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Article ; Online: Role of Radiation in the treatment of Cushing Disease.

Katznelson, Laurence

2022 Volume 25, Issue 5, Page(s) 740–742

Abstract: In Cushing disease (CD), radiation therapy (RT) is mostly used in the adjuvant setting in patients who have failed transsphenoidal surgery or have recurrent CD. Stereotactic radiotherapy (SRT) is administered as either single or several sessions, and the ...

Abstract	In Cushing disease (CD), radiation therapy (RT) is mostly used in the adjuvant setting in patients who have failed transsphenoidal surgery or have recurrent CD. Stereotactic radiotherapy (SRT) is administered as either single or several sessions, and the most commonly used modalities include photon source (Gamma Knife, CyberKnife, and LINAC) or heavy particles (protons). In multicenter studies, Gamma Knife SRT can lead to biochemical control in 80%, with medial time to remission approximately 15 mos, and 70% recurrence free at 10 years. Conventional RT (CRT) consists of administration of small daily fractions over six weeks, with cumulative dose of 45-50 Gy. Biochemical control is achieved in up to 64% of patients with CRT. Choice of radiation modality includes convenience for patients (SRT is more convenient) and proximity to critical structures. Both forms of RT can result in hypopituitarism. RT remains an important modality for the treatment of patients with CD.
MeSH term(s)	Humans ; Pituitary ACTH Hypersecretion/radiotherapy ; Pituitary ACTH Hypersecretion/etiology ; Protons ; Radiosurgery ; Dose Fractionation, Radiation ; Hypopituitarism/etiology
Chemical Substances	Protons
Language	English
Publishing date	2022-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-022-01234-y
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Article ; Online: The role of growth hormone for fertility in women with hypopituitarism.

Chen, Julie / Katznelson, Laurence

Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society

2022 Volume 63, Page(s) 101458

Abstract: Growth hormone (GH) is an important regulator of the female reproductive system. In vitro and non-human in vivo studies demonstrate a role of GH in steroidogenesis, folliculogenesis, and post-fertilization development. Given its ability to modulate the ... ...

Abstract	Growth hormone (GH) is an important regulator of the female reproductive system. In vitro and non-human in vivo studies demonstrate a role of GH in steroidogenesis, folliculogenesis, and post-fertilization development. Given its ability to modulate the reproductive system and potentiate the effects of gonadotropins, a beneficial role of GH replacement therapy to optimize fertility has been suggested. Women with hypopituitarism have lower pregnancy and live birth rates. Limited data suggest a role of GH in enhancing fertility management in women with hypopituitarism. GH replacement therapy may be especially relevant in women with hypopituitarism as well as in women considered poor ovarian responders and require assisted reproductive techniques.
MeSH term(s)	Female ; Fertility ; Growth Hormone/pharmacology ; Hormone Replacement Therapy ; Human Growth Hormone/pharmacology ; Human Growth Hormone/therapeutic use ; Humans ; Hypopituitarism/drug therapy ; Pregnancy
Chemical Substances	Human Growth Hormone (12629-01-5) ; Growth Hormone (9002-72-6)
Language	English
Publishing date	2022-03-29
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1436781-6
ISSN	1532-2238 ; 1096-6374
ISSN (online)	1532-2238
ISSN	1096-6374
DOI	10.1016/j.ghir.2022.101458
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Zs.A 3319: Show issues

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Article ; Online: Glucocorticoid use in patients with adrenal insufficiency following administration of the COVID-19 vaccine: a pituitary society statement.

Katznelson, Laurence / Gadelha, Mônica

Pituitary

2021 Volume 24, Issue 2, Page(s) 143–145

Abstract: Purpose: Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid ... ...

