記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The choice of prophylactic antibiotics for use in endonasal transsphenoidal surgery (ETSS) lacks universal standards. This study aimed to investigate the effectiveness of cefazolin, ampicillin and third-generation cephalosporins for preventing postoperative meningitis and secondary outcomes (in-hospital death and the combination of pneumonia and urinary tract infection) in patients who have undergone ETSS. METHODS: The study used data from the Diagnosis Procedure Combination database in Japan. Data from 10 688 patients who underwent ETSS between April 2016 and March 2021 were included. Matching weight analysis based on propensity scores was conducted to compare the outcomes of patients receiving cefazolin, ampicillin or third-generation cephalosporins as prophylactic antibiotics. RESULTS: Of the 10 688 patients, 9013, 102 and 1573 received cefazolin, ampicillin and third-generation cephalosporins, respectively. The incidence of postoperative meningitis did not significantly differ between the cefazolin group and the ampicillin group (OR, 1.02; 95% CI, 0.14-7.43) or third-generation cephalosporins group (OR, 0.81; 95% CI, 0.10-6.44). Similarly, in-hospital death and the composite incidence of pneumonia and urinary tract infection did not differ between the cefazolin group and the ampicillin or third-generation cephalosporins group. CONCLUSIONS: Cefazolin, ampicillin and third-generation cephalosporins as perioperative prophylactic antibiotics for ETSS do not differ significantly in terms of preventing meningitis.

DOI： 10.1093/jac/dkad329

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To compare the prognosis of late elderly patients with spontaneous intracerebral hemorrhage (ICH) treated by endoscopic evacuation and craniotomy MATERIALS AND METHODS: Using the Diagnosis Procedure Combination database, we identified patients aged ≥ 75 years who underwent surgery for spontaneous ICH within 48 hours after admission between April 2014 and March 2018. Eligible patients were classified into two groups according to the type of surgery (endoscopic surgery and craniotomy). Propensity-score matching weight analysis was conducted to compare the good neurological outcome modified Rankin Scale (mRS) score (0-4) at discharge as the primary endpoint between the two groups. Secondary endpoints were postoperative meningitis, tracheostomy, reoperation within 3 days and total hospitalization costs. RESULTS: Among the 5,396 eligible patients, endoscopic surgery and craniotomy were performed in 895 and 4,501 patients, respectively. In the propensity-score matching weight analysis, all covariates were well balanced. The proportions of patients with a good prognosis (mRS score at discharge: 0-4) did not significantly differ between the surgical procedures (42.1% vs. 42.8%, p = 0.828). The proportions of meningitis, tracheostomy and reoperation were not significantly different between the two groups. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (25,536 vs. 29,603 US dollars, p = 0.012). CONCLUSIONS: Inhospital outcomes did not differ between endoscopic and open surgeries for spontaneous ICH in the late-stage elderly patients aged ≥75 years. Hospitalization costs were significantly higher in the craniotomy group, suggesting that endoscopic surgery may be more acceptable.

DOI： 10.1016/j.jstrokecerebrovasdis.2023.107327

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Crooke cell change was first found in the regressed and suppressed corticotroph (adrenocorticotropic hormone-producing) cells, and now is known to occur in pituitary tumors. The tumor cells of this type can be recognized by morphology with immunohistochemistry, and are well known to predict aggressive behavior such as invasion and rare metastases. This is one of the representative neuroendocrine tumors in the pituitary which is now considered to have malignant potential as proposed in the pancreas and gastrointestinal tracts. It is important to emphasize the pituitary tumor pathology such as Crooke cell change for prognostication and appropriate therapies. This review article describes the evolution from the Crooke cells to Crooke cell tumors which is timely along with the Fifth WHO classification 2022 published online.

DOI： 10.1097/PAI.0000000000001070

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

OBJECTIVE: The growth hormone (GH)-releasing peptide-2 (GHRP-2) test is relatively safe among endocrine stimulation tests for the elderly. We investigated whether anterior pituitary function in elderly patients could be assessed on the basis of GH response to the GHRP-2 test. DESIGN: Sixty-five elderly patients aged 65 years and older with non-functioning pituitary neuroendocrine tumor (PitNET) who underwent pituitary surgery and preoperative endocrine stimulation tests were classified into the "GH normal group" and "GH deficiency group" based on GH response to the GHRP-2 test. The baseline characteristics and anterior pituitary function were compared between the groups. RESULTS: Thirty-two patients were assigned to the GH normal group and 33 to the GH deficiency group. The cortisol and adrenocorticotropic hormone (ACTH) results in the corticotropin-releasing hormone test were significantly higher in the GH normal group than in the GH deficiency group (p < 0.001). The relationship between the cortisol and ACTH results and the GH response revealed significant correlations (p < 0.001). In addition, receiver operating characteristic curve analysis identified that the optimal cut-off point for a peak GH level in the correlation between adrenocortical function and GH response to the GHRP-2 test was 8.08 ng/mL (specificity 0.868, sensitivity 0.852). CONCLUSION: The present study indicated that adrenocortical function was significantly correlated with GH response to the GHRP-2 test in elderly patients before pituitary surgery. For elderly patients with non-functioning PitNET, GH response to the GHRP-2 test may support in diagnosing adrenocortical insufficiency.

DOI： 10.1016/j.ghir.2023.101545

PubMed

researchmap

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

As the molecular pathology of pituitary cell development and the process of tumorigenesis in this organ continues to advance, it is recommended that pituitary neuroendocrine tumors(PitNETs)be classified based on three lineage-specific transcription factors(PIT1, Tpit, and SF1). In the hyperaging society of Japan, the number of cases traditionally classified as nonfunctioning PitNETs is increasing, and it is possible that some of these tumors may be associated with tumors that are known to exhibit aggressive behavior. The molecular pathological background of PitNET development is highly variable, and its pathogenesis in many cases remains unclear. As genomic analysis of PitNETs progresses, it is becoming increasingly clear that abnormalities in germline and somatic cell genomes contribute to our understanding of their etiology but do not explain most of them. Epigenetic modifications, such as deoxyribonucleic acid methylation and histone modifications(methylation and acetylation), are thought to be intricately related to tumorigenesis.

DOI： 10.11477/mf.1436204792

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Various surgical methods are available for managing large intracerebral hemorrhage. This study compared the prognosis of patients with spontaneous intracerebral hemorrhage who underwent endoscopic evacuation, stereotactic aspiration, and craniotomy by using a nationwide inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who underwent surgery for spontaneous intracerebral hemorrhage within 48 h after admission between April 2014 and March 2018. Eligible patients were classified into three groups according to the type of surgery (endoscopic surgery, stereotactic surgery, and craniotomy). Propensity score matching weight analysis was conducted to compare poor modified Rankin Scale score at discharge (severe disability or death) and hospitalization cost among the groups. RESULTS: Among 17,860 eligible patients, craniotomy, stereotactic surgery, and endoscopic surgery were performed in 14,354, 474, and 3,032 patients, respectively. In the matching weight analysis, all covariates were well balanced. Compared with the endoscopic surgery group, the proportion of poor prognosis (modified Rankin Scale score at discharge of 5 or 6) was significantly higher in craniotomy groups (odds ratio 2.51, 95% confidence interval 1.11-5.68; p = 0.028). Subgroup analysis based on hemorrhage location and consciousness level at the time of admission showed no significant difference between the surgical procedures. Hospitalization costs were significantly higher in the craniotomy group than in the endoscopic surgery group (difference US $9,724, 95% confidence interval 2,169-17,259; p = 0.011). CONCLUSIONS: Endoscopic surgery for spontaneous intracerebral hemorrhage was associated with improved prognosis compared with craniotomy at the hospital discharge. Future large-scale clinical trials are needed to evaluate the optimal surgical techniques for intracerebral hemorrhage.

DOI： 10.1007/s12028-022-01634-9

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

BACKGROUND: Endoscopic transsphenoidal surgery (ETSS) is performed more frequently in elderly patients. We investigated endocrinological pitfalls in pituitary surgery in the elderly by a comparative study focusing only on elderly patients. METHODS: Ninety-nine elderly patients aged 65 years and over with non-functioning pituitary adenoma (NFPA) who underwent ETSS were retrospectively examined and classified into the early (aged 65-74 years) and late (aged 75 years and over) elderly groups. The baseline characteristics and anterior pituitary function were compared between the groups. RESULTS: Seventy patients were assigned to the early elderly group and 29 to the late elderly group. Thyroid-stimulating hormone (TSH) response in preoperative and postoperative thyrotropin-releasing hormone (TRH) tests revealed a significant difference between the groups. Preoperative and postoperative TSH responses were significantly correlated in both groups. Residual analysis of the correlation between preoperative free triiodothyronine (T3) secretion quantity and preoperative TSH response in both groups, which was significant, indicated that preoperative TSH response was significantly normal when preoperative free T3 secretion quantity was normal in the early elderly group, but preoperative free T3 secretion quantity was significantly lower regardless of preoperative TSH response in the late elderly group. CONCULSIONS: The present study suggested that preoperative and postoperative TSH secretory capacity was presumed to be normal when preoperative free T3 levels were normal in the early elderly patients with NFPA. On the other hand, TSH secretory capacity in the late elderly patients could only be assessed by the TRH test, which should be taken into account.

DOI： 10.1016/j.heliyon.2023.e17060

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Some patients develop immunoglobulin G4 (IgG4)-related hypophysitis associated with systemic diseases. More than 30 cases of IgG4-related hypophysitis have been reported. However, biopsy has rarely been performed in these patients, and none have had an associated pituitary neuroendocrine tumor (PitNET). We present a case of concurrent IgG4-related hypophysitis and PitNET. CASE PRESENTATION: A 56-year-old Japanese man arrived at the hospital with visual impairment, bitemporal hemianopia, and right abducens nerve palsy. Magnetic resonance imaging revealed pituitary body and stalk swelling as well as a small poorly enhanced right anterior lobe mass. Laboratory and loading test results suggested hypopituitarism. Because IgG4 level was elevated, a systemic examination was performed; multiple nodules were found in both lung fields. The diagnosis was based on an endoscopic transnasal biopsy of the pituitary gland. A histopathological examination revealed a marked infiltration of plasma cells into the pituitary gland, which was strongly positive for IgG4. The histological features of the resected tumor were consistent with those of gonadotroph PitNET, which was immunohistochemically positive for follicle-stimulating hormone-β and steroidogenic factor-1, and no plasma cell infiltration was observed. Based on the histopathological examination results, steroid therapy was initiated, which reduced pituitary gland size and serum IgG4 levels. DISCUSSION AND CONCLUSIONS: This is the first reported case of IgG4-related hypophysitis with PitNET. Although no pathological findings indicating a relationship between the two conditions were found, we were able to preoperatively differentiate multiple lesions via detailed diagnostic imaging.

DOI： 10.1186/s12902-023-01353-y

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Training kits for laparoscopes for deep suturing under endoscopes are commercially available; however, previously reported training kits for endoscopic transnasal transsphenoidal pituitary/skull base surgery (eTSS) were not available in the market. Moreover, the previously reported low cost, self-made kit has the drawback of being unrealistic. This study aimed to create a low cost training kit for eTSS dura mater suturing that was as close to real as possible. Most necessary items were obtained from the 100-yen store ($1 store) or from everyday supplies. As an alternative to the endoscope, a stick-type camera was used. Through the assembly of the materials, a simple and easy-to-use training kit was created, which is almost identical to the actual dural suturing situation. In eTSS, a simple and easy-to-use training kit for dural suturing was successfully created at a low cost. This kit is expected to be used for deep suture operations and the development of surgical instruments for training.

DOI： 10.1038/s41598-023-32311-2

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Indocyanine green (ICG) is a cyanine dye useful for visualizing blood vessels; it has been developed for endoscopy and is used in skull base surgery. Endoscopy is widely used for hematoma removal after an intracerebral hemorrhage since it is minimally invasive and has a shorter operation time than craniotomy. However, with this technique the surgical field is limited and it is difficult to obtain an adequate orientation; thus, it is challenging to locate the bleeding point, and postoperative rebleeding has been reported. We performed intraoperative ICG near-infrared fluorescence imaging to locate the bleeding point. This purpose of this study was to evaluate the usefulness of ICG angiography during endoscopic hematoma removal in two patients, using two endoscope types and comparing their visualization of perforating branches during the procedure. ICG angiography was performed in two different cases of putaminal hemorrhage, using the SPIES NIR/ICG-System and IMAGE1 S Rubina (both KARL STORZ, Tuttlingen, Germany) at the intraoperative bleeding site. The intraoperative use of ICG allowed the clear visualization of the perforating branches and real-time confirmation of active bleeding. We could also distinguish an old hematoma from the active bleeding point. The IMAGE1 S Rubina has adequate brightness for contrast enhancement, allowing surgical manipulation simultaneously to the enhancement phase.ICG fluorescence angiography is useful to identify the damaged vessel and perform hemostasis. We expect other similar devices to be developed in the future, accompanied by flexible and thin rigid endoscopes.

DOI： 10.2176/jns-nmc.2022-0135

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Pituitary incidentalomas are tumors or mass lesions of the pituitary gland. These are incidentally discovered during imaging studies for symptoms that are not causally related to pituitary diseases. The most common symptom that triggers an examination is headache, and the most common type of pituitary incidentalomas are pituitary neuroendocrine tumors (PitNETs) and Rathke cleft cysts. The existing treatment strategy is controversial; however, surgical resection is recommended in cases of clinically non-functioning PitNETs with optic chiasm compression. In contrast, cystic lesions, such as Rathke cleft cysts, should be followed if the patients are asymptomatic. In this case, MRI and pituitary function tests are recommended every six months to one year; if there is no change, the follow-up period should be extended. The natural history of PitNET is partially known, and the management of pituitary incidentalomas is determined by this history. However, the pathogenesis of PitNET has significantly changed with the new World Health Organization classification, and follow-up is important based on this new classification. Therefore, a high level of evidence-based research is needed to consider treatment guidelines for pituitary incidentalomas in the future.

