775 results on '"Pituitary disease"'
Search Results
2. Pregnancy and Pituitary Diseases.
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Urhan, Emre and Karaca, Züleyha
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SALIVA analysis , *ERGOT alkaloids , *BROMOCRIPTINE , *FAMILY planning , *PITUITARY gland , *PITUITARY hormones , *EARLY medical intervention , *KETOCONAZOLE , *PROLACTINOMA , *ADRENAL insufficiency , *MAGNETIC resonance imaging , *ESTROGEN , *PROLACTIN , *DOPAMINE agonists , *GESTATIONAL age , *PYRIDINE , *PITUITARY tumors , *CUSHING'S syndrome , *PITUITARY diseases , *HEALTH care teams , *DEXAMETHASONE , *SYMPTOMS , *PREGNANCY - Abstract
Pregnancy is a period in which the anatomy and physiology of the pituitary gland change significantly. Normal pituitary gland functions are necessary for fertility and the continuation of pregnancy. The presence of a pituitary disease requires management with a multidisciplinary approach to protect the health of the mother and fetus, and it is recommended that these patients become pregnant in a planned manner. Treatment should be considered before pregnancy for pituitary adenomas with a risk of growth. Non-contrast magnetic resonance imaging (MRI) may be performed safely during pregnancy, but the ideal approach is to postpone the MRI until after the birth if possible, and if it is not possible, to take it without contrast. If there are no signs of compression in pituitary adenomas, no treatment is necessary during pregnancy. However, due to increased fetal and maternal morbidity and mortality in Cushing’s disease, treatment is necessary even if there is no compression. In the presence of compression findings, dopamine agonists can be used in all types of pituitary adenomas. Surgery may be performed in the second trimester for pituitary adenomas that cause compression unresponsive to medical treatment and for Cushing’s disease. In pregnant women with pituitary insufficiency, replacement doses should be adjusted according to the gestational week. The diagnosis and treatment of pituitary diseases in this period is more complex and specific than in the nonpregnant period and require a multidisciplinary approach. [ABSTRACT FROM AUTHOR]
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- 2024
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3. An Atypical Sellar Mass: Sellar Tuberculoma in a Young Patient - Case Report
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Arwa Moiz Jamali and Rakeshkumar Luhana
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Intracranial Tuberculoma ,Pituitary Disease ,Antitubercular Agents ,Case Reports ,Medicine (General) ,R5-920 ,Public aspects of medicine ,RA1-1270 - Abstract
BACKGROUND: Central nervous system involvement, though uncommon, is one of the most severe form of tuberculosis. Its manifestations include tuberculoma and tuberculous meningitis, with the majority of cases affecting children and immunocompromised patients. Overall, tuberculomas account for 0.15–2 % of all intracranial lesions but sellar tuberculoma is extremely rare. THE CASE:18 yr. old female patient presented with complain of generalized weakness ,eye pain, headache since 3-4 months .Brain Magnetic resonance imaging (MRI)showed sellar and suprasellar space occupying lesion. Trans sphenoidal approach was used to remove the lesion completely .The pathological evaluation confirmed a tuberculoma and the patient was put on postoperative anti-tubercular therapy. CONCLUSION: Although rare, intracranial tuberculomas, particularly those that originate in the sellar, are notorious for mimicking pituitary tumours by jeopardizing pituitary hormonal function and applying compressive forces on surrounding intracranial structures. However, a prompt assessment can help overcome this diagnostic difficulty with the timely initiation of anti-tubercular therapy (ATT).
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- 2023
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4. The TRH test provides valuable information in the diagnosis of central hypothyroidism in patients with known pituitary disease and low T4 levels
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Sara Ellegaard Christensen, Liv Norma Smith, Christian Alexander H. Rosendal, Helga Angela Gulisano, Kåre Schmidt Ettrup, Peter Vestergaard, Eigil Husted Nielsen, Jesper Scott Karmisholt, and Jakob Dal
- Subjects
thyrotropin-releasing hormone (TRH) ,pituitary disease ,central hypothyroidism ,TRH test ,hypopituitarism ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ObjectiveTo evaluate the value of the thyrotropin-releasing hormone (TRH) test in the diagnosis of central hypothyroidism (CH) in patients with pituitary disease.MethodsSystematic evaluation of 359 TRH tests in patients with pituitary disease including measurements of thyroxine (T4), TBG-corrected T4 (T4corr), baseline TSH (TSH0) and relative or absolute TSH increase (TSHfold, TSHabsolute).ResultsPatients diagnosed with CH (n=39) show comparable TSH0 (p-value 0.824) but lower T4corr (p-value
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- 2023
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5. Pituitary Diseases and COVID-19 Outcomes in South Korea: A Nationwide Cohort Study.
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Ha, Jeonghoon, Kim, Kyoung Min, Lim, Dong-Jun, Song, Keeho, and Seo, Gi Hyeon
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PITUITARY diseases , *COVID-19 , *COVID-19 pandemic , *EXTRACORPOREAL membrane oxygenation , *COHORT analysis , *HYPOPITUITARISM - Abstract
The pituitary gland is either directly or indirectly impacted by SARS-CoV-2 infection. As a consequence of SARS-CoV-2 infection, hypothalamic–pituitary dysfunction or pituitary apoplexy can occur. This study aimed to investigate severe COVID-19 outcomes and COVID-19-related mortality in patients with underlying pituitary disease in Korea using a nationwide cohort database. The data required for this study were obtained from the Health Insurance Review and Assessment Service of Korea. Patients with SARS-CoV-2 infection between January 2020 and December 2021 were divided into the following three groups and analyzed: Group A, those who were hospitalized for SARS-CoV-2 infection without underlying pituitary disease (n = 725,170); Group B, those who were hospitalized for SARS-CoV-2 infection with underlying pituitary disease without exposure to systemic steroids (n = 1509); and Group C, patients with underlying pituitary disease and exposure to systemic steroids (n = 365). Differences in severe COVID-19, requirement for oxygen therapy, intensive care unit admission, application of invasive ventilation or use of extracorporeal membrane oxygenation, and COVID-19-related deaths between groups were then analyzed. Group C had the highest rates of hospitalization after COVID-19 infection (82.2%) and mortality within 30 days of infection (6.8%). Group B had a 1.3-fold increase in severe COVID-19 outcomes compared to Group A. Group C had 1.8-fold and 1.3-fold increases in severe COVID-19 outcomes compared to Group A and Group B, respectively. Group C also had 2.34 and 3.24 times higher mortality rates within 30 days of COVID-19 infection than Group A and Group B, respectively. In conclusion, patients with pituitary disease who are receiving systemic steroids have poorer outcomes and higher mortality associated with COVID-19. Therefore, thorough COVID-19 infection control is required in these patients. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Mapping of the current transition of care practice for patients with pituitary disease at Endo-ERN reference centers
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Savi R Shishkov, Luigi Tuccillo, Violeta M Iotova, Rosario Pivonello, Iris CM Pelsma, Alberto M Pereira, and Nienke R Biermasz
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transition of care ,pituitary disease ,endo-ern ,survey ,quality of care ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Rare endocrine conditions present specific diagnostic and manage ment challenges for healthcare providers, one of which is the understudied transition of care. Despite the need for guidance regarding transition, consensus on structured and protocolled approaches is lacking. Therefore, we aimed to map the current clinical practice and identify unmet needs regarding transition of care for patients with pituitary disease in the reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN). A survey-based, cross-sectional study using the EU Survey tool was performed and completed by 46 physicians (n) from 30 RCs (N). Transition is a common practice among RCs (n = 44/46), usually accomplished by a multidisciplinary team meeting (N = 20/30). Criteria for start and end of transition were defined in half of the RCs, with 16.7% of centers providing dissimilar answers. Transition readiness was assessed by >75% of the RCs, mostly by unvalidated means (e.g. subjective opinions, informal consultations). Pituitary-specific transition assessment tool was applied in one RC only. Transition protocols were present in only 9% of RCs, while in many RCs, tr ansition decisions were taken in combined adult-pediatric meetings or based on clinicians’ personal judgment. A minority of physicians evaluated the effectiveness of transiti on-related interventions (n = 11/46) or medical outcomes (n = 8/46). Patient-reported outcome measures were infrequently used (n = 4/46). Identified unmet needs included the development of guidelines (n = 5/46) and EU-wide approach (n = 2/46). This study exemplifies the unmet needs for a structural definition of the transition period and t ransition management for patients with rare hypothalamic and pituitary conditions from healthcare providers’ perspective.
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- 2023
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7. Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors.
