Long-term follow-up for ectopic ACTH-secreting pituitary adenoma in a single tertiary medical center and a literature review.
Ectopic ACTH-secreting pituitary adenomas
Endocrine similarity
Locations
Journal
Pituitary
ISSN: 1573-7403
Titre abrégé: Pituitary
Pays: United States
ID NLM: 9814578
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
pubmed:
16
12
2019
medline:
24
11
2020
entrez:
16
12
2019
Statut:
ppublish
Résumé
Ectopic ACTH-secreting pituitary adenoma (EAPA) are a rare cause of Cushing's disease. Due to the lack of consensus and experience in terms of the diagnosis and treatment of EAPAs, preoperative identification and optimal treatment remain challenging. To investigate the characteristics of EAPAs and offer some proposals for the diagnosis and management of this uncommon disease, the EAPA patients admitted to our center and all of the EAPA cases reported in the literature were reviewed. In a retrospective electronic medical chart review, 6 patients (0.39%) with EAPAs were identified from 1536 consecutive patients who were admitted to our hospital with a diagnosis of Cushing's syndrome between January 2000 and August 2019. A literature review was performed on the online databases PubMed and EMBASE, and 52 cases conformed to the criteria. The data regarding biochemical tests, imaging examinations and follow-ups were analyzed. The mean age of patients with EAPAs was 37.7 years old, and an obvious female predominance (3.5: 1) was demonstrated. The most common location of EAPAs was the cavernous sinus (34.5%), followed by the sphenoid sinus (31.0%) and the suprasellar region (20.7%). No significant differences in the biochemical test results were found among tumors in different locations. Except for sex, no risk factors related to remission were found. Although no significant differences among different locations were found, the tumors in the cavernous sinus had a relatively higher rate of invisibility in terms of imaging and a higher non-remission rate than tumors in other locations. In patients with negative intrasellar findings, the uncommon disease of EAPA should be considered. Due to the endocrine similarity between intrasellar pituitary corticotrophin adenoma and EAPA, the preoperative identification of EAPA depends on a careful review of the imaging examinations. Locations such as the cavernous sinus, sphenoid sinus and suprasellar region should be considered first. Tumor resection is recommended when the diagnosis is confirmed.
Sections du résumé
BACKGROUND
BACKGROUND
Ectopic ACTH-secreting pituitary adenoma (EAPA) are a rare cause of Cushing's disease. Due to the lack of consensus and experience in terms of the diagnosis and treatment of EAPAs, preoperative identification and optimal treatment remain challenging.
PURPOSE
OBJECTIVE
To investigate the characteristics of EAPAs and offer some proposals for the diagnosis and management of this uncommon disease, the EAPA patients admitted to our center and all of the EAPA cases reported in the literature were reviewed.
METHODS
METHODS
In a retrospective electronic medical chart review, 6 patients (0.39%) with EAPAs were identified from 1536 consecutive patients who were admitted to our hospital with a diagnosis of Cushing's syndrome between January 2000 and August 2019. A literature review was performed on the online databases PubMed and EMBASE, and 52 cases conformed to the criteria. The data regarding biochemical tests, imaging examinations and follow-ups were analyzed.
RESULTS
RESULTS
The mean age of patients with EAPAs was 37.7 years old, and an obvious female predominance (3.5: 1) was demonstrated. The most common location of EAPAs was the cavernous sinus (34.5%), followed by the sphenoid sinus (31.0%) and the suprasellar region (20.7%). No significant differences in the biochemical test results were found among tumors in different locations. Except for sex, no risk factors related to remission were found. Although no significant differences among different locations were found, the tumors in the cavernous sinus had a relatively higher rate of invisibility in terms of imaging and a higher non-remission rate than tumors in other locations.
CONCLUSIONS
CONCLUSIONS
In patients with negative intrasellar findings, the uncommon disease of EAPA should be considered. Due to the endocrine similarity between intrasellar pituitary corticotrophin adenoma and EAPA, the preoperative identification of EAPA depends on a careful review of the imaging examinations. Locations such as the cavernous sinus, sphenoid sinus and suprasellar region should be considered first. Tumor resection is recommended when the diagnosis is confirmed.
