Bing Xing

This study was conducted to evaluate the association between the implementation of the WHO 2017 and 2022 classification updates for pituitary tumours and t

The effects of inhalation anesthesia as compared with total intravenous anesthesia (TIVA) on postoperative recovery quality in patients undergoing transsphenoidal resection of pituitary adenoma have not been well studied. This randomized clinical trial enrolled patients undergoing transsphenoidal surgery between May 2023 to April 2024. Patients were randomly assigned in a 1:1 ratio to receive inhalation anesthesia or TIVA. The primary endpoint was the 15-item Quality of Recovery Scale (QoR-15) score on the first postoperative day. Secondary endpoints included postoperative anesthesia recovery patterns, neuroendocrine stress responses, cellular immune responses, and recovery quality. Subgroup analyses were also conducted for the postoperative QoR-15 scores and neuroendocrine stress responses. Potential influence factors for QoR-15 scores and changes in counts of lymphocytes were explored. A total of 252 patients were randomized. No significant difference in postoperative QoR-15 scores was observed between groups and the between-group difference was well below the minimal clinically important difference (median difference 1.0, 95% confidence interval [CI]– 4.0 to 5.0, P = 0.647). Compared with the inhalation group, the TIVA group exhibited significantly lower Richmond agitation-sedation scale (RASS) score and reduced antiemetic drug use in the postanesthesia care unit. Subgroup analyses for postoperative QoR-15 scores revealed no significant interactions. Adrenocorticotropic hormone levels on postoperative day 1 were lower in the inhalation group, while thyroxine and serum free thyroxine levels were higher. No significant differences in these neuroendocrine indices were found in postoperative month 3. Lymphocyte subset levels did not differ between groups on postoperative day 1, although perioperative changes in immune cell counts were correlated with patient demographic and clinical characteristics. Both anesthesia methods resulted in comparable short-term postoperative recovery quality as measured by the QoR-15 scores. TIVA was associated with smoother anesthesia recovery and lower immediate antiemetic requirements. Differences in early neuroendocrine responses were observed but did not persist at 3 months postoperatively. The trial is registered with the ClinicalTrials.gov platform (registration number: NCT05822817; date of registration: March 13, 2023).

Background: Management of pituitary neuroendocrine tumors (pitNETs) during pregnancy is challenging. Involvement of the multidisciplinary team (MDT) may benefit the collaborative decision‐making. However, this aspect has not been well documented. We provided cases with pitNETs during pregnancy and summarized our experience on the MDT‐guided management. Methods: We performed a retrospective study enrolling all pregnant patients with pitNETs treated at our institute between March 1995 and July 2024. Results: During the indexed period, 121 patients with pitNETs consulted our institute during pregnancy, with 111 of them being treated conservatively and 10 undergoing surgery due to progressive visual defect and other symptoms. The age of the included surgical cases was 33 years, and the gestational session at surgery ranged from 13 to 36 weeks (1 in the first trimester, 4 in the second, and 5 in the third). Of the resected tumors, six were nonfunctioning and the other four were functioning (1 lactotroph, 1 somatotroph, and 1 thyrotroph). All surgical cases received MDT‐guided management by physicians from neurosurgery, endocrinology, ophthalmology, obstetrics, pediatrics, and anesthesiology, leading to gross total tumor resection, improved visual acuity, and successful delivery in all patients. Conclusion: MDT guided management is essential for pitNETs during pregnancy. Surgical tumor resection is necessary for patients whose symptoms deteriorate rapidly. Transsphenoidal operation under general anesthesia is safe for pregnant patients with pitNETs.

Background: Somatic GNAS mutations are acknowledged as a significant etiological factor for acromegaly. However, the relationship between GNAS mutation status, clinical characteristics and gender has not been adequately investigated. This study aims to address these gaps by examining GNAS mutations and delineating the detailed clinical profile of affected patients within a Chinese acromegaly cohort.Methods: Our study encompassed 97 individuals newly diagnosed with acromegaly who underwent surgical treatment between May 2015 and January 2022. We obtained DNA from frozen pituitary adenomas to screen for GNAS hotspot mutations and assessed the associated clinical characteristics.Results: In our cohort, 44.3% (43/97) of patients exhibited somatic GNAS mutations. Patients with mutations were predominantly male (58.1 vs 33.3%, P = 0.015), experienced longer diagnosis delays (72.0 (48.0, 120.0) vs 36.0 (21.0, 75.0) months, P = 0.002), had smaller maximum tumor diameters (1.75 ± 0.83 vs 2.23 ± 0.89 cm, P = 0.008) and demonstrated higher rates of growth hormone (GH) secretion per unit tumor volume (18.93 (9.67, 30.12) vs 10.91 (2.80, 20.40) ng/mL cm⁻³, P = 0.005). Regarding gender-specific differences, GNAS mutations in male patients were linked to significantly higher baseline GH levels (24.40 (14.40, 36.30) vs 10.55 (5.25, 16.95) ng/mL, P = 0.002), while female patients with mutations had notably smaller tumor sizes (1.55 ± 0.55 cm vs 2.32 ± 0.85 cm, P < 0.001).Conclusion: GNAS mutations are prevalent among Chinese acromegaly patients, correlating with reduced pituitary tumor sizes and enhanced GH secretion functions. Our findings underscore the influence of gender on the clinical manifestations of GNAS mutations. Accordingly, we recommend that future clinical and foundational research studies on acromegaly give heightened consideration to gender-specific differences.