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Molteni, Gabriele, Caiazza, Nicole, Fulco, Gianfranco, Sacchetto, Andrea, Gulino, Antonio, and Marchioni, Daniele
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NEUROENDOCRINE tumors , *PITUITARY tumors , *PITUITARY diseases ,TUMOR surgery - Abstract
Background: The endoscopic endonasal approach (EEA) is a well-established technique for the treatment of pituitary neuroendocrine tumor Preservation of normal gland tissue is crucial to retain effective neuroendocrine pituitary function. The aim of this paper is to analyze pituitary endocrine secretion after EEA for pituitary neuroendocrine tumor to identify potential predictors of functioning gland recovery. Methods: Patients who underwent an exclusive EEA for pituitary neuroendocrine tumors between October 2014 and November 2019 were reviewed. Patients were divided into groups according to postoperative pituitary function (Group 1, unchanged; group 2, recovering; group 3, worsening). Results: Among the 45 patients enrolled, 15 presented a silent tumor and showed no hormonal impairment, and 30 patients presented pituitary dysfunction. A total of 19 patients (42.2%) were included in group 1, 12 (26.7%) patients showed pituitary function recovery after surgery (group 2), and 14 patients (31.1%) exhibited the onset of new pituitary deficiency postoperatively (group 3). Younger patients and those with functioning tumor were more likely to have complete pituitary hormonal recovery (p = 0.0297 and p = 0.007, respectively). No predictors of functional gland worsening were identified. Conclusion: EEA for pituitary neuroendocrine tumor is a reliable and safe technique regarding postoperative hormonal function. Preserving pituitary function after tumor resection should be a primary goal in a minimally invasive approach. [ABSTRACT FROM AUTHOR]
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- 2023
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8. China Pituitary Disease Registry (CAPASITY)
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Wang Weiqing, PhD, MD, Head of Department of Endocrine and Metabolism, Shanghai Jiaotong University School of Medicine, Chinese National Clinical Research Center for Endocrine and Metabolic Diseases (Shanghai)
- Published
- 2021
9. Effects of Growth Hormone Administration on Cardiovascular Risk in Cured Acromegalics With Growth Hormone Deficiency
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Karen Klahr Miller, MD, Chief, Neuroendocrine Unit
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- 2020
10. Seoul National University Pituitary Disease Cohort Study (SNU-PIT)
- Author
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Jung Hee Kim, Principal Investigator
- Published
- 2020
11. Pituitary Diseases and COVID-19 Outcomes in South Korea: A Nationwide Cohort Study
- Author
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Jeonghoon Ha, Kyoung Min Kim, Dong-Jun Lim, Keeho Song, and Gi Hyeon Seo
- Subjects
COVID-19 ,pituitary disease ,mortality ,Medicine - Abstract
The pituitary gland is either directly or indirectly impacted by SARS-CoV-2 infection. As a consequence of SARS-CoV-2 infection, hypothalamic–pituitary dysfunction or pituitary apoplexy can occur. This study aimed to investigate severe COVID-19 outcomes and COVID-19-related mortality in patients with underlying pituitary disease in Korea using a nationwide cohort database. The data required for this study were obtained from the Health Insurance Review and Assessment Service of Korea. Patients with SARS-CoV-2 infection between January 2020 and December 2021 were divided into the following three groups and analyzed: Group A, those who were hospitalized for SARS-CoV-2 infection without underlying pituitary disease (n = 725,170); Group B, those who were hospitalized for SARS-CoV-2 infection with underlying pituitary disease without exposure to systemic steroids (n = 1509); and Group C, patients with underlying pituitary disease and exposure to systemic steroids (n = 365). Differences in severe COVID-19, requirement for oxygen therapy, intensive care unit admission, application of invasive ventilation or use of extracorporeal membrane oxygenation, and COVID-19-related deaths between groups were then analyzed. Group C had the highest rates of hospitalization after COVID-19 infection (82.2%) and mortality within 30 days of infection (6.8%). Group B had a 1.3-fold increase in severe COVID-19 outcomes compared to Group A. Group C had 1.8-fold and 1.3-fold increases in severe COVID-19 outcomes compared to Group A and Group B, respectively. Group C also had 2.34 and 3.24 times higher mortality rates within 30 days of COVID-19 infection than Group A and Group B, respectively. In conclusion, patients with pituitary disease who are receiving systemic steroids have poorer outcomes and higher mortality associated with COVID-19. Therefore, thorough COVID-19 infection control is required in these patients.
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- 2023
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12. Expert suggestion for pituitary disease management during the recent COVID-19 pandemic
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Chinese Society of Endocrinology,Chinese Medical Association , et al
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covid-19 ,pituitary disease ,co-morbidities ,Medicine - Abstract
Pituitary disease are often associated with hormonal abnormalities, mass effects and multiple co-morbidities, involving multidisciplinary management and follow-up. The COVID-19 pandemic makes their management much more challenging. Therefore, this expert suggestion aims to standardize the diagnosis and treatment of pituitary disease and strengthen the management of co-morbidities during the current COVID-19 epidemic.
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- 2022
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13. Functioning Endocrine Outcome after Endoscopic Endonasal Transsellar Approach for Pituitary Neuroendocrine Tumors
- Author
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Gabriele Molteni, Nicole Caiazza, Gianfranco Fulco, Andrea Sacchetto, Antonio Gulino, and Daniele Marchioni
- Subjects
pituitary neoplasms ,pituitary disease ,endoscopy ,hypopituitarism ,treatment outcome ,Medicine - Abstract
Background: The endoscopic endonasal approach (EEA) is a well-established technique for the treatment of pituitary neuroendocrine tumor Preservation of normal gland tissue is crucial to retain effective neuroendocrine pituitary function. The aim of this paper is to analyze pituitary endocrine secretion after EEA for pituitary neuroendocrine tumor to identify potential predictors of functioning gland recovery. Methods: Patients who underwent an exclusive EEA for pituitary neuroendocrine tumors between October 2014 and November 2019 were reviewed. Patients were divided into groups according to postoperative pituitary function (Group 1, unchanged; group 2, recovering; group 3, worsening). Results: Among the 45 patients enrolled, 15 presented a silent tumor and showed no hormonal impairment, and 30 patients presented pituitary dysfunction. A total of 19 patients (42.2%) were included in group 1, 12 (26.7%) patients showed pituitary function recovery after surgery (group 2), and 14 patients (31.1%) exhibited the onset of new pituitary deficiency postoperatively (group 3). Younger patients and those with functioning tumor were more likely to have complete pituitary hormonal recovery (p = 0.0297 and p = 0.007, respectively). No predictors of functional gland worsening were identified. Conclusion: EEA for pituitary neuroendocrine tumor is a reliable and safe technique regarding postoperative hormonal function. Preserving pituitary function after tumor resection should be a primary goal in a minimally invasive approach.
- Published
- 2023
- Full Text
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14. Study of Thyrotropin-Releasing Hormone in Normal Volunteers and in Patients With Thyroid or Pituitary Abnormalities
