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Found 4 results

  1. until
    Presented By Jamie J. Van Gompel, MD, FAANS Associate Professor in Neurosurgery and Otorhinolaryngology Program Director, Vice Chair of Education, Department of Neurologic Surgery Associate Program Director, Neurosurgical Skull Base Oncology Fellowship Program Director, International Neurosurgery Fellowship Mayo Clinic - Rochester, MN and Garret W. Choby, MD Rhinologist Endoscopic Skull Base Surgeon Mayo Clinic - Rochester, MN Register here After registering you will receive a confirmation email containing information about joining the webinar. If you have any questions or suggestions please feel free to contact webinar@pituitary.org DATE: Wednesday, March 13, 2019 TIME: 2:00 PM - 3:00 PM Pacific Daylight Time, 4:00 PM - 5:00 PM Central Daylight Time, 5:00 PM - 6:00 PM EDT Webinar Description Does Extent of Resection Matter in Pituitary Surgery and Postoperative Nasal Care Presenter Bios Jamie J. Van Gompel MD(Honors), BS(Honors) is an Associate professor in neurosurgery and Otolaryngology specializing in endoscopic/open skull base at the Mayo Clinic in Rochester, Minnesota, USA. He completed his undergraduate and medical school training at the University of Wisconsin at Madison. He has worked at the NIH as well as completed a Howard Hughes Fellowship studying neuroendocrine tumors. His neurosurgical training was undertaken at the Mayo Clinic and he went on to complete a complex cranial fellowship under the tutelage of Dr. Harry van Loveren at the University of South Florida. Currently, He is the Education Vice Chair, Program Director of the Neurosurgery Program and Associate Program Director of the Skull Base Oncology program. Further manages a busy skull base oncology and pituitary practice in addition to performing research with Active NIH U and R funding. He has authored over 150 publications of which over 30 are pertinent to pituitary pathologies and endoscopic surgery. Garret W. Choby, M.D., is a fellowship-trained rhinologist and endoscopic skull base surgeon practicing at the Mayo Clinic in Rochester, MN. He completed his residency training at the University of Pittsburgh and his fellowship training at Stanford University. Dr. Choby works closely with his neurosurgical partners to treat a variety of pituitary and cranial base tumors. His primary research interests include improving oncologic and quality of life outcomes for patients undergoing endonasal tumor resection and tailoring individualized treatment for patients with chronic rhinosinusitis.
  2. Presented By Jamie J. Van Gompel, MD, FAANS Associate Professor in Neurosurgery and Otorhinolaryngology Program Director, Vice Chair of Education, Department of Neurologic Surgery Associate Program Director, Neurosurgical Skull Base Oncology Fellowship Program Director, International Neurosurgery Fellowship Mayo Clinic - Rochester, MN and Garret W. Choby, MD Rhinologist Endoscopic Skull Base Surgeon Mayo Clinic - Rochester, MN Register here After registering you will receive a confirmation email containing information about joining the webinar. If you have any questions or suggestions please feel free to contact webinar@pituitary.org DATE: Wednesday, March 13, 2019 TIME: 2:00 PM - 3:00 PM Pacific Daylight Time, 4:00 PM - 5:00 PM Central Daylight Time, 5:00 PM - 6:00 PM EDT Webinar Description Does Extent of Resection Matter in Pituitary Surgery and Postoperative Nasal Care Presenter Bios Jamie J. Van Gompel MD(Honors), BS(Honors) is an Associate professor in neurosurgery and Otolaryngology specializing in endoscopic/open skull base at the Mayo Clinic in Rochester, Minnesota, USA. He completed his undergraduate and medical school training at the University of Wisconsin at Madison. He has worked at the NIH as well as completed a Howard Hughes Fellowship studying neuroendocrine tumors. His neurosurgical training was undertaken at the Mayo Clinic and he went on to complete a complex cranial fellowship under the tutelage of Dr. Harry van Loveren at the University of South Florida. Currently, He is the Education Vice Chair, Program Director of the Neurosurgery Program and Associate Program Director of the Skull Base Oncology program. Further manages a busy skull base oncology and pituitary practice in addition to performing research with Active NIH U and R funding. He has authored over 150 publications of which over 30 are pertinent to pituitary pathologies and endoscopic surgery. Garret W. Choby, M.D., is a fellowship-trained rhinologist and endoscopic skull base surgeon practicing at the Mayo Clinic in Rochester, MN. He completed his residency training at the University of Pittsburgh and his fellowship training at Stanford University. Dr. Choby works closely with his neurosurgical partners to treat a variety of pituitary and cranial base tumors. His primary research interests include improving oncologic and quality of life outcomes for patients undergoing endonasal tumor resection and tailoring individualized treatment for patients with chronic rhinosinusitis.