Abstract	Purpose: Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid replacement in patients with adrenal insufficiency. The Pituitary Society surveyed its membership to understand planned approaches to glucocorticoid management in patients with adrenal insufficiency who will receive a COVID-19 vaccine. Methods: Members were asked to complete up to 3 questions regarding their planned approach for use of glucocorticoid replacement in patients with proven adrenal insufficiency. Results: Surveys were sent to 273 members and 103 responded. Thirty-six percent plan to recommend that patients automatically increase glucocorticoid dosage with administration of the first vaccine injection. Of these, 84% plan to increase glucocorticoid dose on the day of vaccination, and 49% plan to increase glucocorticoid dose prior to vaccination. Of the 64% who do not plan to recommend automatic glucocorticoid dose increase with vaccine administration, 88% plan to increase the dose if the patient develops a fever, and 47% plan to increase the dose if myalgias and arthralgias occur. Conclusions: Most clinicians plan to maintain the current glucocorticoid dose with vaccine administration. The vast majority plan and to increase glucocorticoid dose in case of fever, and just under half in case of arthralgias and myalgias. These survey results offer suggested management guidance for glucocorticoid management in patients with adrenal insufficiency.
MeSH term(s)	Adrenal Insufficiency/drug therapy ; Adrenal Insufficiency/epidemiology ; Adrenal Insufficiency/pathology ; COVID-19/epidemiology ; COVID-19/immunology ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; COVID-19 Vaccines/therapeutic use ; Dexamethasone/adverse effects ; Dexamethasone/therapeutic use ; Endocrinology/organization & administration ; Endocrinology/standards ; Glucocorticoids/therapeutic use ; Humans ; Hypothalamo-Hypophyseal System/drug effects ; Pandemics ; Pituitary Diseases/therapy ; Pituitary-Adrenal System/drug effects ; Practice Patterns, Physicians'/standards ; SARS-CoV-2/immunology ; Societies, Medical ; Surveys and Questionnaires
Chemical Substances	COVID-19 Vaccines ; Glucocorticoids ; Dexamethasone (7S5I7G3JQL)
Language	English
Publishing date	2021-02-10
Publishing country	United States
Document type	Journal Article ; Practice Guideline
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-021-01130-x
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Article ; Online: Bilateral adrenalectomy for Cushing's disease.

Katznelson, Laurence

Pituitary

2015 Volume 18, Issue 2, Page(s) 269–273

Abstract: Purpose: Review the indications, outcomes, and consequences of bilateral adrenalectomy (BLA) in patients with Cushing's disease.: Methods: A literature review was performed.: Results: The primary therapy for Cushing's disease is surgery, with ... ...

Abstract	Purpose: Review the indications, outcomes, and consequences of bilateral adrenalectomy (BLA) in patients with Cushing's disease. Methods: A literature review was performed. Results: The primary therapy for Cushing's disease is surgery, with medical therapy and radiation therapy relegated to an adjuvant role. BLA is indicated in cases of persistent disease following pituitary surgery or in situations where rapid normalization of hypercortisolism is required. When performed via the laparoscopic approach, BLA is associated with a significantly reduced morbidity compared to the traditional, open approach. Following BLA, patients are at risk for adrenal crisis and the concern of Nelson's syndrome. However, BLA leads to a rapid resolution of the signs and symptoms of CS and leads to an improved long-term quality of life. Conclusion: BLA should be considered in the treatment algorithm for patients with persistent CD after failed pituitary surgery, especially in patients who have severe consequences of hypercortisolism or desire pregnancy.
MeSH term(s)	ACTH-Secreting Pituitary Adenoma/blood ; ACTH-Secreting Pituitary Adenoma/complications ; ACTH-Secreting Pituitary Adenoma/diagnosis ; ACTH-Secreting Pituitary Adenoma/surgery ; Adenoma/blood ; Adenoma/complications ; Adenoma/diagnosis ; Adenoma/surgery ; Adrenal Glands/metabolism ; Adrenal Glands/pathology ; Adrenal Glands/surgery ; Adrenalectomy ; Cushing Syndrome/blood ; Cushing Syndrome/diagnosis ; Cushing Syndrome/etiology ; Cushing Syndrome/surgery ; Humans ; Patient Selection ; Treatment Outcome
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-014-0633-2
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Article ; Online: Fertility issues in hypopituitarism.

