Cushing s disease and aggressive pituitary tumours

This book PDF is perfect for those who love Electronic Books genre, written by Daniel Bengtsson and published by Linköping University Electronic Press which was released on 07 April 2021 with total hardcover pages 89. You could read this book directly on your devices with pdf, epub and kindle format, check detail and related Cushing s disease and aggressive pituitary tumours books below.

Cushing   s disease and aggressive pituitary tumours
Author : Daniel Bengtsson
File Size : 44,6 Mb
Publisher : Linköping University Electronic Press
Language : English
Release Date : 07 April 2021
ISBN : 9789179296520
Pages : 89 pages
Get Book

Cushing s disease and aggressive pituitary tumours by Daniel Bengtsson Book PDF Summary

This thesis focuses on clinical and epidemiological aspects of aggressive pituitary tumours/carcinomas and Cushing’s disease. Pituitary carcinomas account for only 0.1-0.2% of the tumours originating from the anterior pituitary gland and are defined solely by the event of distant metastases, whereas aggressive pituitary tumours are defined by their clinical behaviour of rapid/progressive growth despite optimal treatment with surgery, radiotherapy and medical agents. The prognosis for individuals with aggressive tumours/carcinomas has been poor with few treatment options. However, case reports indicated better outcomes after treatment with the alkylating agent temozolomide. In study I and III, we investigated 24 patients (16 aggressive tumours and 8 carcinomas) given treatment with temozolomide. We found an initial response rate (tumour regression ≥30%) in 10/21 evaluable patients, with complete regression in two carcinomas. Favourable response was associated with low tumour expression of the DNA repair protein MGMT; in responders median 9% (range 5-20%) vs non-responders median 93% (50-100%). Our results also indicated a longer survival in patients with low MGMT. Out of 11 patients with MGMT >10%, nine died with an estimated median survival of 26 months (95% CI 14-38), whereas only 1/6 patients with lower MGMT died from tumour progression during a follow-up of median 83 months (range 12-161). One of the patients in study I and III had a corticotroph pituitary carcinoma and in addition, Lynch syndrome (LS), a hereditary cancer-predisposing syndrome caused by germline mutations in DNA mismatch repair (MMR) genes and primarily associated with colon and endometrial carcinomas. In study II, we investigated the characteristics of the pituitary carcinoma and found loss of MSH2 and MSH6 protein expression, consistent with the patient’s germline mutation in MSH2. This was the first published case of a pituitary tumour associated with LS. In addition, we identified all known Swedish patients with LS (n=910) and searched for diagnostic codes consistent with a pituitary tumour in the Swedish national patient register. We found in total three patients with clinically relevant pituitary tumours, the reported prevalence in the background population is around 1:1000. The last two studies in the thesis focused on Cushing’s disease (CD), i.e. an ACTH-secreting pituitary tumour resulting in excess levels of cortisol. CD is associated with multiple comorbidities and increased mortality. The reversibility of comorbidities and mortality risk after remission of cortisol levels have been under debate. Study IV examined psychiatric consequences of CD, measured by the use of psychotropic drugs. 179 patients with CD and a quadrupled matched control group were followed from diagnosis and at 5- and 10-year follow-up. We found that use of antidepressants remained at around 25% of patients with CD, regardless of remission status, at diagnosis and follow-up, whereas drugs for somatic comorbidities decreased. Use of antidepressants, sleeping pills and anxiolytics was higher in patients with CD compared to controls at diagnosis and 5-year follow-up. A cross-sectional analysis of 76 patients in sustained biochemical remission for median 9.3 years showed that 25% were taking antidepressants, a significantly higher use than controls, OR 2.0 (95% CI 1.1-3.8). In addition, patients with CD had a higher use of psychotropic drugs, already in the 5-year period before diagnosis. Study V investigated mortality and causes of death in 371 patients with CD, compared to a quadrupled matched control group. Follow-up was median 10.6 years (IQR 5.7-18.2) after time of diagnosis. Overall mortality was increased in patients with CD, HR 2.1 (95% CI 1.5-2.8) and remained elevated for patients in remission at last follow-up (n=303), HR 1.5 (1.02-2.2). For patients not in remission (n=31), HR was 5.6 (2.7-11.6). Cardiovascular diseases (32/66) and infections (12/66) were overrepresented causes of death in patients with CD. Main conclusions of the thesis: Temozolomide improves outcome in patients with aggressive pituitary tumours/carcinomas and a low MGMT expression in the tumour predicts a favourable outcome. As additional therapies evolve, MGMT may help to tailor the treatment.Germline mutations in MMR genes may contribute to the development and clinical course of pituitary tumours and may be a novel cause of hereditary pituitary tumours.Patients with Cushing’s disease have a high use of psychotropic drugs that remains elevated despite achievement of biochemical remission, suggesting persisting negative effects on mental health and highlighting the need for long-term monitoring of psychiatric symptoms. In addition, psychiatric symptoms may be early and important signs of CD.Efforts to achieve biochemical remission are crucial to reduce mortality in CD. However, patients in remission still have an increased mortality compared to controls. This underscores the need for life-long monitoring and treatment of associated comorbidities in patients with CD.

