Skip to main content
Erschienen in:

25.04.2022

The role of endoscopic endonasal surgery in the management of prolactinomas based on their invasiveness into the cavernous sinus

verfasst von: Hussam Abou-Al-Shaar, Arka N. Mallela, Aneek Patel, Rimsha K. Shariff, Samuel S. Shin, Phillip A. Choi, Amir H. Faraji, Pouneh K. Fazeli, Tina Costacou, Eric W. Wang, Juan C. Fernandez-Miranda, Carl H. Snyderman, Paul A. Gardner, Georgios A. Zenonos

Erschienen in: Pituitary | Ausgabe 3/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To review our institutional experience with the surgical management of prolactinomas through the endoscopic endonasal approach with specific focus on cavernous sinus invasion.

Methods

Clinical and radiographic data were collected retrospectively from the electronic medical record of 78 consecutive patients with prolactinomas undergoing endoscopic endonasal resection from 2002 to 2019. Immediate and late post-operative remission were defined as prolactin < 20 ng/mL within 14 days and 1-year of surgery without adjuvant therapy, respectively. Cavernous sinus invasion was quantified by Knosp score.

Results

A total of 78 patients with prolactinoma, 59% being male, underwent surgical resection with a mean age of 37 ± 13 years. Indications for surgery were medication resistance in 38 patients (48.7%), medication intolerance in 11 (14.1%), and patient preference in 29 (37.2%). Patients with Knosp 0–2 achieved higher immediate remission rates (83.8%) compared to patients with Knosp 3 (58.8%) and Knosp 4 (41.7%) patients (p = 0.003). Long-term remission rates were 48.7% and increased to 71.8% when combined with adjuvant treatments. Knosp 4 prolactinomas had significantly higher tumor volumes, higher preoperative prolactin levels, higher recurrence rates, higher rates of adjuvant therapy utilization, and were more likely to have failed dopamine agonist therapy compared to other tumor grades (p < 0.05). We encountered 18 complications in our series, and no cerebrospinal fluid leaks.