Chen, Julie / Chang, Julia J / Chung, Esther H / Lathi, Ruth B / Aghajanova, Lusine / Katznelson, Laurence

Reviews in endocrine & metabolic disorders

2023

Abstract: Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with ... ...

Abstract	Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.
Language	English
Publishing date	2023-12-14
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2185718-0
ISSN	1573-2606 ; 1389-9155
ISSN (online)	1573-2606
ISSN	1389-9155
DOI	10.1007/s11154-023-09863-9
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Zs.A 6069: Show issues

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Article ; Online: How Many Lives Will You Save? A Mixed Methods Evaluation of a Novel, Online Game for Patient Safety and Quality Improvement Education.

Ruiz Colón, Gabriela / Evans, Kambria / Kanzawa, Mia / Phadke, Anuradha / Katznelson, Laurence / Shieh, Lisa

American journal of medical quality : the official journal of the American College of Medical Quality

2023 Volume 38, Issue 6, Page(s) 306–313

Abstract: Medical trainees have limited knowledge of quality improvement and patient safety concepts. The authors developed a free quality improvement/patient safety educational game entitled Safety Quest (SQ). However, 1803 undergraduate medical trainees, ... ...

Abstract	Medical trainees have limited knowledge of quality improvement and patient safety concepts. The authors developed a free quality improvement/patient safety educational game entitled Safety Quest (SQ). However, 1803 undergraduate medical trainees, graduate medical trainees, and continuing medical education learners globally completed at least 1 level of SQ. Pre- and post-SQ knowledge and satisfaction were assessed among continuing medical education learners. Thematic analysis of feedback given by trainees was conducted. Among graduate medical trainees, SQ outranked other learning modalities. Three content areas emerged from feedback: engagement, ease of use, and effectiveness; 87% of comments addressing engagement were positive. After completing SQ, 98.6% of learners passed the post-test, versus 59.2% for the pretest ( P < 0.0001). Ninety-three percent of learners agreed that SQ was engaging and interactive, and 92% believed it contributed to their professional growth. With an increased need for educational curricula to be delivered virtually, gamification emerges as a unique strategy that learners praise as engaging and effective.
MeSH term(s)	Humans ; Quality Improvement ; Patient Safety ; Learning ; Curriculum ; Educational Measurement
Language	English
Publishing date	2023-10-18
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1131772-3
ISSN	1555-824X ; 1062-8606
ISSN (online)	1555-824X
ISSN	1062-8606
DOI	10.1097/JMQ.0000000000000153
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Zs.A 2436: Show issues

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Article ; Online: Sustained improvements in plasma ACTH and clinical status in a patient with Nelson's syndrome treated with pasireotide LAR, a multireceptor somatostatin analog.

Katznelson, Laurence

The Journal of clinical endocrinology and metabolism

2013 Volume 98, Issue 5, Page(s) 1803–1807

Abstract: Context: Nelson's syndrome refers to aggressive pituitary corticotroph adenoma growth after bilateral adrenalectomy for treatment of Cushing's disease (CD). Pasireotide, a novel somatostatin analog, has been effective in treating CD. Here, the first ... ...