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- 2018
15. A New Clinical Model to Estimate the Pre-Test Probability of Cushing's Syndrome: The Cushing Score.
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Parasiliti-Caprino, Mirko, Bioletto, Fabio, Frigerio, Tommaso, D'Angelo, Valentina, Ceccato, Filippo, Ferraù, Francesco, Ferrigno, Rosario, Minnetti, Marianna, Scaroni, Carla, Cannavò, Salvatore, Pivonello, Rosario, Isidori, Andrea, Broglio, Fabio, Giordano, Roberta, Spinello, Maurizio, Grottoli, Silvia, and Arvat, Emanuela
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CUSHING'S syndrome ,MEDICAL personnel ,PROBABILITY theory ,DIAGNOSIS ,ADRENAL diseases - Abstract
Background: Hypercortisolism accounts for relevant morbidity and mortality and is often a diagnostic challenge for clinicians. A prompt diagnosis is necessary to treat Cushing's syndrome as early as possible. Objective: The aim of this study was to develop and validate a clinical model for the estimation of pre-test probability of hypercortisolism in an at-risk population. Design: We conducted a retrospective multicenter case-control study, involving five Italian referral centers for Endocrinology (Turin, Messina, Naples, Padua and Rome). One hundred and fifty patients affected by Cushing's syndrome and 300 patients in which hypercortisolism was excluded were enrolled. All patients were evaluated, according to current guidelines, for the suspicion of hypercortisolism. Results: The Cushing score was built by multivariable logistic regression, considering all main features associated with a clinical suspicion of hypercortisolism as possible predictors. A stepwise backward selection algorithm was used (final model AUC=0.873), then an internal validation was performed through ten-fold cross-validation. Final estimation of the model performance showed an average AUC=0.841, thus reassuring about a small overfitting effect. The retrieved score was structured on a 17.5-point scale: low-risk class (score value: ≤5.5, probability of disease=0.8%); intermediate-low-risk class (score value: 6-8.5, probability of disease=2.7%); intermediate-high-risk class (score value: 9-11.5, probability of disease=18.5%) and finally, high-risk class (score value: ≥12, probability of disease=72.5%). Conclusions: We developed and internally validated a simple tool to determine pre-test probability of hypercortisolism, the Cushing score, that showed a remarkable predictive power for the discrimination between subjects with and without a final diagnosis of Cushing's syndrome. [ABSTRACT FROM AUTHOR]
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- 2021
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16. A New Clinical Model to Estimate the Pre-Test Probability of Cushing’s Syndrome: The Cushing Score
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Mirko Parasiliti-Caprino, Fabio Bioletto, Tommaso Frigerio, Valentina D’Angelo, Filippo Ceccato, Francesco Ferraù, Rosario Ferrigno, Marianna Minnetti, Carla Scaroni, Salvatore Cannavò, Rosario Pivonello, Andrea Isidori, Fabio Broglio, Roberta Giordano, Maurizio Spinello, Silvia Grottoli, and Emanuela Arvat
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cortisol ,adrenocorticotrophic hormone ,hypercortisolism ,pituitary disease ,adrenal disease ,corticosteroids ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundHypercortisolism accounts for relevant morbidity and mortality and is often a diagnostic challenge for clinicians. A prompt diagnosis is necessary to treat Cushing’s syndrome as early as possible.ObjectiveThe aim of this study was to develop and validate a clinical model for the estimation of pre-test probability of hypercortisolism in an at-risk population.DesignWe conducted a retrospective multicenter case-control study, involving five Italian referral centers for Endocrinology (Turin, Messina, Naples, Padua and Rome). One hundred and fifty patients affected by Cushing’s syndrome and 300 patients in which hypercortisolism was excluded were enrolled. All patients were evaluated, according to current guidelines, for the suspicion of hypercortisolism.ResultsThe Cushing score was built by multivariable logistic regression, considering all main features associated with a clinical suspicion of hypercortisolism as possible predictors. A stepwise backward selection algorithm was used (final model AUC=0.873), then an internal validation was performed through ten-fold cross-validation. Final estimation of the model performance showed an average AUC=0.841, thus reassuring about a small overfitting effect. The retrieved score was structured on a 17.5-point scale: low-risk class (score value: ≤5.5, probability of disease=0.8%); intermediate-low-risk class (score value: 6-8.5, probability of disease=2.7%); intermediate-high-risk class (score value: 9-11.5, probability of disease=18.5%) and finally, high-risk class (score value: ≥12, probability of disease=72.5%).ConclusionsWe developed and internally validated a simple tool to determine pre-test probability of hypercortisolism, the Cushing score, that showed a remarkable predictive power for the discrimination between subjects with and without a final diagnosis of Cushing’s syndrome.
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- 2021
- Full Text
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17. Diagnostic accuracy of morning serum cortisol concentration in predicting secondary adrenal insufficiency.
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Barbar, Bruna, Mathieson, Campbell, Boot, Chris, Quinton, Richard, James, Andy, Perros, Petros, Pearce, Simon, Napier, Catherine, Gan, Earn, Mitchell, Anna, and Mamoojee, Yaasir H.
- Subjects
- *
ADRENAL insufficiency , *HYDROCORTISONE , *MORNING , *PITUITARY diseases , *HYPOTHALAMIC-pituitary-adrenal axis - Abstract
Keywords: adrenal axis; cortisol; pituitary disease; synacthen test EN adrenal axis cortisol pituitary disease synacthen test 515 516 2 11/06/23 20231201 NES 231201 Adrenal insufficiency (AI) can be a life-threatening disease, which is why patients at risk of having secondary AI due to pituitary disease and/or its management typically undergo periodic evaluation with dynamic testing. Currently, a proportion of patients being weaned off immunosuppressive glucocorticoid therapy undergo SST, after suspending glucocorticoids for 24 h, to confirm recovery of the HPA axis.[3] If similar basal serum cortisol thresholds could be determined for the increasing number of patients at risk of iatrogenic secondary AI due to glucocorticoids prescribed as disease-modifying agents, then even greater resource savings could be implemented without any adverse impact on patient safety. [Extracted from the article]
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- 2023
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18. Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods
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Beata Uziȩbło-Życzkowska, Agnieszka Jurek, Przemysław Witek, Grzegorz Zieliński, Grzegorz Gielerak, and Paweł Krzesiński
- Subjects
acromegaly ,left atrial strain ,left ventricular strain ,pituitary disease ,speckle tracking echocardiography ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Background: Acromegaly is a rare disease that requires modern treatment to decrease the risk of mortality, mainly from vascular diseases. Identifying acromegalic patients with increased cardiovascular risk is challenging. Speckle-tracking echocardiography (STE) is a modern, well-validated, and reproducible method of assessing left ventricular longitudinal deformation and providing a sensitive assessment of myocardial contractility. We hypothesized that STE may be useful in evaluating subclinical dysfunction of the left heart in acromegalic patients, especially when a left ventricle (LV) assessment is completed with STE of the left atrium (LA).Purpose: To assess the diagnostic value of speckle-tracking echocardiography in identifying the occurrence of LV and LA functional impairment in patients with acromegaly, in comparison to patients without this rare pituitary disease.Methods: Echocardiographic assessments of LV and LA function using the new STE method were performed in 60 subjects: 30 acromegalic (ACRO group) patients and a CONTROL group with 30 patients matched in terms of age, gender, systolic/diastolic pressure, and history of hypertension for at least 12 months.Results: The ACRO group, compared to the CONTROL group, presented: (1) higher left ventricular mass (left ventricular mass index: 132 vs. 108 g/m2, p < 0.001) and, in consequence, more frequent LV hypertrophy (80.0 vs. 53.3%; p = 0.028); (2) impaired LV systolic function measured by both left ventricular ejection fraction (LVEF) (63.4 vs. 66.9%, p < 0.001) and global longitudinal strain (GLS) (−18.1 vs. −19.4%, p = 0.023); (3) greater LA anteroposterior diameter (40.3 vs. 36.9 mm, p = 0.003) and indexed left atrial volume (37.9 vs. 27.6 ml/m2, p < 0.001); and (4) impaired echocardiographic strain parameters corresponding with LA function.Conclusions: Acromegaly, even in young patients with good blood pressure control, may be associated with left ventricular hypertrophy and subclinical impairment of the left ventricular and left atrial mechanical function, which may be identified by speckle-tracking echocardiography. Further research in this area is necessary to clarify the prognostic value of these phenomena.
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- 2020
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19. Left Heart Dysfunction in Acromegaly Revealed by Novel Echocardiographic Methods.
- Author
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Uziȩbło-Życzkowska, Beata, Jurek, Agnieszka, Witek, Przemysław, Zieliński, Grzegorz, Gielerak, Grzegorz, and Krzesiński, Paweł
- Subjects
ACROMEGALY ,LEFT ventricular hypertrophy ,PITUITARY diseases ,ECHOCARDIOGRAPHY ,VENTRICULAR ejection fraction ,CARDIAC patients - Abstract
Background: Acromegaly is a rare disease that requires modern treatment to decrease the risk of mortality, mainly from vascular diseases. Identifying acromegalic patients with increased cardiovascular risk is challenging. Speckle-tracking echocardiography (STE) is a modern, well-validated, and reproducible method of assessing left ventricular longitudinal deformation and providing a sensitive assessment of myocardial contractility. We hypothesized that STE may be useful in evaluating subclinical dysfunction of the left heart in acromegalic patients, especially when a left ventricle (LV) assessment is completed with STE of the left atrium (LA). Purpose: To assess the diagnostic value of speckle-tracking echocardiography in identifying the occurrence of LV and LA functional impairment in patients with acromegaly, in comparison to patients without this rare pituitary disease. Methods: Echocardiographic assessments of LV and LA function using the new STE method were performed in 60 subjects: 30 acromegalic (ACRO group) patients and a CONTROL group with 30 patients matched in terms of age, gender, systolic/diastolic pressure, and history of hypertension for at least 12 months. Results: The ACRO group, compared to the CONTROL group, presented: (1) higher left ventricular mass (left ventricular mass index: 132 vs. 108 g/m
2 , p < 0.001) and, in consequence, more frequent LV hypertrophy (80.0 vs. 53.3%; p = 0.028); (2) impaired LV systolic function measured by both left ventricular ejection fraction (LVEF) (63.4 vs. 66.9%, p < 0.001) and global longitudinal strain (GLS) (−18.1 vs. −19.4%, p = 0.023); (3) greater LA anteroposterior diameter (40.3 vs. 36.9 mm, p = 0.003) and indexed left atrial volume (37.9 vs. 27.6 ml/m2 , p < 0.001); and (4) impaired echocardiographic strain parameters corresponding with LA function. Conclusions: Acromegaly, even in young patients with good blood pressure control, may be associated with left ventricular hypertrophy and subclinical impairment of the left ventricular and left atrial mechanical function, which may be identified by speckle-tracking echocardiography. Further research in this area is necessary to clarify the prognostic value of these phenomena. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
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20. MiR-1299 promotes the synthesis and secretion of prolactin by inhibiting FOXO1 expression in drug-resistant prolactinomas.