Conclusion

The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.
Literatur
1.
Zurück zum Zitat Wong A, Eloy JA, Couldwell WT, Liu JK (2015) Update on prolactinomas. Part 1: clinical manifestations and diagnostic challenges. J Clin Neurosci 22:1562–1567CrossRefPubMed Wong A, Eloy JA, Couldwell WT, Liu JK (2015) Update on prolactinomas. Part 1: clinical manifestations and diagnostic challenges. J Clin Neurosci 22:1562–1567CrossRefPubMed
2.
Zurück zum Zitat Wong A, Eloy JA, Couldwell WT, Liu JK (2015) Update on prolactinomas. Part 2: treatment and management strategies. J Clin Neurosci 22:1568–1574CrossRefPubMed Wong A, Eloy JA, Couldwell WT, Liu JK (2015) Update on prolactinomas. Part 2: treatment and management strategies. J Clin Neurosci 22:1568–1574CrossRefPubMed
3.
Zurück zum Zitat Colao A, Di Sarno A, Landi ML, Cirillo S, Sarnacchiaro F, Facciolli G, Pivonello R, Cataldi M, Merola B, Annunziato L, Lombardi G (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82(11):3574–3579CrossRefPubMed Colao A, Di Sarno A, Landi ML, Cirillo S, Sarnacchiaro F, Facciolli G, Pivonello R, Cataldi M, Merola B, Annunziato L, Lombardi G (1997) Long-term and low-dose treatment with cabergoline induces macroprolactinoma shrinkage. J Clin Endocrinol Metab 82(11):3574–3579CrossRefPubMed
4.
Zurück zum Zitat Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007) Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 356(1):29–38CrossRefPubMed Schade R, Andersohn F, Suissa S, Haverkamp W, Garbe E (2007) Dopamine agonists and the risk of cardiac-valve regurgitation. N Engl J Med 356(1):29–38CrossRefPubMed
5.
Zurück zum Zitat Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356(1):39–46CrossRefPubMed Zanettini R, Antonini A, Gatto G, Gentile R, Tesei S, Pezzoli G (2007) Valvular heart disease and the use of dopamine agonists for Parkinson’s disease. N Engl J Med 356(1):39–46CrossRefPubMed
6.
Zurück zum Zitat Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27:485–534CrossRefPubMed Gillam MP, Molitch ME, Lombardi G, Colao A (2006) Advances in the treatment of prolactinomas. Endocr Rev 27:485–534CrossRefPubMed
7.
Zurück zum Zitat Noronha S, Stokes V, Karavitaki N, Grossman A (2016) Treating prolactinomas with dopamine agonists: always worth the gamble? Endocrine 51:205–210CrossRefPubMed Noronha S, Stokes V, Karavitaki N, Grossman A (2016) Treating prolactinomas with dopamine agonists: always worth the gamble? Endocrine 51:205–210CrossRefPubMed
8.
Zurück zum Zitat Drake WM, Stiles CE, Howlett TA, Toogood AA, Bevan JS, Steeds RP, UK Dopamine Agonist Valvulopathy Group (2014) A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. J Clin Endocrinol Metab 99:90–96CrossRefPubMed Drake WM, Stiles CE, Howlett TA, Toogood AA, Bevan JS, Steeds RP, UK Dopamine Agonist Valvulopathy Group (2014) A cross-sectional study of the prevalence of cardiac valvular abnormalities in hyperprolactinemic patients treated with ergot-derived dopamine agonists. J Clin Endocrinol Metab 99:90–96CrossRefPubMed
9.
Zurück zum Zitat Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994) A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 331:904–909CrossRefPubMed Webster J, Piscitelli G, Polli A, Ferrari CI, Ismail I, Scanlon MF (1994) A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med 331:904–909CrossRefPubMed
10.
Zurück zum Zitat Verhelst J, Abs R, Maiter D, van den Bruel A, Vandeweghe M, Velkeniers B, Mockel J, Lamberigts G, Petrossians P, Coremans P, Mahler C, Stevenaert A, Verlooy J, Raftopoulos C, Beckers A (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84:2518–2522CrossRefPubMed Verhelst J, Abs R, Maiter D, van den Bruel A, Vandeweghe M, Velkeniers B, Mockel J, Lamberigts G, Petrossians P, Coremans P, Mahler C, Stevenaert A, Verlooy J, Raftopoulos C, Beckers A (1999) Cabergoline in the treatment of hyperprolactinemia: a study in 455 patients. J Clin Endocrinol Metab 84:2518–2522CrossRefPubMed
11.
Zurück zum Zitat Dekkers OM, Lagro J, Burman P, Jorgensen JO, Romijn JA, Pereira AM (2010) Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab 95:43–51CrossRefPubMed Dekkers OM, Lagro J, Burman P, Jorgensen JO, Romijn JA, Pereira AM (2010) Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis. J Clin Endocrinol Metab 95:43–51CrossRefPubMed
12.
Zurück zum Zitat Thomson JA, Gray CE, Teasdale GM (2002) Relapse of hyperprolactinemia after transsphenoidal surgery for microprolactinoma: lessons from long-term follow-up. Neurosurgery 50:36–39 (discussion 9-40)PubMed Thomson JA, Gray CE, Teasdale GM (2002) Relapse of hyperprolactinemia after transsphenoidal surgery for microprolactinoma: lessons from long-term follow-up. Neurosurgery 50:36–39 (discussion 9-40)PubMed
13.
Zurück zum Zitat Jethwa PR, Patel TD, Hajart AF, Eloy JA, Couldwell WT, Liu JK (2016) Cost-effectiveness analysis of microscopic and endoscopic transsphenoidal surgery versus medical therapy in the management of microprolactinoma in the United States. World Neurosurg 87:65–76CrossRefPubMed Jethwa PR, Patel TD, Hajart AF, Eloy JA, Couldwell WT, Liu JK (2016) Cost-effectiveness analysis of microscopic and endoscopic transsphenoidal surgery versus medical therapy in the management of microprolactinoma in the United States. World Neurosurg 87:65–76CrossRefPubMed
14.
