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      Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement

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          Abstract

          Introduction

          With the goal of generate uniform criteria among centers dealing with pituitary tumors and to enhance patient care, the Pituitary Society decided to generate criteria for developing Pituitary Tumors Centers of Excellence (PTCOE).

          Methods

          To develop that task, a group of ten experts served as a Task Force and through two years of iterative work an initial draft was elaborated. This draft was discussed, modified and finally approved by the Board of Directors of the Pituitary Society. Such document was presented and debated at a specific session of the Congress of the Pituitary Society, Orlando 2017, and suggestions were incorporated. Finally the document was distributed to a large group of global experts that introduced further modifications with final endorsement.

          Results

          After five years of iterative work a document with the ideal criteria for a PTCOE is presented.

          Conclusions

          Acknowledging that very few centers in the world, if any, likely fulfill the requirements here presented, the document may be a tool to guide improvements of care delivery to patients with pituitary disorders. All these criteria must be accommodated to the regulations and organization of Health of a given country.

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          Most cited references53

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          Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK).

          Pituitary adenomas (PAs) are associated with increased morbidity and mortality. The optimal delivery of services and the provision of care for patients with PAs require distribution of the resources proportionate to the impact of these conditions on the community. Currently, the resource allocation for PAs in the health care system is lacking a reliable and an up-to-date epidemiological background that would reflect the recent advances in the diagnostic technologies, leading to the earlier recognition of these tumours. To determine the prevalence, the diagnostic delay and the characteristics of patients with PA in a well-defined geographical area of the UK (Banbury, Oxfordshire). Sixteen general practitioner (GP) surgeries covering the area of Banbury and a total population of 89 334 inhabitants were asked to participate in the study (data confirmed on 31 July 2006). Fourteen surgeries with a total of 81,449 inhabitants (91% of the study population) agreed to take part. All cases of PAs were found following an exhaustive computer database search of agreed terms by the staff of each Practice and data on age, gender, presenting manifestations and their duration, imaging features at diagnosis, history of multiple endocrine neoplasia type 1 and family history of PA were collected. A total of 63 patients with PA were identified amongst the study population of 81,149, with a prevalence of 77.6 PA cases/100,000 inhabitants (prolactinomas; PRLoma: 44.4, nonfunctioning PAs: 22.2, acromegaly; ACRO: 8.6, corticotroph adenoma: 1.2 and unknown functional status; UFS: 1.2/100,000 inhabitants). The distribution of each PA subtype was for PRLoma 57%, nonfunctioning PAs 28%, ACRO 11%, corticotroph adenoma 2% and UFS 2%. The median age at diagnosis and the duration of symptoms until diagnosis (in years) were for PRLoma 32.0 and 1.5, nonfunctioning PAs 51.5 and 0.8, ACRO 47 and 4.5 and corticotroph adenoma 57 and 7, respectively. PRLoma was the most frequent PA diagnosed up to the age of 60 years (0-20 years: 75% and 20-60 years: 61% of PAs) and nonfunctioning PA after the age of 60 years (60% of PAs). Nonfunctioning PAs dominated in men (57% of all men with PA) and PRLoma in women (76% of all women with PA). Five patients (7.9%) presented with classical pituitary apoplexy, with a prevalence of 6.2 cases/100,000 inhabitants. Based on a well-defined population in Banbury (Oxfordshire, UK), we have shown that PAs have a fourfold increased prevalence than previously thought; our data confirm that PAs have a higher burden on the Health Care System and optimal resource distribution for both clinical care and research activities aiming to improve the outcome of these patients are needed.
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            Should operations be regionalized? The empirical relation between surgical volume and mortality.

            This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had death rates, adjusted for case mix, 25 to 41 per cent lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. For example, hospitals doing 50 to 100 total hip replacements attained a mortality rate for this procedure almost as low as that of hospitals doing 200 or more. Some procedures, such as cholecystectomy, showed no relation between volume and mortality. The results may reflect the effect of volume or experience on mortality, or referrals to institutions with better outcomes, as well as a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations.
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              Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas.

              In June 2005, an ad hoc Expert Committee formed by the Pituitary Society convened during the 9th International Pituitary Congress in San Diego, California. Members of this committee consisted of invited international experts in the field, and included endocrinologists and neurosurgeons with recognized expertise in the management of prolactinomas. Discussions were held that included all interested participants to the Congress and resulted in formulation of these guidelines, which represent the current recommendations on the diagnosis and management of prolactinomas based upon comprehensive analysis and synthesis of all available data.
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                Author and article information

                Contributors
                endocrine@usc.es
                Journal
                Pituitary
                Pituitary
                Pituitary
                Springer US (New York )
                1386-341X
                1573-7403
                7 September 2017
                7 September 2017
                2017
                : 20
                : 5
                : 489-498
                Affiliations
                [1 ]ISNI 0000000109410645, GRID grid.11794.3a, Division of Endocrinology, , Santiago de Compostela University, ; Santiago de Compostela, Spain
                [2 ]ISNI 0000 0000 9081 2336, GRID grid.412590.b, Division of Endocrinology, , University of Michigan Health System, ; Ann Arbor, MI USA
                [3 ]ISNI 0000 0000 9935 6525, GRID grid.411668.c, Department of Neurosurgery, , University Hospital Erlangen, ; Erlangen, Germany
                [4 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Neuroendocrine Unit, , Massachusetts General Hospital, ; Boston, MA USA
                [5 ]ISNI 0000 0004 0378 8294, GRID grid.62560.37, Department of Neurosurgery, , Brigham & Women’s Hospital, ; Boston, MA USA
                [6 ]ISNI 0000 0004 0386 9924, GRID grid.32224.35, Department of Radiation Oncology, , Massachusetts General Hospital, ; Boston, MA USA
                [7 ]ISNI 0000 0001 2152 9905, GRID grid.50956.3f, Cedars-Sinai Medical Center, ; Los Angeles, CA USA
                [8 ]GRID grid.15496.3f, Department of Neurosurgery, , San Raffaele University Health Institute Milan, ; Milan, Italy
                [9 ]ISNI 0000 0004 0488 9484, GRID grid.415719.f, Oxford Centre for Diabetes, Endocrinology and Metabolism, , Churchill Hospital, ; Oxford, UK
                [10 ]ISNI 0000000417581884, GRID grid.18887.3e, Division of Endocrinology, , San Raffaele University Hospital, ; Milan, Italy
                Article
                838
                10.1007/s11102-017-0838-2
                5606938
                28884415
                8a4e4f71-8934-45e9-a814-d015b0ed8d95
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Pituitary Society Position Statement
                Custom metadata
                © Springer Science+Business Media, LLC 2017

                Medicine
                acromegaly,cushing’s disease,thyrotropinomas,gonadotropins,transsphenoidal surgery,pituitary radiotherapy

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