Significación clínica de la consistencia del adenoma hipofisario en pacientes sometidos a cirugía transesfenoidal endoscópica

Acitores Cancela, Alberto; Rodríguez Berrocal, Víctor
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Los adenomas hipofisarios o tumores neuroendocrinos hipofisarios &#40;PitNET&#41; suponen&#44; seg&#250;n la &#250;ltima clasificaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a>&#44; una de las neoplasias intracraneales m&#225;s frecuentes&#44; con una prevalencia en la poblaci&#243;n general&#44; de acuerdo con estudios de imagen y autopsias&#44; del 10-15&#37;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a>&#46; La inmensa mayor&#237;a se corresponden con tumores benignos&#44; de crecimiento lento&#46; Sin embargo&#44; a pesar de ello&#44; pueden llegar a tener importantes repercusiones cl&#237;nicas y ocasionar un importante deterioro en la calidad de vida&#44; incluso a edades muy tempranas&#44; al poder provocar sintomatolog&#237;a por exceso &#40;acromegalia&#44; enfermedad de Cushing&#41; o defecto hormonal &#40;hipopituitarismo&#41;&#44; o por compresi&#243;n de estructuras vecinas &#40;p&#233;rdida de visi&#243;n o afectaci&#243;n de los pares oculomotores&#41;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Actualmente&#44; el tratamiento de primera elecci&#243;n para la mayor&#237;a de estos tumores &#40;salvo los prolactinomas&#41; es la ex&#233;resis quir&#250;rgica&#44; fundamentalmente a trav&#233;s de un abordaje endonasal endosc&#243;pico que logra unos muy buenos resultados&#44; especialmente en manos expertas<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a>&#46; Si bien es cierto que la mayor&#237;a &#40;85-90&#37;&#41; de los PitNET son tumores de consistencia blanda&#44; lo cual facilita enormemente la extirpaci&#243;n&#44; existe un 10-15&#37; de tumores duros o fibrosos que pueden dificultar en gran medida el acto quir&#250;rgico y aumentar la morbimortalidad del procedimiento<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El concepto de consistencia o dureza en un tumor hipofisario es&#44; a menudo&#44; subjetivo y puede ser dif&#237;cil de definir y estandarizar&#46; Sin embargo&#44; en los &#250;ltimos a&#241;os se ha alcanzado cierto consenso en cuanto a su clasificaci&#243;n&#44; atendiendo a par&#225;metros bien definidos&#46; Una de las clasificaciones m&#225;s detallada es la de Rutkowski et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a>&#44; que los clasifica en cinco categor&#237;as seg&#250;n sean qu&#237;sticos&#44; blandos&#44; intermedios&#44; duros y calcificados&#44; si bien&#44; a nuestro parecer&#44; y de manera m&#225;s habitual en la literatura&#44; se pueden agrupar en dos categor&#237;as igualmente discriminativas &#40;principalmente blandos vs&#46; fibrosos&#41;&#46; Se consideran tumores blandos aquellos f&#225;cilmente aspirables con un terminal convencional de aspiraci&#243;n de 10 F y tumores fibrosos&#47;duros aquellos que requieren de una fragmentaci&#243;n previa y disecci&#243;n con curetas o disecci&#243;n extracapsular<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4&#44;7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Todav&#237;a no se conoce con detalle qu&#233; factor o factores pueden determinar el aumento de la consistencia en estos tumores&#46; Principalmente se ha implicado un incremento de las fibras de col&#225;geno &#40;tipos I&#44; III y IV&#41;&#44; e incluso una mayor expresi&#243;n del factor de crecimiento transformante beta-1 &#40;TGF-&#946;1&#41;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Existen ciertos subtipos histol&#243;gicos que se han asociado a consistencias m&#225;s blandas &#40;corticotropinomas&#41; o fibrosas&#47;duras &#40;tirotropinomas&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a>&#46; Ciertos tratamientos m&#233;dicos previos &#40;agonistas dopamin&#233;rgicos&#44; an&#225;logos de somatostatina o incluso temozolomida&#41; se han intentado relacionar con cambios en la consistencia del tumor&#44; aunque con resultados dispares&#46; Algunos trabajos han vinculado la administraci&#243;n prequir&#250;rgica de bromocriptina en el manejo de prolactinomas&#44; con una mayor fibrosis del adenoma<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Independientemente de la causa&#44; este aumento de la consistencia en algunos de ellos parece influir en la forma de presentaci&#243;n cl&#237;nica&#46; Se ha descrito que los tumores duros se asocian m&#225;s frecuentemente a deficiencia hormonal&#44; mayor tama&#241;o y d&#233;ficit visual&#44; aunque esto puede ser dif&#237;cil de desligar de otras caracter&#237;sticas tumorales<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento quir&#250;rgico&#44; tambi&#233;n parece evidente que una consistencia m&#225;s fibrosa del adenoma podr&#237;a influir en los resultados y el pron&#243;stico del mismo&#46; La t&#233;cnica quir&#250;rgica difiere en estos casos&#44; muchas veces obliga a una fragmentaci&#243;n tumoral