Zurück zum Zitat Zygourakis CC, Imber BS, Chen R, Han SJ, Blevins L, Molinaro A, Kahn JG, Aghi MK (2017) Cost-effectiveness analysis of surgical versus medical treatment of prolactinomas. J Neurol Surg B Skull Base 78:125–131PubMed Zygourakis CC, Imber BS, Chen R, Han SJ, Blevins L, Molinaro A, Kahn JG, Aghi MK (2017) Cost-effectiveness analysis of surgical versus medical treatment of prolactinomas. J Neurol Surg B Skull Base 78:125–131PubMed
15.
Zurück zum Zitat Molitch ME (2015) Endocrinology in pregnancy: management of the pregnant patient with a prolactinoma. Eur J Endocrinol 172(5):R205–R213CrossRefPubMed Molitch ME (2015) Endocrinology in pregnancy: management of the pregnant patient with a prolactinoma. Eur J Endocrinol 172(5):R205–R213CrossRefPubMed
16.
Zurück zum Zitat Koutourousiou M, Vaz Guimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA (2017) Endoscopic endonasal surgery for tumors of the cavernous sinus: a series of 234 patients. World Neurosurg 103:713–732CrossRefPubMed Koutourousiou M, Vaz Guimaraes Filho F, Fernandez-Miranda JC, Wang EW, Stefko ST, Snyderman CH, Gardner PA (2017) Endoscopic endonasal surgery for tumors of the cavernous sinus: a series of 234 patients. World Neurosurg 103:713–732CrossRefPubMed
17.
Zurück zum Zitat Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman CH, Gardner PA (2018) Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg 129:430–441CrossRefPubMed Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman CH, Gardner PA (2018) Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg 129:430–441CrossRefPubMed
18.
Zurück zum Zitat Cohen-Cohen S, Gardner PA, Alves-Belo JT, Truong HQ, Snyderman CH, Wang EW, Fernandez-Miranda JC (2018) The medial wall of the cavernous sinus. Part 2: selective medial wall resection in 50 pituitary adenoma patients. J Neurosurg 131(1):131–140CrossRefPubMed Cohen-Cohen S, Gardner PA, Alves-Belo JT, Truong HQ, Snyderman CH, Wang EW, Fernandez-Miranda JC (2018) The medial wall of the cavernous sinus. Part 2: selective medial wall resection in 50 pituitary adenoma patients. J Neurosurg 131(1):131–140CrossRefPubMed
19.
Zurück zum Zitat Schlechte JA, Sherman BM, Chapler FK, VanGilder J (1986) Long term follow-up of women with surgically treated prolactin-secreting pituitary tumors. J Clin Endocrinol Metab 62:1296–1301CrossRefPubMed Schlechte JA, Sherman BM, Chapler FK, VanGilder J (1986) Long term follow-up of women with surgically treated prolactin-secreting pituitary tumors. J Clin Endocrinol Metab 62:1296–1301CrossRefPubMed
20.
Zurück zum Zitat Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1999) Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery 44:254–261 (discussion 61-3)CrossRefPubMed Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB (1999) Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery 44:254–261 (discussion 61-3)CrossRefPubMed
21.
Zurück zum Zitat Maira G, Anile C, De Marinis L, Barbarino A (1989) Prolactin-secreting adenomas: surgical results and long-term follow-up. Neurosurgery 24:736–743CrossRefPubMed Maira G, Anile C, De Marinis L, Barbarino A (1989) Prolactin-secreting adenomas: surgical results and long-term follow-up. Neurosurgery 24:736–743CrossRefPubMed
22.
Zurück zum Zitat Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M (2002) Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab 87:3180–3186CrossRefPubMed Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M (2002) Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab 87:3180–3186CrossRefPubMed
23.
Zurück zum Zitat Rodman EF, Molitch ME, Post KD, Biller BJ, Reichlin S (1984) Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma. JAMA 252:921–924CrossRefPubMed Rodman EF, Molitch ME, Post KD, Biller BJ, Reichlin S (1984) Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma. JAMA 252:921–924CrossRefPubMed
24.
Zurück zum Zitat Massoud F, Serri O, Hardy J, Somma M, Beauregard H (1996) Transsphenoidal adenomectomy for microprolactinomas: 10 to 20 years of follow-up. Surg Neurol 45:341–346CrossRefPubMed Massoud F, Serri O, Hardy J, Somma M, Beauregard H (1996) Transsphenoidal adenomectomy for microprolactinomas: 10 to 20 years of follow-up. Surg Neurol 45:341–346CrossRefPubMed
25.
Zurück zum Zitat Serri O, Rasio E, Beauregard H, Hardy J, Somma M (1983) Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. N Engl J Med 309:280–283CrossRefPubMed Serri O, Rasio E, Beauregard H, Hardy J, Somma M (1983) Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. N Engl J Med 309:280–283CrossRefPubMed
26.
Zurück zum Zitat Abe T, Ludecke DK (2002) Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol 57:369–378 (discussion 78-9)CrossRefPubMed Abe T, Ludecke DK (2002) Transnasal surgery for prolactin-secreting pituitary adenomas in childhood and adolescence. Surg Neurol 57:369–378 (discussion 78-9)CrossRefPubMed
27.
Zurück zum Zitat Qu X, Wang M, Wang G, Han T, Mou C, Han L, Jiang M, Qu Y, Zhang M, Pang Q, Xu G (2011) Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur J Endocrinol 164:499–504CrossRefPubMed Qu X, Wang M, Wang G, Han T, Mou C, Han L, Jiang M, Qu Y, Zhang M, Pang Q, Xu G (2011) Surgical outcomes and prognostic factors of transsphenoidal surgery for prolactinoma in men: a single-center experience with 87 consecutive cases. Eur J Endocrinol 164:499–504CrossRefPubMed
28.
Zurück zum Zitat Yano S, Kawano T, Kudo M, Makino K, Nakamura H, Kai Y, Morioka M, Kuratsu J (2009) Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas. Neurol Med Chir (Tokyo) 49:1–7CrossRef Yano S, Kawano T, Kudo M, Makino K, Nakamura H, Kai Y, Morioka M, Kuratsu J (2009) Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas. Neurol Med Chir (Tokyo) 49:1–7CrossRef
