Skip to main content
Erschienen in: Endocrine 1/2020

13.03.2020 | Review

Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence

verfasst von: M. Araujo-Castro, E. Pascual-Corrales, J. S. Martínez San Millan, G. Rebolleda, H. Pian, I. Ruz-Caracuel, G. De Los Santos Granados, L. Ley Urzaiz, H. F. Escobar-Morreale, V. Rodríguez Berrocal

Erschienen in: Endocrine | Ausgabe 1/2020

Einloggen, um Zugang zu erhalten

Abstract

There is a lack of evidence on timing, frequency, and duration of postoperative endocrine, radiologic, and ophthalmologic assessments that should be performed after pituitary surgery (PS). However, it is known that careful optimization of treatment and follow-up strategies as well as a multidisciplinary approach may have a significant impact on long-term outcomes, improving surgical results, minimize complications and facilitate their correct treatment if occurring, and optimize the hormonal, ophthalmological, and radiological reassessment throughout the follow-up. Considering that there are no specific guidelines on the postoperative management of patients with pituitary tumors (PT), we present our protocol for the postoperative management of patients with PT. It has been elaborated by the multidisciplinary team of a Spanish Pituitary Tumor Center of Excellence (PTCE) that includes at least one neurosurgeon, ENT, neuroradiologist, neuro-ophthalmologist, endocrine pathologist and endocrinologist specialized in pituitary diseases. We elaborated this guideline with the aim of sharing our experience with other centers involved in the management of PT thereby facilitating the postoperative management of patients submitted to PS.
Literatur
1.
Zurück zum Zitat W.A. Hall, M.G. Luciano, J.L. Doppman, N.J. Patronas, E.H. Oldfield, Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann. Intern. Med. 120(10), 817–820 (1994)CrossRef W.A. Hall, M.G. Luciano, J.L. Doppman, N.J. Patronas, E.H. Oldfield, Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. Ann. Intern. Med. 120(10), 817–820 (1994)CrossRef
10.
11.
Zurück zum Zitat J. Estrada, J. García-Uría, C. Lamas, J. Alfaro, T. Lucas, S. Diez et al. The complete normalization of the adrenocortical function as the criterion of cure after transsphenoidal surgery for Cushing’s disease. J. Clin. Endocrinol. Metab. 86(12), 5695–5699 (2001)PubMed J. Estrada, J. García-Uría, C. Lamas, J. Alfaro, T. Lucas, S. Diez et al. The complete normalization of the adrenocortical function as the criterion of cure after transsphenoidal surgery for Cushing’s disease. J. Clin. Endocrinol. Metab. 86(12), 5695–5699 (2001)PubMed
12.
Zurück zum Zitat J. Newell-Price, Transsphenoidal surgery for Cushing’s disease: defining cure and following outcome. Clin. Endocrinol. 56(1), 19–21 (2002)CrossRef J. Newell-Price, Transsphenoidal surgery for Cushing’s disease: defining cure and following outcome. Clin. Endocrinol. 56(1), 19–21 (2002)CrossRef
13.
Zurück zum Zitat L.B. Yap, H.E. Turner, C.B.T. Adams, J.A.H. Wass, Undetectable postoperative cortisol does not always predict long-term remission in Cushing’s disease: a single centre audit. Clin. Endocrinol. 56(1), 25–31 (2002)CrossRef L.B. Yap, H.E. Turner, C.B.T. Adams, J.A.H. Wass, Undetectable postoperative cortisol does not always predict long-term remission in Cushing’s disease: a single centre audit. Clin. Endocrinol. 56(1), 25–31 (2002)CrossRef
14.
Zurück zum Zitat L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guidelinesummary of recommendations. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014). https://doi.org/10.1210/jc.2014-2700. Epub 2014 Oct 30 L. Katznelson, E.R. Laws Jr, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz et al. Acromegaly: an endocrine society clinical practice guidelinesummary of recommendations. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014). https://​doi.​org/​10.​1210/​jc.​2014-2700. Epub 2014 Oct 30
18.