DOI： 10.3390/cancers14174324

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Minimally invasive surgery for spontaneous intracerebral hemorrhage (ICH) has become increasingly popular in recent years. However, there are no reports on the recent trends in surgical procedures for spontaneous ICH. To investigate current trends in surgical methods for spontaneous ICH using a nationwide inpatient database from Japan. MATERIALS AND METHODS: Patients who underwent surgery for spontaneous ICH between April 2014 and March 2018 were identified in a nationwide inpatient database from Japan. We examined patient characteristics, diagnoses, types of surgery, complications, and discharge status. RESULTS: We identified 21,129 inpatients who underwent surgery for spontaneous ICH. The procedures were as follows: 16,256 (76.9%) transcranial hemorrhage evacuations, 3722 (17.6%) endoscopic hemorrhage evacuations, and 1151 (5.4%) stereotactic aspirations of hemorrhage. Patients tended to receive transcranial hemorrhage evacuations in hospitals with fewer surgical cases. The proportions of endoscopic hemorrhage evacuations increased annually, whereas those of stereotactic surgery decreased. The proportions of transcranial surgery remained almost unchanged. Tracheostomy and hospitalization costs were lower in the stereotactic aspirations of hemorrhage group, and the proportions of reoperation were higher in the endoscopic hemorrhage evacuations group. CONCLUSIONS: The use of endoscopic surgery for spontaneous ICH has increased in Japan. This study can form the basis of future clinical investigations into spontaneous ICH surgery.

DOI： 10.1016/j.jstrokecerebrovasdis.2022.106664

PubMed

researchmap

記述言語：英語  

Background: Injury to the internal carotid artery (ICA) during endoscopic transsphenoidal surgery (ETSS) is a serious complication with a risk of mortality. ICA injury during ETSS usually occurs during intrasellar manipulations and rarely occurs in the extrasellar portion. Several hemostatic procedures have been proposed for ICA injury in the intrasellar portion, whereas hemostatic methods for ICA injury in the extrasellar portion, where the ICA is surrounded by bone structures, are less well known. Case Presentation: A 65-year-old man with an incidental pituitary tumor underwent ETSS. The petrous portion of the left ICA was injured during resection of the sphenoid septum connected with left carotid prominence using a cutting forceps. Bleeding was too heavy for simple hemostatic techniques. Hemostasis using a crushed muscle patch was tried unsuccessfully during controlling of the bleeding. Eventually, the injured site of the ICA was covered with cotton patties followed by closing with a vascularized pedicled nasoseptal flap. Cerebral angiography immediately after surgery showed no extravasation from the injured site of the left ICA petrous portion. However, a carotid-cavernous sinus fistula originating from the injured ICA site was detected 7 days after surgery, so the vascular reconstructive surgery combined with left ICA occlusion was performed. The overall postoperative course was uneventful. Conclusion: We believe that emergency application of the cottonoids may be effective for hemostasis against ICA injury in the extrasellar portion during ETSS, but further vascular reconstruction combined with ICA occlusion on the injured side and removal of the cottonoids would be required.

DOI： 10.3389/fsurg.2022.895233

PubMed

researchmap

記述言語：英語  

DOI： 10.1016/j.bja.2021.04.006

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Somatostatin analogs are recommended for pharmacotherapy of TSH-secreting pituitary adenoma (TSHoma). A multicenter clinical trial was conducted to evaluate the efficacy and safety of lanreotide autogel treatment for TSHoma. A total of 13 Japanese patients with TSHoma were enrolled from February to December 2018 and treated with lanreotide autogel 90 mg every 4 weeks, with dose adjustments to 60 mg or 120 mg. Analysis was performed on data from patients receiving preoperative treatment (n = 6) up to 24 weeks and from those receiving primary or postoperative treatment (n = 7) up to 52 weeks. The primary efficacy endpoints were serum concentrations of TSH, free triiodothyronine (FT3), and free thyroxine (FT4). The secondary efficacy endpoints were pituitary tumor size and clinical symptoms. The serum concentrations of TSH, FT3, and FT4 decreased with treatment, and euthyroid status was maintained until final assessment. FT4 at final assessment was within reference ranges in 10/13 patients. The median (interquartile range) percent change in pituitary tumor size from baseline at final assessment was -23.8% (-38.1, -19.8). The clinical symptoms were also improved. The patients receiving preoperative treatment did not develop perioperative thyroid storm. Regarding safety, adverse events were observed in 12/13 patients, but none discontinued treatment. The common adverse events were gastrointestinal disorders (12/13 patients) and administration site reactions (5/13 patients). Lanreotide autogel may be effective for controlling thyroid function and reducing the pituitary tumor size, and is tolerable in patients with TSHoma (Japic Clinical Trials Information; JapicCTI-173772).

DOI： 10.1507/endocrj.EJ20-0707

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

In 2017, WHO published an updated classification of the pituitary adenomas according to the lineages defined by the transcription factors, PIT1, SF1 and TPIT. Nomenclature of the pituitary tumors follows the mature cell types such as somatotroph (GH), lactotroph (LH), thyrotroph, corticotroph, and gonadotroph (FSH, LH). Null cell adenomas are defined by the absence of expression of any hormones and transcription factors. Not infrequently, the pituitary adenomas are invasive to the adjacent structures and are designated as aggressive adenomas. Knosp grading is often used to define the aggressiveness of the tumor. Sparsely granulated somatotroph adenomas and Crooke cell corticotroph adenomas are representative aggressive adenomas. Recently, genomics regarding various adenomas have been clarified, such as GNAS for somatotrophs and USP8 for corticotrophs. Familial pituitary adenomas are another aspect which has been clarified such as MEN1, Carney's complex, familial isolated pituitary adenoma and McCune-Albright syndrome. The pituitary adenomas often produce GH or PRL, hormones of PIT1 transcription factor. It has been agreed that the pituitary adenomas share the characteristics of neuroendocrine neoplasms. The terminology of pituitary neuroendocrine tumor has been discussed. This review article covers various aspects of pituitary adenomas.

DOI： 10.1007/s10014-021-00410-5

PubMed

researchmap

担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

The complications of endonasal transsphenoidal surgery (ETSS) include meningitis and sinusitis, and these complications are troublesome. Some reports have investigated the type of bacteria and the susceptibility of sphenoid sinus mucosal flora to drugs. However, most specimens can be collected after perioperative antibiotic administration. In this study, 95 and 103 sphenoid sinus mucosal samples collected during ETSS from September 2013 to February 2015 and from June 2017 to January 2019, respectively, were examined for bacterial culture. Sphenoid sinus mucosal samples were collected after antibiotic administration in the first period, whereas samples were collected before antibiotic administration in the second period. Hence, the specimens in the second period were not affected by antibiotics. Moreover, drug susceptibility tests for the detected bacteria were performed. Overall, 52 and 51 bacterial isolates were collected during both periods. Gram-positive cocci (GPCs), including Staphylococcus aureus and Staphylococcus epidermidis, were more common in the non-antibiotic group than in the antibiotic group (p <0.01). However, the proportion of gram-negative rods (GNRs) did not significantly differ between the two groups (p = 0.54). The antibiotic group had a significantly higher proportion of bacteria resistant to ampicillin (p <0.01) and first-generation cephalosporin (p = 0.01) than the non-antibiotic group. In conclusion, there was a difference in bacterial flora in the sphenoid sinus mucosal samples collected before and after intraoperative antibiotic administration.

DOI： 10.2176/nmc.oa.2020-0387

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Internal carotid artery (ICA) stenosis rarely occurs in pituitary apoplexy. Little is known of the causes of this condition. The present study investigated the factors related to ICA stenosis associated with pituitary apoplexy. METHODS: Forty-five patients with pituitary apoplexy were retrospectively examined and divided into the stenotic and normal ICA groups. The baseline characteristics of patient background, tumor properties, clinical findings, and treatment overview were compared between the groups. RESULTS: Eight patients were assigned to the stenotic ICA group and 37 to the normal ICA group. Patient age in the stenotic ICA group was significantly lower than that in the normal ICA group (p = 0.001). Maximum tumor diameter (p = 0.001), tumor volume (p = 0.044), and Knosp grade (p < 0.001) were significantly greater in the stenotic ICA group than in the normal ICA group. The stenotic ICA group had a significantly higher incidence of sphenoid sinus mucosal thickening (SSMT) than the normal ICA group (p = 0.039). Multivariate logistic regression analysis demonstrated that age (odds ratio 0.915, 95% confidence interval 0.846-0.991, p = 0.029) was a significant and independent predictor of ICA stenosis associated with pituitary apoplexy. Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off point for age was 35.0 years (specificity 0.946, sensitivity 0.750). CONCLUSIONS: Our study revealed that age, tumor size, and SSMT were strongly related to the occurrence of ICA stenosis in pituitary apoplexy. Among these factors, age had the potential of being an independent predictor of the condition.

DOI： 10.1016/j.wneu.2021.02.005

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pituitary tumors are discovered either incidentally by imaging studies (incidentalomas) or via evaluation of certain clinical symptoms (symptomatic tumors). In this study, we first surveyed patients with incidentalomas who underwent surgery. Cases included 62.3% non-functioning adenomas (NFPAs), 14.5% functioning adenomas, and 13.8% Rathke's cleft cysts. Next, we compared the clinical features and surgical outcomes of 145 patients whose preoperative diagnosis was NFPA (incidentalomas [n = 79] vs. symptomatic tumors [n = 66]). The patients with incidentalomas were older (59.9 vs. 55.3 years, p < 0.05) and had smaller tumors compared with the patients with symptomatic tumors (mean maximum diameter: 23.1 vs. 27.5 mm, p < 0.01). The main reason for undergoing imaging studies was headache (n = 25) in the incidentaloma group and visual disturbance (n = 46) in the symptomatic tumor group. The incidence of preoperative pituitary hormone deficiencies was lower in the incidentaloma than symptomatic tumor group (growth hormone deficiency: 37.7% vs. 66.7%, p < 0.01; gonadotropin deficiency: 19.0% vs. 39.4%, p < 0.01; adrenocorticotropic hormone deficiency: 3.8% vs. 18.2%, p < 0.01; thyroid stimulating hormone deficiency: 6.3% vs. 12.1%, p = 0.25). Postoperative pituitary function was better preserved in the incidentaloma than symptomatic tumor group (no deficiency: 58.2% vs. 28.8%, p < 0.01). The difference in postoperative complications between groups was not statistically significant (incidentalomas vs. symptomatic tumors: 21.5% vs. 19.7%, p = 0.84). In conclusion, incidentalomas were detected while smaller size and lower incidence of hormone deficiency than symptomatic tumors, and the pituitary hormones were also preserved after surgery. It is important to observe incidentalomas carefully and to judge whether to operate appropriately before they become symptomatic tumors.

DOI： 10.1507/endocrj.EJ20-0335

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Expression profiles of gonadal steroid receptor variants have been reportedly associated with malignancy in breast and prostate cancers [1,2]. However, such associations with pituitary tumors remain unclear. Therefore, the expression levels of the wild-type ESR1 (ERα66) and the ESR1 variants (ERαi34, ERαi45c, and ERαΔ5) transcripts encoding constitutively active ERα proteins with C-terminal truncation in non-functioning pituitary adenomas (NFPAs) were evaluated using reverse transcription-digital polymerase chain reaction. The results revealed that the expression levels of the variants were approximately two orders of magnitude lower than that of ERα66 in NFPAs. These data were based on our previous article entitled "Accurate assessment of estrogen receptor profiles in non-functioning pituitary adenomas using RT-digital PCR and immunohistochemistry" [3].

DOI： 10.1016/j.dib.2020.106452

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Non-functioning pituitary adenomas (NFPAs) are common pituitary tumors, and surgery is generally the only treatment option. Few attempts have been made to explore target molecules for the development of NFPA pharmacological treatments. METHOD: We quantitatively assessed the expression profiles of estrogen receptor (ER) transcripts and proteins in NFPA samples, using reverse transcription-digital polymerase chain reaction (RT-dPCR) and immunohistochemistry, and further investigated the correlations between the expression levels of ER and those of downstream responsive genes. All patients had undergone surgery at the same high-volume hospital. A total of 20 patients with NFPAs were included. All patients were new-onset, and none were diagnosed with intratumoral hemorrhages or cysts. RESULTS: NFPA samples exhibited a bimodal ESR1 expression pattern and were categorized into significantly different high- and low-ESR1 expression level groups (P < 0.05). In contrast, expression levels of ESR1 variants and ESR2 could barely be detected. Similar results were obtained through the immunohistochemical staining of NFPAs, using well-validated antibodies against ERs. The expression levels of ESR1 positively correlated with those of GREB1, an estrogen-responsive gene [correlation coefficient (r) = 0.623, P = 0.003]. CONCLUSIONS: ESR1 expression levels in NFPAs exhibited a bimodal pattern and were positively correlated with GREB1 expression levels. The accurate assessment of ER expression levels may further advance future NFPA-related research.

DOI： 10.1016/j.lfs.2020.118416

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Skull base reconstruction after an endoscopic endonasal approach into the cerebrospinal fluid (CSF) space is always challenging. Various reconstructive methods are available, but no standard technique is established. This report describes the endoscopic skull base dural closure using a modified nonpenetrating clip device with shaft length of 15 cm. Six patients with an intra-suprasellar or suprasellar tumor who underwent extended endoscopic endonasal transsphenoidal surgery were targeted. For closure of the skull base dural defect after tumor removal, fascia lata was first placed as an inlay graft and was subsequently fixed with the dura using a modified nonpenetrating clip device. No CSF leakage from the closed dura with an inlay fascia lata fixed with clips was confirmed by the Valsalva maneuver. To complete skull base reconstruction, fascia lata was then positioned as an overlay graft and covered with vascularized pedicled nasoseptal flaps. Five of six patients experienced no CSF rhinorrhea postoperatively. The modified nonpenetrating clip device may achieve effective dural closure in the deep and narrow nasal cavity. We introduce this clip device technique as one of the endoscopic skull base dural closure methods.

