https://repositorio.fleni.org.ar/xmlui/handle/123456789/30 2026-04-05T19:30:12Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1183 Pituitary metastases: a diagnostic and therapeutic challenge Loto, Mónica; Rogozinski, Amelia; Alfieri, Analía; Ballarino, María Carolina; Battistone, María Florencia; Chervin, Alberto B.; Danilowicz, Karina; Diez, Sabrina; Fainstein Day, Patricia; Furioso, Alejandra; Glerean, Mariela; González Pernas, Mariana Soledad; Katz, Débora Adela; Mallea-Gil, María Susana; Martínez, Marcela; Miragaya, Karina; Sabate, María Isabel; Slavinsky, Patricia; Sosa, Soledad; Szuman, Gabriela; Tkatch, Julieta; Vitale, Nicolás Marcelo; Guitelman, Mirtha Introduction: Sellar metastases (SM) are rare manifestations of malignancy. Breast and lung cancer are the most common primary tumors. Most cases are diagnosed in patients with advanced malignant disease; however, symptoms of pituitary involvement can precede the diagnosis of the primary tumor. Methods: Retrospective analysis of symptoms at presentation, hormonal, radiological and histological findings, management, and outcome of patients with SM from 2009 to 2020. Results: Eighteen patients'cases were included, 11 with histological confirmation. Median (m) age was 53 years (range 35-75), 53% male. Primary malignant tumors: 8 lungs, 6 breast, 1 follicular thyroid carcinoma, 1 Hodgkin lymphoma, and 2 clear cell renal carcinomas. The m time between the diagnosis of the primary neoplasm and the occurrence of the SM was 108 months (range: 11-180). In 8 patients the diagnosis of the primary neoplasm was made after the finding of the symptomatic sellar mass. Insipidus diabetes, adenohypophysis deficit, visual disorders, headache, and cranial nerve deficits were evident in 78, 77, 61, 39 and 39% of the cases, respectively. Fifteen patients harbored supra / parasellar masses, in three a lesion was limited to the pituitary gland, and stalk. Eleven out of 18 (61.1%) of the patients were operated on by the trans-sphenoidal approach, for diagnostic and / or decompressive purposes. Eighteen died, with a median survival time of 6 months (1-36). Discussion: In the presence of a pituitary lesion with diffuse gadolinium uptake, associated with insipidus diabetes and / or visual disorder SM should be suspected even in patients without a history of oncological disease. 2024-01-01T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1045 Hipofisitis primaria: diagnóstico y tratamiento. Estudio multicéntrico Tkatch, Julieta; Szuman, Gabriela; Agüero, Mónica; Alfieri, Analía; Ballarino, María Carolina; Bamberger, Elizabeth; Battistone, María Florencia; Boero, Laura; Danilowicz, Karina; Donoso, Marina; Fainstein Day, Patricia; Furioso, Alejandra; Glerean, Mariela; González Pernas, Mariana Soledad; Guitelman, Mirtha; Katz, Débora Adela; Loto, Mónica; Pignatta, Analía; Slavinsky, Patricia; Sosa, Soledad Introducción: La hipofisitis es una enfermedad infrecuente que plantea un desafío en el diagnóstico y tratamiento. El objetivo de este estudio multicéntrico y retrospectivo fue describir: a) características de pacientes con hipofisitis primaria (HP), b) métodos diagnósticos, y c) tratamientos realizados. Además, evaluar: a) presentación clínica, b) bioquímica, c) radiológica, d) oftalmológica al diagnóstico y evolución según el tratamiento recibido. Métodos: Estudio retrospectivo donde se estudiaron 28 pacientes (23 mujeres/5 varones) con HP, edad promedio de 38±11.1 años. Resultados. Los síntomas fueron: cefalea: 68%, poliuria-polidipsia: 50% y alteraciones visuales: 48%. El examen de laboratorio inicial informó disfunción adenohipofisaria en 71% de los pacientes, siendo el eje gonadal el más afectado. Los hallazgos radiológicos más frecuentes fueron: lesión simétrica:78.5%, aumento homogéneo post contraste: 78.5% y engrosamiento de tallo:70%. En 4/23 mujeres (17%) se relacionó