- Author
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Xiao, Zheng, Wang, Zongming, Hu, Bin, Mao, Zhigang, Zhu, Dimin, Feng, Yajuan, and Zhu, Yonghong
- Subjects
- *
PROLACTIN , *SECRETION , *PITUITARY diseases , *INTRACRANIAL tumors , *PROLACTINOMA , *DOPAMINE agonists , *CHROMATIN - Abstract
Prolactinoma is a clinically common intracranial tumor. When serum prolactin levels are not controlled despite administration of a dopamine agonist, the condition is referred to as drug-resistant prolactinoma. The mechanism underlying persistent prolactin secretion in drug-resistant prolactinoma remains unclear. MicroRNAs play an important role in tumorigenesis and development as well as chemotherapeutic resistance. This study was conducted to investigate the mechanism by which miRNA regulates prolactin secretion in drug-resistant prolactinoma. We first found that miR-1299 was elevated in drug-resistant prolactinoma and inhibited FOXO1 in a targeted manner through miRNA sequencing and luciferase assays. We then confirmed that FOXO1 binds to the promoter of the prolactin gene to inhibit its expression through chromatin immunoprecipitation-quantitative PCR and cytological experiments. Finally, inhibition or overexpression of miR-1299 in primary tumor cells confirmed that drug-resistant prolactinoma promoted prolactin secretion by promoting miR-1299 expression and reducing intracellular FOXO1. These results indicate that FOXO1 and miR-1299 are potential therapeutic targets for drug-resistant prolactinoma as well as other pituitary diseases. • Drug-resistant prolactinomas can target and inhibit the expression of FOXO1 by up-regulating miR-1299. • We also found a low FOXO1 level in tumor cells leads to high-level synthesis and secretion of prolactin and poor control of serum prolactin levels. • miR-1299 and FOXO1 may be useful in treating drug-resistant prolactinomas and other related pituitary diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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21. Immunotherapy-Induced Hypophysitis Following Treatment With Tislelizumab in an Elderly Patient With Bladder Cancer and Prostate Cancer: A Case Report.
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Zhang N, Qu X, Zhang X, Sun X, and Kang L
- Abstract
Immune checkpoint inhibitors represent a hopeful and emerging group of medications employed in the regulation of the immune response against cancer, displaying tremendous potential in cancer treatment. However, the administration of these drugs has been linked to the occurrence of adverse events, among which hypophysitis appears to be a prevailing complication affecting a substantial number of patients. Given the potential gravity of this condition, it is strongly recommended to actively monitor hormone levels throughout the treatment process, allowing for the prompt detection and provision of appropriate therapeutic measures. The present study showcases a case involving a 72-year-old individual afflicted with both bladder cancer and prostate cancer, who subsequently developed autoimmune hypophysitis and secondary adrenocortical insufficiency following the administration of programmed death protein 1 (PD-1) inhibitors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Zhang et al.)
- Published
- 2023
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22. The TRH test provides valuable information in the diagnosis of central hypothyroidism in patients with known pituitary disease and low T4 levels.
- Author
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Christensen SE, Smith LN, Rosendal CAH, Gulisano HA, Ettrup KS, Vestergaard P, Nielsen EH, Karmisholt JS, and Dal J
- Subjects
- Humans, Hyperthyroidism diagnosis, Thyrotropin, Thyrotropin-Releasing Hormone analysis, Thyrotropin-Releasing Hormone metabolism, Thyroxine analysis, Thyroxine metabolism, Hypothyroidism diagnosis, Pituitary Diseases diagnosis
- Abstract
Objective: To evaluate the value of the thyrotropin-releasing hormone (TRH) test in the diagnosis of central hypothyroidism (CH) in patients with pituitary disease., Methods: Systematic evaluation of 359 TRH tests in patients with pituitary disease including measurements of thyroxine (T4), TBG-corrected T4 (T4
corr ), baseline TSH (TSH0 ) and relative or absolute TSH increase (TSHfold , TSHabsolute )., Results: Patients diagnosed with CH (n=39) show comparable TSH0 (p-value 0.824) but lower T4corr (p-value <0.001) and lower TSH increase (p-value <0.001) compared to patients without CH. In 54% (42 of 78 cases) of patients with low T4corr , the CH diagnosis was rejected based on a high TSHfold . In these cases, a spontaneous increase and mean normalization in T4corr (from 62 to 73 nmol/L, p-value <0.001) was observed during the follow-up period (7.6 ± 5.0 years). Three of the 42 patients (7%) were started on replacement therapy due to spontaneous deterioration of thyroid function after 2.8 years. Patients diagnosed with CH reported significantly more symptoms of hypothyroidism (p-value 0.005), although, symptoms were reported in most patients with pituitary disease. The TRH test did not provide clinical relevant information in patients with normal T4 or patients awaiting pituitary surgery (78%, 281 of 359). There were only mild and reversible adverse effects related to the TRH test except for possibly one case (0.3%) experiencing a pituitary apoplexy., Conclusion: The TRH test could be reserved to patients with pituitary disease, low T4 levels without convincing signs of CH. Approximately 50% of patients with a slightly decreased T4 were considered to have normal pituitary thyroid function based on the TRH test results., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Christensen, Smith, Rosendal, Gulisano, Ettrup, Vestergaard, Nielsen, Karmisholt and Dal.)- Published
- 2023
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23. Mapping of the current transition of care practice for patients with pituitary disease at Endo-ERN reference centers
- Author
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Shishkov, S.R., Tuccillo, L., Iotova, V.M., Pivonello, R., Pelsma, I.C.M., Pereira, A.M., Biermasz, N.R., Endo-ERN Reference Cemters of the Main Thematic Group: Hypothalamic and Pituitary Conditions, Endo-ERN Pituitary Transition of Care Study Group, Shishkov, Savi R, Tuccillo, Luigi, Iotova, Violeta M, Pivonello, Rosario, Pelsma, Iris Cm, Pereira, Alberto M, Biermasz, Nienke R, Endocrinology, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
Endocrinology ,pituitary disease ,transition of care ,quality of care ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,Endo-ERN ,survey - Abstract
Rare endocrine conditions present specific diagnostic and management challenges for healthcare providers, one of which is the understudied transition of care. Despite the need for guidance regarding transition, consensus on structured and protocolled approaches is lacking. Therefore, we aimed to map the current clinical practice and identify unmet needs regarding transition of care for patients with pituitary disease in the reference centers (RCs) of the European Reference Network on Rare Endocrine Conditions (Endo-ERN). A survey-based, cross-sectional study using the EU Survey tool was performed and completed by 46 physicians (n) from 30 RCs (N). Transition is a common practice among RCs (n = 44/46), usually accomplished by a multidisciplinary team meeting (N = 20/30). Criteria for start and end of transition were defined in half of the RCs, with 16.7% of centers providing dissimilar answers. Transition readiness was assessed by >75% of the RCs, mostly by unvalidated means (e.g. subjective opinions, informal consultations). Pituitary-specific transition assessment tool was applied in one RC only. Transition protocols were present in only 9% of RCs, while in many RCs, transition decisions were taken in combined adult-pediatric meetings or based on clinicians’ personal judgment. A minority of physicians evaluated the effectiveness of transition-related interventions (n = 11/46) or medical outcomes (n = 8/46). Patient-reported outcome measures were infrequently used (n = 4/46). Identified unmet needs included the development of guidelines (n = 5/46) and EU-wide approach (n = 2/46). This study exemplifies the unmet needs for a structural definition of the transition period and transition management for patients with rare hypothalamic and pituitary conditions from healthcare providers’ perspective.