  3. A shorter duration of adrenal insufficiency — when the adrenal gland is not working properly — after surgical removal of a pituitary tumor may predict recurrence in Cushing’s disease patients, a new study suggests. The study, “Recovery of the adrenal function after pituitary surgery in patients with Cushing Disease: persistent remission or recurrence?,” was published in the journal Neuroendocrinology. Cushing’s disease is a condition characterized by excess cortisol in circulation due to a tumor in the pituitary gland that produces too much of the adrenocorticotropic hormone (ACTH). This hormone acts on the adrenal glands, telling them to produce cortisol. The first-line treatment for these patients is pituitary surgery to remove the tumor, but while success rates are high, most patients experience adrenal insufficiency and some will see their disease return. Adrenal insufficiency happens when the adrenal glands cannot make enough cortisol — because the source of ACTH was suddenly removed — and may last from months to years. In these cases, patients require replacement hormone therapy until normal ACTH and cortisol production resumes. However, the recovery of adrenal gland function may mean one of two things: either patients have their hypothalamus-pituitary-adrenal axis — a feedback loop that regulates ACTH and cortisol production — functioning normally, or their disease returned. So, a team of researchers in Italy sought to compare the recovery of adrenal gland function in patients with a lasting remission to those whose disease recurred. The study included 61 patients treated and followed at the Ospedale Maggiore Policlinico of Milan between 1990 and 2017. Patients had been followed for a median of six years (minimum three years) and 10 (16.3%) saw their disease return during follow-up. Overall, the median time to recovery of adrenal function was 19 months, but while most patients in remission (67%) had not yet recovered their adrenal function after a median of six years, all patients whose disease recurred experienced adrenal recovery within 22 months. Among those with disease recurrence, the interval from adrenal recovery to recurrence lasted a median of 1.1 years, but in one patient, signs of disease recurrence were not seen for 15.5 years. Statistical analysis revealed that the time needed for adrenal recovery was negatively associated with disease recurrence, suggesting that patients with sorter adrenal insufficiency intervals were at an increased risk for recurrence. “In conclusion, our study shows that the duration of adrenal insufficiency after pituitary surgery in patients with CD is significantly shorter in recurrent CD than in the persistent remission group,” researchers wrote. “The duration of AI may be a useful predictor for CD [Cushing’s disease] recurrence and those patients who show a normal pituitary-adrenal axis within 2 years after surgery should be strictly monitored being more at risk of disease relapse,” they concluded. From https://cushingsdiseasenews.com/2019/01/29/faster-adrenal-recovery-may-predict-recurrence-cushings-disease/
  4. The surgical removal of two-thirds of the pituitary gland is associated with high initial remission rates and low operative morbidity in patients with suspected Cushing’s disease, when no tumor is found on the gland during surgical exploration. Cushing’s disease (CD) is caused by increased levels of glucocoticosteroids, such as adrenocorticotropic hormone (ACTH), circulating in the blood. In nearly 70 percent of cases this happens as a result of benign tumors on the pituitary gland, which produce excess ACTH. In these patients, the most effective and first-line treatment is surgical removal of the pituitary gland tumor. During the diagnostic stage, clinicians use several methods to identify and localize the source of excessive ACTH. But these methods can fail, and the presence of a tumor in the pituitary is not always confirmed. If the tumor remains unidentified during surgical exploration, it falls to the surgeon’s discretion about how to manage their patients. Researchers at the University of Colorado Denver School of Medicine provided an overview of their experience on the management of patients with presumed Cushing’s disease who underwent surgical treatment. The study, “Negative surgical exploration in patients with Cushing’s disease: benefit of two-thirds gland resection on remission rate and a review of the literature,” was published in the Journal of Neurosurgery. “The diagnosis and treatment of CD is one of the most challenging entities that pituitary neurosurgeons, endocrinologists, and pathologists face,” the researchers wrote. “The ability to make a correct diagnosis and deliver a high likelihood of remission after surgery relies heavily on the performance of a meticulous workup and rational surgical strategy.” The team retrospectively analyzed all cases that had been referred to the Department of Neurosurgery of CU School of Medicine between 1989 and 2011 for a potential ACTH-secreting pituitary tumor. During this period, 161 cases of Cushing’s patients who underwent surgical tumor resection were reported. In 22 patients, the surgeon was unable to detect a tumor. In these cases the surgical team decided to remove two-thirds of the gland, with resection of the lateral and inferior portions of the pituitary. All 22 patients were treated using a consistent technique performed by a single surgeon. Posterior tissue analysis confirmed that six of these patients had pituitary ACTH-secreting tumors. In the remaining 16 patients, no tumor was identified. In three patients the team believed that overproduction of ACTH could be due to an overgrowth of ACTH-secreting cells rather than expansion. The team believes that these findings underscore the difficulty of accurately diagnosing very small pituitary tumors pre- and post-operatively. The 22 patients were followed for a mean time of 98.9 months, or 8.2 years. No remissions were observed in the six patients who had ACTH-secreting tumors or in 12 of the remaining patients. Blood analysis in follow-up exams confirmed these patients had normal levels of glucocoticosteroids. Four patients continued to show persistent elevated amounts of ACTH. Additional clinical evaluations revealed that two patients had ACTH-secreting lung tumors, and one patient was suspected of having an ACTH-secreting tumor on a brain region close to the pituitary. There was one case where the clinical team was unable to identify the origin of elevated ACTH. Only three patients required hormone replacement after the two-thirds gland removal to overcome a newly detected hormone deficit. The approach used by the surgical team was, overall, found to be safe with no severe side effects reported. “Currently, when the neurosurgeon is faced with the inability to identify a discrete adenoma intraoperatively, there is little uniformity in the literature as to how to proceed,” the team wrote. “We believe this [pituitary resection] approach will be useful to help guide surgeons in the operative treatment of this particularly difficult group of patients.” From https://cushingsdiseasenews.com/2017/12/14/pituitary-gland-resection-may-help-presumed-cushings-disease-patients/
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