Doctoral defence: Kristina Isand "Natural history of non-functioning pituitary microadenomas and venous thromboembolism in patients with pituitary adenomas and Cushing syndrome"

On October 13th Kristina Isand will defend her thesis "Natural history of non-functioning pituitary microadenomas and venous thromboembolism in patients with pituitary adenomas and Cushing syndrome".

Supervisors:
Professor Vallo Volke, University of Tartu
Professor John Andrew Hall Wass, Oxford Centre for Diabetes
Aparna Pal, Oxford Centre for Diabetes

Opponent:
Associate professor Sebastian J. C. M. M. Neggers, Erasmus University Medical Center Rotterdam (Netherlands)

Summary
Pituitary adenomas are common anterior pituitary tumors, an estimated prevalence is around 10%. They are classified as functioning and non-functioning pituitary adenomas (NFPAs), the latter do not cause hormonal hypersecretion but may present with compressive symptoms such as headache, visual field defects, or hypopituitarism. Microadenomas are often incidental findings. Knowledge about the natural course of NFPAs remains limited.

Cushing’s disease (CD) is a rare but serious endocrine disorder. Patients with CD have a significantly increased risk of venous thromboembolism (VTE), which can be up to ten times higher than in the general population. For reasons that remain unclear, the elevated risk persists even years after remission. The exact magnitude of VTE risk across different types of pituitary tumors is still not well defined.

The first study was a multicentre retrospective study in patients with micro-NFPA from 23 centres in the UK. The second study included patients with acromegaly, NFPA, CD; it analysed primary VTE events. The third study used retrospective data from the ERCUSYN including 2,174 patients from 26 European countries analysing VTE’s and data on thromboprophylaxis protocols.

The risk of micro-NFPA progression is low, and the development of new hypopituitarism is rare.

In CD, VTE risk is elevated, particularly in men, in patients requiring repeat surgery, in those with elevated urinary free cortisol, and in the postoperative period.

You can also watch the defence via Teams.