con embarazos o puerperio La conducta inicial fue expectante (CE) en 14 pacientes, cirugía de resección/descompresión en 8 y tratamiento con inmunosupresores en 6. Quince pacientes tuvieron confirmación histológica, 9 resultaron hipofisitis linfocitaria, 5 hipofisitis por IgG4 y una xantomatosa. Trece fueron diagnosticados por criterios clínicos establecidos. El tamaño de la lesión disminuyó en 43% de pacientes con CE, 62.5% con cirugía y 50% con inmunosupresores. Los síntomas compresivos mejoraron en los 3 grupos, con escaso efecto sobre la función adenohipofisaria, sin resolución de la diabetes insípida. Discusión: En pacientes sin síntomas compresivos adoptamos CE. En aquellos pacientes sin certeza diagnóstica o con síntomas compresivos graves, se optó por cirugía transesfenoidal. 2023-06-06T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1029 The clinical and biochemical spectrum of ectopic acromegaly Fainstein Day, Patricia; Ullmann, Tamara Estefanía; Dalurzo, Mercedes Corina Liliana; Sevlever, Gustavo Emilio; Smith, David Eduardo Ectopic acromegaly is a rare condition caused by extrapituitary central or peripheral neuroendocrine tumours (NET) that hypersecrete GH or, more commonly, GHRH. It affects less than 1% of acromegaly patients and a misdiagnosis of classic acromegaly can lead to an inappropriate pituitary surgery. Four types of ectopic acromegaly have been described: 1) Central ectopic GH-secretion: Careful cross-sectional imaging is required to exclude ectopic pituitary adenomas. 2) Peripheral GH secretion: Extremely rare. 3) Central ectopic GHRH secretion: Sellar gangliocytomas immunohistochemically positive for GHRH are found after pituitary surgery. 4) Peripheral GHRH secretion: The most common type of ectopic acromegaly is due to peripheral GHRH-secreting NETs. Tumours are large and usually located in the lungs or pancreas. Pituitary hyperplasia resulting from chronic GHRH stimulation is difficult to detect or can be misinterpreted as pituitary adenoma in the MRI. Measurement of serum GHRH levels is a specific and useful diagnostic tool. Surgery of GHRH-secreting NETs is often curative. 2024-02-14T00:00:00Z https://repositorio.fleni.org.ar/xmlui/handle/123456789/1003 Pituitary stem cells: past, present and future perspectives Pérez Millán, María Inés; Cheung, Leonard Y.M.; Mercogliano, Florencia; Camilletti, María Andrea; Chirino Felker, Gonzalo T.; Moro, Lucía Natalia; Miriuka, Santiago Gabriel; Brinkmeier, Michelle L.; Camper, Sally A. Pituitary cells that express the transcription factor SOX2 are stem cells because they can self-renew and differentiate into multiple pituitary hormone-producing cell types as organoids. Wounding and physiological challenges can activate pituitary stem cells, but cell numbers are not fully restored, and the ability to mobilize stem cells decreases with increasing age. The basis of these limitations is still unknown. The regulation of stem cell quiescence and activation involves many different signalling pathways, including those mediated by WNT, Hippo and several cytokines; more research is needed to understand the interactions between these pathways. Pituitary organoids can be formed from human or mouse embryonic stem cells, or from human induced pluripotent stem cells. Human pituitary organoid transplantation is sufficient to induce corticosterone release in hypophysectomized mice, raising the possibility of therapeutic applications. Today, pituitary organoids have the potential to assess the role of individual genes and genetic variants on hormone production ex vivo, providing an important tool for the advancement of exciting frontiers in pituitary stem cell biology and pituitary organogenesis. In this article, we provide an overview of notable discoveries in pituitary stem cell function and highlight important areas for future research. 2023-12-15T00:00:00Z