Identifiants
pubmed: 31838612
doi: 10.1007/s11102-019-01017-y
pii: 10.1007/s11102-019-01017-y
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
149-159Subventions
Organisme : CAMS Innovation Fund for Medical Science
ID : CAMS-2016-I2M-1-002
Organisme : The National Key Research and Development Program of China
ID : 2016YFC0901501
Références
Handb Clin Neurol. 2014;124:221-34
pubmed: 25248590
Rom J Morphol Embryol. 2017;58(4):1447-1451
pubmed: 29556639
Neurosurg Focus. 2015 Feb;38(2):E10
pubmed: 25639312
Neurosurgery. 1987 Aug;21(2):223-7
pubmed: 2821448
JAMA. 1981 Dec 11;246(23):2722-4
pubmed: 6273604
J Neurol Surg B Skull Base. 2017 Apr;78(2):120-124
pubmed: 28321374
Endocrine. 2014 Dec;47(3):717-24
pubmed: 24927792
J Neurosurg. 1995 Dec;83(6):1092-4
pubmed: 7490628
Clin Endocrinol (Oxf). 1999 Dec;51(6):809-14
pubmed: 10619988
J Clin Endocrinol Metab. 2008 Jul;93(7):2454-62
pubmed: 18413427
Neurol Med Chir (Tokyo). 2004 Jul;44(7):380-5
pubmed: 15347217
J Neurosurg. 1975 Oct;43(4):437-9
pubmed: 1159481
J Clin Endocrinol Metab. 1999 Aug;84(8):2912-23
pubmed: 10443699
Neurol Med Chir (Tokyo). 2012;52(2):91-5
pubmed: 22362291
Exp Clin Endocrinol Diabetes. 2012 Feb;120(2):63-7
pubmed: 22187295
Pituitary. 2011 Sep;14(3):295-8
pubmed: 19051038
Eur J Endocrinol. 2011 Sep;165(3):383-92
pubmed: 21715416
Nat Clin Pract Endocrinol Metab. 2009 Mar;5(3):174-9
pubmed: 19107133
JAMA. 2017 Feb 7;317(5):516-524
pubmed: 28170483
Pituitary. 2015 Apr;18(2):279-82
pubmed: 25129688
Neurosurgery. 2002 Mar;50(3):618-25
pubmed: 11841732
J Neurosurg. 2003 Apr;98(4):891-6
pubmed: 12691418
Lancet. 2001 Mar 10;357(9258):783-91
pubmed: 11253984
J Clin Endocrinol Metab. 1995 Jun;80(6):1774-7
pubmed: 7775621
South Med J. 1993 Feb;86(2):249-50
pubmed: 8381988
Endocr Pathol. 1997 Spring;8(1):65-74
pubmed: 12114673
J Clin Endocrinol Metab. 2006 Oct;91(10):3746-53
pubmed: 16868050
Clin Nucl Med. 2018 Jan;43(1):e25-e26
pubmed: 29189371
Neuroradiology. 1993;35(7):546-8
pubmed: 8232888
J Neurosurg. 2003 Jun;98(6):1312-7
pubmed: 12816280
Laryngoscope. 2013 May;123(5):1132-5
pubmed: 23299948
J Clin Endocrinol Metab. 2004 Mar;89(3):1131-9
pubmed: 15001598
AJNR Am J Neuroradiol. 2000 Apr;21(4):690-6
pubmed: 10782779
Neurosurgery. 2017 Apr 1;80(4):525-533
pubmed: 27352274
Neurosurgery. 1994 Mar;34(3):529-32; discussion 532
pubmed: 7832831
Endocr J. 2004 Feb;51(1):97-103
pubmed: 15004415
J Clin Endocrinol Metab. 1979 Jul;49(1):23-9
pubmed: 221528
J Laryngol Otol. 1997 Jun;111(6):565-7
pubmed: 9231094
BMJ. 2013 Mar 27;346:f945
pubmed: 23535464
Neurosurgery. 1990 Apr;26(4):681-5
pubmed: 2184378
Neurosurgery. 1999 Oct;45(4):914-7; discussion 917-8
pubmed: 10515490
World Neurosurg. 2017 Feb;98:870.e5-870.e10
pubmed: 28003168
Clin Neurosurg. 1999;45:48-56
pubmed: 10461502
Neurosurgery. 2007 Oct;61(4):E879; discussion E879
pubmed: 17986925
Pituitary. 2014 Oct;17(5):423-9
pubmed: 24065616
J Comput Assist Tomogr. 2003 May-Jun;27(3):424-6
pubmed: 12794610
Head Neck Pathol. 2012 Mar;6(1):75-100
pubmed: 22430769
Endocr Rev. 1998 Oct;19(5):647-72
pubmed: 9793762
N Engl J Med. 1985 Feb 28;312(9):587-8
pubmed: 3969130
Acta Neurochir (Wien). 2000;142(8):855-64
pubmed: 11086823
Endocrine. 2017 Apr;56(1):10-18
pubmed: 27189147
N Engl J Med. 1985 Jan 10;312(2):100-3
pubmed: 2981108
J Clin Endocrinol Metab. 2017 Jul 1;102(7):2133-2135
pubmed: 28899077
World Neurosurg. 2016 Nov;95:617.e13-617.e18
pubmed: 27567574
Pituitary. 2017 Aug;20(4):477-484
pubmed: 28526958
J Clin Endocrinol Metab. 2004 Dec;89(12):6348-57
pubmed: 15579802
Endocr J. 1998 Oct;45(5):631-6
pubmed: 10395243
Ann Intern Med. 1986 Dec;105(6):862-7
pubmed: 3022629
Am J Surg Pathol. 1986 Aug;10(8):546-52
pubmed: 3017137
Ann Nucl Med. 2013 Jul;27(6):538-45
pubmed: 23543506
Lancet. 2015 Aug 29;386(9996):913-27
pubmed: 26004339
Pathol Int. 2000 Nov;50(11):901-4
pubmed: 11107067