{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:33:10Z","timestamp":1788669190794,"version":"build-2803163510"},"reference-count":45,"publisher":"The Endocrine Society","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2006,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Context: Partial or total removal of the pituitary cures 60\u201380% of patients with Cushing\u2019s disease (CD) in whom an adenoma cannot be identified at surgery. Many patients who fail complete or partial hypophysectomy are cured by sellar and parasellar irradiation.<\/jats:p>\n               <jats:p>Design\/Patients: As part of a series of prospective studies of CD, we identified 12 patients (34.5 \u00b1 19.9 yr; 11 females; four children) with tumors located completely within the neurohypophysis among 730 patients undergoing surgery for CD.<\/jats:p>\n               <jats:p>Setting: The study was conducted at a tertiary referral center at a clinical research hospital.<\/jats:p>\n               <jats:p>Results: All 12 patients had clinical and biochemically defined CD. Tumor was visible at surgery in 11 patients; all 12 tumors were positive for ACTH by immunohistochemistry. Two tumors were excised at repeat surgery because of persistent hypercortisolism within 14 d of negative exploration of the adenohypophysis. There were no long-term complications. At follow-up of 71.9 \u00b1 34.2 months (range, 30\u2013138 months), all patients are in remission of CD. Adult patients have had significant improvement in weight and body mass indices, with restoration of normal menses in all women. In the four pediatric patients, height, weight, and body mass indices have been restored toward normal by surgical remission of CD. Hypopituitarism or long-term neurohypophysial dysfunction has not occurred.<\/jats:p>\n               <jats:p>Conclusion: We report a new subset of patients with CD, ACTH-secreting adenomas that arise wholly within the posterior lobe of the pituitary gland. In cases of CD in which an adenoma is not identified in the adenohypophysis and in patients with persistent hypercortisolism after complete or partial excision of the anterior lobe, tumor within the neurohypophysis should be considered; selective adenomectomy of a neurohypophyseal, ACTH-secreting tumor can produce long-term remission.<\/jats:p>","DOI":"10.1210\/jc.2006-0277","type":"journal-article","created":{"date-parts":[[2006,4,25]],"date-time":"2006-04-25T00:37:38Z","timestamp":1145925458000},"page":"2656-2664","source":"Crossref","is-referenced-by-count":22,"title":["Surgical Remission of Pituitary Adenomas Confined to the Neurohypophysis in Cushing\u2019s Disease"],"prefix":"10.1210","volume":"91","author":[{"given":"Robert J.","family":"Weil","sequence":"first","affiliation":[{"name":"Surgical Neurology Branch (R.J.W., A.O.V., H.L.D., J.W., E.H.O.), National Institutes of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander O.","family":"Vortmeyer","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch (R.J.W., A.O.V., H.L.D., J.W., E.H.O.), National Institutes of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynnette K.","family":"Nieman","sequence":"additional","affiliation":[{"name":"Reproductive Medicine and Biology Branch (L.K.N.), National Institute of Child Health and Development, National Institutes of Health, Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hetty L.","family":"DeVroom","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch (R.J.W., A.O.V., H.L.D., J.W., E.H.O.), National Institutes of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Wanebo","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch (R.J.W., A.O.V., H.L.D., J.W., E.H.O.), National Institutes of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward H.","family":"Oldfield","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch (R.J.W., A.O.V., H.L.D., J.W., E.H.O.), National Institutes of Neurological Disorders and Stroke, National Institutes of Health Bethesda, Maryland 20892-1414"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071613593169600_R1","first-page":"145","article-title":"Hyperactivation of the neurohypophysis as the pathological basis of eclampsia and other hypertensive states","volume":"10","author":"Cushing","year":"1934","journal-title":"Am J Pathol"},{"key":"2020071613593169600_R2","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3171\/jns.1983.59.2.0195","article-title":"Transsphenoidal microsurgical management of Cushing\u2019s disease","volume":"59","author":"Boggan","year":"1983","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R3","doi-asserted-by":"crossref","first-page":"6348","DOI":"10.1210\/jc.2003-032180","article-title":"Microsurgery for Cushing\u2019s disease: initial outcome and long-term results","volume":"89","author":"Hammer","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613593169600_R4","first-page":"1","article-title":"Tumors of the pituitary gland","author":"Asa","year":"1998","journal-title":"Washington, DC: Armed Forces Institute of Pathology;"},{"key":"2020071613593169600_R5","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1111\/j.1365-2265.1994.tb02486.x","article-title":"Morbidity and mortality in Cushing\u2019s disease: an epidemiological approach","volume":"40","author":"Etxabe","year":"1994","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2020071613593169600_R6","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1056\/NEJM199503233321207","article-title":"Cushing\u2019s syndrome","volume":"332","author":"Orth","year":"1995","journal-title":"N Engl J Med"},{"key":"2020071613593169600_R7","doi-asserted-by":"crossref","first-page":"5593","DOI":"10.1210\/jc.2003-030871","article-title":"Diagnosis and complications of Cushing\u2019s syndrome: a consensus