Cushing   s disease and aggressive pituitary tumours

This thesis focuses on clinical and epidemiological aspects of aggressive pituitary tumours/carcinomas and Cushing’s disease. Pituitary carcinomas account for only 0.1-0.2% of the tumours originating from the anterior pituitary gland and are defined solely by the event of distant metastases, whereas aggressive pituitary tumours are defined by their

Get Book
Management of Pituitary Tumors  An Issue of Neurosurgery Clinics   E Book

This issue of the Neurosurgery Clinics of North America, Guest Edited by Drs. Manish Aghi and Lewis Blevins, is devoted to Management of Pituitary Tumors. Experts in the field have assembled to provide articles on Imaging of the pituitary and parasellar region; Management of Incidentally Found Nonfunctional Pituitary Tumors; Endoscopic

Get Book
Molecular Pathology of Pituitary Adenomas

The pituitary gland is an important one since it controls several of the other hormone glands, such as the thyroid and adrenals. A pituitary adenoma is an abnormal growth or tumor in this gland, and they are the subject of very active clinical and pathological research. This book examines the

Get Book
Pituitary Disorders  An Issue of Endocrinology and Metabolism Clinics of North America

This issue of Endocrinology and Metabolism Clinics will cover Pituitary Disorders. Curated by Dr. Niki Karavitaki, this issue will explore topics in the field that are relevant for practicing clinicians. This issue is one of four selected each year by the series Consulting Editor, Adriana G. Ioachimescu. The volume will

Get Book
Diagnosis and Management of Pituitary Tumors

Eminent clinicians and specialists thoroughly review in great detail every aspect of pituitary tumors. The topics covered include prolactinomas, somatotroph adenomas, corticotroph adenomas, thyrotroph adenomas, nonfunctioning tumors, pituitary tumors, invasive adenomas, and pituitary carcinomas, as well as lesions, exclusive of pituitary adenomas, that occur in the sellar region. Also discussed

Get Book
Pituitary Disorders  An Issue of Endocrinology and Metabolism Clinics of North America  E Book

This issue of Endocrinology and Metabolism Clinics, edited by Drs. Anat Ben-Shlomo and Maria Fleseriu, is devoted to Pituitary Disorders. Articles in this issue include: Pathogenesis of Pituitary Tumors; Prognostic Clinicopathological Classification of Pituitary Adenomas; Familial Isolated Pituitary Adenomas (FIPA) and Mutations in the Aryl Hydrocarbon Receptor Interacting Protein (AIP)

Get Book
Pituitary Disorders  an Issue of Endocrinology and Metabolism Clinics of North America  Volume 49 3

This issue of Endocrinology and Metabolism Clinics will cover Pituitary Disorders. Curated by Dr. Niki Karavitaki, this issue will explore topics in the field that are relevant for practicing clinicians. This issue is one of four selected each year by the series Consulting Editor, Adriana G. Ioachimescu. The volume will

Get Book
Treatment of Pituitary Adenomas

Download or read online Treatment of Pituitary Adenomas written by Rudolf Fahlbusch,Klaus von Werder, published by Unknown which was released on 1978. Get Treatment of Pituitary Adenomas Books now! Available in PDF, ePub and Kindle.

Get Book