Abstract	Context: Nelson's syndrome refers to aggressive pituitary corticotroph adenoma growth after bilateral adrenalectomy for treatment of Cushing's disease (CD). Pasireotide, a novel somatostatin analog, has been effective in treating CD. Here, the first case report of a patient with Nelson's syndrome treated with pasireotide is presented. Case presentation: A 55-year-old female was diagnosed with CD in 1973 at age 15 years and underwent bilateral adrenalectomy 1 year later. She subsequently developed Nelson's syndrome and underwent multiple surgeries and radiotherapy for adenoma growth. After presentation with ocular pain, third cranial nerve palsy, and a finding of suprasellar tumor enlargement with hemorrhage, she began pasireotide long-acting release 60 mg/28 days im. At baseline, fasting plasma ACTH was 42 710 pg/mL (normal, 5-27 pg/mL), and fasting plasma glucose was 98 mg/dL. After 1 month, ACTH declined to 4272 pg/mL, and it has remained stable over 19 months of follow-up. Hyperpigmentation progressively improved. Magnetic resonance imaging scans show reduction in the suprasellar component. Fasting plasma glucose increased to 124 mg/dL, and the patient underwent diabetes management. Evidence acquisition and synthesis: In this clinical case seminar, the current understanding of the treatment of Nelson's syndrome and the use of pasireotide in CD are summarized. Conclusion: A case of Nelson's syndrome with clinically significant and dramatic biochemical and clinical responses to pasireotide administration is reported. Hyperglycemia was noted after pasireotide administration. Pasireotide may represent a useful tool in the medical management of Nelson's syndrome. Further study of the potential benefits and risks of pasireotide in this population is necessary.
MeSH term(s)	Adrenocorticotropic Hormone/blood ; Central Nervous System Cysts/etiology ; Central Nervous System Cysts/prevention & control ; Delayed-Action Preparations ; Dipeptidyl-Peptidase IV Inhibitors/therapeutic use ; Female ; Growth Hormone-Releasing Hormone/antagonists & inhibitors ; Humans ; Hyperglycemia/chemically induced ; Hyperglycemia/drug therapy ; Hyperpigmentation/etiology ; Hyperpigmentation/prevention & control ; Middle Aged ; Nelson Syndrome/blood ; Nelson Syndrome/drug therapy ; Nelson Syndrome/physiopathology ; Pyrazines/therapeutic use ; Severity of Illness Index ; Sitagliptin Phosphate ; Somatostatin/administration & dosage ; Somatostatin/adverse effects ; Somatostatin/analogs & derivatives ; Somatostatin/therapeutic use ; Treatment Outcome ; Triazoles/therapeutic use
Chemical Substances	Delayed-Action Preparations ; Dipeptidyl-Peptidase IV Inhibitors ; Pyrazines ; Triazoles ; Somatostatin (51110-01-1) ; Adrenocorticotropic Hormone (9002-60-2) ; Growth Hormone-Releasing Hormone (9034-39-3) ; pasireotide (98H1T17066) ; Sitagliptin Phosphate (TS63EW8X6F)
Language	English
Publishing date	2013-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	3029-6
ISSN	1945-7197 ; 0021-972X
ISSN (online)	1945-7197
ISSN	0021-972X
DOI	10.1210/jc.2013-1497
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Article ; Conference proceedings: Transcavernous Resection of Adenoma Embedded in Medial Wall in MRI-Negative Cushing Disease

Bex, Alix / Vigo, Vera / Gambatesa, Enrico / Lee, Christine / Patel, Zara / Katznelson, Laurence / Fischbein, Nancy / Fernandez-Miranda, Juan

Journal of Neurological Surgery Part B: Skull Base

2024 Volume 85, Issue S 01

Event/congress	33rd Annual Meeting North American Skull Base Society, Atlanta Marriott Marquis Atlanta, Georgia, United States, 2024-02-16
Language	English
Publishing date	2024-02-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	2654269-9
ISSN	2193-634X ; 2193-6331
ISSN (online)	2193-634X
ISSN	2193-6331
DOI	10.1055/s-0044-1780410
Database	Thieme publisher's database

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Article ; Online: The New USMLE Step 1 Paradigm: An Opportunity to Cultivate Diversity of Excellence.

Pershing, Suzann / Co, John Patrick T / Katznelson, Laurence

Academic medicine : journal of the Association of American Medical Colleges

2020 Volume 95, Issue 9, Page(s) 1325–1328

Abstract: The February 2020 announcement that United States Medical Licensing Examination (USMLE) Step 1 results will be reported as pass/fail instead of numerical scores has been controversial. Step 1 scores have played a key role in residency selection, ... ...