- Published
- 2023
24. New Hope for a Tumor-Directed Therapy for Cushing Disease.
- Author
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Tritos, Nicholas A.
- Subjects
CUSHING'S syndrome ,MEDICAL care - Published
- 2023
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25. Diagnostic Work-Up and Nonsurgical Management of Pituitary Disease
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Beech, Thomas J., Arlt, Wiebke, Watkinson, John C., editor, and Scott-Coombes, David M., editor
- Published
- 2014
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26. The prevalence and volumetry of pituitary cysts in children with growth hormone deficiency and idiopathic short stature.
- Author
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Krasnow, Nicholas, Pogostin, Bradley, Haigney, James, Groh, Brittany, Weiler, Winston, Tenner, Michael, Kessler, Marion, Frey, Michael, and Noto, Richard A.
- Abstract
Background: Pituitary cysts have been speculated to cause endocrinopathies. We sought to describe the prevalence and volumetry of pituitary cysts in patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS). Methods: Six hundred and eighteen children evaluated for growth failure at the Division of Pediatric Endocrinology at New York Medical College between the years 2002 and 2012, who underwent GH stimulation testing and had a brain magnetic resonance imaging (MRI) prior to initiating GH treatment were randomly selected to be a part of this study. High resolution MRI was used to evaluate the pituitary gland for size and the presence of a cyst. Cyst prevalence, cyst volume and percentage of the gland occupied by the cyst (POGO) were documented. Results: Fifty-six patients had a cyst, giving an overall prevalence of 9.1%. The prevalence of cysts in GHD patients compared to ISS patients was not significant (13.5% vs. 5.7%, p=0.46). Mean cyst volume was greater in GHD patients than ISS patients (62.0 mm
3 vs. 29.4 mm3 , p=0.01). POGO for GHD patients was significantly greater (p=0.003) than for ISS patients (15.3%±12.8 vs. 7.1%±8.0). Observers were blinded to patient groups. Conclusions: GHD patients had a significantly greater volume and POGO compared to ISS patients. This raises the question of whether cysts are implicated in the pathology of growth failure. [ABSTRACT FROM AUTHOR]- Published
- 2018
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27. Spectrum of Pituitary disorders: A retrospective study from Basrah, Iraq [version 2; referees: 2 approved]
- Author
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Abbas Ali Mansour, Ali Hussain Ali Alhamza, Ammar Mohammed Saeed Abdullah Almomin, Ibrahim Abbood Zaboon, Nassar Taha Yaseen Alibrahim, Rudha Naser Hussein, Muayad Baheer Kadhim, Haider Ayad Yassin Alidrisi, Hussein Ali Nwayyir, Adel Gassab Mohammed, Dheyaa Kadhim Al-Waeli, and Ibrahim Hani Hussein
- Subjects
Research Article ,Articles ,Sellar and parasellar region lesions ,pituitary disease ,pituitary adenoma ,classification ,epidemiology. - Abstract
Background: Pituitary disorders spectrum includes a wide variety of diseases.This study aimed at a comprehensive description of such disorders for patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq). Methods: Retrospective data analysis of FDEMC for the period from January 2012 through June 2017. We included all patients with pituitary disorders who have MRI pituitary. Results: The pituitary disorders were more common among women. Those with macroadenoma were older than those with microadenoma with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disorders in this registry (67.2%). Growth hormone secreting adenoma were the commonest adenoma seen in 41.0% followed by clinically non-functioning pituitary adenoma(NFPA)in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4 % of growth hormone secreting adenoma, 61.2% in NFPA and 62.0% of prolactinoma (of them six were giant prolactinoma) Conclusion: Pituitary adenoma constituted the bulk of pituitary disorders in Basrah, growth hormone secreting adenoma is the commonest adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of pituitary adenoma treatment is needed.
- Published
- 2018
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28. Spectrum of Sellar and Parasellar Region Lesions: A retrospective study from Basrah, Iraq [version 1; referees: 1 approved, 1 approved with reservations]
- Author
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Abbas Ali Mansour, Ali Hussain Ali Alhamza, Ammar Mohammed Saeed Abdullah Almomin, Ibrahim Abbood Zaboon, Nassar Taha Yaseen Alibrahim, Rudha Naser Hussein, Muayad Baheer Kadhim, Haider Ayad Yassin Alidrisi, Hussein Ali Nwayyir, Adel Gassab Mohammed, Dheyaa Kadhim Al-Waeli, and Ibrahim Hani Hussein
- Subjects
Research Article ,Articles ,Sellar and parasellar region lesions ,pituitary disease ,pituitary adenoma ,classification ,epidemiology. - Abstract
Background: Sellar and parasellar region lesions spectrum includes a wide variety of diseases. This study aimed at providing a comprehensive overview of such lesions in patients from Faiha Specialized Diabetes, Endocrine and Metabolism Center (FDEMC) in Basrah (Southern Iraq). Methods: Retrospective data analysis from FDEMC for the period January 2012 through June 2017. We included all patients with sellar and parasellar region lesions who received a MRI scan on their pituitary region Results: The total enrolled patients were 232 (84 men and 148 women),with age range 15-75 years.Pituitary disease and adenoma were more common among women. Those with macroadenoma were older than those with microadenoma, with nearly equal gender prevalence of macroadenoma. Pituitary adenoma constituted the bulk of pituitary disease in this setting (67.2%). Growth hormone secreting adenoma were the most common adenoma seen in 41.0%, followed by clinically non-functioning pituitary adenoma (NFPA) in 31.4% and prolactinoma in 26.9%. About 64.8% of pituitary adenoma was macroadenoma. Macroadenoma was seen in 73.4% of growth hormone secreting adenoma (acromegaly), 61.2% in NFPA and 62.0% of prolactinom a(of them six were giant prolactinoma). Conclusion: Pituitary adenoma constituted the bulk of sellar and parasellar region lesions, growth hormone secreting adenoma is the the most common adenoma followed by NFPA and prolactinoma due to referral bias. A change in practice of adenoma treatment is needed.
- Published
- 2018
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29. What to Do with Incidentally Discovered Pituitary Abnormalities?
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Fabienne Langlois and Maria Fleseriu
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Adenoma ,Incidental Findings ,medicine.medical_specialty ,Pituitary disease ,medicine.diagnostic_test ,business.industry ,Pituitary Diseases ,Incidentaloma ,Magnetic resonance imaging ,Physical examination ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Asymptomatic ,Patient management ,Diagnosis, Differential ,Pituitary adenoma ,Pituitary Gland ,medicine ,Humans ,Pituitary Neoplasms ,Medical history ,Radiology ,medicine.symptom ,business - Abstract
Pituitary incidentalomas are discovered in approximately 10% to 40% of brain images. A complete patient history, physical examination, and dedicated pituitary function testing are needed, and subsequent results should lead to appropriate patient management. However, most lesions are asymptomatic pituitary adenomas or Rathke cleft cysts with a benign course. Many lesions can be clinically significant, including prolactinomas or other pituitary adenomas that warrant specific pituitary disease treatment. In other cases, mass effect causing visual compromise or refractory headache indicates a need for surgery. Here, various facets of a complex evaluation and treatment algorithm for pituitary incidentalomas are reviewed.
