{"doi":"10.1016/j.hest.2022.05.003","title":"Delayed cerebral ischemia associated with surgery for pituitary macroadenomas that express elevated levels of PACAP","abstract":"Delayed cerebral ischemia (DCI) and cerebral vasospasm (VS) are rare but serious post-operative complications after surgery for pituitary macroadenomas; the mechanism of which are poorly understood. Pituitary adenylate cyclase-activating polypeptide (PACAP) is a vasoactive neuropeptide expressed in pituitary adenomas and may play a role in DCI/VS. The aim of this case-control study was to investigate the association between tumor expression of PACAP and DCI/VS following pituitary surgery. Tumor tissue from five patients with DCI/VS following pituitary surgery and nine matched controls were evaluated for PACAP expression by immunohistochemistry. Nuclear PACAP expression was significantly elevated in patients with DCI/VS following pituitary surgery compared to controls (0.396 ± 0.0.16 a.u. vs 0.093 ± 0.04 a.u, p < 0.0001). There was a positive linear relationship between nuclear PACAP expression and pre-operative tumor volume (r2 = 0.41, p < 0.02) with a significant difference in slopes between the DCI/VS group compared to controls (y = x(5.0 × 10−3), r2 = 0.76 vs y = x(7.4 × 10−4), r2 = 0.07, p < 0.05). Elevated levels of tumor PACAP expression is associated with DCI/VS following pituitary surgery and may have a role in tumor growth. PACAP signaling may play a role the development of DCI, but further studies are needed.","journal":"Brain Hemorrhages","year":2022,"id":295374,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9589,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":981695,"name":"Kate U. Rosen","orcid":null,"position":1,"is_corresponding":false},{"id":865653,"name":"Stephen Bowden","orcid":"0000-0001-6320-210X","position":2,"is_corresponding":false},{"id":981317,"name":"Andrew Y. Powers","orcid":"0000-0002-3156-7777","position":3,"is_corresponding":false},{"id":812550,"name":"Jesse Liu","orcid":"0000-0001-5819-7860","position":4,"is_corresponding":false},{"id":416337,"name":"Aclan Dog⫧an","orcid":"0000-0002-4113-1619","position":5,"is_corresponding":false},{"id":654799,"name":"Holly E. Hinson","orcid":"0000-0003-1598-9782","position":6,"is_corresponding":false},{"id":311873,"name":"Maria Fleseriu","orcid":"0000-0001-9284-6289","position":7,"is_corresponding":false},{"id":641478,"name":"Randy Woltjer","orcid":null,"position":8,"is_corresponding":false},{"id":416338,"name":"Justin S. Cetas","orcid":"0000-0001-6711-035X","position":9,"is_corresponding":false},{"id":388343,"name":"Dominic A. Siler","orcid":"0000-0003-4474-6464","position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":null,"created_at":"2026-07-19T00:31:08.861377Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}