Catalina Poiana

Catalina Poiana

Craniopharyngioma in Adults - Neurosurgical Outcome

Craniopharyngiomas are rare tumors developed in the area of the sella turcica and especially the suprasellar region. Despite their benign histological nature they are locally aggressive and surgical intervention is a major challenge due to the risk of damaging critical neural and vascular neighbouring structures. Objective: To study the postsurgical evolution of craniopharyngioma in adults after total or partial surgical resection. Material and methods: We performed a retrospective review of adult craniopharyngioma patients evaluated and followed up in the Pituitary Diseases Department of the National Institute of Endocrinology in Bucharest between 1998 and 2018. Results: A total of 60 patients (39.62±15.6 years-old) diagnosed with craniopharyngioma were included. All underwent initial surgery (68.3 % transcranial, 31.7% transsphenoidal approach). Gross total resection (GTR) was achieved in 21 cases (35%), in all the others partial resection was obtained (non-GTR). Immediate non-threatening postsurgical complications were anosmia (in 2 cases), cerebrospinal fluid-CSF leak (3 cases), subdural hematoma (2 cases). After surgery 13 cases (21.66%) had cognitive impairment (2 with GTR, 11 with non-GTR), 14 (23.3%) had hypothalamic syndrome (diurnal sleepiness, appetite and memory dysfunction- present in 1 case with GTR, 13 with non-GTR), 27 cases (45%) reported lethargy (7 GTR, 20 non-GTR), 24 (40%) complained of headaches (6 GTR, 18 nonGTR). All these complications were signifi cantly more frequent in cases with incomplete tumor resection compared to those with GTR: p= 0.000; 0.000; 0.036 and 0.009, respectively. Conclusions: Craniopharyngioma as well as its treatment are associated with very significant morbidity. Aggressive surgical resection with the aim of GTR is possible in a signifi cant percentage of cases and if it is carefully considered in view of the surgically perceived risk of neurologic injury it is associated with lower postsurgical morbidity.

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The Vasopressin System in Metabolic Syndrome and Insulin Resistance - a Mini-Review

Metabolic syndrome (MetS), type 2 diabetes, and consequent cardiovascular complications are serious healthcare problems worldwide [1,2]. The prevalence of MetS or its components around the world is variable in different ethnic populations [3,4], and this can be explained by interactions between susceptibility genes specifically expressed in certain ethnic groups and environmental factors [5]. Nonetheless, the number of people aff ected by these conditions is continuously increasing at a global level [4,6] and along with it the mortality and morbidity of populations [7,8]. Cardiovascular disease (CVD) is the main cause of mortality in people suffering from MetS and/or diabetes [9]. The research in this field is ongoing, in the attempt to elucidate the pathophysiological mechanisms and pathways involved in MetS, and to find reliable biomarkers for diagnosis and disease prognosis, as well as therapeutic targets. [...]

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Recent Advances in the Genetics of Pheochromocytomas and Paragangliomas

Pheochromocytomas (Pheos) and paragangliomas (Pgls) are rare neuroendocrine tumors, with the same embriologic origin. Based on WHO classification, chromaffin tumors of the adrenal medulla are called Pheos, whereas tumors arising from extra-adrenal chromaffi n cells, along the autonomous nervous chains, are named Pgls [1]. Furthermore, there are two types of Pgls according to their homologous nervous chain: sympathetic and parasympathetic tumors. Sympathetic Pgls are developing from the pre- and paravertebral sympathetic ganglia (ex: Pgls of the thorax, mediastinum, abdomen) and from the connective tissue within the pelvic organs (ex:urinary bladder Pgl). They release dopamine or norepinephrine (NE) because they lack phenylethanolamine N-methyltransferase (PNMT), the enzyme in charge of transforming NE into epinephrine (E), that is specific to adrenal medulla. [...]

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Familial Isolated Pituitary Adenomas

Pituitary adenomas (PAs) are the most frequent cause of cranial tumors [1,2], benign by histology but with high morbidity caused by their complications – hypersecretion of pituitary hormones but also compression of surrounding structures thus affecting the visual field or causing pituitary deficiency. Their etiology, although intensely studied in the last 30 years, is still largely unknown. The natural evolution and the response to current treatment options of PAs (surgery, medication and radiotherapy) are very variable, influenced by various factors, some identified and some still to be found. Early diagnose and treatment is associated with better prognosis thus identifications of patients at risk for developing a PA and targeted follow-up would result in a better management of the disease [...]

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Parathyroid Hormone-Related Bone Loss in End-Stage Renal Disease: Where to Measure?

Renal osteodystrophy is almost universally found in patients with end-stage renal disease (ESRD). Although bone biopsy is the gold standard for assessment of bone status it is infrequently used.
Guidelines (KDIGO, 2009) recommend the use of dual-energy X-ray absorptiometry (DXA), as a method for measuring bone quantity, in all dialysis patients who either have had fractures or have risk factors for osteoporosis but state against routine use of DXA for bone mineral density (BMD) measurement. This is because low BMD measured by DXA was consistently associated with an increased risk of low trauma fractures in general population but in patients with ESRD studies produced conflicting results (Inaba et al., 2005
Jamal et al., 2002
Kaji et al., 2002
Urena et al., 2003
Yamaguchi et al., 1996). There are many causes of this heterogeneity including secondary hyperparathyroidism, presence of low bone turnover disease, osteomalacia, site of BMD measurement or fracture assessment (clinical vs. radiological).

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