- Published
- 2021
30. Impaired aldosterone response to ACTH without hypoaldosteronism: An unrecognized secretory pattern in search of clinical implications
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Yael Sofer, Naftali Stern, Gabi Shefer, Yona Greenman, Yonit Marcus, and Karen Tordjman
- Subjects
Hypothalamo-Hypophyseal System ,endocrine system ,medicine.medical_specialty ,Hydrocortisone ,Pituitary disease ,Endocrinology, Diabetes and Metabolism ,Pituitary-Adrenal System ,Context (language use) ,Adrenocorticotropic hormone ,Orthostatic vital signs ,chemistry.chemical_compound ,Endocrinology ,Addison Disease ,Adrenocorticotropic Hormone ,Internal medicine ,medicine ,Humans ,Aldosterone ,Glucocorticoids ,Retrospective Studies ,business.industry ,medicine.disease ,Hypoaldosteronism ,Cushing Disease ,chemistry ,business ,hormones, hormone substitutes, and hormone antagonists ,Glucocorticoid ,medicine.drug - Abstract
Context Aldosterone has been recently characterized as a 'stress hormone'. Stress per se elicits a sizable rise in aldosterone secretion, which could be replicated by the administration of a low dose (0.03-1 μg, IV) of adrenocorticotropic hormone (ACTH). Whether or not the aldosterone response to ACTH could be selectively impaired, that is, in association with intact cortisol response, is presently unknown. Objective To determine whether or not the aldosterone response to low dose of ACTH is impaired in subjects referred to assess the hypothalamic-pituitary-adrenal axis (HPA). Design Retrospective analysis. Setting Outpatient referral endocrine day care centre. Patients One hundred and ninety-five consecutive subjects who underwent the low dose (1 μg) ACTH test, in whom decreased cortisol reserve was suspected due to former/present glucocorticoid excess, pituitary disease or/and unexplained weakness. Main outcome measures The outcome was the detection of lack of aldosterone response, defined as a rise Results In all, 46/195 subjects had subnormal aldosterone response as compared with 52/195 subjects showing diminished cortisol response. Nine subjects had combined deficient aldosterone and cortisol response. In the 37 subjects with isolated subnormal aldosterone response common associations were the use of exogenous glucocorticoids, mostly prednisone (n = 16); former Cushing disease (n = 2); nonfunctioning pituitary adenoma (n = 8); hypothyroidism (n = 11); the use of statins (n = 11), angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (n = 6), sex steroids in transgenders and orthostatic hypotension (n = 3). Twenty-seven percent (25/93) of the subjects with recent exposure to glucocorticoids had impaired aldosterone response to ACTH. Conclusion Blunted aldosterone response to ACTH in the absence of hypoaldosteronism was seen in ~27% of subjects referred for HPA assessment using the low dose 1 μg ACTH test. Exposure to glucocorticoid excess was often linked to this impairment, independent of the cortisol response to ACTH.
- Published
- 2021
31. The less common presentation of pituitary apoplexy and its management: A case report.
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Sani, Huzairi and Zulkufli, Nada Syazana
- Subjects
- *
CEREBROVASCULAR disease , *PITUITARY gland , *SYMPTOMS , *PITUITARY diseases , *INFARCTION , *HYPOPITUITARISM , *PITUITARY cancer - Abstract
Pituitary apoplexy is the event of haemorrhage, infarction or both affecting the pituitary gland. It commonly occurs in non-functioning pituitary adenoma. This case study reports an uncommon presentation of pituitary apoplexy where the patient only presented with a 2- week history of visual symptoms and was otherwise clinically stable, causing the disastrous pituitary event to be unsuspected on initial presentation. [ABSTRACT FROM AUTHOR]
- Published
- 2020
32. Radiological "Teddy Bear" Sign on CT Imaging to Aid Internal Carotid Artery Localization in Transsphenoidal Pituitary and Anterior Skull Base Surgery.
- Author
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Yeung, W., Twigg, V., Carr, S., Sinha, S., and Mirza, S.
- Subjects
- *
TEDDY bears , *COMPUTED tomography , *INTERNAL carotid artery , *SKULL base , *PREOPERATIVE period , *SURGERY - Abstract
Objectives Internal carotid artery (ICA) injury remains a rare but potentially fatal complication of transsphenoidal pituitary or anterior skull base surgery. Preoperative imagingmust be scrutinized to minimize risk. On axial computed tomography (CT), the protrusions of the ICAs into the sphenoid resemble a "teddy bear." This article aims to describe the sign, its grading system (0--2) and quantify its presence. Design Retrospective review of preoperative CT imaging. Setting Tertiary referral center in the United Kingdom. Participants One hundred patients who underwent endoscopic transsphenoidal surgery for pituitary disease were enrolled. Main Outcome Measure The presence and grading of the "teddy bear" sign were assessed on preoperative CT imaging. Results A grade 2 (strongly positive) "teddy bear" sign was identified in 40% at the level of the superior pituitary fossa, 78% at the inferior pituitary fossa, and 59% at the clivus. A grade 1 (intermediate) sign was seen in 23.5, 7.5, and 10% of cases, respectively. In 5% of cases, the sign was grade 0 at all levels--indicating poor intraoperative localization of the ICA. Conclusion The "teddy bear" sign is a useful preoperative tool for identification of anatomy predisposing patients to a higher risk of ICA injury. Those patients who have an absent or grade 0 "teddy bear" sign require extra care to ensure intraoperative localization of the ICAs which may include the use of neuronavigation or a Doppler probe. A grade 2 sign predicts good intraoperative localization of the ICA intraoperatively to inform the safe lateral limit of sellar bone resection. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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33. Discordance between mass spectrometry and immunometric IGF-1 assay in pituitary disease: a prospective study.
- Author
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Bonert, Vivien, Carmichael, John, Wu, Zengru, Mirocha, James, Perez, Daniel A., Clarke, Nigel J., Reitz, Richard E., McPhaul, Michael J., and Mamelak, Adam
- Abstract
Purpose: Measuring IGF-1, a biomarker for GH activity, is critical to evaluating disordered hypothalamic-pituitary GH axis. Inconsistent IGF-1 measurements among different immunoassays are well documented. We switched from Immulite 2000 immunoassay to narrow-mass-extraction, high-resolution liquid chromatography mass-spectrometry (LC-MS) compliant with recent consensus recommendations on assay standardization. Comparability of these two assays in patients with pituitary disease in a clinical practice setting is not known. We sought to compare IGF-1 levels on Immulite 2000 and LC-MS in samples from naïve and treated patients with secretory and non-secretory pituitary masses. Methods: We prospectively collected serum samples from 101 patients treated at the Cedars-Sinai Pituitary Center between February 2012 and March 2014. We intentionally recruited more patients with acromegaly or GH deficiency to ensure a clinically representative cohort. Samples were classified as in or out of the respective reference ranges. Bland-Altman analysis was used to assess agreement between assays. Results: Twenty-four percent of samples were classified differently as below, in, or above range. Agreement between the assays was poor overall, with a significant bias for immunoassay reporting higher values than LC-MS. This pattern was also observed in patients with acromegaly and those with ≥ 2 pituitary hormone deficiencies. Conclusions: IGF-1 results may differ after switching from an older immunoassay to a consensus-compliant assay such as LC-MS. Clinicians should consider the potential impact of assay switching before altering treatment due to discrepant results, particularly in patients monitored over time, such as those with acromegaly and GH deficiency. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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34. Evaluation of sex hormone profile and semen parameters in acromegalic male patients
- Author
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Ates Kadioglu, Mazhar Ortac, Pinar Kadioglu, Cem Sulu, Hande Mefkure Ozkaya, and M. Yilmaz
- Subjects
Male ,medicine.medical_specialty ,Turkey ,Pituitary disease ,medicine.drug_class ,Pituitary Diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Semen ,Gastroenterology ,03 medical and health sciences ,Semen quality ,0302 clinical medicine ,Endocrinology ,Sex hormone-binding globulin ,Pituitary adenoma ,Internal medicine ,Acromegaly ,medicine ,Humans ,Pituitary Neoplasms ,Testosterone ,biology ,business.industry ,Remission Induction ,Patient Acuity ,Middle Aged ,medicine.disease ,Androgen ,Semen Analysis ,Growth Hormone ,030220 oncology & carcinogenesis ,biology.protein ,Genetic Fitness ,business - Abstract
To investigate the changes in semen quality and bioavailable testosterone concentrations in acromegalic male patients according to their disease activity and compare them with patients with non-functional pituitary adenoma (NFA) and healthy controls (HC). Twenty-four acromegalic patients with active disease, 22 acromegalic patients in remission, 10 HCs, and 10 patients with NFA were included. Total and calculated bioavailable testosterone concentrations were lower in patients with pituitary disease. Patients with acromegaly had more severely impaired total testosterone levels and semen parameters in comparison to HCs and patients with NFA. The degree of impairment was more prominent in acromegalic patients with active disease than acromegalic patients in remission. Acromegalic patients in remission had residual impairments in both semen quality and testosterone concentrations. Patients with NFA had the lowest concentrations of calculated bioavailable testosterone, followed by acromegalic patients with active disease and acromegalic patients in remission. Increasing growth hormone (GH) levels were found to be associated with both more severely impaired semen quality and androgen concentrations. Growth hormone hypersecretion can disturb reproductive biology and thereof semen quality. The reduction in semen quality and androgen levels may not fully recover upon disease control. Clinicians should be aware of the increased risk of impaired semen parameters and reduced total/bioavailable levels in acromegalic patients, especially in the setting of active disease.