Zurück zum Zitat I. Ciric, A. Ragin, C. Baumgartner, D. Pierce, Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2), 225–236 (1997)CrossRef I. Ciric, A. Ragin, C. Baumgartner, D. Pierce, Complications of transsphenoidal surgery: Results of a national survey, review of the literature, and personal experience. Neurosurgery 40(2), 225–236 (1997)CrossRef
19.
Zurück zum Zitat F.G. Barker, A. Klibanski, B. Swearingen, Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J. Clin. Endocrinol. Metab. 88(10), 4709–4719 (2003)CrossRef F.G. Barker, A. Klibanski, B. Swearingen, Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J. Clin. Endocrinol. Metab. 88(10), 4709–4719 (2003)CrossRef
30.
Zurück zum Zitat J. Strychowsky, S. Nayan, K. Reddy, F. Farrokhyar, D. Sommer, Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J. Otolaryngol. Head. Neck Surg. 40(2), 175–185 (2011)PubMed J. Strychowsky, S. Nayan, K. Reddy, F. Farrokhyar, D. Sommer, Purely endoscopic transsphenoidal surgery versus traditional microsurgery for resection of pituitary adenomas: systematic review. J. Otolaryngol. Head. Neck Surg. 40(2), 175–185 (2011)PubMed
34.
35.
Zurück zum Zitat C. Meco, G. Oberascher, E. Arrer, G. Moser, K. Albegger, β-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol. Head. Neck Surg. 129(5), 508–517 (2003)CrossRef C. Meco, G. Oberascher, E. Arrer, G. Moser, K. Albegger, β-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol. Head. Neck Surg. 129(5), 508–517 (2003)CrossRef
36.
Zurück zum Zitat I. Singer, J.R. Oster, L.M. Fishman, The management of diabetes insipidus in adults. Arch. Intern. Med. 157(12), 1293–1301 (1997)CrossRef I. Singer, J.R. Oster, L.M. Fishman, The management of diabetes insipidus in adults. Arch. Intern. Med. 157(12), 1293–1301 (1997)CrossRef
38.
Zurück zum Zitat E.C. Nemergut, Z. Zuo, J.A. Jane, E.R. Laws, Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J. Neurosurg. 103(3), 448–454 (2005)CrossRef E.C. Nemergut, Z. Zuo, J.A. Jane, E.R. Laws, Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J. Neurosurg. 103(3), 448–454 (2005)CrossRef
39.
Zurück zum Zitat J.A. Loh, J.G. Verbalis, Diabetes insipidus as a complication after pituitary surgery. Nat. Clin. Pract. Endocrinol. Metab. 3(6), 489–494 (2007)CrossRef J.A. Loh, J.G. Verbalis, Diabetes insipidus as a complication after pituitary surgery. Nat. Clin. Pract. Endocrinol. Metab. 3(6), 489–494 (2007)CrossRef
40.
Zurück zum Zitat J. Hensen, A. Henig, R. Fahlbusch, M. Meyer, M. Boehnert, M. Buchfelder, Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin. Endocrinol. 50(4), 431–439 (1999)CrossRef J. Hensen, A. Henig, R. Fahlbusch, M. Meyer, M. Boehnert, M. Buchfelder, Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin. Endocrinol. 50(4), 431–439 (1999)CrossRef
41.
Zurück zum Zitat K. Eguchi, T. Uozumi, K. Arita, K. Kurisu, T. Yano, M. Sumida et al. Pituitary function in patients with rathke’s cleft cyst: significance of surgical management. Endocr. J. 41(5), 535–540 (1994)CrossRef K. Eguchi, T. Uozumi, K. Arita, K. Kurisu, T. Yano, M. Sumida et al. Pituitary function in patients with rathke’s cleft cyst: significance of surgical management. Endocr. J. 41(5), 535–540 (1994)CrossRef
43.