y a una disecci&#243;n extraglandular lo que provoca una mayor manipulaci&#243;n de la gl&#225;ndula normal&#46; Se ha publicado recientemente que una consistencia m&#225;s fibrosa se relaciona con menores tasas de resecci&#243;n completa en comparaci&#243;n con los tumores blandos &#40;48&#44;7 vs&#46; 76&#44;3&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">4&#44;8</span></a>&#44; implicando tambi&#233;n que los pacientes reciban con mayor frecuencia tratamientos adyuvantes despu&#233;s de la cirug&#237;a hasta tres veces m&#225;s&#46; Adem&#225;s&#44; estos tumores fibrosos se relacionan con una mayor probabilidad de complicaciones quir&#250;rgicas&#44; tales como la rotura intraoperatoria del diafragma selar con salida de l&#237;quido cefalorraqu&#237;deo &#40;LCR&#41;&#44; que es cinco veces m&#225;s frecuente en tumores fibrosos &#40;esto implica la necesidad de usar t&#233;cnicas reconstructivas m&#225;s complejas en la fase de cierre&#41; o el panhipopituitarismo posquir&#250;rgico y la diabetes ins&#237;pida permanente&#44; siendo ambas hasta 10 veces m&#225;s frecuentes en las cirug&#237;as de tumores fibrosos&#46; Todo ello&#44; provocado por la manipulaci&#243;n glandular y tumoral ya mencionada previamente<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a>&#46; Si bien es cierto que resulta complejo analizar estos resultados de forma aislada por la coexistencia de otros factores como son el tama&#241;o del tumor&#44; la invasi&#243;n del seno cavernoso o la edad<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a>&#44; estos se mantienen tras haber realizado los an&#225;lisis estad&#237;sticos multivariables&#44; para controlar esos factores de confusi&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Parece l&#243;gico que&#44; en este contexto&#44; si se pudiera identificar preoperatoriamente al subgrupo de pacientes con tumores duros o fibrosos&#44; estos podr&#237;an ser derivados te&#243;ricamente a cirujanos con alta experiencia en esta patolog&#237;a&#44; en el seno de unidades de referencia multidisciplinares<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Es por ello&#44; que en los &#250;ltimos 10-15 a&#241;os&#44; se ha intentado predecir la consistencia de estos tumores hipofisarios a partir de las pruebas radiol&#243;gicas preoperatorias &#40;fundamentalmente la resonancia magn&#233;tica cerebral&#41;&#44; que han experimentado una gran evoluci&#243;n en estos &#250;ltimos a&#241;os&#46; En primer lugar&#44; para poder informar al paciente de una manera m&#225;s precisa e individualizada sobre las expectativas y el manejo de su tumor&#44; as&#237; como para planificar de una forma m&#225;s precisa la cirug&#237;a&#46; Sin embargo&#44; estos intentos de predicci&#243;n de la consistencia han resultado infructuosos&#44; arrojando resultados muchas veces contradictorios&#46; Se han realizado an&#225;lisis de secuencias de difusi&#243;n&#44; perfusi&#243;n&#44; la captaci&#243;n de contraste en T1 y comportamiento en T2&#44; o incluso an&#225;lisis m&#225;s complejos &#40;elastograf&#237;a&#41;&#44; todos ellos con resultados diversos e inconsistentes&#46; Es por ello que creemos que&#44; probablemente&#44; y al menos de momento&#44; el uso de la radiolog&#237;a como m&#233;todo aislado para predecir la consistencia de estos tumores no terminar&#225; de resolver la cuesti&#243;n<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a>&#46; Recientemente hemos propuesto un modelo predictivo que considera no solo las caracter&#237;sticas radiol&#243;gicas preoperatorias&#44; sino tambi&#233;n otros criterios &#40;cl&#237;nicos y bioqu&#237;micos&#41; que se han mostrado efectivos en la predicci&#243;n de la consistencia del tumor<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a>&#46; Adem&#225;s&#44; para simplificar su aplicaci&#243;n&#44; hemos dise&#241;ado y publicado una escala que facilita su uso &#40;<span class="elsevierStyleItalic">pituitary tumor consistency</span> &#91;PiTCon&#93; <span class="elsevierStyleItalic">score</span>&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Es evidente que esto solo se trata de un paso inicial&#44; que deber&#225; ser validado a trav&#233;s de estudios multic&#233;ntricos con un mayor n&#250;mero de pacientes&#44; pero consideramos que puede ir en la direcci&#243;n adecuada&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">La consistencia&#44; as&#237; como la invasi&#243;n del seno cavernoso&#44; el tama&#241;o y los tratamientos previos &#40;cirug&#237;as o radioterapia&#41; son&#44; por tanto&#44; variables que determinan la dificultad de extirpaci&#243;n quir&#250;rgica&#44; afectando a sus resultados y marcando la evoluci&#243;n de estos pacientes&#46; Con excepci&#243;n de la primera mencionada&#44; el resto de estas variables son f&#225;cilmente identificables en la consulta a trav&#233;s de la radiolog&#237;a y la historia cl&#237;nica del paciente&#46; Por ello&#44; consideramos que es importante intentar predecir tambi&#233;n