29.
Zurück zum Zitat Rudnik A, Kos-Kudla B, Larysz D, Zawadzki T, Bazowski P (2007) Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol Lett 28:438–444PubMed Rudnik A, Kos-Kudla B, Larysz D, Zawadzki T, Bazowski P (2007) Endoscopic transsphenoidal treatment of hormonally active pituitary adenomas. Neuro Endocrinol Lett 28:438–444PubMed
30.
Zurück zum Zitat Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248CrossRefPubMed Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M (2006) The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 83:240–248CrossRefPubMed
31.
Zurück zum Zitat Smith TR, Hulou MM, Huang KT, Gokoglu A, Cote DJ, Woodmansee WW, Laws ER Jr (2015) Current indications for the surgical treatment of prolactinomas. J Clin Neurosci 22:1785–1791CrossRefPubMed Smith TR, Hulou MM, Huang KT, Gokoglu A, Cote DJ, Woodmansee WW, Laws ER Jr (2015) Current indications for the surgical treatment of prolactinomas. J Clin Neurosci 22:1785–1791CrossRefPubMed
32.
Zurück zum Zitat Akin S, Isikay I, Soylemezoglu F, Yucel T, Gurlek A, Berker M (2016) Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases. Acta Neurochir (Wien) 158:933–942CrossRef Akin S, Isikay I, Soylemezoglu F, Yucel T, Gurlek A, Berker M (2016) Reasons and results of endoscopic surgery for prolactinomas: 142 surgical cases. Acta Neurochir (Wien) 158:933–942CrossRef
33.
Zurück zum Zitat Donegan D, Atkinson JL, Jentoft M, Natt N, Nippoldt TB, Erickson B, Meyer F, Erickson D (2017) Surgical outcomes of prolactinomas in recent era: results of a heterogenous group. Endocr Pract 23:37–45CrossRefPubMed Donegan D, Atkinson JL, Jentoft M, Natt N, Nippoldt TB, Erickson B, Meyer F, Erickson D (2017) Surgical outcomes of prolactinomas in recent era: results of a heterogenous group. Endocr Pract 23:37–45CrossRefPubMed
34.
Zurück zum Zitat Song YJ, Chen MT, Lian W, Xing B, Yao Y, Feng M, Wang RZ (2017) Surgical treatment for male prolactinoma: a retrospective study of 184 cases. Medicine (Baltimore) 96:e5833CrossRef Song YJ, Chen MT, Lian W, Xing B, Yao Y, Feng M, Wang RZ (2017) Surgical treatment for male prolactinoma: a retrospective study of 184 cases. Medicine (Baltimore) 96:e5833CrossRef
35.
Zurück zum Zitat Han YL, Chen DM, Zhang C, Pan M, Yang XP, Wu YG (2018) Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery. Medicine (Baltimore) 97:e13198CrossRef Han YL, Chen DM, Zhang C, Pan M, Yang XP, Wu YG (2018) Retrospective analysis of 52 patients with prolactinomas following endoscopic endonasal transsphenoidal surgery. Medicine (Baltimore) 97:e13198CrossRef
36.
Zurück zum Zitat Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–617 (discussion 7-8)PubMed Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–617 (discussion 7-8)PubMed
37.
Zurück zum Zitat Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23:518–521CrossRefPubMed Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23:518–521CrossRefPubMed
38.
Zurück zum Zitat Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121:1606–1610CrossRefPubMed Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121:1606–1610CrossRefPubMed
39.
Zurück zum Zitat Ma Q, Su J, Li Y, Wang J, Long W, Luo M, Liu Q (2018) The chance of permanent cure for micro- and macroprolactinomas, medication or surgery? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 9:636CrossRef Ma Q, Su J, Li Y, Wang J, Long W, Luo M, Liu Q (2018) The chance of permanent cure for micro- and macroprolactinomas, medication or surgery? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 9:636CrossRef
40.
Zurück zum Zitat Menucci M, Quinones-Hinojosa A, Burger P, Salvatori R (2011) Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary 14:68–74CrossRefPubMedPubMedCentral Menucci M, Quinones-Hinojosa A, Burger P, Salvatori R (2011) Effect of dopaminergic drug treatment on surgical findings in prolactinomas. Pituitary 14:68–74CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Lamba N, Noormohamed N, Simjian T, Alsheikh MY, Jamal A, Doucette J, Zaidi H, Smith TR, Mekary RA (2018) Fertility after transsphenoidal surgery in patients with prolactinomas: a meta-analysis. Clin Neurol Neurosurg 176:53–60CrossRefPubMed Lamba N, Noormohamed N, Simjian T, Alsheikh MY, Jamal A, Doucette J, Zaidi H, Smith TR, Mekary RA (2018) Fertility after transsphenoidal surgery in patients with prolactinomas: a meta-analysis. Clin Neurol Neurosurg 176:53–60CrossRefPubMed
42.
Zurück zum Zitat Glezer A, Bronstein MD (2020) Prolactinomas in pregnancy: considerations before conception and during pregnancy. Pituitary 23(1):65–69CrossRefPubMed Glezer A, Bronstein MD (2020) Prolactinomas in pregnancy: considerations before conception and during pregnancy. Pituitary 23(1):65–69CrossRefPubMed
Metadaten
Titel
The role of endoscopic endonasal surgery in the management of prolactinomas based on their invasiveness into the cavernous sinus
verfasst von
Hussam Abou-Al-Shaar
Arka N. Mallela
Aneek Patel
Rimsha K. Shariff
Samuel S. Shin
Phillip A. Choi
Amir H. Faraji
Pouneh K. Fazeli
Tina Costacou
Eric W. Wang
Juan C. Fernandez-Miranda
Carl H. Snyderman
Paul A. Gardner
Georgios A. Zenonos
Publikationsdatum
25.04.2022
Verlag
Springer US
Erschienen in
Pituitary / Ausgabe 3/2022
Print ISSN: 1386-341X
Elektronische ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-022-01221-3