Zurück zum Zitat I. Halac, D. Zimmerman, Endocrine manifestations of craniopharyngioma. Childs Nerv. Syst. 21(8–9), 640–648 (2005). Epub 2005 Jul 27CrossRef I. Halac, D. Zimmerman, Endocrine manifestations of craniopharyngioma. Childs Nerv. Syst. 21(8–9), 640–648 (2005). Epub 2005 Jul 27CrossRef
46.
Zurück zum Zitat B.R. Olson, D. Rubino, J. Gumowski, E.H. Oldfield, Isolated hyponatremia after transsphenoidal pituitary surgery. J. Clin. Endocrinol. Metab. 80(1), 85–91 (1995)PubMed B.R. Olson, D. Rubino, J. Gumowski, E.H. Oldfield, Isolated hyponatremia after transsphenoidal pituitary surgery. J. Clin. Endocrinol. Metab. 80(1), 85–91 (1995)PubMed
49.
Zurück zum Zitat W.T. Burke, D.J. Cote, S.I. Iuliano, H.A. Zaidi, E.R. Laws, A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery. Pituitary 21(1), 25–31 (2018)CrossRef W.T. Burke, D.J. Cote, S.I. Iuliano, H.A. Zaidi, E.R. Laws, A practical method for prevention of readmission for symptomatic hyponatremia following transsphenoidal surgery. Pituitary 21(1), 25–31 (2018)CrossRef
50.
Zurück zum Zitat C.E. Taplin, C.T. Cowell, M. Silink, G.R. Ambler, Fludrocortisone therapy in cerebral salt wasting. Pediatrics 118(6), e1904–e1908 (2006). Epub 2006 Nov 13CrossRef C.E. Taplin, C.T. Cowell, M. Silink, G.R. Ambler, Fludrocortisone therapy in cerebral salt wasting. Pediatrics 118(6), e1904–e1908 (2006). Epub 2006 Nov 13CrossRef
51.
Zurück zum Zitat R. Guerrero, A. Pumar, A. Soto, M.A. Pomares, S. Palma, M.A. Mangas et al. Early hyponatraemia after pituitary surgery: Cerebral salt-wasting syndrome. Eur. J. Endocrinol. 156(6), 611–616 (2007)CrossRef R. Guerrero, A. Pumar, A. Soto, M.A. Pomares, S. Palma, M.A. Mangas et al. Early hyponatraemia after pituitary surgery: Cerebral salt-wasting syndrome. Eur. J. Endocrinol. 156(6), 611–616 (2007)CrossRef
52.
Zurück zum Zitat S.L. Atkin, A.M. Coady, M.C. White, B. Mathew, Hyponatraemia secondary to cerebral salt wasting syndrome following routine pituitary surgery. Eur. J. Endocrinol. 135(2), 245–247 (1996)CrossRef S.L. Atkin, A.M. Coady, M.C. White, B. Mathew, Hyponatraemia secondary to cerebral salt wasting syndrome following routine pituitary surgery. Eur. J. Endocrinol. 135(2), 245–247 (1996)CrossRef
53.
Zurück zum Zitat M. Fleseriu, I.A. Hashim, N. Karavitaki, S. Melmed, M.H. Murad, R. Salvatori et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101(11), 3888–3921 (2016). Epub 2016 Oct 13CrossRef M. Fleseriu, I.A. Hashim, N. Karavitaki, S. Melmed, M.H. Murad, R. Salvatori et al. Hormonal replacement in hypopituitarism in adults: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 101(11), 3888–3921 (2016). Epub 2016 Oct 13CrossRef
56.