DOI： 10.2176/nmc.tn.2020-0103

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Somapacitan is a long-acting, reversible albumin-binding growth hormone (GH) derivative in development. This study aimed to evaluate the safety and efficacy of once-weekly somapacitan versus daily GH over 52 weeks in Japanese patients with adult growth hormone deficiency (AGHD). DESIGN: Phase 3, multicentre, randomised, parallel-group, open-label, active-controlled trial (NCT03075644). Patients Previously GH-treated Japanese patients with AGHD were randomised 3:1 to somapacitan (n = 46) or daily GH (n = 16) for 20 weeks' dose titration and 32 weeks' fixed-dose treatment. Measurements Primary endpoint was the incidence of adverse events (AEs). Secondary endpoints included change from baseline to week 52 in visceral, subcutaneous and total adipose tissue (VAT, SAT and TAT). RESULTS: Mean (SD) prescribed doses after titration were 1.780 (1.058) mg/week for somapacitan and 0.197 (0.083) mg/day for daily GH. Rate of AEs per 100 patient-years was similar between arms (somapacitan, 312.7; daily GH, 309.8). Four AEs in the somapacitan arm were serious; none were considered treatment-related. Mean insulin-like growth factor-I standard deviation score (IGF-I SDS) was maintained from baseline in both arms. No significant differences were observed between arms for change from baseline to week 52 in VAT, SAT or TAT (estimated difference, somapacitan - daily GH [95% CI]: -1.74 [-18.13; 14.66], -11.53 [-35.54; 12.48] and -12.85 [-47.31; 21.62] cm2 , respectively). CONCLUSIONS: Treatment in both groups was well tolerated, with no unexpected safety findings. Impact on adipose tissue was similar with somapacitan and daily GH in patients with AGHD. A short visual summary of our work is available (1). (Otsuka et al. Animated summary. URL TBC).

DOI： 10.1111/cen.14273

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Between 2010 and 2014, microscopic transsphenoidal surgery (mTSS) was performed more frequently than endoscopic TSS (eTSS) in the USA. However, few epidemiological studies on pituitary surgery are currently available. METHODS: We performed a retrospective study on patients who had undergone pituitary surgery between July 2010 and March 2016. To this end, a nationwide inpatient database in Japan was used. Patients' characteristics, diagnoses, types of surgery, complications, and discharge status were examined. RESULTS: A total of 16,253 inpatients who received pituitary surgery were identified. Patients were diagnosed with diseases for insurance claims described below: pituitary adenoma, hyperprolactinemia, other pituitary disorders (e.g., Rathke's cleft cyst), hyperpituitarism, craniopharyngioma, acromegaly, Cushing's disease, and pituitary cancer. Among them, pituitary adenomas, primarily the non-functioning ones, were the most frequent (66.9%). A total of 14,285 (88%) patients underwent TSS, while 1968 (12%) patients were treated using transcranial surgery. The number of patients undergoing TSS increased each year. The number of eTSS operations was 8140 (77%) and that of mTSS operations was 2419 (23%). Of note, eTSS increased each year. We found that high-volume hospitals more frequently selected eTSS. Compared with mTSS, eTSS was associated with a reduction of hyponatremia incidence (odds ratio, 0.69; p = 0.019). Additionally, it was not associated with other major complications. CONCLUSION: The present study showed that both TSS and eTSS increased on a yearly basis. We believe that the present study will be the basis of future epidemiological investigations of pituitary surgery.

DOI： 10.1007/s00701-020-04270-4

PubMed

researchmap

掲載種別：研究論文（学術雑誌）   出版者・発行元：The Endocrine Society  

<title>Abstract</title>
BACKGROUND: There is not enough evidence regarding the need for perioperative prophylactic steroid at the time of transsphenoidal pituitary surgery [1], and it is currently administered empirically. In patients with normal preoperative adrenal function, the meta-analysis of nonrandomized studies [2] and only two randomized controlled studies [3,4] suggested no necessity to routine steroid administration, but the number of the studies subjects was small. Analysis using big data has not been performed. Therefore, this study examined the relationship between perioperative steroid administration and complications using a nationwide Diagnosis Procedure Combination database in Japan.


Method: We performed a retrospective study on patients who had undergone pituitary surgery (excluding meningiomas, Cushing’s disease, and preoperative steroid administration) between July 2010 and March 2016. To this end, a nationwide inpatient database in Japan was used, and the patients were divided into a prophylactic steroid-administered group and a nonadministered group. Patients’ complications, including hypopituitarism, diabetes insipidus, meningitis, hyponatremia, and hypokalemia, and discharge status were examined by inverse probability of treatment weighting using propensity score.


Result: A total of 7,725 inpatients received prophylactic steroids, whereas 864 did not. The inverse probability of treatment weighting using propensity score revealed that the incidence of hypopituitarism and diabetes insipidus was significantly higher in the prophylactic steroid group than in the nonsteroid group (3.5% vs. 0.5%, P 0.001 and 9.6% vs. 6.0%, P = 0.001, respectively). There were no significant differences in the incidences of meningitis, electrolyte abnormalities, and length of hospital stay.


This study using big data suggests that prophylactic steroid administration may not be necessary in patients with an intact adrenocortical function undergoing transsphenoidal pituitary surgery.


1. Fleseriu M, et al. J Clin Endocrinol Metab. 101:3888–3921 (2016)


2. Tohti M, et al. PLoS One 10: e0119621 (2015)


3. Sterl K, et al. Neurosurgery 85: E226-e232 (2019)4. Lee HC, et al. Neurosurg (2020, in press)

DOI： 10.1210/jendso/bvaa046.462

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Non-functioning pituitary adenoma (NFPA) is one common cause of adult growth hormone deficiency (AGHD). In Japan, a GH-releasing peptide (GHRP)-2 test is used to evaluate GH secretion. Although the cut-off for peak GH during a GHRP-2 test for severe AGHD is ≤9 ng/mL, severe AGHD may further diminish responses (range, nearly no-response to ≤9 ng/mL). We studied whether the peak GH responses during a GHRP-2 test could be predicted based on clinical characteristics of patients with NFPA. We compared patients with almost no-response during a GHRP-2 test with other patients considered as severe AGHD. Among the 76 patients with NFPA who were admitted to our institution, 36 patients (mean age, 61 years; male/female, n = 23/n = 13) were diagnosed with severe AGHD based on a preoperative GHRP-2 test. Based on the preoperative median peak GH concentration (2.83 ng/mL), patients were divided into two groups (<median = low or group L, n = 18; ≥median = moderate or group M, n = 18). Clinical manifestations, body mass index, severity of hypopituitarism and tumor size, volume, and extension were analyzed retrospectively. Compared with group M, group L patients were significantly older and more gonadotropin and ACTH deficient. A lower peak GH release during a GHRP-2 test was associated with a higher number of anterior pituitary hormone deficiencies across all 76 patients. Postoperatively, seven in group M and no patient in group L were assessed as having no longer severe AGHD, respectively. Preoperative peak GH concentrations assessed during a GHRP-2 test reflected the severity of hypopituitarism and the recovery of postoperative GH secretion.

DOI： 10.1507/endocrj.EJ19-0288

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

CONTEXT: Growth hormone (GH) replacement requires daily GH injections, which is burdensome for some adult patients with GH deficiency (AGHD). OBJECTIVE: To demonstrate efficacy and safety of somapacitan, a once-weekly reversible albumin-binding GH derivative, versus placebo in AGHD. DESIGN: Randomized, parallel-group, placebo-controlled (double-blind) and active-controlled (open-label) Phase 3 trial, REAL 1 (NCT02229851). SETTING: Clinics in 17 countries. PATIENTS: Treatment-naïve patients with AGHD (n=301 main period, 272 extension period); 257 patients completed the trial. INTERVENTIONS: Patients were randomized 2:2:1 to once-weekly somapacitan, daily GH, or once-weekly placebo for 34 weeks (main period). During the 52-week extension period, patients continued treatment with somapacitan or daily GH. MAIN OUTCOME MEASURES: Body composition measured using dual-energy X-ray absorptiometry (DXA). Primary endpoint was change to week 34 in truncal fat percentage. IGF-I SDS values were used to dose titrate. RESULTS: At 34 weeks, somapacitan significantly reduced truncal fat percentage (estimated difference: -1.53% [-2.68; -0.38]; p=0.0090), demonstrating superiority compared with placebo and improved other body composition parameters (including visceral fat and lean body mass) and IGF-I SDS. At 86 weeks, improvements were maintained with both somapacitan and daily GH. Somapacitan was well tolerated, with similar adverse events (including injection-site reactions) compared with daily GH. CONCLUSIONS: In AGHD patients somapacitan administered once-weekly demonstrated superiority over placebo, and overall treatment effects and safety of somapacitan were in accordance with known effects and safety of GH replacement for up to 86 weeks of treatment. Somapacitan may provide an effective alternative to daily GH in AGHD.

DOI： 10.1210/clinem/dgaa049

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ons/opy277

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Hemangioblastomas usually occur in the cerebellum and are often a component of von Hippel-Lindau disease. Edema-like changes along the optic tract are commonly observed in association with tumors in the sellar and suprasellar regions, such as craniopharyngiomas and pituitary adenomas. Here, we describe a case of sporadic suprasellar hemangioblastoma with edema-like changes along the optic tract that completely resolved after surgery. CASE DESCRIPTION: The patient was a 28-year-old woman with failing vision and a bitemporal hemianopia. Magnetic resonance imaging revealed a tumor accompanied by a 10-mm cyst. Fluid-attenuated inversion recovery axial magnetic resonance imaging revealed a hyperintense region along the optic tract. Other regions of the central nervous system were normal. Endoscopic transsphenoidal surgery was performed, and the histopathologic findings confirmed hemangioblastoma. Six months after surgery, the edema-like change along the optic tract had disappeared. The patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In addition, the genetic test was negative for von Hippel-Lindau mutations. CONCLUSIONS: When examining a patient with suprasellar tumor, clinicians must consider the possibility of hemangioblastoma. Adequate treatment can improve the edematous change and visual disturbance.

DOI： 10.1016/j.wneu.2018.03.114

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioScientifica Ltd.  

Objective: Somapacitan is a reversible albumin-binding growth hormone (GH) derivative, developed for once-weekly administration. This study aimed to evaluate the safety of once-weekly somapacitan vs once-daily Norditropin®. Local tolerability and treatment satisfaction were also assessed. Design: 26-week randomized, controlled phase 3 safety and tolerability trial in six countries (NCT02382939). Methods: Male or female patients aged 18–79 years with adult GH deficiency (AGHD), treated with once-daily GH for ≥6 months, were randomized to once-weekly somapacitan (n=61) or once-daily Norditropin (n=31) administered subcutaneously by pen. Both treatments were dose titrated for 8 weeks to achieve insulin-like growth factor I (IGF-I) standard deviation score (SDS) levels within the normal range, and then administered at a fixed dose. Outcome measures were adverse events (AEs), including injection site reactions
occurrence of anti-somapacitan/anti-GH antibodies and change in treatment satisfaction, assessed using the Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9). Results: Mean IGF-I SDS remained between 0 and 2 SDS throughout the trial in both groups. AEs were mostly mild or moderate and transient in nature. The most common AEs were nasopharyngitis, headache and fatigue in both groups. More than 1500 somapacitan injections were administered and no clinically significant injection site reactions were reported. No anti-somapacitan or anti-GH antibodies were detected. The TSQM-9 score for convenience increased significantly more with somapacitan vs Norditropin (P=0.0171). Conclusions: In this 26-week trial in patients with AGHD, somapacitan was well tolerated and no safety issues were identified. Once-weekly somapacitan was reported to be more convenient than once-daily Norditropin.

DOI： 10.1530/EJE-17-1073

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Verlag  

Multiple pituitary adenomas are rare. We present a quite unique case of double pituitary adenomas associated with persistent trigeminal artery (PTA) treated by endoscopic surgery. To the best of our knowledge, this is the first report in the literature. A 64-year-old woman was referred to our hospital for suspicion of acromegaly. Preoperative magnetic resonance imaging revealed two separate intrasellar masses with intrasellar vascular structure. Right cerebral angiography showed medial-type PTA. The patient underwent endoscopic transsphenoidal surgery and both tumors were resected completely. Postoperative immunohistopathologic examination revealed two histologic types of adenoma: the first tumor was positive for growth hormone (GH), while the second was considered nonfunctioning. Postoperatively, the patient’s serum levels of GH and insulin-like growth factor-1 returned to normal. We observed an extremely rare case of double pituitary adenomas associated with PTA. Preoperative neuroimaging and modern endoscopic surgery are valuable to confirm diagnosis of double pituitary adenomas and identify anatomical localization of PTA.

DOI： 10.1007/s10143-017-0924-y

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chiasmapexy is used to treat empty sella syndrome, and various materials are used for the elevation of the optic chiasm. However, the use of artificial substances may have the risk of graft infection, and fat and muscle may be absorbed over the long term after surgery. In addition, bone and cartilage may be unavailable in adequate amounts. Here, we describe a new technique for chiasmapexy using an iliac crest bone graft. CASE DESCRIPTION: The first patient was a 71-year-old woman who had undergone transsphenoidal surgery twice for the treatment of pituitary adenoma and Rathke cleft cyst. The optic chiasm collapsed after the second surgery and her visual field worsened gradually. We performed chiasmapexy using fat, fascia, and a septal mucosal flap, but the optic chiasm did not remain in the normal position because of graft shrinkage. Finally, we used an iliac crest bone graft, which resulted in good visual function. The second patient was a 58-year-old man who was incidentally diagnosed with empty sella syndrome. The patient's bitemporal hemianopia gradually progressed. As in the first case, we used an iliac crest bone graft, which halted the deterioration of visual function after chiasmapexy. CONCLUSIONS: The advantages of iliac bone are that it is less likely to absorb and become infected than synthetic materials. This method may be suitable for reoperative cases, especially those wherein the septal cartilage has been removed in a previous surgery. This method will halt visual deterioration and may be one of the considerable options for chiasmapexy operations.

DOI： 10.1016/j.wneu.2017.08.080

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel's cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.