- Published
- 2021
35. The value of [68Ga]Ga-DOTA-TATE PET/CT in diagnosis and management of suspected pituitary tumors
- Author
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Ming Young S. Wan, Irada J. Aliyeva, Irfan Kayani, Aziz Aliyev, Rizwan Syed, Fuad Novruzov, Francesco Giammarile, Elnur Mehdi, and Jamshed Bomanji
- Subjects
Pituitary disease ,Biophysics ,R895-920 ,030209 endocrinology & metabolism ,Neuroendocrine tumors ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,chemistry.chemical_compound ,Medical physics. Medical radiology. Nuclear medicine ,0302 clinical medicine ,Computer Science (miscellaneous) ,Medicine ,Radiology, Nuclear Medicine and imaging ,neoplasms ,Prolactinoma ,DOTA-TATE ,PET-CT ,medicine.diagnostic_test ,business.industry ,Somatostatin receptor ,Pituitary tumors ,medicine.disease ,chemistry ,Positron emission tomography ,Molecular Medicine ,Original Article ,business ,Nuclear medicine - Abstract
Background Gallium 68-tetraazacyclododecane-tetraacetic acid-octreotate ([68Ga]Ga-DOTA-TATE) is a selective somatostatin analogue ligand, which shows increased affinity for somatostatin receptor subtype (SSTR) 2 and has been used routinely for imaging neuroendocrine tumors with PET/CT. We investigated the utility of [68Ga]Ga-DOTA-TATE positron emission tomography/computed tomography (PET/CT) in patients with suspected pituitary pathology. We reviewed imaging for twenty consecutive patients (8 men, 12 women, mean age of 48.2, range 14–78) with suspected pituitary pathology who were referred for [68Ga]Ga-DOTA-TATE PET/CT. Results Nine patients presented with recurrent Cushing’s syndrome following surgical resection of pituitary adenomas due to recurrent Cushing’s disease (seven patients) and ectopic ACTH secreting tumor (2 patients). All seven patients with recurrent Cushing’s disease showed positive pituitary [68Ga]Ga-DOTA-TATE uptake while both cases of ectopic hormonal secretion had absented pituitary uptake. In 1 of these 2 patients, [68Ga]Ga-DOTA-TATE was able to localize the source of ectopic ACTH tumor. Six patients presented de novo with Cushing’s due to ectopic ACTH secretion; [68Ga]Ga-DOTA-TATE PET/CT was able to localize ectopic tumors in six of eight patients (3 lungs, 2 pancreases, 1 mid-gut) There was high uptake [68Ga]Ga-DOTA-TATE in 3 cases of recurrent central hyperthyroidism (SUVmax 6.6–14.3) and 2 cases of prolactinoma (SUVmax 5.5 and 11.3). Conclusion Absent [68Ga]Ga-DOTA-TATE activity in the pituitary fossa is useful in excluding pituitary disease in recurrent Cushing’s. Recurrent pituitary thyrotropinomas and prolactinomas showed moderate to high pituitary activity. In addition, in Cushing’s syndrome, [68Ga]Ga-DOTA-TATE is useful for detection of ectopic sources of ACTH production, especially where anatomic imaging is negative.
- Published
- 2021
36. Use of the Free Thyroxine Index to Refine the Lower Limit of a Free Thyroxine Immunoassay for Detection of Secondary Hypothyroidism
- Author
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James V. Hennessey, Gregory P. Westcott, and Christopher M. Mulla
- Subjects
medicine.medical_specialty ,Pituitary disease ,Endocrinology, Diabetes and Metabolism ,Urology ,Thyrotropin ,030209 endocrinology & metabolism ,Hypopituitarism ,Thyroid Function Tests ,Lower limit ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Hypothyroidism ,Thyroid-stimulating hormone ,Humans ,Medicine ,030212 general & internal medicine ,Retrospective Studies ,Immunoassay ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Thyroxine ,Triiodothyronine ,business ,hormones, hormone substitutes, and hormone antagonists ,Hormone - Abstract
Objective To determine the utility of measuring free T4 index (FT4I) in patients with low free T4 (FT4) levels using immunoassay and normal thyroid-stimulating hormone for the evaluation of secondary hypothyroidism. Methods We performed a retrospective medical chart review of patients seen at a single institution as outpatients who had a simultaneously normal thyroid-stimulating hormone level, low FT4 level, and any FT4I measured between June 2014 and October 2016. Demographic, laboratory, and imaging data were collected. Using FT4I as the reference for diagnosis of hypothyroidism, the sensitivity and specificity of the FT4 immunoassay’s lower-limit thresholds were determined. Within each threshold group, available brain imaging and biochemical evaluation were categorized according to the presence or absence of pituitary disease. Results A total of 155 sets of result pairs (FT4 and FT4I) performed on 118 subjects were analyzed. The lower limit of a normal FT4 level by immunoassay at this institution was 0.93 ng/dL, though all pairs with FT4 ≥0.89 ng/dL had a normal FT4I. All pairs with FT4 ≤0.67 ng/dL had a low FT4I. No pituitary macroadenomas were identified in any subject, though the rates of pituitary imaging in this patient sample were low. Conclusion Patients with a borderline low FT4 level by immunoassay often have normal FT4I. In such patients at our center, significant structural and biochemical pituitary pathology was uncommon.
- Published
- 2021
37. Prevalence of Thyroid Disease in Patients Surgically Treated for Pituitary Disease
- Author
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Daham Kim, Yongin Cho, Cheol Ryong Ku, Hyein Jung, Ju Hyung Moon, Eui Hyun Kim, Dong Yeob Shin, Sun Ho Kim, and Eun Jig Lee
- Subjects
prevalence ,thyroid disease ,hypothyroidism ,hyperthyroidism ,thyroid cancer ,pituitary disease ,Medicine - Abstract
Thyroid disease mainly has a thyroid origin but can occasionally have a pituitary origin. Clinicians face several challenges when these conditions occur together. We aimed to determine the prevalence of thyroid disorders in patients undergoing trans-sphenoidal adenomectomy (TSA) for pituitary disease. We reviewed the medical records of patients undergoing TSA for pituitary disease between 2008 and 2017 at Severance Hospital. Thyroid disorders were categorized using blood test results and medical histories at the time of preoperative evaluation. Among 2202 patients, 44 (2%), 218 (9.9%), and 74 (3.4%) had hyperthyroidism, hypothyroidism, and post-thyroidectomy status before TSA, respectively. Among the 44 patients with hyperthyroidism, 30 (68.2%) had central hyperthyroidism. Among the 218 patients with hypothyroidism, 165 (75.7%) had central hypothyroidism. Central hypothyroidism was more common in patients with adrenocorticotropic hormone-secreting pituitary adenomas (aOR (adjusted odds ratio) 1.85), Rathke’s cleft cysts (aOR 2.34), and craniopharyngiomas (aOR 2.58) (all p < 0.05) than in those with nonfunctioning pituitary adenomas. Contrastingly, thyroid cancer had an increased prevalence in patients with growth hormone- (aOR 3.17), prolactin- (aOR 3.66), and thyroid-stimulating hormone-secreting (aOR 6.28) pituitary adenomas (all p < 0.05). Pituitary disease sometimes accompanies thyroid disorders; their characteristics vary according to the type of pituitary disease.
- Published
- 2019
- Full Text
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38. A Patient’s Perspective on Pituitary Tumors
- Author
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Perrin, Patsy, Powell, Michael P., editor, Lightman, Stafford L., editor, and Laws, Edward R., Jr., editor
- Published
- 2003
- Full Text
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39. Cushing’s Disease
- Author
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Atkinson, A. Brew, Sheppard, Michael C., editor, and Stewart, Paul M., editor
- Published
- 2002
- Full Text
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40. Thyrotropin-Secreting Pituitary Adenomas
- Author
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Beck-Peccoz, Paolo, Persani, Luca, Sheppard, Michael C., editor, and Stewart, Paul M., editor
- Published
- 2002
- Full Text
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41. Pituitary Incidentaloma
- Author
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Molitch, Mark E., Sheppard, Michael C., editor, and Stewart, Paul M., editor
- Published
- 2002
- Full Text
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42. Pituitary Dysfunction as a Cause of Cardiovascular Disease
- Author
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Tasos Gogakos, Apostolos Gogakos, Zoe Efstathiadou, and Marina Kita
- Subjects
Pharmacology ,endocrine system ,medicine.medical_specialty ,Pituitary gland ,Vasopressin ,Somatotropic cell ,Pituitary disease ,business.industry ,Hypothalamus ,Thyroid Gland ,Hypopituitarism ,medicine.disease ,Prolactin cell ,Endocrinology ,medicine.anatomical_structure ,Anterior pituitary ,Cardiovascular Diseases ,Posterior pituitary ,Internal medicine ,Drug Discovery ,Quality of Life ,medicine ,Humans ,business - Abstract
The hypothalamic-pituitary axis is responsible for the neuroendocrine control of several organ systems. The anterior pituitary directly affects the functions of the thyroid gland, the adrenal glands, and gonads, and regulates growth and milk production. The posterior hypophysis, through nerve connections with the hypothalamic nuclei, releases vasopressin and oxytocin responsible for water balance and social bonding, sexual reproduction and childbirth, respectively. Pituitary gland hormonal excess or deficiency results in dysregulation of metabolic pathways and mechanisms that are important for the homeostasis of the organism and are associated with increased morbidity and mortality. Cardiovascular (CV) disorders are common in pituitary disease and have a significant impact on survival. Hormonal imbalance is associated with CV complications either through direct effects on the heart structure and function and vasculature or indirectly by altering the metabolic profile. Optimal endocrine control can prevent or reverse CV defects and preserve survival and quality of life. In this review, we discuss the effects of pituitary hormone excess and deficiency on the CV system. Specifically, we assess the impact of Somatotroph, Corticotroph, Gonadotroph, and Lactotroph anterior pituitary axes on the CV system. The effect of posterior pituitary function on the CV system is also explored.