la consistencia del PitNET&#44; completando as&#237; una suerte de cribaje de casos de pacientes complejos&#44; que podr&#237;an ser derivados&#44; de manera individualizada&#44; a unidades y centros de referencia &#40;CSUR&#41; con el objetivo de intentar maximizar las posibilidades de curaci&#243;n y minimizar las complicaciones&#44; mejorando as&#237; la calidad de vida de estos pacientes&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financiaci&#243;n</span><p id="par0050" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido financiaci&#243;n alguna del sector p&#250;blico ni privado&#46;</p></span></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PiTCon score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">S&#237;ntomas compresivos</span><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Panhipopituitarismo</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Extensi&#243;n craneocaudal &#40;mm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intervenci&#243;n quir&#250;rgica previa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t">25-45&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">80-95&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 95&#37;&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">presentaci&#243;n cl&#237;nica con cefalea o s&#237;ntomas visuales&#46;</p>"
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          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">C&#225;lculo e interpretaci&#243;n del &#171;PiTCon&#187; <span class="elsevierStyleItalic">score</span> &#40;acr&#243;nimo de <span class="elsevierStyleItalic">&#171;pituitary tumor consistency&#187;</span>&#41;</p>"
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      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:16 [
            0 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recomendaciones sobre el diagn&#243;stico y seguimiento radiol&#243;gico de los tumores neuroendocrinos hipofisarios"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Fajardo-Monta&#241;ana"
                            1 => "R&#46; Villar"
                            2 => "B&#46; G&#243;mez-Ans&#243;n"
                            3 => "B&#46; Brea"
                            4 => "A&#46;J&#46; Mosqueira"
                            5 => "E&#46; Molla"
                          ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocrinol Diabetes y Nutr&#46;"
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                        "volumen" => "69"
                        "numero" => "9"
                        "paginaInicial" => "744"
                        "paginaFinal" => "761"
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              "identificador" => "bib0090"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and Management of Pituitary Adenomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;A&#46; Tritos"
                            1 => "K&#46;K&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.2023.5444"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2023"
                        "volumen" => "329"
                        "numero" => "16"
                        "paginaInicial" => "1386"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37097352"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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              "identificador" => "bib0095"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reported outcomes in transsphenoidal surgery for pituitary adenomas&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Layard Horsfall"
                            1 => "A&#46; Lawrence"
                            2 => "A&#46; Venkatesh"
                            3 => "R&#46;T&#46;S&#46; Loh"
                            4 => "R&#46; Jayapalan"
                            5 => "O&#46; Koulouri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11102-023-01303-w"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pituitary&#46;"
                        "fecha" => "2023"
                        "volumen" => "26"
                        "numero" => "2"
                        "paginaInicial" => "171"
                        "paginaFinal" => "181"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36862265"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
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            3 => array:3 [
              "identificador" => "bib0100"
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                      "titulo" => "Is it possible to predict the development of diabetes insipidus after pituitary surgery&#63; Study of 241 endoscopic transsphenoidal pituitary surgeries"
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                            3 => "A&#46; Garc&#237;a Fern&#225;ndez"
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                        "paginaFinal" => "1464"