DOI： 10.2176/nmc.ra.2017-0039

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ENDOCRINE SOC  

A multicenter, open-label, phase 2 study was conducted to investigate the efficacy and safety of long-acting pasireotide formulation in Japanese patients with acromegaly or pituitary gigantism. Medically naive or inadequately controlled patients (on somatostatin analogues or dopamine agonists) were included. Primary end point was the proportion of all patients who achieved biochemical control (mean growth hormone [GH] levels&lt;2.5 mu g/L and normalized insulin-like growth factor-1 [IGF-1]) at month 3. Thirty-three patients (acromegaly, n=32; pituitary gigantism, n=1) were enrolled and randomized 1: 1: 1 to receive open-label pasireotide 20mg, 40mg, or 60mg. The median age was 52 years (range, 31-79) and 20 patients were males. At month 3, 18.2% of patients (6/33; 90% confidence interval: 8.2%, 32.8%) had biochemical control (21.2% [7/33] when including a patient with mean GH&lt;2.5 mu g/L and IGF-1&lt;lower limit of normal). Reductions in the median GH and IGF-1 levels observed at month 3 were maintained up to month 12; the median percent change from baseline to month 12 in GH and IGF-1 levels were -74.71% and -59.33%, respectively. Twenty-nine patients completed the 12-month core phase, 1 withdrew consent, and 3 discontinued treatment due to adverse events (AEs; diabetes mellitus, hyperglycemia, liver function abnormality, n=1 each). Almost all patients (97%; 32/33) experienced AEs; the most common AEs were nasopharyngitis (48.5%), hyperglycemia (42.4%), diabetes mellitus (24.2%), constipation (18.2%), and hypoglycemia (15.2%). Serious AEs were reported in 7 patients with the most common being hyperglycemia (n=2). Long-acting pasireotide demonstrated clinically relevant efficacy and was well tolerated in Japanese patients with acromegaly or pituitary gigantism.

DOI： 10.1507/endocrj.EJ16-0624

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：THIEME MEDICAL PUBL INC  

ObjectiveThe pulsed laser-induced liquid jet (LILJ) system is an emerging surgical instrument intended to assist both maximal removal of the lesion and functional maintenance through preservation of fine vessels and minimal damage to the surrounding tissue. The system ejects the minimum required amount of pulsed water through a handy bayonet-shaped catheter. We have already shown a significant increase in removal rate, in addition to a noteworthy reduction of intraoperative blood loss and procedure time in the treatment of large pituitary and skull base tumors in a single-institution series. The present study evaluated the safety of the system in multiple institutions.
MethodsThe study included 46 patients, 29 men and 17 women (mean age: 59.1 years) who underwent microsurgical/endoscopic resection of lesions in or in the vicinity of the pituitary fossa through the transsphenoidal approach between October 2011 and June 2012 at six institutions. The histologic diagnoses were pituitary adenoma (31 cases), meningioma (4), craniopharyngioma (3), cavernous angioma (2), and Rathke cyst cleft (1). Lesion volume ranged from 2.0 to 30.4 cm(3) (mean: 3.7 cm(3)). Cavernous sinus invasion was observed in 11 cases and suprasellar extension in 29 cases.
ResultsPreservation of intralesional arteries (diameter: 150 mu m) was achieved in all situations in&gt;80% of cases. Intended surgical steps were achieved except for some restrictions in motion due to the use of an optical quartz fiber. No complications occurred directly related to the use of the device.
ConclusionsThe LILJ system can be used for safe removal of lesions in or in the vicinity of the pituitary fossa.

DOI： 10.1055/s-0034-1396436

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called "fascia patchwork closure" for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.

DOI： 10.1007/s10143-015-0614-6

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Chondromas originating from the sella turcica are rare, and the most common initial symptoms are headache and visual disturbance. We describe a case of sellar chondroma with endocrine impairment as an initial manifestation that completely resolved after surgery. A 40-year-old Japanese woman with amenorrhea and galactorrhea for the last 2 years was referred to our department of neurosurgery for the evaluation of high prolactin levels and a tumor in the sella turcica. A biochemical assessment indicated endocrine dysfunction. Magnetic resonance imaging and computed tomography indicated a tumor in the sella turcica. The patient's presentation favored the preoperative diagnosis of pituitary adenoma or Rathke's cleft cyst. However, because calcification was detected, other types of tumors, such as craniopharyngioma, meningioma, and chordoma, were also considered. Endoscopic transsphenoidal surgery was performed, and the possibility of a bony tumor was recognized. Finally, the tumor was completely removed, and the histopathological findings confirmed chondroma. The postoperative course was uneventful, and endocrine function improved. Five years after surgery, the patient is doing well without pituitary insufficiency, pituitary hormone medications, or signs of tumor recurrence. In cases of sellar chondroma, endocrine dysfunction sometimes precedes other symptoms, such as headache and visual disturbance. When examining a patient with an intrasellar tumor harboring calcification, clinicians must consider the possibility of sellar chondroma. Furthermore, to the best of our knowledge, this case is the first of sellar chondroma treated with endoscopic surgery to be reported.

DOI： 10.1272/jnms.82.146

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

Gremlin is an antagonist of bone morphogenetic protein (BMP) and a major driving force in skeletal modeling in the fetal stage. Several recent reports have shown that Gremlin is also involved in angiogenesis of lung cancer and diabetic retinopathy. The purpose of this study was to investigate the role of Gremlin in tumor angiogenesis in pituitary adenoma. Double fluorescence immunohistochemistry of Gremlin and CD34 was performed in pituitary adenoma tissues obtained during transsphenoidal surgery in 45 cases (7 PRLoma, 17 GHoma, 2 ACTHoma, and 2 TSHoma). Gremlin and microvascular density (MVD) were detected by double-immunofluorescence microscopy in CD34-positive vessels from tissue microarray analysis of 60 cases of pituitary adenomas (6 PRLoma, 23 GHoma, 22 NFoma, 5 ACTHoma, and 4 TSHoma). In tissue microarray analysis, MVD was significantly correlated with an increased Gremlin level (linear regression: P &lt; 0.005, r(2) = 0.4958). In contrast, Gremlin expression showed no correlation with tumor subtype or Knosp score. The high level of expression of Gremlin in pituitary adenoma tissue with many CD34-positive vessels and the strong coherence of these regions indicate that Gremlin is associated with angiogenesis in pituitary adenoma cells.

DOI： 10.1155/2015/834137

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HINDAWI PUBLISHING CORP  

Background and Importance. Sellar arachnoid cysts and Rathke's cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant. Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke's cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable. Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.

DOI： 10.1155/2015/389474

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN NEUROSURGICAL SOC  

In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing midline skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.

DOI： 10.2176/nmc.st.2014-0081

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Angiogenesis plays a crucial role in tumor growth. Recently, endocan has emerged as a new marker of vascular endothelial cells from cancers in other organs. In this study, we elucidated the relationship between endocan expression and tumor invasion of pituitary adenoma. Tumor tissues were obtained from 70 patients with pituitary adenoma and were examined using fluorescence immunohistochemistry. Tissue samples included 4 adrenocorticotrophic hormone producing adenomas, 10 growth hormone-producing adenomas, 49 clinically nonfunctioning adenomas, 6 prolactin producing adenomas, and 1 thyroid-stimulating hormone producing adenoma. Endocan was exclusively expressed in CD34-positive vascular endothelial cells, with over 90 % colocalization. The CD34 expression was significantly elevated with endocan expression (linear regression slope, 1.200; r(2) = 0.268, F = 23.08, p &lt; 0.0001). As a percentage of CD34 expression, endocan expression was elevated in a Knosp grading dependent manner (Spearman's r-value, 0.651; p &lt; 0.0001), and was also significantly elevated in macroadenomas compared with microadenomas (p = 0.0133). However, no differences in endocan expression were observed between hormonal subtypes (p = 0.066; Kruskal-Wallis test), age (Spearman's rank correlation test, p = 0.4909), or sex (Mann-Whitney test, p = 0.1701). These data show that endocan is closely related to tumor angiogenesis, and may predict tumor invasion into neighboring cavernous sinuses in pituitary adenomas.

DOI： 10.1007/s11060-014-1377-6

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Secretoglobin (SCGB) 3A2 was originally identified as a downstream target for the homeodomain transcription factor NKX2-1 in the lung. NKX2-1 plays a role in the genesis and expression of genes in the thyroid, lung and ventral forebrain; Nkx2-1-null mice have no thyroid and pituitary and severely hypoplastic lungs and hypothalamus. To demonstrate whether SCGB3A2 plays any role in pituitary hormone production, NKX2-1 and SCGB3A2 expression in the mouse pituitary gland was examined by immunohistochemical analysis and RT-PCR. NKX2-1 was localized in the posterior pituitary lobe, whereas SCGB3A2 was observed in both anterior and posterior lobes as shown by immunohistochemistry and RT-PCR. Expression of CCAAT-enhancer binding proteins (C/EBPs), which regulate mouse Scgb3a2 transcription, was also examined by RT-PCR. C/EBP beta, gamma, delta and zeta were expressed in the adult mouse pituitary gland. SCGB3A2 was expressed in the anterior and posterior lobes from postnatal days 1 and 5, respectively and the areas where SCGB3A2 expression was found coincided with the area where FSH-secreting cells were found. Double-staining for SCGB3A2 and pituitary hormones revealed that SCGB3A2 was mainly localized in gonadotrophs in 49 % of FSH-secreting cells and 47 % of LH-secreting cells. In addition, SCGB3A2 dramatically inhibited LH and FSH mRNA expression in rat pituitary primary cell cultures. These results suggest that SCGB3A2 regulates FSH/LH production in the anterior pituitary lobe and that transcription factors other than NKX2-1 may regulate SCGB3A2 expression.

DOI： 10.1007/s00441-014-1794-z

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：SPRINGER JAPAN KK  

There have been several reports of temozolomide (TMZ) treatment of pituitary carcinomas and atypical adenomas. O-6-methyl-guanine-DNA methyltransferase is not the sole molecule determining the sensitivity to TMZ in pituitary carcinomas and atypical adenomas. The Japan Society of Hypothalamic and Pituitary Tumors study suggests that MSH6, one of mismatch repair pathway enzyme, fulfills a contributory role to the efficacy of TMZ treatment for pituitary carcinomas and atypical adenomas. The preserved MSH6 function might be essential for the responsiveness to TMZ treatment in pituitary carcinomas and atypical adenomas.

DOI： 10.1007/s00795-013-0050-z

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.clineuro.2013.09.010

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ENDOCRINE SOC  

Context: IgG4-related hypophysitis is a novel clinical disease entity, which is typically complicated by hypopituitarism.
Objective: The objective of the study was to describe a novel case of IgG4-related hypophysitis without pituitary insufficiency and summarize the current relevant literature.
Patient and Methods: A55-year-old Japanese man presented with an enlarged pituitary gland and bitemporal hemianopsia. Endocrine studies revealed normal pituitary function, although his serum IgG4 level was high. The patient underwent a transsphenoidal biopsy of the pituitary gland, and the pathological tissues were consistent with IgG4-related hypophysitis. Oral prednisolone therapy was started, and after 6 months, his serum IgG4 level decreased and visual field improved.
Conclusion: We described the first case of IgG4-related hypophysitis without pituitary insufficiency. However, further case collection is needed to characterize the pathophysiology of IgG4-related hypophysitis. (J Clin Endocrinol Metab 98: 1808-1811, 2013)

DOI： 10.1210/jc.2013-1088

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ENDOCRINE SOC  

Context: Temozolomide (TMZ) is an alkylating agent and was a first-line chemotherapeutic agent for malignant gliomas. Recently, TMZ has been documented to be effective against atypical pituitary adenomas (APAs) and pituitary carcinomas (PCs).
Objective: The clinical and pathological characteristics of APAs and PCs treated with TMZ in Japan were surveyed and analyzed retrospectively.
Design: Members of the Japan Society of Hypothalamic and Pituitary Tumors were surveyed regarding the clinical characteristics of APAs and PCs treated with TMZ. Stored tumor samples were gathered from the responders and were assessed by the immunohistochemistry of Ki-67, O-6-methyl-guanine-DNA methyltransferase, p53, MSH6, and anterior pituitary hormones. Responses to TMZ treatment were defined as complete response (CR), partial response (PR), progressive disease (PD), and stable disease (SD) according to RECIST (Response Evaluation Criteria in Solid Tumors) version 2.0.
Subjects: Three samples from 3 subjects with APA and 11 samples from 10 subjects with PC were available.
Results: The 13 subjects had APAs and PCs consisting of 5 prolactin-producing tumors, 5 ACTH-producing tumors, and 3 null cell adenomas. The clinical response to TMZ treatment was as follows: 4 cases of CR and PR (31%), 2 cases of SD (15%), 6 cases of recurrence after CR and PR (46%), and 1 case of PD (8%). However, considerable subjects had recurrent disease after a response to TMZ. The immunohistochemical findings of Ki-67, O6-methyl-guanine-DNA methyltransferase, and p53 did not show any significant correlation with the efficacy of TMZ. However, the immunopositivity of MSH6 was positively correlated with TMZ response (P = .015, Fisher's exact test).
Conclusions: This study showed that preserving MSH6 function was contributory to the effectiveness of TMZ in malignant pituitary neoplasms. It is necessary to survey more cases and evaluate multifactor analyses. (J Clin Endocrinol Metab 98: 1130-1136, 2013)

DOI： 10.1210/jc.2012-2924

Web of Science

PubMed

researchmap

記述言語：英語  

We reviewed 94 patients with Rathke's cleft cyst (RCC) who were surgically treated at Nippon Medical School Hospital between December 1995 and July 2009 to clarify the effect of surgery on their endocrine function. In our statistical analysis we considered their age and sex, the cyst volume, and preoperative MRI findings. Using simple linear- and multiple regression analysis we evaluated the association between these factors and their preoperative hormone baseline levels. To assess pre- and postoperative anterior pituitary function we subjected the results of various hormone loading tests to the Wilcoxon rank sum test. Surgery improved headache and visual impairment in most patients and elevated PRL levels were significantly normalized after surgery (p = 0.004). However, pre- and postoperative anterior pituitary hormone loading tests revealed that the levels of GH, TSH, LH, and FSH were not improved significantly by surgery. Although the ACTH loading test showed postoperative improvement, the change was not statistically significant. We suggest that RCC patients with headache or visual impairment are good candidates for surgery. We also recommend that patients with hyperprolactinemia and those with ACTH deficiency whose MRI findings reveal low-intensity on T1WI and high-intensity on T2WI are likely to benefit from surgery. In contrast, RCC patients with other hormone dysfunctions do not appear to benefit from surgical intervention.