Abstract	The February 2020 announcement that United States Medical Licensing Examination (USMLE) Step 1 results will be reported as pass/fail instead of numerical scores has been controversial. Step 1 scores have played a key role in residency selection, including screening for interviews. Although Step 1 scores are viewed as an objective criterion, they have been shown to disadvantage female and underrepresented minority applicants, cause student anxiety and financial burden, and affect student well-being. Furthermore, Step 1 scores incompletely predict applicants' overall residency performance. With this paradigm shift in Step 1 score reporting, residency programs will have fewer objective, standardized metrics for selection decisions, which may lead to greater emphasis on USMLE Step 2 Clinical Knowledge scores or yield unintended consequences, including shifting weight to metrics such as medical school reputation.Yet, greater breadth in residency selection metrics will better serve both applicants and programs. Some students excel in coursework, others in research or leadership. All factors should be recognized, and broader metrics should be implemented to promote and recognize diversity of excellence. Given the need for metrics for residency selection as well as for a more holistic approach to evaluating residency applicants, assessment during medical school should be revisited and made more meaningful. Another opportunity may involve use of situational judgment tests to predict professionalism and performance on other competencies. It will be important to evaluate the impact of the new Step 1 paradigm and related initiatives going forward. Residency application overload must also be addressed.
MeSH term(s)	Competency-Based Education ; Cultural Diversity ; Education, Medical, Undergraduate/methods ; Educational Measurement/methods ; Female ; Humans ; Internship and Residency ; Licensure, Medical ; Male ; Minority Groups ; Sex Factors ; United States
Language	English
Publishing date	2020-05-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	96192-9
ISSN	1938-808X ; 1040-2446
ISSN (online)	1938-808X
ISSN	1040-2446
DOI	10.1097/ACM.0000000000003512
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Article ; Online: A proposed clinical classification for pituitary neoplasms to guide therapy and prognosis.

Ho, Ken K Y / Fleseriu, Maria / Wass, John / Katznelson, Laurence / Raverot, Gerald / Little, Andrew S / Castaño, Justo P / Reincke, Martin / Lopes, M Beatriz / Kaiser, Ursula B / Chanson, Philippe / Gadelha, Mônica / Melmed, Shlomo

The lancet. Diabetes & endocrinology

2024 Volume 12, Issue 3, Page(s) 209–214

Abstract: No comprehensive classification system that guides prognosis and therapy of pituitary adenomas exists. The 2022 WHO histopathology-based classification system can only be applied to lesions that are resected, which represent few clinically significant ... ...

Abstract	No comprehensive classification system that guides prognosis and therapy of pituitary adenomas exists. The 2022 WHO histopathology-based classification system can only be applied to lesions that are resected, which represent few clinically significant pituitary adenomas. Many factors independent of histopathology provide mechanistic insight into causation and influence prognosis and treatment of pituitary adenomas. We propose a new approach to guide prognosis and therapy of pituitary adenomas by integrating clinical, genetic, biochemical, radiological, pathological, and molecular information for all adenomas arising from anterior pituitary cell lineages. The system uses an evidence-based scoring of risk factors to yield a cumulative score that reflects disease severity and can be used at the bedside to guide pituitary adenoma management. Once validated in prospective studies, this simple manageable classification system could provide a standardised platform for assessing disease severity, prognosis, and effects of therapy on pituitary adenomas.
MeSH term(s)	Humans ; Pituitary Neoplasms/diagnosis ; Pituitary Neoplasms/therapy ; Prospective Studies ; Prognosis ; Adenoma/diagnosis ; Adenoma/therapy ; Risk Factors
Language	English
Publishing date	2024-01-29
Publishing country	England
Document type	Journal Article ; Review
ISSN	2213-8595
ISSN (online)	2213-8595
DOI	10.1016/S2213-8587(23)00382-0
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