statement","volume":"88","author":"Arnaldi","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613593169600_R8","doi-asserted-by":"crossref","first-page":"753","DOI":"10.3171\/jns.2000.93.5.0753","article-title":"Multiple pituitary adenomas in Cushing\u2019s disease","volume":"93","author":"Ratliff","year":"2000","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R9","first-page":"2912","article-title":"Extrapituitary parasellar microadenoma in Cushing\u2019s disease","volume":"84","author":"Pluta","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613593169600_R10","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3171\/jns.1997.87.3.0343","article-title":"Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function","volume":"87","author":"Mason","year":"1997","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R11","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.3171\/jns.2003.98.6.1312","article-title":"Ectopic intracavernous sinus adrenocorticotropic hormone-secreting microadenoma: could this be a common cause of failed transsphenoidal surgery in Cushing disease? Case report","volume":"98","author":"Kim","year":"2003","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R12","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1056\/NEJM199409083311002","article-title":"Cushing\u2019s syndrome in children and adolescents\u2014presentation, diagnosis, and therapy","volume":"331","author":"Magiakou","year":"1994","journal-title":"N Engl J Med"},{"key":"2020071613593169600_R13","doi-asserted-by":"crossref","first-page":"967","DOI":"10.3171\/jns.2003.98.5.0967","article-title":"Transsphenoidal microsurgical treatment of Cushing disease: postoperative assessment of surgical efficacy by application of an overnight low-dose dexamethasone suppression test","volume":"98","author":"Chen","year":"2003","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R14","doi-asserted-by":"crossref","first-page":"948","DOI":"10.3171\/jns.2003.98.5.0948","article-title":"Cushing\u2019s disease","volume":"98","author":"Oldfield","year":"2003","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R15","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.3171\/jns.2002.97.6.1343","article-title":"Basis of persistent and recurrent Cushing\u2019s disease: an analysis of findings at repeated pituitary surgery","volume":"97","author":"Dickerman","year":"2002","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R16","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1177\/002215540104900612","article-title":"Immunohistochemical localization and comparison of carboxypeptidases D, E, and Z, \u03b1-MSH, ACTH, and MIB-1 between human anterior and corticotroph cell \u201cbasophil invasion\u201d of the posterior pituitary","volume":"49","author":"Fan","year":"2001","journal-title":"J Histochem Cytochem"},{"key":"2020071613593169600_R17","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1056\/NEJM199509143331101","article-title":"Body weight and mortality among women","volume":"333","author":"Manson","year":"1995","journal-title":"N Engl J Med"},{"key":"2020071613593169600_R18","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1093\/oxfordjournals.aje.a113598","article-title":"Cigarette smoking, relative weight, and menopause","volume":"117","author":"Willett","year":"1983","journal-title":"Am J Epidemiol"},{"key":"2020071613593169600_R19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199801013380101","article-title":"The effect of age on the association between body-mass index and mortality","volume":"338","author":"Stevens","year":"1998","journal-title":"N Engl J Med"},{"key":"2020071613593169600_R20","volume-title":"Home and Garden Bulletin no. 232","year":"2000","edition":"5th"},{"key":"2020071613593169600_R21","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1001\/jama.1995.03520300035033","article-title":"Weight, weight change, and coronary heart disease in women","volume":"273","author":"Willett","year":"1995","journal-title":"JAMA"},{"key":"2020071613593169600_R22","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1164\/ajrccm.160.6.9902115","article-title":"Prognostic value of nutritional status in chronic obstructive pulmonary disease","volume":"160","author":"Landbo","year":"1999","journal-title":"Am J Respir Crit Care Med"},{"issue":"Suppl 3","key":"2020071613593169600_R23","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1159\/000182782","article-title":"Body composition during adolescence: methods, limitations and determinations","volume":"39","author":"Rolland-Cachera","year":"1993","journal-title":"Horm Res"},{"issue":"Suppl 3","key":"2020071613593169600_R24","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1159\/000182783","article-title":"Catch-up growth during adolescence","volume":"39","author":"Largo","year":"1993","journal-title":"Horm Res"},{"key":"2020071613593169600_R25","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/j.1749-6632.2002.tb04417.x","article-title":"Diagnostic tests for Cushing\u2019s syndrome","volume":"970","author":"Nieman","year":"2002","journal-title":"Ann NY Acad Sci"},{"key":"2020071613593169600_R26","first-page":"551","article-title":"MR height of the pituitary gland as a function of age and sex: especially physiological hypertrophy in adolescence and in climacterium","volume":"18","author":"Tsunoda","year":"1997","journal-title":"Am J Neuroradiol"},{"key":"2020071613593169600_R27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3171\/jns.1994.80.1.0037","article-title":"Early repeat surgery for Cushing\u2019s disease","volume":"80","author":"Ram","year":"1994","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R28","doi-asserted-by":"crossref","first-page":"927","DOI":"10.3171\/jns.1998.89.6.0927","article-title":"Localization of pituitary adenomas by using intraoperative ultrasound in patients with Cushing\u2019s disease and no demonstrable