DOI： 10.1507/endocrj.EJ12-0039

PubMed

researchmap

記述言語：英語   出版者・発行元：JAPAN SOC HISTOCHEMISTRY & CYTOCHEMISTRY  

Skull base metastasis from differentiated thyroid carcinoma including follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) is a rare clinical entity. Eighteen FTC cases and 10 PTC cases showing skull base metastasis have been reported. The most common symptom of skull base metastasis from FTC and PTC is cranial nerve dysfunction. Bone destruction and local invasion to the surrounding soft tissues are common on radiological imaging. Skull base metastases can be the initial clinical presentation of FTC and PTC in the presence of silent primary sites. The possibility of skull base metastasis from FTC and PTC should be considered in patients with the clinical symptoms of cranial nerve dysfunction and radiological findings of bone destruction. A variety of genetic alterations in thyroid tumors have been identified to have a fundamental role in their tumorigenesis. Molecular histochemical studies are useful for elucidating the histopathological features of thyroid carcinoma. Recent molecular findings may provide novel molecular-based treatment strategies for thyroid carcinoma.

DOI： 10.1267/ahc.13019

Web of Science

PubMed

researchmap

記述言語：英語  

BACKGROUND: Knot-tying in the deep operative field is very complicated because of the narrow working space during endoscopic transsphenoidal surgery. We present a novel technique for tying deep knots called the "easy slip-knot," which was developed from a knot used to tie fishing lines. METHOD: After threading the dura, an easy slip-knot is made outside the nostril. One end of the string is pulled, the knot then naturally slips, and should reach the operative field without needing a knot-pusher. FINDINGS: This method is not complicated, is easily applied to the operative field by slipping the knot into position, and is able to tie sutures securely. CONCLUSIONS: The easy slip-knot should be useful for endoscopic surgery.

DOI： 10.1007/s00701-011-0988-3

PubMed

researchmap

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

The functional differentiation of pituitary cells and adenomas follows the combination of transcription factors and co-factors in three cell lineages [growth hormone-prolactin-thyroid-stimulating hormone lineage, adrenocorticotrophic hormone (ACTH)/pro-opiomelanocortin (POMC) lineage, and follicular stimulating hormone (FSH)/luteinizing hormone (LH) lineage], which include Pit-1, GATA-2, SF-1, NeuroD1/beta2, Tpit, ERα, and others. Only rarely are hormones from different lineages co-expressed in the same adenoma cells. Most corticotroph cell adenomas belonging to the ACTH/POMC lineage are mono-hormonal. In our study of 89 corticotroph cell adenomas, 5 cases expressed both ACTH and alpha-subunit
these adenomas did not express any other anterior pituitary hormones or subunits. To clarify the mechanism involved, we studied the transcription factors that regulate pituitary cell differentiation. NeuroD1 and T-pit, markers of the ACTH/POMC lineage, and SF-1 and DAX-1, related to the LH/FSH cell lineage were expressed in all cases. GATA2, a synergistic factor in the gonadotroph cell lineage with SF-1, was also expressed in three of five cases. As ACTH and alpha-subunit are the earliest hormones to appear during development, we speculate that these particular adenomas are derived from committed ACTH progenitor cells. The molecular process governing functional differentiation of these adenomas requires further investigation. © 2008 Humana Press Inc.

DOI： 10.1007/s12022-008-9014-6

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: The aim of this study was to determine the correlation between the expression of somatostatin receptors by immunohistochemistry and the percent suppression of GH levels in the octreotide suppression test. Patients and Methods: Twenty-two patients with acromegaly who underwent an octreotide suppression test before surgery were studied. We performed immunohistochemistry for Somatostatin receptor 2A (SSTR2A) and Somatostatin receptor 5 (SSTR5) on the surgical specimens from all patients, which we scored according to the number of tumor cells staining positive at the surface membrane (3+: &gt
50%, 2+: 25-50%, 1+: &lt
25%). We sought correlations of percent suppression in the octreotide suppression test with these immunohistochemistry scores. Results: Somatostatin receptor 2A (SSTR2A) showed the highest frequency of score 3+ (13 of 22, 59.1%) by immunohistochemistry. Subtype 5 showed the highest frequency for score 2+ (9 of 22, 40.9%), and one (4.5%) was immunonegative. For subtype 2A, there was a significant correlation with percent decrease (P=0.002&lt
0.01). In contrast, there was no significant correlation for SSTR5. Conclusion: Immunohistochemistry for SSTR2A in pathology specimens from acromegalic patients enabled selection of those experiencing clinical benefit from octreotide. Therefore, performing immunohistochemistry for detection of SSTR2A is recommended for all specimens obtained by surgery. © 2007 Humana Press Inc.

DOI： 10.1007/s12022-007-9004-0

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Numerous surgical approaches have been used to treat petrous apex cholesterol granulomas. They are usually treated via the transtemporal- or middle fossa approach
some are managed endoscopically. We present a patient treated by the endoscopic transsphenoidal approach and review the literature. © 2007 Springer-Verlag.

DOI： 10.1007/s00701-006-1105-x

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to immunohistochemically assess the proliferation activity of pituitary incidentalomas. A series of 52 incidentalomas studied included 22 gonadotroph cell adenomas, 21 null cell adenomas, and 9 clinically silent adenomas (identified as functioning by immunohistochemistry). We also analyzed the differences in proliferation activity between 43 non-functioning pituitary incidentalomas (not including 9 silent adenomas), and 43 symptomatic non-functioning adenomas (NFAs) that caused visual disturbance. Cell proliferation markers were immunostained using monoclonal Ki-67 (MIB-1) antibody and monoclonal anti-topoisomerase II alpha (Topo-II alpha) antibody. The average of MIB-1 labeling indices in pituitary incidentalomas was 0.61% +/- 0.06%. Overall, both MIB-1 and Topo-II alpha labeling indices of the incidentalomas were significantly lower than those of symptomatic NFAs. There were no significant differences in immunopositivity between the two groups based on gender, age, or subtype. The MIB-1 index of the smallest adenoma group in pituitary incidentalomas was significantly lower than in symptomatic NFAs, while the Topo-II alpha incidentaloma was significantly lower than in symptomatic NFAs. Our findings suggest that small or less invasive pituitary incidentalomas should be observed with follow-up MRI. Large or invasive incidentalomas should be surgically treated if the patients show visual disturbances, hypopituitarism, or pituitary apoplexy during the follow-up period.

DOI： 10.1385/EP:17:3:263

PubMed

researchmap

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO  

DOI： 10.1053/j.sult.2004.10.001

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Thyrotropin (TSH)-secreting adenomas are rare and, as most adenomas are large, invasive and difficult to cure by surgery only, many require additional medical treatment. Many TSH-secreting adenomas cosecrete growth hormone (GH) and/or prolactin (PRL). We evaluated the relationship between pathology and the effect of dopamine agonist bromocriptine and somatostatin analogue octreotide in 20 operated patients with TSH-secreting adenomas. The four men and 16 women ranged in age from 23 to 62 years; three had clinically overt acromegaly; two manifested galactorrhea-amenorrhea. Endocrinologically, elevated serum GH, and/or IGF-1 were observed in six patients and elevated serum PRL was observed in eight. Immunohistochemically, 16 of the 20 adenomas were positive for GH and/or PRL (GH-positive, n=13; PRL-positive, n=9). Pituitary-specific transcription factor Pit-1 was demonstrated in the nuclei of all adenoma cells. Octreotide tests showed suppression of serum TSH (&lt;50%) in ten of 14 patients. Preoperative octreotide treatment effectively reduced serum TSH and tumor size in two patients. Electron micrographs of octreotide-treated TSH-secreting adenomas showed shrinkage of the cytoplasm and diffuse distribution of secretory granules. Our study suggests that cosecretion of GH and/or PRL from TSH-secreting adenoma has no correlation with response of tumor cells to medical treatment.

DOI： 10.1007/s00401-004-0863-x

Web of Science

PubMed

researchmap

記述言語：日本語  

The development of computed tomography(CT) and magnetic resonance imaging (MRI) has resulted in the discovery of unsuspected endocrinologically silent pituitary masses(pituitary incidentalomas). The management of these pituitary incidentalomas is controversial. Some lesions may increase in size, compress optic chiasm while others will remain unchanged in size. Five hundred and six patients with pituitary incidentalomas were obtained by questionnaire from March 1999 to May 2000 under the auspices of the Ministry of Health, Labor and Welfare in Japan. In thirty-three patients with pituitary incidentalomas (13.3%) developed tumor enlargement during the mean follow-up period of 45.5 months. Of 115 estimated non-functioning adenomas, 23(20.0%) tumor increased during mean follow up period of 50.7 months (range 10 to 173 months), while 5(5.4%) of 94 estimated Rathke's cysts increased in size during follow up. Pituitary apoplexy was occurred in one patient of 248 patients (0.4%). Pituitary incidentalomas usually follow a benign course. Transsphenoidal adenectomy is indicated for a solid mass attached to optic chiasma. For other patients, MRI every 6 months for the first 2 years, and then yearly may be recommended.

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：MEDIMOND PUBLISHING CO  

Prolactinomas are the most common functioning tumors. Medical therapy is the initial treatment of choice for most patients with prolactinomas. Dopamine agonists enable a rapid normalization of PRL level, restoration of fertility and of libido, and cause tumor shrinkage. Bromocriptine use has an extensive safety experience and is preferred. However, between 5 to 10% of patients either do not respond to bromocriptine or have only minimum responses. Pergolide and quinagolide are dopamine agonists used for the treatment of hyperprolactinemia. Cabergoline, a selective and long-lasting dopamine agonist appears to be more efficacious and better tolerated. An as yet unsolved question is whether patients with prolactinoma should continue dopamine agonist life-long.

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：MEDIMOND PUBLISHING CO  

The aim of this study was to clalyfy the natural history of pituitary incidentalomas in order to establish an appropriate approach to them. One hundred and thirty-three patients with pituitary incidentalomas have been followed up in our department. Seventy-five patients(56.4%) underwent surgery, while fifty-eight patients(43.6%) were followed up conservatively. Clinical and biochemical assessment, CT or MRI of the pituitary, and visual field testing were assessed at baseline and 6 Months and Yearly thereafter. Pituitary incidentalomas usually follow a benign course. We recommend transsphenoidal adenectomy for a solid mass attached to the optic chiasma estimated to be a pituitary adenoma by MRI. Other patients should be followed up by MRI and biochemical assessment every 6 Months for the first 1 Years, and then Yearly. Asymptomatic cystic mass could be followed up without surgical intervention because they tend to stay same size, or sometimes be cured spontaneously.

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：HUMANA PRESS INC  

Among pituitary disorders having mass effect of the pituitary gland, nonfunctioning pituitary macroadenoma and lymphocytic hypophysitis are difficult to differentiate without histological examination. In order to efficiently distinguish lymphocytic hypophysitis and pituitary tumors, we studied the presence of autoantibodies against prohormone-processing enzymes, prohormone convertase (PC) 1/3, PC2, carboxypeptidase E (CPE), and PC2 regulatory protein, 702, by radioligand assay using recombinant human S-35-labeled protein in patients with clinically nonfunctioning pituitary macroadenoma, lymphocytic hypophysitis, and other pituitary diseases. The indexes for anti-PC1/3 antibodies (Ab) were significantly higher in patients with nonfunctioning pituitary macroadenoma than in patients with lymphocytic hypophysitis. Patients positive for either anti-PC1/3 or anti-7B2 Ab were significantly frequent among patients with nonfunctioning pituitary macroadenoma than in other pituitary diseases and healthy controls. None of the patients was positive for anti-PC2 Ab or anti-CPE Ab. These results suggest that autoantibodies against PC1/3 and 7B2 are novel tumor-associated autoantibodies and can be helpful in the diagnosis of clinically nonfunctioning pituitary macroadenoma.

Web of Science

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Among pituitary disorders having mass effect of the pituitary gland, nonfunctioning pituitary macroadenoma and lymphocytic hypophysitis are difficult to differentiate without histological examination. In order to efficiently distinguish lymphocytic hypophysitis and pituitary tumors, we studied the presence of autoantibodies against prohormone-processing enzymes, prohormone convertase (PC) 1/3, PC2, carboxypeptidase E (CPE), and PC2 regulatory protein, 7B2, by radioligand assay using recombinant human 35S-labeled protein in patients with clinically nonfunctioning pituitary macroadenoma, lymphocytic hypophysitis, and other pituitary diseases. The indexes for anti-PC1/3 antibodies (Ab) were significantly higher in patients with nonfunctioning pituitary macro-adenoma than in patients with lymphocytic hypophysitis. Patients positive for either anti-PC1/3 or anti-7B2 Ab were significantly frequent among patients with non-functioning pituitary macroadenoma than in other pituitary diseases and healthy controls. None of the patients was positive for anti-PC2 Ab or anti-CPE Ab. These results suggest that autoantibodies against PC1/3 and 7B2 are novel tumor-associated autoantibodies and can be helpful in the diagnosis of clinically nonfunctioning pituitary macroadenoma.

DOI： 10.1385/ENDO:22:3:335

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPAN ENDOCRINE SOCIETY  

A previous study reported a high prevalence of autoantibodies to alpha-enolase in lymphocytic hypophysitis and these antibodies efficiently distinguished lymphocytic hypophysitis from pituitary tumors. To confirm this, we examined autoantibodies to alpha-enolase in patients with lymphocytic hypophysitis (n = 17), pituitary non-functioning adenoma (n = 13), other pituitary diseases (n = 17) and other autoimmune diseases (n = 30), and compared to healthy controls (n = 46). Autoantibodies were found in 41.2%, 46.2%, 23.5%, 20.0% and 4.3%, respectively. Our findings indicate that detection of anti-alpha-enolase antibodies is not suitable for specific diagnosis of lymphocytic hypophysitis.

