Nurperi Gazioglu1, Huseyin Canaz2, Mahmut Camlar3, Necmettin Tanrıöver4, Naci Kocer5, Civan Islak5, Olcay Evliyaoglu6, Oya Ercan6. 1. Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey. 2. Department of Neurosurgery, Istanbul Bilim University, Istanbul, Turkey. huseyin.canaz@istanbulbilim.edu.tr. 3. Department of Neurosurgery, Tepecik Research and Training Hospital, University of Health Sciences, Izmir, Turkey. 4. Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. 5. Department of Radiology, Division of Neuroradiology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey. 6. Pediatric Endocrinology and Adolescent Divisions, Department of Pediatrics, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
Abstract
AIM: Pituitary adenomas are rare in childhood in contrast with adults. Adrenocorticotropic hormone (ACTH)-secreting adenomas account for Cushing's disease (CD) which is the most common form of ACTH-dependent Cushing's syndrome (CS). Treatment strategies are generally based on data of adult CD patients, although some difficulties and differences exist in pediatric patients. The aim of this study is to share our experience of 10 children and adolescents with CD. PATIENTS AND METHOD: Medical records, images, and operative notes of 10 consecutive children and adolescents who underwent transsphenoidal surgery for CD between 1999 and 2014 in Cerrahpasa Faculty of Medicine were retrospectively reviewed. Mean age at operation was 14.8 ± 4.2 years (range 5-18). The mean length of symptoms was 24.2 months. The mean follow-up period was 11 years (range 4 to 19 years). RESULTS: Mean preoperative cortisol level was 23.435 μg/dl (range 8.81-59.8 μg/dl). Mean preoperative ACTH level was 57.358 μg/dl (range 28.9-139.9 μg/dl). MR images localized microadenoma in three patients (30%), macroadenoma in four patients (40%) in our series. Transsphenoidal microsurgery and endoscopic transsphenoidal surgery were performed in 8 and 2 patients respectively. Remission was provided in 8 patients (80%). Five patients (50%) met remission criteria after initial operations. Three patients (30%) underwent additional operations to meet remission criteria. CONCLUSION: Transsphenoidal surgery remains the mainstay therapy for CD in pediatric patients as well as adults. It is an effective treatment option with low rate of complications. Both endoscopic and microscopic approaches provide safe access to sella and satisfactory surgical results.
AIM: Pituitary adenomas are rare in childhood in contrast with adults. Adrenocorticotropic hormone (ACTH)-secreting adenomas account for Cushing's disease (CD) which is the most common form of ACTH-dependent Cushing's syndrome (CS). Treatment strategies are generally based on data of adult CDpatients, although some difficulties and differences exist in pediatric patients. The aim of this study is to share our experience of 10 children and adolescents with CD. PATIENTS AND METHOD: Medical records, images, and operative notes of 10 consecutive children and adolescents who underwent transsphenoidal surgery for CD between 1999 and 2014 in Cerrahpasa Faculty of Medicine were retrospectively reviewed. Mean age at operation was 14.8 ± 4.2 years (range 5-18). The mean length of symptoms was 24.2 months. The mean follow-up period was 11 years (range 4 to 19 years). RESULTS: Mean preoperative cortisol level was 23.435 μg/dl (range 8.81-59.8 μg/dl). Mean preoperative ACTH level was 57.358 μg/dl (range 28.9-139.9 μg/dl). MR images localized microadenoma in three patients (30%), macroadenoma in four patients (40%) in our series. Transsphenoidal microsurgery and endoscopic transsphenoidal surgery were performed in 8 and 2 patients respectively. Remission was provided in 8 patients (80%). Five patients (50%) met remission criteria after initial operations. Three patients (30%) underwent additional operations to meet remission criteria. CONCLUSION: Transsphenoidal surgery remains the mainstay therapy for CD in pediatric patients as well as adults. It is an effective treatment option with low rate of complications. Both endoscopic and microscopic approaches provide safe access to sella and satisfactory surgical results.
Authors: Katarzyna Pasternak-Pietrzak; Elżbieta Moszczyńska; Marcin Roszkowski; Karolina Kot; Elżbieta Marczak; Wiesława Grajkowska; Maciej Pronicki; Mieczysław Szalecki Journal: PLoS One Date: 2019-12-12 Impact factor: 3.240
Authors: Rosario Ferrigno; Valeria Hasenmajer; Silvana Caiulo; Marianna Minnetti; Paola Mazzotta; Helen L Storr; Andrea M Isidori; Ashley B Grossman; Maria Cristina De Martino; Martin O Savage Journal: Rev Endocr Metab Disord Date: 2021-01-30 Impact factor: 6.514