Purpose: To examine the effects of serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) on choroidal structures with different blood glucose levels in patients with diabetes mellitus (DM) with acromegaly without diabetic retinopathy. Methods: Eighty-eight eyes of 44 patients with acromegaly were divided into a nondiabetic group (23 patients, 46 eyes) and a diabetic group (21 patients, 42 eyes). Forty-four age- and sex-matched healthy controls and 21 patients with type 2 DM without diabetic retinopathy were also included. Linear regression models with a simple slope analysis were used to identify the correlation and interaction between endocrine parameters and choroidal thickness (ChT), total choroidal area (TCA), luminal area (LA), stromal area (SA), and choroidal vascular index (CVI). Results: Our study revealed significant increases in the ChT, LA, SA, and TCA in patients with acromegaly compared with healthy controls, with no difference in the CVI. Comparatively, patients with DM with acromegaly had greater ChT than matched patients with type 2 DM, with no significant differences in other choroidal parameters. The enhancement of SA, LA and TCA caused by an acromegalic status disappeared in patients with diabetic status, whereas ChT and CVI were not affected by the interaction. In the diabetic acromegaly, higher IGF-1 (P = 0.006) and GH levels (P = 0.049), longer DM duration (P = 0.007), lower blood glucose (P = 0.001), and the interaction between GH and blood glucose were associated independently with thicker ChT. Higher GH levels (P = 0.016, 0.004 and 0.007), longer DM duration (P = 0.022, 0.013 and 0.013), lower blood glucose (P = 0.034, 0.011 and 0.01), and the interaction of IGF-1 and blood glucose were associated independently with larger SA, LA, and TCA. As blood glucose levels increased, the positive correlation between serum GH level and ChT diminished, and became insignificant when blood glucose was more than 7.35 mM/L. The associations between serum IGF-1 levels and LA, SA, and TCA became increasingly negative, with LA, becoming significantly and negatively associated to the GH levels only when blood glucose levels were more than 8.59 mM/L. Conclusions: Acromegaly-related choroidal enhancements diminish in the presence of DM. In diabetic acromegaly, blood glucose levels are linked negatively with changes in choroidal metrics and their association with GH and IGF-1. Translational Relevance: We revealed the potential beneficial impacts of IGF-1 and GH on structural measures of the choroid in patients with DM at relatively well-controlled blood glucose level, which could provide a potential treatment target for diabetic retinopathy.

Introduction: Chronic exposure to excessive endogenous cortisol leads to brain changes in Cushing’s disease (CD). However, it remains unclear how CD affects large-scale functional networks (FNs) and whether these effects are reversible after treatment. This study aimed to investigate functional network changes of CD patients and their reversibility in a longitudinal cohort. Methods: Active CD patients (N = 37) were treated by transsphenoidal pituitary surgery and reexamined 3 months later. FNs were computed from resting-state fMRI data of the CD patients and matched normal controls (NCs, N = 37). A pattern classifier was built on the FNs to distinguish active CD patients from controls and applied to FNs of the CD patients at the 3-month follow-up. Two subgroups of endocrine-remitted CD patients were identified according to their classification scores, referred to as image-based phenotypically (IBP) recovered and unrecovered CD patients, respectively. The informative FNs identified by the classification model were compared between NCs, active CD patients, and endocrine-remitted patients as well as between IBP recovered and unrecovered CD patients to explore their functional network reversibility. Results: All 37 CD patients reached endocrine remission after treatment. The classification model identified three informative FNs, including cerebellar network (CerebN), fronto-parietal network (FPN), and default mode network. Among them, CerebN and FPN partially recovered toward normal at 3 months after treatment. Moreover, the informative FNs were correlated with 24-h urinary-free cortisol and emotion scales in CD patients. Conclusion: These findings suggest that CD patients have aberrant FNs that are partially reversible toward normal after treatment.

Purpose: To investigate the prevalence of low blood testosterone level (LTL) and its determinant factors among active male acromegaly patients, as well as the effect of surgery on LTL in male acromegaly patients.Methods: A retrospective, single-center study focused on 252 male acromegaly patients aged 18 years–60 years diagnosed in the Peking Union Medical College Hospital from January 2015 to December 2018 was carried out. The measurements of preoperative and postoperative testosterone levels, serum growth hormone (GH), insulin-like growth factor 1 (IGF-1), and other clinical data were analyzed.Results: Forty per cent of subjects included were diagnosed with LTL pre surgery. Patients were divided into normal testosterone level (NTL) and LTL groups based on their testosterone level. There were significant differences (p < 0.01) between groups in the presence of macroadenomas, invasion of the cavernous sinus, compression of the optic chiasm, and serum GH and prolactin levels pre surgery. Invasion of the cavernous sinus [odds ratio (OR) = 4.299; p = 0.000] and serum prolactin level (OR = 1.023, p = 0.001) were independent predictors of LTLs in male patients before surgical intervention. A total of 67.9% of LTL patients recovered during the follow-up, with a new-onset rate of 3.4%. Body mass index, invasion of the cavernous sinus, GH, IGF-1, and prolactin levels, the presence of a prolactin-secreting tumor, and recovery from acromegaly were significantly different (p < 0.05) in the NTL group and in the LTL group during the follow-up. The presence of a prolactin-secreting tumor (OR = 0.224; p = 0.001) and recovery from acromegaly (OR = 0.168; p = 0.006) were independent predictors of LTLs in male acromegaly patients during the follow-up.Conclusion: The invasiveness of tumor and levels of blood prolactin are independent factors for LTLs before surgery, whereas GH and IGF-1 levels are not. Most male patients can recover from LTL after tumor restriction surgery: those who recover from acromegaly have a better chance of recovering from LTL.