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                      "titulo" => "Development and clinical validation of a grading system for pituitary adenoma consistency"
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                            4 => "A&#46;R&#46; Tafreshi"
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                        "paginaFinal" => "1807"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32503003"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical relevance of tumor consistency in pituitary adenoma"
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                            0 => "A&#46; Acitores Cancela"
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                            5 => "P&#46; Iglesias"
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                        "tituloSerie" => "Hormones &#40;Athens&#41;&#46;"
                        "fecha" => "2021"
                        "volumen" => "20"
                        "numero" => "3"
                        "paginaInicial" => "463"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34148222"
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                          ]
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                    ]
                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Predicting tumor consistency and extent of resection in non-functioning pituitary tumors"
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                            3 => "E&#46; Ferrante"
                            4 => "L&#46; Tariciotti"
                            5 => "E&#46; Kuhn"
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                        "fecha" => "2023"
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                        "paginaFinal" => "220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36808379"
                            "web" => "Medline"
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                0 => array:2 [
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                      "titulo" => "Expression of TGF&#946;1 and pituitary adenoma fibrosis"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Wang"
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                            2 => "D&#46; Shi"
                            3 => "Z&#46; Ye"
                            4 => "F&#46; Qin"
                            5 => "Y&#46; Guo"
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                        "tituloSerie" => "Br J Neurosurg&#46;"
                        "fecha" => "2009"
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                        "numero" => "3"
                        "paginaInicial" => "293"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19533462"
                            "web" => "Medline"
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              ]
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                      "titulo" => "Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas&#58; A single-center study of 90 cases"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "K&#46; Horiguchi"
                            3 => "M&#46; Yamaguchi-Okada"
                            4 => "H&#46; Nishioka"
                            5 => "A&#46; Takeshita"
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                      ]
                    ]
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                        "tituloSerie" => "J Neurosurg&#46;"
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                        "numero" => "6"
                        "paginaInicial" => "1462"
                        "paginaFinal" => "1473"
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                      "titulo" => "Effect of dopaminergic drug treatment on surgical findings in prolactinomas"
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                            3 => "R&#46; Salvatori"
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                            3 => "V&#46; Hasenmajer"
                            4 => "M&#46; Minnetti"
                            5 => "V&#46; Sada"
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                  "host" => array:1 [
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                        "tituloSerie" => "BMC Endocr Disord&#46;"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Radiological Knosp&#44; Revised-Knosp&#44; and Hardy&#8211;Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas&#58; Study of 228 Cases"
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                        "tituloSerie" => "Front Oncol&#46;"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35127519"
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                      "titulo" => "Pilot study to define criteria for Pituitary Tumors Centers of Excellence &#40;PTCOE&#41;&#58; results of an audit of leading international centers"
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