Zurück zum Zitat J.F. Bonneville, F. Bonneville, F. Cattin, S. Nagi, MRI of the pituitary gland:indications and results in gynaecology and in obstetrics. Gynecol. Obstet. Fertil. 33(3), 147–153 (2005)CrossRef J.F. Bonneville, F. Bonneville, F. Cattin, S. Nagi, MRI of the pituitary gland:indications and results in gynaecology and in obstetrics. Gynecol. Obstet. Fertil. 33(3), 147–153 (2005)CrossRef
58.
Zurück zum Zitat J.B. Kerrison, M.J. Lynn, C.A. Baer, S.A. Newman, V. Biousse, N.J. Newman, Stages of improvement in visual fields after pituitary tumor resection. Am. J. Ophthalmol. 130(6), 813–820 (2000)CrossRef J.B. Kerrison, M.J. Lynn, C.A. Baer, S.A. Newman, V. Biousse, N.J. Newman, Stages of improvement in visual fields after pituitary tumor resection. Am. J. Ophthalmol. 130(6), 813–820 (2000)CrossRef
64.
Zurück zum Zitat R.V. Lloyd, R.Y. Osamura, G. Klöppel, J Rosai, Pathology and Genetics of Tumours of Endocrine Organs. Fourth edition. IARC WHO Classification of Tumours. Vol 10. (2017) R.V. Lloyd, R.Y. Osamura, G. Klöppel, J Rosai, Pathology and Genetics of Tumours of Endocrine Organs. Fourth edition. IARC WHO Classification of Tumours. Vol 10. (2017)
65.
Zurück zum Zitat J. Trouillas, P. Roy, N. Sturm, E. Dantony, C. Cortet-Rudelli, G. Viennet et al. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol. 126(1), 123–135 (2013). https://doi.org/10.1007/s00401-013-1084-y. Epub 2013 Feb 12CrossRefPubMed J. Trouillas, P. Roy, N. Sturm, E. Dantony, C. Cortet-Rudelli, G. Viennet et al. A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol. 126(1), 123–135 (2013). https://​doi.​org/​10.​1007/​s00401-013-1084-y. Epub 2013 Feb 12CrossRefPubMed
67.
Zurück zum Zitat E. Manojlovic-Gacic, J. Bollerslev, and O. Casar-Borota. Invited Review: Pathology of pituitary neuroendocrine tumours: present status, modern diagnostic approach, controversies and future perspectives from a neuropathological and clinical standpoint. Neuropathol Appl Neurobiol. 2019. https://doi.org/10.1111/nan.12568 E. Manojlovic-Gacic, J. Bollerslev, and O. Casar-Borota. Invited Review: Pathology of pituitary neuroendocrine tumours: present status, modern diagnostic approach, controversies and future perspectives from a neuropathological and clinical standpoint. Neuropathol Appl Neurobiol. 2019. https://​doi.​org/​10.​1111/​nan.​12568
68.
Zurück zum Zitat G. Raverot, P. Burman, A. McCormack, A. Heaney, S. Petersenn, V. Popovic et al. European society of endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur. J. Endocrinol. 178(1), G1–G24 (2018). https://doi.org/10.1530/EJE-17-0796. Epub 2017 Oct 18CrossRefPubMed G. Raverot, P. Burman, A. McCormack, A. Heaney, S. Petersenn, V. Popovic et al. European society of endocrinology clinical practice guidelines for the management of aggressive pituitary tumours and carcinomas. Eur. J. Endocrinol. 178(1), G1–G24 (2018). https://​doi.​org/​10.​1530/​EJE-17-0796. Epub 2017 Oct 18CrossRefPubMed
69.
Zurück zum Zitat P.J. Trainer, H.S. Lawrie, J. Verhelst, T.A. Howlett, D.G. Lowe, A.B. Grossman et al. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin. Endocrinol. 38(1), 73–78 (1993)CrossRef P.J. Trainer, H.S. Lawrie, J. Verhelst, T.A. Howlett, D.G. Lowe, A.B. Grossman et al. Transsphenoidal resection in Cushing’s disease: undetectable serum cortisol as the definition of successful treatment. Clin. Endocrinol. 38(1), 73–78 (1993)CrossRef
70.