DOI： 10.1507/endocrj.50.697

Web of Science

PubMed

researchmap

記述言語：日本語   出版者・発行元：株式会社医学書院  

27歳女.頭痛と発熱で受診した.髄液所見からウイルス性髄膜炎の診断で保存的加療を開始した.低Na血症とその顔貌から内分泌機能異常が疑われ,各種ホルモン検査を施行したところgrowth hormone(GH)とsomatomedin C(IGF-1)の高値,その他の下垂体ホルモンの低値が確認された.頭部MRIで下垂体腺腫を指摘された.経蝶形骨腫瘍摘出術を施行した.病理所見で下垂体腺腫の炎症が認められた

DOI： 10.11477/mf.1406100550

Scopus

PubMed

CiNii Research

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2003&ichushi_jid=J01231&link_issn=&doc_id=20031219090006&doc_link_id=10.11477%2Fmf.1406100550&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1406100550&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIO SCIENTIFICA LTD  

Objective: The development of computed tomography (CT) and magnetic resonance imaging (MRI) has resulted in the discovery of unsuspected endocrinologically silent pituitary masses (pituitary incidentalomas). The aim of this study was to perform a national survey on pituitary incidentalomas in order to establish an appropriate approach to them.
Design and methods: Five hundred and six patients with pituitary incidentalomas were obtained by questionnaire from March 1999 to May 2000 under the auspices of the Ministry of Health, Labor and Welfare in Japan. Two hundred and fifty-eight patients underwent surgery (surgical group), while 248 patients were followed up conservatively for a mean period of 26.9 months (range 6-173 months) (non-surgical group). Clinical and biochemical assessment, CT or MRI of the pituitary, and visual field testing by Goldman perimetry were assessed at baseline and 6 months and yearly thereafter.
Results: Thirty-three patients with pituitary incidentalomas (13.3%) developed tumor enlargement during the mean follow-up period of 45.5 months. Of 115 estimated non-functioning adenomas, 2 3 tumors (20.0%) increased during a mean follow-up period of 50.7 months (range 10-173 months), while 5 of 94 (5.3%) estimated Rathke's cysts increased in size during follow-up. Pituitary apoplexy occurred in one of 248 patients (0.4%).
Conclusions: Pituitary incidentalomas usually follow a benign course. We recommend transsphenoidal adenectomy for a solid mass attached to the optic chiasma estimated to be a pituitary adenoma by MRI. Other patients should be followed up by MRI every 6 months for the first 2 years, and then yearly.

DOI： 10.1530/eje.0.1490123

Web of Science

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

A 53-year-old Japanese woman was diagnosed with Cushing's disease caused by a adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma on the basis of clinical an imaging data. The surgically resected tumor tissue was investigated histopathologically using immunohistochemical analysis of pituitary hormones. Our study revealed that the adenoma expressed not only ACTH but growth hormone (GH) in the tumor cells. Furthermore, immunohistochemical double staining showed that some adenoma cells were positive for both ACTH and GH. In situ hybridization for GH mRNA revealed that the adenoma cells produced GH as opposed to simply storing it. Although many pituitary adenomas produce multiple pituitary hormones, pituitary adenoma producing both ACTH and GH in the same adenoma cells, such as seen in this case, is extremely rare. To elucidate the molecular mechanism involved, we investigated the expression of transcription factors NeuroD1 and Pit-1 and found that both transcription factors were expressed in many tumor cells. This case report describes a very rare case of pituitary adenoma that produced both ACTH and GH. We propose a hitherto undescribed translineage expression of transcription factors as the basic mechanism of this unique functional differentiation.

DOI： 10.1097/01.MP.0000030451.28828.00

Web of Science

PubMed

researchmap

記述言語：英語   出版者・発行元：AMER MEDICAL ASSOC  

Web of Science

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

It has been reported that RCAS1 (receptor-binding cancer antigen expressed on SiSO cells) acts as a ligand for a receptor present on normal peripheral lymphocytes and induces apoptotic cell death. It is expressed In uterine and ovarian carcinomas, especially in invasive cancers. This immunohistochemical study is aimed to elucidate the expression of RCAS1 in human pituitary adenomas in order to clarify its role in their proliferative regulation and invasiveness. Five normal pituitary glands, 50 human pituitary adenomas, and one malignant glioma. were subjected to immunohistochemical studies. In normal pituitary glands, immunostaining of RCAS1 and MIB-1 was not found. In malignant glioma, large numbers of cell nuclei were positive for MlB-1 (MIB-1 Index: 28%), and RCAS1 was detected both in the cytoplasm and on the membrane of the tumor cells. Expression of RCAS1 was noted in 48% of pituitary adenomas immunohistochemically (60.0% of growth hormone-secreting adenomas, 60.0% of prolactin-secreting adenomas, 42.9% of adrenocordcotrophin-secreting adenomas, 40.0% of thyroid-stimulating hormone-secreting adenomas, 33.3% of nonfunctioning adenomas, and 44.4% of gonadotropin-subunit-positive adenomas). It showed no correlation with tumor type, size, and invasiveness. The statistically significant relationship between RCAS1 and MIB-1 positivity was Identified in our study. These results suggest that expression of RCAS1 as well as MIB-1 positivity predict the growth potential of individual pituitary adenomas.

DOI： 10.1038/modpathol.3880467

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：URBAN & FISCHER VERLAG  

The anterior pituitary is composed of several cell types, each responsible for the production of specific hormones. Each hormone secreting cells is defined by the activation of its respective hormone genes in a temporally and spatially regulated manner. Recent development in cytochemistry and molecular biology have provided various aspects of human pituitary adenomas, i. e., functional differentiation and classification. The molecular factors that determine hormone production have now been identified as transcription factors. Many novel transcription factors that play a role in anterior pituitary development are implicated. In this review, we focus on the transcriptional factors roles on functional differentiation of the pituitary cells and adenomas and the contribution of cytochemistry and recent development in molecular biological techniques.

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

p27 (Kip1) plays regulatory roles in the cell cycle by inhibiting the activity of cyclin dependent kinases (CDKs). This immunohistochemical study is aimed at elucidating the expression of p27 in human pituitary and in various types of pituitary adenomas in order to clarify its role in the regulation of proliferation. Sixteen normal pituitary glands and 179 human pituitary adenomas were used for immunohistochemical studies. The tissues were fixed in 10% formalin and embedded in paraffin. Indirect peroxidase method was performed after heat-induced antigen retrieval using a monoclonal antibody against p27 protein, p27 protein was expressed in the nuclei of ali 16 normal human pituitary glands, p27 protein was also expressed in 128 of 179 cases of pituitary adenomas (71.5%). A marked decrease of p27 expression was noted in ACTH-secreting adenomas, 8/20 (40.0%), compared with other types of pituitary adenomas - GH-secreting adenomas, 35/46 (76.1%)
PRL-secreting adenomas, 22/33 (66.7%)
TSH-secreting adenomas, 8/11 (72.7%)
and nonfunctioning adenomas, 55/69 (79.7%). These results suggest that p27 may play some role in the regulation of proliferation in ali types of pituitary adenomas. The lower levels of p27 in ACTH-secreting adenoma is of particular interest with respect to the intermediate lobe-derived pituitary tumor developed in p27 knockout mice.

DOI： 10.1385/EP:12:2:181

Scopus

PubMed

researchmap

記述言語：英語   出版者・発行元：Histochemical Society Inc.  

Immunohistochemistry (IHC) and recently in situ hybridization (ISH) have elucidated various aspects of human pituitary adenomas, i.e., functional differentiation and classification, transcription factors and mechanism of hormone production, regulation of hormone secretion, and processing of prohormones. Recently, the use of tyramide (catalyzed signal amplification
TSA or CSA) and RT-PCR has been effective for detection of trivial amount of proteins (peptides) and mRNA, respectively. Immunomolecular histochemistry is expected to further clarify the function and biology of human pituitary adenomas.

DOI： 10.1177/002215540004800401

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Lippincott Williams and Wilkins  

We investigated the localization of pituitary homeo box 1 (Ptx1) protein in five human non-neoplastic pituitaries and 73 of all types of pituitary adenomas using immunohistochemistry, and the expression of Ptx1 messenger RNA (mRNA) in 18 representative pituitary adenomas using the reverse transcriptase polymerase chain reaction (RT-PCR) technique. By immunohistochemical analysis, Ptx1 protein was extensively detected in the nuclei of normal human pituitary cells. Ptx1 was detected in 10/14 (71.4%) of growth hormone (GH)-secreting adenomas, 12/12 (100%) of prolactin (PRL)-secreting adenomas, 18/20 (90%) of adrenocorticotropic hormone (ACTH)-secreting adenomas, 6/7 (85.7%) of thyroid-stimulating hormone (TSH)-secreting adenomas, and 17/20 (85%) of clerically non-functioning adenomas, including 9/10 (90%) of gonadotropinsubunit-positive adenomas. Thus, there was no relationship between Ptx1 expression and a particular type of pituitary adenomas. By RT-PCR analysis, Ptx1 mRNA was expressed in all 18 cases of pituitary adenomas, including two cases negative for Ptx1 protein by immunohistochemistry. These results suggested that Ptx1 may be an universal transcription factor in both neoplastic and non-neoplastic conditions in human pituitaries. The synergistic action with other transcription factors may be speculated to determine the specific production of the anterior pituitary hormones.

DOI： 10.1038/modpathol.3880204

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER VERLAG  

The pituitary homeobox1 gene (Ptx1) was initially identified as encoding a pituitary-restricted transcription factor for the proopiomelanocortin (POMC) gene. In order to elucidate the expression pattern of the Ptx1 protein, we investigated the localization of the protein in adult rat pituitary gland and in various pituitary cell lines. We produced an antibody specific for:Ptx1 protein, and confirmed its specificity by Western blot analysis. Immunohistochemically, many nuclei in the anterior pituitary cells as well as in the intermediate cells were positive for Ptx1 staining with this specific antibody. Immunohistochemical double staining revealed the presence of Ptx1 not only in all types of hormone-secreting cells but also in some folliculo-stellate (FS) cells. Furthermore, the expression of Ptx1 mRNA was confirmed in various pituitary cell lines and in the FS cell line by using the reverse transcriptase-polymerase chain reaction (IRT-PCR) method. Our studies indicated that Ptx1 may not only play a role as a basic transcriptional factor for production of various hormones, but may also play some important role(s) in FS cells. Possible synergistic actions with other factors remain to be investigated. The novel finding of Ptx1 in FS cells is of particular interest, and may suggest that FS cells and hormone-secreting cells are derived from a common cellular ancestor.

DOI： 10.1007/PL00008809

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

OBJECTIVE AND IMPORTANCE: Adrenocorticotropin (ACTH)-secreting pituitary adenomas causing Cushing's disease are often difficult to identify because of their variable locations and their small size. This report presents histological evidence of an ectopic ACTH-secreting adenoma located entirely within the cavernous sinus.
CLINICAL PRESENTATION: A 62-year-old woman presented with central obesity, hypertension, and osteoporosis. Endocrinological evaluation suggested the presence of an ACTH-secreting pituitary adenoma; however, imaging studies, including dynamic magnetic resonance imaging, did not reveal any visible lesions in the pituitary gland. Bilateral cavernous sinus sampling demonstrated a large central/peripheral ACTH gradient, with a right/left ACTH gradient. The patient was treated as having pituitary-dependent Cushing's disease, until she died suddenly as a result of acute respiratory failure.
INTERVENTION: In a postmortem histological examination, an ACTH-secreting adenoma was found in the right cavernous sinus, which was completely surrounded by dura mater and had no direct connection with the pituitary gland.
CONCLUSION: Although they are rare, such adenomas located in the cavernous sinus should be recognized as one of the reasons for inaccurate cavernous sinus sampling and the failure of transsphenoidal surgery for patients with ACTH-dependent Cushing's syndrome.

DOI： 10.1097/00006123-199910000-00041

Web of Science

Scopus

PubMed

researchmap

担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Rab proteins are low molecular weight GTP-binding proteins. Among these proteins, the Rab3 isoforms are considered to be involved in the exocytosis of synaptic vesicles and secretory granules in the central nervous system and anterior pituitary gland. In recent reports, the expression of Rab3 isoforms in anterior pituitary glands of mammalian species was extensively investigated. In the present study, we investigated the localization of Rab3 protein in 5 human nontumorous pituitaries and 114 human pituitary adenomas using immunohistochemical methods. In five human nontumorous pituitaries, Rab3 protein was expressed in the cytoplasm of anterior pituitary cells. Double staining for anterior pituitary hormones revealed the expression of Rab3 in growth hormone-secreting cells, but rare expression was observed in the other anterior pituitary hormone-secreting cells. Among the pituitary adenomas, 71 (62.3%) of 114 pituitary adenomas were positive for Rab3, Among the different pituitary adenoma types, the incidence of Rab3 immunopositivity was highest in growth hormone-secreting adenomas (100%), followed by adrenocorticotropic hormone-secreting adenomas (71.4%), thyroid-stimulating hormone-secreting adenomas (57.1%), nonfunctioning adenomas (56.0%), and prolactin-secreting adenomas (33.3%), After an embedding immunoelectron microscopic study, Rab3 was localized along the limiting membrane of secretory granules in the Rab3-positive pituitary adenomas, Western blotting showed the molecular weight of Rab3 to be 25 kDa in the pituitary adenomas, which were immunohistochemically positive for Rab3 protein. These results suggested that Rab3 might be involved in regulating the exocytosis of secretory granules of the anterior pituitary cells, especially growth hormone-secreting ones, which are particularly characterized by densely granulated cytologic features.

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）  

DOI： 10.1507/endocrj.46.Suppl_S81

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Humana Press  

Retinoid-X receptors (RXRs) are transcriptional factors that belong to the steroid/thyroid hormone receptor (TR) superfamily. It has been demonstrated that those nuclear receptors act as ligand-activated transcription factors in pituitary cells. To determine whether RXRs play roles in the celt differentiation of pituitary adenomas, we have investigated the expression of RXRγ mRNA in various types of pituitary adenomas using in situ reverse transcriptase-polymerase chain reaction (RT-PCR). The synergistic function on promoters of specific hormones between these nuclear receptors and pituitary specific transcription factor, Pit-1, has been noticed in in vitro experiments. The colocalization between RXRγ mRNA and Pit-1 protein was examined by combined in situ RT-PCR and immunohistochemistry. RXRγ mRNA was detected in normal pituitary gland as well as all five growth hormone- (GH)-secreting adenomas and five thyroid stimulating hormone (TSH) secreting adenomas, two of four prolactin- (PRL) secreting adenomas, one of two adrenocorticotropin- (ACTH) secreting adenomas, one of four nonfunctioning adenomas. By in situ hybridization and in situ RT-PCR followed by immunohistochemistry, the colocalization of Pit-1 mRNA with RXRγ as well as RXRγ mRNA with Pit-1 was observed in adenoma cells of GH-secreting adenomas and TSH-secreting adenomas. We suggest that RXRγ may play a role in cell differentiation and hormonal transcription synergistically with Pit-1 in normal and neoplastic human pituitaries.

