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Julian L. Robinson

T he usual picture of pituitary apoplexy is seen in a patient already known to have a pituitary adenoma and consists of sudden onset of headache, amblyopia, diplopia, drowsiness, confusion and/or coma. 1 In the ensuing three cases, however, the clinical picture was dominated by visual loss, and in two of them there was no previous indication of the presence of a pituitary tumor. Furthermore, although all three patients had suffered a hemorrhage into a pituitary tumor, a delay of up to 10 days after the onset of symptoms did not cause permanent blindness

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Cavett M. Robert Jr., Joel A. Feigenbaum, and W. Eugene Stern

P ituitary tumors produce a variety of symptoms, depending on their direction of growth. 3 The most commonly disturbed structure, the optic chiasm, 7 has received much attention since the earliest days of pituitary tumor study. Less well described have been ocular movement disorders resulting from encroachment upon the cavernous sinus. Past reports have varied considerably in the stated frequency of paralysis of ocular muscles. In 1910, de Lapersonne and Cantonnet 2 reported ocular complications in 27% of a series of patients with pituitary tumors. Since

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Anne Klibanski, E. Chester Ridgway, and Nicholas T. Zervas

H ypersecretion of prolactin (PRL), growth hormone, or corticotropin typically occurs in patients with pituitary tumors. The majority of pituitary tumors secrete PRL alone, or in combination with other anterior pituitary hormones. 4 Excess secretion of PRL in these patients produces a range of well described clinical syndromes, including amenorrhea, ovulatory dysfunction, and galactorrhea in women, as well as hypogonadism and impaired sexual function in men. 2, 3 The diagnosis and medical and surgical management of these patients are dependent upon

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Paul B. Nelson, Alan G. Robinson, David F. Archer, and Joseph C. Maroon

P ituitary tumors are found in 2% to 12% of patients with amenorrhea. 7, 8, 10 Treatment of amenorrhea with gonadotropins and more recently bromocriptine (CB 154) now enables these infertile patients to become pregnant. 2, 3, 8, 10, 14, 15 The major risk of pregnancy in patients with pituitary tumors is further enlargement of the tumor with impairment of vision. 2, 6 Induced pregnancies are generally limited to patients without demonstrable pituitary tumors. However, patients with unrecognized or small pituitary tumors may undergo induced pregnancy and may

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Zvi Ram, Thomas H. Shawker, Mary H. Bradford, John L. Doppman, and Edward H. Oldfield

P ituitary microadenomas often are not visualized on preoperative magnetic resonance (MR) imaging 1, 2, 6, 9 and may be difficult to find during surgical exploration of the pituitary, particularly in a patient with Cushing's disease. Although ultrasound is routinely used during surgery to localize islet-cell and parathyroid tumors, 5, 7 the use of ultrasound to localize and define pituitary tumors has never been evaluated. To enhance intraoperative localization of pituitary adenomas, we assessed the feasibility of using ultrasound to detect and localize

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Samer Ghostine, Michelle S. Ghostine, and Walter D. Johnson

. Traditionally, radiotherapy has been given in a fractionated manner at standard doses of 1.8–2 Gy per daily fraction. In contrast, SRS is a new method, now more commonly used, in which fewer doses or a single dose of radiation is delivered with high levels of conformity and selectivity. Radiosurgical Techniques Different techniques and instruments have been built to target ionizing radiation to specific intracranial legions while sparing the surrounding healthy brain tissues. In applying radiation to pituitary tumors, the biggest challenge is to destroy neoplastic

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Thomas C. Witt

Pituitary adenomas frequently pose challenging clinical problems. Stereotactic radiosurgery (SRS) is one treatment option in selected patients. The purpose of this report is to identify the advantages and disadvantages of radiosurgery in cases of pituitary tumors to assess better its role in relation to other treatment. Methods for optimizing outcome are described. The author reviews several recent series to determine rates of growth control, endocrine response, and complications. In general, growth control is excellent, complications are very low, and reduction of excessive hormone secretion is fair. Depending on the clinical situation, SRS may be the treatment of choice in selected patients.

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Vijay R. Ramakrishnan, Jeffrey D. Suh, Jennifer Y. Lee, Bert W. O'Malley Jr., M. Sean Grady, and James N. Palmer

suprasellar region. Suprasellar extension of pituitary macroadenomas frequently occurs, and in one study it was found in nearly 80% of cases. 9 Currently, it is not known what directs extrasellar extension of pituitary tumors into the sphenoid sinus, cavernous sinuses, or suprasellar region. The sphenoid sinus is known to have a variable pneumatization pattern, with 86% well pneumatized (sellar), 11% pneumatized only to the anterior face of the sella (presellar), and 3% poorly pneumatized (conchal). 3 The right and left sphenoid sinuses are typically separated by a

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Atul Goel, Abhidha Shah, Sukhdeep Singh Jhawar, and Naina K. Goel

A fluid level within a cystic fluid cavity (“fluid-fluid” level) has been recorded in a number of brain tumors and nonneoplastic lesions. 1 , 4–6 There are only isolated reports mentioning the presence of this feature in pituitary tumors. 2 , 3 Our literature survey did not reveal any clinical series focusing on the management of such pituitary tumors. We report our experience in the management of 106 pituitary tumors with fluid-fluid levels and analyze patients' immediate postsurgery and long-term clinical outcome. Methods Between 2000 and March

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John L. D. Atkinson, Jan L. Kasperbauer, E. Meredith James, John I. Lane, and Todd B. Nippoldt

in transsphenoidal surgical identification of small adrenocorticotropin—producing tumors that conventional MR imaging has failed to demonstrate. 8 Transsellar color Doppler ultrasonography has also been used to assess the adequacy of pituitary resection. 1 Although the application of ultrasound in surgery is quite diverse, to our knowledge we present the first case of a transcranial—transdural real-time ultrasound—assisted removal of a large pituitary tumor via the transsphenoidal route. Case Report History This 63-year-old obese woman, who had Type II diabetes