Zurück zum Zitat D.R. McCance, D.S. Gordon, T.F. Fannin, D.R. Hadden, L. Kennedy et al. Assessment of endocrine function after transsphenoidal surgery for Cushing’s disease. Clin. Endocrinol. 38(1), 79–86 (1993)CrossRef D.R. McCance, D.S. Gordon, T.F. Fannin, D.R. Hadden, L. Kennedy et al. Assessment of endocrine function after transsphenoidal surgery for Cushing’s disease. Clin. Endocrinol. 38(1), 79–86 (1993)CrossRef
71.
Zurück zum Zitat D.R. McCance, M. Besser, A.B. Atkinson, Assessment of cure after transsphenoidal surgery for Cushing’s disease. Clin. Endocrinol. 44(1), 1–6 (1996)CrossRef D.R. McCance, M. Besser, A.B. Atkinson, Assessment of cure after transsphenoidal surgery for Cushing’s disease. Clin. Endocrinol. 44(1), 1–6 (1996)CrossRef
73.
Zurück zum Zitat R. Pivonello, M.C. De Martino, M. De Leo, L. Tauchmanovà, A. Faggiano, G. Lombardi et al. Cushing’s syndrome: aftermath of the cure. Arq. Bras. Endocrinol. Metabol. 51(8), 1381–1391 (2007)CrossRef R. Pivonello, M.C. De Martino, M. De Leo, L. Tauchmanovà, A. Faggiano, G. Lombardi et al. Cushing’s syndrome: aftermath of the cure. Arq. Bras. Endocrinol. Metabol. 51(8), 1381–1391 (2007)CrossRef
75.
Zurück zum Zitat C. Beauregard, G. Dickstein, A. Lacroix, Classic and recent etiologies of Cushing’s syndrome: diagnosis and therapy. Treat. Endocrinol. 1(2), 79–94 (2002)CrossRef C. Beauregard, G. Dickstein, A. Lacroix, Classic and recent etiologies of Cushing’s syndrome: diagnosis and therapy. Treat. Endocrinol. 1(2), 79–94 (2002)CrossRef
76.
Zurück zum Zitat M.A. Czepielewski, G.A.F.S. Rollin, A. Casagrande, N.P. Ferreira, Criteria of cure and remission in Cushing’s disease: an update. Arq. Bras. Endocrinol. Metabol. 51(8), 1362–1372 (2007)CrossRef M.A. Czepielewski, G.A.F.S. Rollin, A. Casagrande, N.P. Ferreira, Criteria of cure and remission in Cushing’s disease: an update. Arq. Bras. Endocrinol. Metabol. 51(8), 1362–1372 (2007)CrossRef
78.
Zurück zum Zitat R.M. Salassa, E.R. Laws, P.C. Carpenter, R.C. Northcutt, Transsphenoidal removal of pituitary microadenoma in Cushing’s disease. Mayo Clin. Proc. 53(1), 24–28 (1978)PubMed R.M. Salassa, E.R. Laws, P.C. Carpenter, R.C. Northcutt, Transsphenoidal removal of pituitary microadenoma in Cushing’s disease. Mayo Clin. Proc. 53(1), 24–28 (1978)PubMed
79.
Zurück zum Zitat P.C. Carpenter, Cushing’s syndrome: update of diagnosis and management. Mayo Clin. Proc. 61(1), 49–58 (1986)CrossRef P.C. Carpenter, Cushing’s syndrome: update of diagnosis and management. Mayo Clin. Proc. 61(1), 49–58 (1986)CrossRef
80.