DOI： 10.1007/BF02738818

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pit-1 is a transcription factor which has been reported to regulate differentiation toward GH,PRL and TSH in the anterior pituitary glands. In the human pituitary adenomas, Pit-1 is highly expressed in GH secreting and TSH secreting adenomas as it can well be anticipated. Interestingly, human non-functioning pituitary adenomas also express Pit-1, especially it was expressed in all αSU positive nonfunctioning adenomas. The human anterior pituitary cells are special in comparison with rodents in a finding that αSU is frequently colocalized with GH. As αSU is the first hormone appearing during fetal development in the rodent pituitary glands, it may be postulated that αSU Pit-1 positive cells undergo differentiation in the GH cell lineage. From this background, this paper proposes that &quot;αSU positive Pit-1 Positive&quot; cells are the ones in the GH cell lineage, more specifically a dedifferentiated cell lineage toward αSU/GH/Pit-1.

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：JAPAN SOC HISTOCHEMISTRY & CYTOCHEMISTRY  

Recent technological development has disclosed various transcription factors in the pituitary glands. The cloning of Pit-l, homeodomain containing nuclear binding transcription factors stimulated the subsequent discoveries of many factors participating in the transcription for the specific pituitary hormones. These include Pituitary homeobox1 (Ptx1), Prophet of Pit-1 (Prop-1), NeuroD1, steroidogenic factor-1 (SF-1) and DAX-1. These factors have been shown not only to interact but also to function with various receptors synergistically to promote specific hormones, such as GHPRL-TSH group, POMC and gonadotropin (FSH/LH).

DOI： 10.1267/ahc.32.107

Web of Science

Scopus

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

The pituitary-specific transcriptional factor Pit-1 is known to play a role in the development and differentiation of pituitary cells. Recent investigations have suggested a role for this transcriptional factor in pituitary adenomas, especially growth hormone (GH)- and prolactin (PRL)-secreting pituitary adenomas. In this study we analyzed the expression of Pit-1 mRNA and its protein in 24 clinically nonfunctioning pituitary adenomas in comparison;with normal pituitary glands using in situ hybridization (ISH) and immunohistochemistry (IHC). The interaction between inhibin/activin, a member of the transforming growth factor-beta family, and Pit-1 was also studied. Immunohistochemically, Pit-1 protein was detected in 9 of 24 adenomas (37.5%), and 8 of these 9 were also positive for the a subunit of glycoprotein (alpha SU). The expression of Pit-1 mRNA was detected in 14 of 24 (58.3%) clinically nonfunctioning adenomas, and it was found in all cases which expressed the Pit-1 protein. By the combined ISH and IHC method, Pit-1 mRNA was frequently observed in alpha SU-immunopositive cells in adenomas. The inhibin/activin alpha subunit was detected in all 24 adenomas and the beta A subunit was detected in 13 of 24 adenomas. The inhibin/activin beta A subunit was detected frequently with Pit-1 mRNA. From our observations, the inhibin/activin beta A subunit in nonfunctioning adenomas may have related the expression of Pit-1 mRNA in these adenomas.

DOI： 10.1159/000023194

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER-VERLAG WIEN  

DOI： 10.1007/s007010050122

Web of Science

Scopus

PubMed

researchmap

記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：JAPAN SOC HISTOCHEMISTRY & CYTOCHEMISTRY  

It has been an interesting problem to understand why specific hormones are produced from specific cells. It is known that in the human anterior pituitary gland, tumors are classified into those of growth hormone (GH), prolactin (PRL), ACTH, thyroid stimulating hormone (TSH), and gonadotrophin secreting adenomas as well as nonfunctioning adenomas. In human pituitary adenomas, GH secreting adenoma is usually plurihormonal, i.e., the adenoma not only produces GH but also PRL and TSH. TSH secreting adenoma is also plurihormonal, and adenoma produces TSH as well as GH and PRL. Thus, it was supposed that common transcriptional factors participate in the functional differentiation of GH, PRL, and TSH. Pit-1 has been proposed to regulate GH, PRL, and TSH cells and the dwarf mutants in mice were produced by Pit-1 gene mutations. Simmons et al. (1990) observed Pit-1 protein expression in GH, PRL, and TSH cells [10], in the adult rat pituitary gland although Pit-1 mRNA expression was observed in all cell types (Fig. 1). Therefore it was anticipated that, in human pituitary tumors, the functional expression in GH and TSH secreting adenomas may be under the regulation of Pit-1 protein. We describe here the overview of transcriptional factors depicted by immunohistochemistry and in situ hybridization.

DOI： 10.1267/ahc.31.281

Web of Science

Scopus

researchmap

担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：(株)医学書院  

1)3D-C-TAは同時期の脳血管撮影の所見を反映していた. 2)proximal clipping後の再破裂は術後1週間以内のものが多く,この時期に3D-CTAを用いてVAの血行動態を把握することに意義がある. 3)チタン製clipは,術後3D-CTAを行う上でアーチファクトが少なく有効であった

DOI： 10.11477/mf.1436901429

Web of Science

Scopus

PubMed

CiNii Research

J-GLOBAL

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=1997&ichushi_jid=J01228&link_issn=&doc_id=19970801860003&doc_link_id=10.11477%2Fmf.1436901429&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436901429&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：医歯薬出版(株)  

下垂体および下垂体近傍腫場に対する経鼻的腫瘍摘出術は,近年の手術機器の進歩により内視鏡手術が主流となっている.そして,この術式は2012年の診療報酬改定で新たな術式として追加された.内視鏡手術はトルコ鞍上部や海綿静脈洞など,従来の顕微鏡手術では死角となる部分も観察・摘出可能であり,手術成積が向上している.また従来開頭手術が行われてきた頭蓋咽頭腫や髄膜腫など,他の頭蓋底腫瘍に対しても,トルコ鞍外の頭蓋底の骨を削除し,術野を拡大することによって経鼻的手術が可能となった.一方,2006年から日本神経内視鏡学会により技術認定制度が発足した.この学会で主催されている講習会で神経内視鏡手術の基本的手技を学ぶことにより,脳神経外科領域においても内視鏡手術の裾野が大きく広がっている.今後,若手の脳神経外科医を中心にこの術式が広まっていくものと思われる.(著者抄録)

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00060&link_issn=&doc_id=20231003020032&doc_link_id=issn%3D0039-2359%26volume%3D286%26issue%3D14%26spage%3D1265&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D286%26issue%3D14%26spage%3D1265&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01160&link_issn=&doc_id=20230905310028&doc_link_id=10.1507%2Fendocrine.99.S.HPT_90&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.99.S.HPT_90&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本意識障害学会  

researchmap

記述言語：日本語   出版者・発行元：(株)文光堂  

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・2017年以降のWHO脳腫瘍分類の改訂や高齢化などの時代背景の影響も加味しながら,下垂体神経内分泌腫瘍の疫学に関して概説した.・分子病理学的研究が進むにつれ,下垂体神経内分泌腫瘍は3つの転写因子(PIT1,Tpit,SF1)に基づく系統分類が可能になった.・下垂体神経内分泌腫瘍の発生原因としての分子病理学的背景は非常に多様性に富んでおり,症例の多くは依然として発症機序が不明である.

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・2017年以降のWHO脳腫瘍分類の改訂や高齢化などの時代背景の影響も加味しながら,下垂体神経内分泌腫瘍の疫学に関して概説した.・分子病理学的研究が進むにつれ,下垂体神経内分泌腫瘍は3つの転写因子(PIT1,Tpit,SF1)に基づく系統分類が可能になった.・下垂体神経内分泌腫瘍の発生原因としての分子病理学的背景は非常に多様性に富んでおり,症例の多くは依然として発症機序が不明である.

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(株)日本医事新報社  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本小児神経外科学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本医療安全学会  

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01883&link_issn=&doc_id=20221222050009&doc_link_id=issn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D30&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D30&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01883&link_issn=&doc_id=20221222050006&doc_link_id=issn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D24&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D24&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01883&link_issn=&doc_id=20221222050007&doc_link_id=issn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D26&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D26&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(株)メディカ出版  

researchmap

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01883&link_issn=&doc_id=20221222050008&doc_link_id=issn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D28&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0910-8459%26volume%3D39%26issue%3D1%26spage%3D28&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(有)科学評論社  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(一社)日本脳神経外科コングレス  

ロボット手術は低侵襲手術をより安全・確実に実施することを可能にする技術である。現在脳神経外科領域においては、定位手術において精度と能率を向上させるための補助に主に用いられている。一方で人の手による手術を超える技術は開発途上である。欧米および日本では、マイクロサージェリーに適したロボットとして、内視鏡下のロボット、MRI内でマイクロ下手術を可能とするシステム、さらに深部手術、スーパーマイクロサージェリーを可能にするシステムなどが開発中である。ロボット手術が広く普及するための必須条件として、安全性・確実性の他にロボット手術が従来の手術に比較して十分な付加価値のあることが重要である。またロボット手術は、外科手術のデジタル化につながり、さまざまな外科要素を数値化し客観的な評価および訓練の導入を可能にする。さらに人工知能を導入することにより、周囲組織・機器を同定し、精度の高い操作を補助する、また自動で画像やセンサーガイド下の計画・指示どおりの手術治療を可能にするシステムの確立が可能となると考えられる。(著者抄録)

researchmap

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・経鼻下垂体手術の歴史は術後の髄膜炎をいかに少なくするかの手術法改良の変遷とも言える.・頭蓋底再建法の改良の中で多層再建法に加え,主に本邦において深部硬膜縫合法が提唱されている.・深部硬膜縫合法のポイントとピットフォールに関して動画を用いて詳細に記述する.

DOI： 10.11477/mf.1436204601

PubMed

J-GLOBAL

researchmap

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J01228&link_issn=&doc_id=20220617390025&doc_link_id=10.11477%2Fmf.1436204601&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1436204601&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：日本脳神経CI学会  

これまでに進められた研究プロジェクトのコンセプトと現況、課題をまとめた。プロジェクトIの脳神経外科領域robotic system(Smart Arm)の開発では、1)深部狭小術野操作を可能とするシステムと、2)浅術野の超微細手術を可能とするシステムを構築した。今回、1)において特に経鼻内視鏡手術支援用robotic systemの構築を企画した。プロジェクトIIでは外科技術のデジタル評価、プロジェクトIIIでは自動化手術を試みた。

researchmap

記述言語：日本語   出版者・発行元：日本脳神経CI学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

当院で内視鏡下経鼻的下垂体腫瘍摘出術を施行した症候性下垂体卒中45例(男性33例、女性12例、平均年齢56.0±18.1歳)を対象に、下垂体卒中に誘発される内頸動脈狭窄の病態解析を行った。その結果、内頸動脈狭窄は8例で認められた。多変量解析では年齢が下垂体卒中における内頸動脈狭窄の有意な独立予後因子として示され、若年者では下垂体卒中において内頸動脈狭窄を呈する可能性が示唆された。尚、下垂体卒中に内頸動脈狭窄が発生する年齢のカットオフ値は35.0歳であった。

DOI： 10.1507/endocrine.97.s.hpt_119

CiNii Research

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

経鼻的生検術を行った自己免疫性下垂体炎3症例を提示し、生検術の方法と注意点について報告した。視床下部下垂体に限局した病変で、診断が絞れないケース対して下垂体部の生検術を行う場合には術中髄液漏のリスクを考慮して、トルコ鞍を後方まで十分に削除し、下垂体硬膜を大きく切開した後、後葉の方向から行っている。各種検査で診断を絞ることができなかった症例1(79歳男性)と症例2(64歳女性)は、生検にてそれぞれ頭蓋咽頭腫、リンパ球汎下垂体炎と診断された。症例3(56歳男性)はIgG4関連下垂体炎が最も疑われたが、MRI所見が非典型的であり、生検にて下垂体腺腫を合併したIgG4関連下垂体炎と診断された。正常組織を一部摘出する生検術は最小限の侵襲で行う必要があり、下垂体および周辺の解剖を理解して正確な生検術を行い、下垂体機能を悪化させないことも極めて重要である。

DOI： 10.1507/endocrine.97.s.hpt_32

CiNii Research

researchmap

その他リンク： https://search.jamas.or.jp/link/ui/2022074895

記述言語：日本語   出版者・発行元：(NPO)日本レーザー医学会  

researchmap

記述言語：日本語   出版者・発行元：(株)日本医事新報社  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：一般社団法人 日本内分泌学会  

当院で経鼻的下垂体手術を施行した非機能性下垂体腺腫(NFPA)20例(男性15例、女性5例、平均年齢60.7歳)を対象に、デジタルPCR法(dPCR)と免疫組織化学染色法を用いてエストロゲン受容体(ESR)発現の定量解析を行った。その結果、dPCRによる遺伝子の絶対定量と特異的抗体を用いた免疫組織化学染色法を組み合わせることで、NFPAにおけるESR発現の正確な定量系を確立することができた。また、本研究ではESR1遺伝子発現と術前の臨床像との間に相関性を見い出すことはできなかったが、ESR1発現がGREB1を介してNFPAの臨床像に関与する可能性が示唆された。

DOI： 10.1507/endocrine.97.s.hpt_101

CiNii Research

J-GLOBAL

researchmap

その他リンク： https://search.jamas.or.jp/link/ui/2022074918

記述言語：日本語   出版者・発行元：間脳・下垂体・副腎系研究会  

34歳女性。全身倦怠感、左眼の視力低下、両眼の耳側半盲を主訴に前医を受診し、頭部MRIにて下垂体腫瘍を指摘され、当院へ紹介となった。臨床検査およびMRI所見から複合型下垂体前葉機能低下と著明な視機能障害を伴うトルコ鞍部腫瘍を認めたため、経鼻内視鏡下に腫瘍生検術が施行された。迅速病理検査にて下垂体腺腫またはsolitary fibrous tumorが疑われ、拡大経鼻内視鏡下に下垂体腫瘍摘出術が行われ、病理組織学的に下垂体細胞腫と診断された。術翌日より左眼の視力、両眼の耳側半盲は著明に改善し、最終的に左眼の視力は術前の0.06から1.0まで改善した。術後はホルモン療法にて甲状腺機能の良好なコントロールが得られた。

