| Ultrasound-assisted Microsurgery for Cushing's Disease. | |
MedLine Citation:
|
PMID: 20013609 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
OBJECTIVE: Localization of microadenomas in Cushing's disease may be difficult as in up to 45% of patients sellar MRI fails to detect a pituitary tumor. Intraoperative transsphenoidal ultrasound may identify microadenomas as hyperechoic structures. We report on the first 18 consecutive cases with intraoperative use of a new device for direct contact high-frequency-ultrasound in patients with Cushing's disease. PATIENTS AND TECHNIQUE: 18 patients (14 female, 4 male, age 24-71 years) with typical endocrinological findings for Cushing's disease were included in the study. One macroadenoma and 13 microadenomas were suspected or identified preoperatively by MRI. In 4 cases, two of them with recurrent disease, sellar MRIs were negative. During transsphenoidal microsurgery an end fire ultrasound-probe (B-mode frequency range 7.5-13 Mhz, field of view 5 mm, penetration 20 mm) was introduced after opening of sellar floor. The pituitary gland was scanned in direct contact to the capsule. RESULTS: In 13 out of 17 cases (77%) with later on proven microadenomas high-frequency-ultrasound identified the tumors as hyperechoic masses, including 3 of the 4 cases with negative preoperative MRI. In 2 cases ultrasound correctly localized the tumor at a site different from MRI finding (MRI false positive). In the macroadenoma, identification of the border between tumor and anterior pituitary gland was not possible. In all 18 patients postoperative early decline of serum cortisol to subnormal levels confirmed remission of hypercortisolism (100%). Other pituitary functions were unaltered in 17 cases (94%). CONCLUSIONS: Intraoperative scanning of the pituitary gland with high-frequency-ultrasound probes may identify intrapituitary anatomy and pathologies even in MRI-negative cases. This may prevent extensive exploration of the gland with the risk of subsequent hypopituitarism. |
Authors:
|
U J Knappe; M Engelbach; K Konz; H-J Lakomek; W Saeger; R Sch??nmayr; W A Mann |
Related Documents
:
|
15376489 - Lymphocytic hypophysitis with a long latent period before development of a pituitary mass. 3786729 - Pituitary adenomas: high-resolution mr imaging at 1.5 t. 11566239 - Dynamic gadolinium-enhanced mr imaging of pituitary adenomas: usefulness of sequential ... 8665579 - Primary low cerebrospinal fluid pressure syndrome with galactorrhea: findings at mr ima... 9518219 - Imaging of the pituitary in children with growth disorders. 15136289 - Resolution of macroprolactinoma-induced symptomatic hydrocephalus following cabergoline... 17712509 - Diffusion tensor imaging and white matter tractography in patients with brainstem lesions. 20164559 - Diagnostic utility of novel mri-based biomarkers for alzheimer's disease: diffusion ten... 1575459 - 1h and 31p magnetic resonance spectroscopy of the brain in degenerative cerebral disord... |
Publication Detail:
|
Type: JOURNAL ARTICLE |
Journal Detail:
|
Title: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association Volume: - ISSN: 1439-3646 ISO Abbreviation: - Publication Date: 2009 Dec |
Date Detail:
|
Created Date: 2009-12-16 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9505926 Medline TA: Exp Clin Endocrinol Diabetes Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
?? J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart ?? New York. |
Affiliation:
|
Department of Neurosurgery, Johannes Wesling Klinikum, Minden, Germany. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Diagnostic Accuracy of rhTSH Test with Neck Ultrasonography in Differentiated Thyroid Cancer Follow-...
Next Document: New Mutations in the RET Protooncogene-L881V - Associated with Medullary Thyroid Carcinoma and -R770...