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Innere Medizin

Podcast

Magendarminfekte: Dos and Don'ts bei Kleinkindern

Die Leitlinie zur akuten infektiösen Gastroenteritis wurde 2024 umfassend überarbeitet. Cola und Saft zur oralen Hydratation und einige Antidiarrhoika sollten vermieden werden. Von einem standardmäßigen Erregerpanel wird abgeraten. Die Hintergründe zu diesen und weiteren Empfehlungen erläutert Leitlinienkoordinator Prof. Carsten Posovszky.

Körperlich fitte Krebskranke leben länger

Krebspatienten, auch und vor allem solche in fortgeschrittenen Stadien, profitieren offenbar von guter körperlicher Verfassung. Hohe Muskelkraft und kardiorespiratorische Fitness sind laut Ergebnissen einer Metaanalyse mit geringerer Mortalität assoziiert.

Vorhofflimmern: Antikoagulation vor Schlaganfall von Vorteil

Erleiden Menschen mit Vorhofflimmern einen ischämischen Schlaganfall, ist dieser weniger schwer, auch sind Infarktgröße und Blutungsrisiko geringer, wenn sie zuvor orale Antikoagulanzien erhalten haben. Die Art der Antikoagulation spielt dabei keine Rolle.

HCL-Systeme bei Typ-1-Diabetes: Blutzuckerkontrolle besser, Risiko für Ketoazidose aber höher

Eine bessere Blutzuckerkontrolle und weniger Fälle von hypoglykämischem Koma, dafür mehr diabetische Ketoazidosen. Dieses HCL-Insulin-Therapie-Profil zeigte sich in einem Vergleich von Hybrid-Closed-Loop(HCL)- und Open-Loop-Systemen bei Typ-I-Diabetes im DPV-Register.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Innere Medizin

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