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(公財)成長科学協会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(株)日本臨床社  

researchmap

記述言語：日本語   出版者・発行元：(株)日本臨床社  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

researchmap

記述言語：日本語   出版者・発行元：(株)中外医学社  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本病理学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本脳腫瘍病理学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本病理学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

下垂体細胞腫(pituicytoma)の手術6例を対象に、臨床的検討を行った。全例が男性で、手術時年齢は平均58.6歳であった。症状は視野障害、副腎不全、性欲減退、偶発腫など多様であった。下垂体前葉ホルモンの3種(LH、FSH、GH)の低下を1例に認めた他は、いずれも汎下垂体機能低下を呈していた。MRI画像上の特徴は全例に腫瘍ないし腫瘍内にflow voidを認め、強いガドリニウム造影効果を示した。術前診断として、手術経験順に並べた時の前半2例は下垂体腺腫を考えて手術を行い、後半4例はpituicytomaも鑑別に挙げた上で手術を行った。前半2例は術中に予期せぬ出血に苦慮し、腫瘍は部分摘出に留まった。術中出血量は平均1350mlで、1例が術中輸血を必要とした。後半4例はワーキングスペースを広く確保する工夫を行い、術中出血量を平均212mlに抑えることができた。4例とも肉眼的に全摘出が可能で、その後の再発を認めていない。

J-GLOBAL

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J01160&link_issn=&doc_id=20190708500001&doc_link_id=10.1507%2Fendocrine.95.S.HPT_5&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.95.S.HPT_5&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(公社)日本医師会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：間脳・下垂体・副腎系研究会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

全国調査結果より、嚢胞性下垂体偶発腫の治療指針に関して考察した。全国調査では経過観察群の約半数程度である43.5%を嚢胞性疾患が占めており、うちの大多数がラトケ嚢胞(90.7%)で、一部くも膜嚢胞や頭蓋咽頭腫が含まれていた。大部分の症例では経過観察中に腫瘍サイズの増大はみられなかったが、一部のラトケ嚢胞例や頭蓋咽頭腫では増大が確認された。以上、嚢胞性下垂体偶発腫は基本的には経過観察のみで、概ね良好に経過すると考えられるが、経過中に症候性となった場合や頭蓋咽頭腫例では手術を検討し、それぞれの疾患の病態に則した手術手技を用い、内分泌機能や視機能の温存に努める必要があると考えられた。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(有)科学評論社  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：科学評論社  

CiNii Books

CiNii Research

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

症候性ラトケ嚢胞に対し手術を行った86例を対象に治療成績を検討した。その結果、全例中5例(5.8%)に再発を認めた。通常の嚢胞壁部分切除と洗浄ドレナージを行った78例のうち再発は2例(2.6%)で、再手術を行ったところ嚢胞壁と正常下垂体との境界が同定できたため嚢胞を摘出した。2例とも嚢胞壁の病理所見で重層扁平上皮化生を認めた。一方、洗浄ドレナージと嚢胞-脳槽開窓を行った大型の嚢胞8例のうち再発は3例(37.5%)で、再手術で嚢胞を縮小し、その後サイバーナイフを照射した。経過観察中(平均経過観察期間40.3ヵ月)に1例で嚢胞が消失、2例で嚢胞が更に縮小し、3例とも新たな下垂体機能の低下は認めなかった。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

65歳女。食欲低下、倦怠感を主訴とした。MRIで下垂体後葉の前方に8mm大の境界明瞭、低信号域の腫瘤様陰影を認め、ホルモン基礎値と負荷試験の結果から中枢性甲状腺低下症、中枢性性腺機能低下症、重症成人成長ホルモン分泌不全症、高PRL血症と診断した。画像上、下垂体の病変は後葉の前方に位置していたが、尿崩症は認めなかった。腫瘍性病変が否定できないため、経蝶形骨洞的下垂体手術を施行した。手術時、下垂体硬膜は非常に厚く線維化し、下垂体後葉の前方に白色調の線維に富む腫瘤を認め摘出した。病理組織学的に切除した病変部は線維化に富み、正常下垂体前葉にCD68陽性の泡沫状の組織球浸潤を認め、Xanthomatous hypophysitisが疑われた。CD1a、S-100、Grocotto、Ziehl-Neelsenは陰性で、Ki-67は1%未満であった。術後に頭痛が出現し、CTにて気脳症を認めたため髄液漏閉鎖術を行った。術後の負荷試験では成長ホルモン分泌低下のみを認め、中枢性甲状腺機能低下症、高PRL血症は改善していた。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(株)中外医学社  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(公財)成長科学協会  

重症成人成長ホルモン分泌不全症患者の治療成績について検討した。非糖尿病合併の重症成人成長ホルモン分泌不全症患者7例(男性4名、女性3名、24〜58歳)を対象とした。全例が複数の下垂体ホルモン分泌不全を合併し、補充療法が行われていた。成長ホルモンの補充によりIGF-1値は改善したが、-1SDを越えず、十分な補充はまだ達成できていなかった。GH補充前の安静時代謝量(REE)は、計算によって得られる本来想定される基礎代謝量(BEE)に比較して低い傾向であった。GH補充によってREEは経時的に増加し、36週目には有意に高値となり、BEEより高値となった。GH補充に伴い、体重、除脂肪体重、脂肪重量は有意な変化を示さなかった。徐脂肪体重は増加傾向を示し、脂肪重量は24ヵ月目までは減少傾向を示し、36ヵ月目でやや増加傾向を示した。GH補充によって、空腹時血糖、HbA1cともに大きな変化は認めなかったが、空腹時血糖は、低下傾向を示した。GH補充によって脂質プロファイルに有意な変化は認めなかった。中性脂肪値は低下傾向を示した。

researchmap

記述言語：日本語   出版者・発行元：(公財)成長科学協会  

重症成人成長ホルモン分泌不全症患者の治療成績について検討した。非糖尿病合併の重症成人成長ホルモン分泌不全症患者7例(男性4名、女性3名、24〜58歳)を対象とした。全例が複数の下垂体ホルモン分泌不全を合併し、補充療法が行われていた。成長ホルモンの補充によりIGF-1値は改善したが、-1SDを越えず、十分な補充はまだ達成できていなかった。GH補充前の安静時代謝量(REE)は、計算によって得られる本来想定される基礎代謝量(BEE)に比較して低い傾向であった。GH補充によってREEは経時的に増加し、36週目には有意に高値となり、BEEより高値となった。GH補充に伴い、体重、除脂肪体重、脂肪重量は有意な変化を示さなかった。徐脂肪体重は増加傾向を示し、脂肪重量は24ヵ月目までは減少傾向を示し、36ヵ月目でやや増加傾向を示した。GH補充によって、空腹時血糖、HbA1cともに大きな変化は認めなかったが、空腹時血糖は、低下傾向を示した。GH補充によって脂質プロファイルに有意な変化は認めなかった。中性脂肪値は低下傾向を示した。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

クッシング病13例、先端巨大症6例、非機能性下垂体腺腫9例を対象に、経蝶形骨洞的下垂体腺腫摘除術の術中術野血と、無麻酔下で採血された海綿静脈洞血のCRH、GHRH、SST濃度を、末梢血のそれらと同時に測定した。その結果、視床下部ホルモンを高濃度に含む下垂体門脈血が灌流すると想定される経蝶形骨洞的下垂体腺腫摘除術中の術中術野血と、海綿静脈洞血の中枢血では下垂体腫瘍組織型を問わず、下垂体ホルモンACTHとGHがいずれも末梢血濃度の数十倍〜千倍の高濃度を示した。一方、中枢血中のCRH、GHRHあるいはSST各濃度はいずれも末梢血中の各視床下部ホルモン濃度と有意差がなかった。即ち、ヒトの視床下部機能は末梢血のみならず、中枢血を用いても類推・評価することは困難と考えられた。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

J-GLOBAL

researchmap

記述言語：英語   出版者・発行元：(一社)日本内分泌学会  

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

症例1は57歳女性で、脳ドックで見つかった非機能性下垂体腺腫で、左内頸-上下垂体動脈分岐部に6mmの内向き動脈瘤を認めた。動脈瘤は腫瘍に巻き込まれ、腫瘍摘出の際に破裂する危険があった。GDCコイルによる塞栓術を行い、術後に抗血小板剤を投与した。塞栓術後3ヵ月に経鼻内視鏡下腫瘍摘出術を行った。症例2は40歳女性で、視力視野障害を主訴にみつかった非機能性下垂体腺腫で、MRAで前交通動脈瘤7mmを伴っていた。動脈瘤は腫瘍に巻き込まれていた。開頭クリッピングと経鼻内視鏡下腫瘍摘出術を同時に行った。症例3は53歳女性で、急速に進行する右視力低下を主訴に見つかった非機能性下垂体腺腫で、鞍上進展と右海綿静脈洞への進展を伴っていた。右内頸-上下垂体動脈分岐部に内向き動脈瘤を認め、動脈瘤は腫瘍に巻き込まれていた。開頭と経鼻の同時手術を行い、開頭側、経鼻側より腫瘍を摘出した。3例とも術後経過は良好である。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

4体の屍体頭部に対し、視交叉後方部頭蓋咽頭腫として水風船を用いた擬腫瘍を留置し、経錐体法(TPA)と内視鏡下経鼻手術(EEA)の術野を比較した。その結果、EEAは0.5ccの擬腫瘍を留置した術野では、視野角0°の内視鏡で動眼神経((A)と後交通動脈(B)が良好に観察できた。また、視野角30°、70°の斜視鏡でBからのperforatorや他の周囲構造の観察が容易であった。1ccの擬腫瘍を留置した術野では、視野角0°の内視鏡で0.5ccより観察範囲が狭まったが、擬腫瘍を内側に圧排することで良好に観察できた。また、斜視鏡を用いることで圧排を行うことなしにA、Bを良好に観察できた。一方、TPAは0.5ccと1ccの擬腫瘍を留置したいずれの術野で進入経路の対側のBやAの視認性が不良であった。擬腫瘍の容積が小さい場合はA-B間とA-小脳テント間が狭かったが、容積の増大に伴い拡大し、6mlの時点で0mlより有意に拡大した。

J-GLOBAL

researchmap

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J01160&link_issn=&doc_id=20160408480011&doc_link_id=10.1507%2Fendocrine.91.Suppl.HPT_35&url=https%3A%2F%2Fdoi.org%2F10.1507%2Fendocrine.91.Suppl.HPT_35&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(公社)日本医師会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(株)蕗書房  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：蕗書房 ; 2011-  

CiNii Books

CiNii Research

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(公財)成長科学協会  

以前よりコラーゲン線維を主体とした下垂体腺腫固有の仮性被膜があることが示されていたが、近年これが再度注目され、手術時にも被膜外摘出が治療成績の向上に有用であると言われている。今回、下垂体腺腫において被膜外摘出を行った症例において、仮性被膜の特徴および内分泌学的所見を検討した。対象は内視鏡単独経鼻的手術を行った下垂体腺腫64例である。内訳は男性29、女性35名、年齢は16〜81歳(平均50.9歳)で機能別分類はGHoma、PRLoma、ACTHoma、および臨床的非機能性腺腫(CNFA)がそれぞれ9、7、1、47例であった。各症例で病理学的検索を行い、被膜が厚く存在する群をA、腺腫から薄い被膜を経て正常下垂体前葉に移行する群をB、被膜をほとんど認めない群をCとした。また、CNFAについては、同一時期に同一術者が手術を行った被膜内摘出群を対象とし、内分泌機能(GH分泌能)の変化についても比較検討した。病理学的にA、B、C群はそれぞれ50、41、9%であった。機能別にはA群がCNFAで53%と最も多いのに対し、GH、PRLomaではB群がそれぞれ56、58%と多かった。またGHomaにC群は見られなかった。また、CNFAについて被膜内摘出群と外摘出群のGH分泌能の変化を検討したところ、両群間に差は認められなかった(Mann-Whitney検定(p=0.059))。下垂体腺腫の仮性被膜にはさまざまなパターンがあり、9%の症例で明確な被膜が認められなかった。また、被膜外摘出による内分泌機能の悪化も見られなかった。今後、実際の再発率について長期観察が重要になると思われる。(著者抄録)

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本脳神経CI学会  

内視鏡下経鼻手術を施行した下垂体腺腫のうち、鞍上進展する非機能性腺腫290例を対象に、術中所見におけるクモ膜下腔進展の有無と術前画像による評価について検討した。術前画像による評価は、腫瘍の形状をRound type(腫瘍外周が不整なく平滑であるもの)とLobular type(不整形に伸びてくびれを伴うもの)に分けて行った。その結果、術中所見でクモ膜下腔進展を確認した症例は37例で、いずれもLobular typeであった。進展がみられなかった症例は253例で、うち249例(98.4%)がRound typeであった。腫瘍径は20〜52mm(平均32mm)で、Round typeとLobular typeの比較では有意差はなかった。術前の画像診断で鞍隔膜による強いくびれを認めたのは4例で、いずれもLobular typeであったが、うち3例は術中所見でクモ膜下腔進展を認め、1例はクモ膜下腔進展を認めず術中髄液流出がなかった。以上、術前の画像診断に沿った下垂体腺腫の摘出戦略は有用であると考えられた。

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

J-GLOBAL

researchmap

記述言語：日本語   出版者・発行元：(公財)成長科学協会  

重症成人成長ホルモン分泌不全症患者の治療成績について検討した。ノルディトロピン成人成長ホルモン分泌不全症特定使用成績調査において、2013年12月末時点でAGHDの新規症例としてAHQを回収した180例と下垂体機能低下症のない一般成人より回奴したAHQ 67例を解析対象とした。心理社会領域と症状領域の両領域において、成人成長ホルモン分泌不全症患者のQOLが低下していた。成長ホルモン治療前後でQOLの評価が可能であったのは40例であったが、3ヵ月目という比較的早期にもかかわらず症状関連領域で有意な改善を認めた。成長ホルモン治療によるQOL改善は偶発的な現象ではないと考えられた。

J-GLOBAL