetic Resonance Imaging ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neurosurgical Procedures - methods ; Pituitary ; Remission ; Retrospective Studies ; Sphenoid Sinus - diagnostic imaging ; Sphenoid Sinus - surgery ; Subarachnoid space ; Surgery ; Tumors</subject><ispartof>Pituitary, 2017-08, Vol.20 (4), p.403-408</ispartof><rights>Springer Science+Business Media New York 2017</rights><rights>Pituitary is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-62d45d49b1dea755b0008d5f6ea506a014095e29b56baaf077b42a98ed88296f3</citedby><cites>FETCH-LOGICAL-c416t-62d45d49b1dea755b0008d5f6ea506a014095e29b56baaf077b42a98ed88296f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11102-017-0798-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11102-017-0798-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28233140$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sasagawa, Yasuo</creatorcontrib><creatorcontrib>Hayashi, Yasuhiko</creatorcontrib><creatorcontrib>Tachibana, Osamu</creatorcontrib><creatorcontrib>Oishi, Masahiro</creatorcontrib><creatorcontrib>Fukui, Issei</creatorcontrib><creatorcontrib>Iizuka, Hideaki</creatorcontrib><creatorcontrib>Nakada, Mitsutoshi</creatorcontrib><title>Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery</title><title>Pituitary</title><addtitle>Pituitary</addtitle><addtitle>Pituitary</addtitle><description>Purpose
To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients.
Methods
Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging.
Results
Twelve patients (15.4%), predominantly female (10 women,
p
= .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm,
p
= .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients
(p
= .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8
%, p
= .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7
%, p
= .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (
p
= .248).
Conclusions
Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.</description><subject>Acromegaly</subject><subject>Acromegaly - diagnostic imaging</subject><subject>Acromegaly - surgery</subject><subject>Adenoma</subject><subject>Aged</subject><subject>Cerebrospinal fluid</subject><subject>Empty Sella Syndrome - diagnostic imaging</subject><subject>Empty Sella Syndrome - surgery</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Leakage</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neurosurgical Procedures - methods</subject><subject>Pituitary</subject><subject>Remission</subject><subject>Retrospective Studies</subject><subject>Sphenoid Sinus - diagnostic imaging</subject><subject>Sphenoid Sinus - surgery</subject><subject>Subarachnoid space</subject><subject>Surgery</subject><subject>Tumors</subject><issn>1386-341X</issn><issn>1573-7403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU2LFDEQhoMo7of-AC8S8OKltSqdrz7KsLrCghcFbyGdTs9k6e60Sdpl_r0ZZhURPFWgnvetSr2EvEJ4hwDqfUZEYA2gakB1upFPyCUK1TaKQ_u0vlstm5bj9wtylfM9QFW1_Dm5YJq1LXK4JD93U1iCsxN1B5usKz6FXILLNI7UuhRnv7dTcHS1JfilZPoQyoH6eS1Hmv00WWqXgZaDD4nGrbgqyHSM0xQfwrKnJdkl5_XglxiGOiVvae_T8QV5Ntop-5eP9Zp8-3jzdXfb3H359Hn34a5xHGVpJBu4GHjX4-CtEqIHAD2IUXorQFqoX-iEZ10vZG_tCEr1nNlO-0Fr1smxvSZvz75rij82n4uZQ3antRcft2xQKyaURokVffMPeh-3tNTtDHZY7ToQvFJ4puppck5-NGsKs01Hg2BOoZhzKKaGYk6hGFk1rx-dt372wx_F7xQqwM5Arq2l3uev0f91_QU87Zkx</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Sasagawa, Yasuo</creator><creator>Hayashi, Yasuhiko</creator><creator>Tachibana, Osamu</creator><creator>Oishi, Masahiro</creator><creator>Fukui, Issei</creator><creator>Iizuka, Hideaki</creator><creator>Nakada, Mitsutoshi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery</title><author>Sasagawa, Yasuo ; Hayashi, Yasuhiko ; Tachibana, Osamu ; Oishi, Masahiro ; Fukui, Issei ; Iizuka, Hideaki ; Nakada, Mitsutoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-62d45d49b1dea755b0008d5f6ea506a014095e29b56baaf077b42a98ed88296f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acromegaly</topic><topic>Acromegaly - diagnostic imaging</topic><topic>Acromegaly - surgery</topic><topic>Adenoma</topic><topic>Aged</topic><topic>Cerebrospinal fluid</topic><topic>Empty Sella Syndrome - diagnostic imaging</topic><topic>Empty Sella Syndrome - surgery</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Leakage</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neurosurgical Procedures - methods</topic><topic>Pituitary</topic><topic>Remission</topic><topic>Retrospective Studies</topic><topic>Sphenoid Sinus - diagnostic imaging</topic><topic>Sphenoid Sinus - surgery</topic><topic>Subarachnoid space</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sasagawa, Yasuo</creatorcontrib><creatorcontrib>Hayashi, Yasuhiko</creatorcontrib><creatorcontrib>Tachibana, Osamu</creatorcontrib><creatorcontrib>Oishi, Masahiro</creatorcontrib><creatorcontrib>Fukui, Issei</creatorcontrib><creatorcontrib>Iizuka, Hideaki</creatorcontrib><creatorcontrib>Nakada, Mitsutoshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pituitary</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sasagawa, Yasuo</au><au>Hayashi, Yasuhiko</au><au>Tachibana, Osamu</au><au>Oishi, Masahiro</au><au>Fukui, Issei</au><au>Iizuka, Hideaki</au><au>Nakada, Mitsutoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery</atitle><jtitle>Pituitary</jtitle><stitle>Pituitary</stitle><addtitle>Pituitary</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>20</volume><issue>4</issue><spage>403</spage><epage>408</epage><pages>403-408</pages><issn>1386-341X</issn><eissn>1573-7403</eissn><abstract>Purpose
To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients.
Methods
Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging.
Results
Twelve patients (15.4%), predominantly female (10 women,
p
= .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm,
p
= .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients
(p
= .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8
%, p
= .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7
%, p
= .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (
p
= .248).
Conclusions
Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>28233140</pmid><doi>10.1007/s11102-017-0798-6</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Pituitary, 2017-08, Vol.20 (4), p.403-408 |
| issn | 1386-341X 1573-7403 |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Acromegaly Acromegaly - diagnostic imaging Acromegaly - surgery Adenoma Aged Cerebrospinal fluid Empty Sella Syndrome - diagnostic imaging Empty Sella Syndrome - surgery Endocrinology Female Human Physiology Humans Leakage Magnetic Resonance Imaging Male Medicine Medicine & Public Health Middle Aged Neurosurgical Procedures - methods Pituitary Remission Retrospective Studies Sphenoid Sinus - diagnostic imaging Sphenoid Sinus - surgery Subarachnoid space Surgery Tumors |
| title | Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery |
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