pituitary tumor on magnetic resonance imaging","volume":"89","author":"Watson","year":"1998","journal-title":"J Neurosurg"},{"key":"2020071613593169600_R29","doi-asserted-by":"crossref","first-page":"2381","DOI":"10.1210\/jcem.82.8.4188","article-title":"Surgical management of pituitary tumors","volume":"82","author":"Wilson","year":"1997","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613593169600_R30","doi-asserted-by":"crossref","first-page":"487","DOI":"10.7326\/0003-4819-109-6-487","article-title":"Transsphenoidal microsurgery for Cushing disease. A report of 216 cases","volume":"109","author":"Mampalam","year":"1988","journal-title":"Ann Intern Med"},{"key":"2020071613593169600_R31","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1126\/science.1062736","article-title":"Pituitary development: regulatory codes in mammalian organogenesis","volume":"295","author":"Scully","year":"2002","journal-title":"Science"},{"key":"2020071613593169600_R32","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1056\/NEJM199701163360303","article-title":"The long-term outcome of pituitary irradiation after unsuccessful transsphenoidal surgery in Cushing\u2019s disease","volume":"336","author":"Estrada","year":"1997","journal-title":"N Engl J Med"},{"key":"2020071613593169600_R33","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0090-3019(88)90097-3","article-title":"Pituitary adenomas in Cushing\u2019s disease: do they arise from the intermediate lobe?","volume":"30","author":"Raffel","year":"1985","journal-title":"Surg Neurol"},{"key":"2020071613593169600_R34","first-page":"297","article-title":"Pars intermedia basophil adenoma of the hypophysis","volume":"14","author":"Rasmussen","year":"1938","journal-title":"Am J Pathol"},{"key":"2020071613593169600_R35","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1210\/jcem-54-2-286","article-title":"Adrenocorticotropin-secreting pituitary adenomas originating form the anterior or the intermediate lobe in Cushing\u2019s disease: differences in the regulation of hormone secretion","volume":"54","author":"Lamberts","year":"1982","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613593169600_R36","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/j.1365-2265.1986.tb01668.x","article-title":"A study of corticotroph adenomas in Cushing\u2019s disease: no evidence of intermediate lobe origin","volume":"24","author":"McNicol","year":"1986","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2020071613593169600_R37","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1101\/gad.1065703","article-title":"Tpit determines alternate fates during pituitary cell differentiation","volume":"17","author":"Pulichino","year":"2003","journal-title":"Genes Dev"},{"key":"2020071613593169600_R38","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1101\/gad.1065603","article-title":"Human and mouse TPIT gene mutations cause early onset pituitary ACTH deficiency","volume":"17","author":"Pulichino","year":"2003","journal-title":"Genes Dev"},{"key":"2020071613593169600_R39","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/(SICI)1097-0029(19990701)46:1<59::AID-JEMT6>3.0.CO;2-S","article-title":"Immunohistochemical survey of migration of human anterior pituitary cells in developmental, pathological, and clinical aspects: a review","volume":"46","author":"Hori","year":"1999","journal-title":"Microsc Res Tech"},{"key":"2020071613593169600_R40","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.gde.2005.04.011","article-title":"Genetic control of pituitary development and hypopituitarism","volume":"15","author":"Zhu","year":"2005","journal-title":"Curr Opin Genet Dev"},{"key":"2020071613593169600_R41","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1210\/endo-110-4-1430","article-title":"Equine Cushing\u2019s disease: plasma immunoreactive proopiolipomelanocortin peptide and cortisol levels basally and in response to diagnostic tests","volume":"110","author":"Orth","year":"1982","journal-title":"Endocrinology"},{"key":"2020071613593169600_R42","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1126\/science.6255564","article-title":"Pituitary intermediate lobe in dog: two cell types and high bioactive adrenocorticotropin content","volume":"211","author":"Halmi","year":"1981","journal-title":"Science"},{"key":"2020071613593169600_R43","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1210\/me.2002-0392","article-title":"Pituitary corticotroph ontogeny and regulation in transgenic zebrafish","volume":"17","author":"Liu","year":"2003","journal-title":"Mol Endocrinol"},{"key":"2020071613593169600_R44","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1007\/s004010051079","article-title":"Pharyngeal pituitary: development, malformation, and tumorigenesis","volume":"98","author":"Hori","year":"1999","journal-title":"Acta Neuropathol"},{"key":"2020071613593169600_R45","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1210\/jc.2004-1300","article-title":"Congenital isolated adrenocorticotropin deficiency: an underestimated cause of neonatal death, explained by TPIT gene mutations","volume":"90","author":"Vallette-Kasic","year":"2005","journal-title":"J Clin Endocrinol Metab"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/91\/7\/2656\/9062520\/jcem2656.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/91\/7\/2656\/9062520\/jcem2656.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,17]],"date-time":"2020-07-17T01:08:14Z","timestamp":1594948094000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/91\/7\/2656\/2656459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,7,1]]},"references-count":45,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2006,7,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jc.2006-0277","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,7,1]]}}}