Zurück zum Zitat Z. Ram, L.K. Nieman, G.B. Cutler, G.P. Chrousos, J.L. Doppman, E.H. Oldfield, Early repeat surgery for persistent Cushing’s disease. J. Neurosurg. 80(1), 37–45 (1994)CrossRef Z. Ram, L.K. Nieman, G.B. Cutler, G.P. Chrousos, J.L. Doppman, E.H. Oldfield, Early repeat surgery for persistent Cushing’s disease. J. Neurosurg. 80(1), 37–45 (1994)CrossRef
81.
Zurück zum Zitat F. Esposito, J.R. Dusick, P. Cohan, P. Moftakhar, D. McArthur, C. Wang et al. Clinical review: Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing’s disease. J. Clin. Endocrinol. Metab. 91(1), 7–13 (2006). Epub 2005 Oct 18CrossRef F. Esposito, J.R. Dusick, P. Cohan, P. Moftakhar, D. McArthur, C. Wang et al. Clinical review: Early morning cortisol levels as a predictor of remission after transsphenoidal surgery for Cushing’s disease. J. Clin. Endocrinol. Metab. 91(1), 7–13 (2006). Epub 2005 Oct 18CrossRef
82.
Zurück zum Zitat D. Bochicchio, M. Losa, M. Buchfelder, Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing’s Disease Survey Group. J. Clin. Endocrinol. Metab. 80(11), 3114–3120 (1995)PubMed D. Bochicchio, M. Losa, M. Buchfelder, Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing’s Disease Survey Group. J. Clin. Endocrinol. Metab. 80(11), 3114–3120 (1995)PubMed
83.
Zurück zum Zitat A.M. Pereira, M.O. van Aken, H. van Dulken, P.J. Schutte, N.R. Biermasz, J.W. Smit et al. Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J. Clin. Endocrinol. Metab. 88(12), 5858–5864 (2003)CrossRef A.M. Pereira, M.O. van Aken, H. van Dulken, P.J. Schutte, N.R. Biermasz, J.W. Smit et al. Long-term predictive value of postsurgical cortisol concentrations for cure and risk of recurrence in Cushing’s disease. J. Clin. Endocrinol. Metab. 88(12), 5858–5864 (2003)CrossRef
84.
Zurück zum Zitat A.L. Serban, E. Sala, G. Carosi, G. Del Sindaco, C. Giavoli, M. Locatelli et al. Recovery of adrenal function after pituitary surgery in patients with Cushing disease: persistent remission or recurrence? Neuroendocrinology 108(3), 211–218 (2019). https://doi.org/10.1159/000496846. Epub 2019 Jan 13CrossRefPubMed A.L. Serban, E. Sala, G. Carosi, G. Del Sindaco, C. Giavoli, M. Locatelli et al. Recovery of adrenal function after pituitary surgery in patients with Cushing disease: persistent remission or recurrence? Neuroendocrinology 108(3), 211–218 (2019). https://​doi.​org/​10.​1159/​000496846. Epub 2019 Jan 13CrossRefPubMed
85.
Zurück zum Zitat A.B. Atkinson, A. Kennedy, M.I. Wiggam, D.R. McCance, B. Sheridan, Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance. Clin. Endocrinol. 63(5), 549–559 (2005)CrossRef A.B. Atkinson, A. Kennedy, M.I. Wiggam, D.R. McCance, B. Sheridan, Long-term remission rates after pituitary surgery for Cushing’s disease: the need for long-term surveillance. Clin. Endocrinol. 63(5), 549–559 (2005)CrossRef
Metadaten
Titel
Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence
verfasst von
M. Araujo-Castro
E. Pascual-Corrales
J. S. Martínez San Millan
G. Rebolleda
H. Pian
I. Ruz-Caracuel
G. De Los Santos Granados
L. Ley Urzaiz
H. F. Escobar-Morreale
V. Rodríguez Berrocal
Publikationsdatum
13.03.2020
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 1/2020
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-020-02247-y

Weitere Artikel der Ausgabe 1/2020

Endocrine 1/2020 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.