- Published
- 2020
43. Cryptorchidism is a Useful Clue for Idiopathic Hypogonadotropic Hypogonadism in Pituitary Stalk Thickening
- Author
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Shamharini Nagaratnam, Mohamed Badrulnizam Long Bidin, Norzaini Rose Mohd Zain, and Subashini Rajoo
- Subjects
Delayed puberty ,endocrine system ,Pathology ,medicine.medical_specialty ,pituitary disease ,Pituitary disease ,Endocrinology, Diabetes and Metabolism ,Case Report ,030209 endocrinology & metabolism ,Hypopituitarism ,Short stature ,Growth hormone deficiency ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Hypogonadotropic hypogonadism ,030225 pediatrics ,medicine ,Pituitary stalk ,business.industry ,Micropenis ,medicine.disease ,hypopituitarism ,hypogonadotrophic hypogonadism ,growth hormone ,medicine.symptom ,business ,cryptorchidism - Abstract
Pituitary stalk lesions can represent a wide range of pathologies. The exact cause is often unknown due to hesitancy to proceed with biopsy. We present a 16-year-old adolescent who presented with delayed puberty, short stature and bilateral cryptorchidism. He was found to have a thickened pituitary stalk of uncertain etiology with partial hypopituitarism (gonadotrophin and growth hormone deficiency) on further assessment. The presence of bilateral cryptorchidism and micropenis represents lack of “mini puberty,” a phenomenon of activation of the hypothalamic - pituitary-gonadal (HPG) axis in -utero or within the first few months of life.1 These key clinical features have been useful to establish an early temporal relationship and suggest a congenital origin of disease. This enabled a more conservative approach of surveillance to be employed as opposed to invasive pathological examination with pituitary stalk biopsy.
- Published
- 2021
44. A case of carcinoma larynx with overt hypothyroidism scheduled for feeding jejunostomy
- Author
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Swaraj Jyoti Sonowal, Nilanjana Howbora, Tridip Jyoti Borah, Dokne Chintey, and Anupam Das
- Subjects
Larynx ,endocrine system ,medicine.medical_specialty ,endocrine system diseases ,Pituitary disease ,business.industry ,Thyroid ,Primary hypothyroidism ,Hypoxia (medical) ,medicine.disease ,Gastroenterology ,medicine.anatomical_structure ,Parenteral nutrition ,Internal medicine ,medicine ,medicine.symptom ,Gastrointestinal function ,business ,Hyponatremia ,hormones, hormone substitutes, and hormone antagonists - Abstract
The function of the thyroid gland is to secrete sufficient amount of thyroid hormones for regulation of cellular metabolism throughout the body. Patients need medical care for hyper functioning (hyperthyroidism) or hypo functioning (hypothyroidism) of the thyroid gland. Hypothyroidism is a very common disease affecting 0.5% to 0.8% of the adult population in the world. Primary hypothyroidism results in a decreased production of thyroid hormones despite adequate or increased levels of TSH and accounts for 95% of all cases of hypothyroidism. Secondary hypothyroidism results due to hypothalamic or pituitary disease that accounts for 5% of cases of hypothyroidism [1]. Hypothyroidism can cause decreased myocardial contractility, baroreceptor dysfunction, weight gain, non-pitting edema, hyponatremia, decreased ventilatory response to hypoxia and hypercarbia, diminished gastrointestinal function and impaired drug metabolism. Feeding jejunostomy is a surgical procedure by which a tube is inserted in the lumen of the proximal jejunum, primarily to provide enteral nutrition or administer medications. This procedure becomes a vital path for providing nutrition and medication when a person becomes unable to swallow due to obstruction of the food pipe [2]. Carcinoma larynx is a disease in which malignant cells originate from larynx mostly squamous-cell carcinomas which can invade the surrounding structures. Here, we report on the anaesthetic management of a patient of carcinoma larynx with overt hypothyroidism for feeding jejunostomy.
- Published
- 2021
45. Improved survival in patients with thyroid function test abnormalities secondary to immune-checkpoint inhibitors
- Author
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Joana Lima Ferreira, Inês Lucena Sampaio, Joana Oliveira, Ana Paula Santos, Ana Paula da Silva Marques, Margarida Victor, Isabel Torres, Sofia Castro, Cláudia Costa, Bernardo Marques, and Hugo Duarte
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Pituitary disease ,Immunology ,Thyroid Function Tests ,Thyroid function tests ,Gastroenterology ,Thyroiditis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Central hypothyroidism ,Humans ,Immunology and Allergy ,Immune Checkpoint Inhibitors ,medicine.diagnostic_test ,business.industry ,Thyroid ,Primary hypothyroidism ,medicine.disease ,Survival Analysis ,Thyroid Diseases ,medicine.anatomical_structure ,Oncology ,Female ,Nivolumab ,Thyroid function ,business ,030215 immunology - Abstract
Immune-checkpoint inhibitors (ICI) are monoclonal antibodies which target molecules to enhance antitumor response. Several adverse events have been described and the major ICI-related endocrinopathies are thyroid dysfunction and hypophysitis. Its occurrence has been associated with improved outcomes, but it is still to be proven. We performed a retrospective study of patients treated with ICI between 2014 and 2019 at an oncologic center to characterize thyroid function test abnormalities (TFTA) and to evaluate clinical outcomes. We excluded patients without regular monitoring of thyroid function, with previous thyroid or pituitary disease, previous head/neck radiotherapy and who performed only one ICI cycle. We included 161 of 205 patients treated with pembrolizumab, nivolumab or ipilimumab for several neoplasms, with a median duration of 18.9 weeks (9.1-42.6) of ICI treatment and 49.4 weeks (26.5-75.8) of follow-up. New-onset TFTA was diagnosed in 18% of patients (n = 29), in median at 10.6 weeks (6.1-31.1) of ICI therapy. On the whole, 8.7% had primary hypothyroidism, 4.3% central hypothyroidism, 2.5% biphasic thyroiditis and 2.5% thyrotoxicosis. Patients who experienced primary or central thyroid dysfunction had a significantly improved overall response rate (58.6% vs 34.2%, p = 0.015) and overall survival (3.27 vs 1.76 years, p = 0.030), compared to the control group. The risk of mortality was two times higher for control group (adjusted HR = 2.43, 95% CI 1.13-5.23, p = 0.023). This study recognizes that primary and central thyroid dysfunction can be a predictive clinical biomarker of a better response to ICI across several neoplasms.
- Published
- 2020
46. SF-12 or SF-36 in pituitary disease? Toward concise and comprehensive patient-reported outcomes measurements
- Author
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Amir H Zamanipoor Najafabadi, Merel van der Meulen, Nienke R. Biermasz, Daniel J. Lobatto, Wouter R van Furth, Thea P. M. Vliet Vlieland, Cornelie D. Andela, and Alberto M. Pereira
- Subjects
Adult ,medicine.medical_specialty ,Longitudinal study ,Pituitary disease ,SF-36 ,Intraclass correlation ,Endocrinology, Diabetes and Metabolism ,Health-related quality of life ,Pituitary Diseases ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Quality of life ,Internal medicine ,Surveys and Questionnaires ,medicine ,Humans ,Longitudinal Studies ,Patient Reported Outcome Measures ,Longitudinal cohort ,business.industry ,Pituitary tumors ,Limits of agreement ,Patient-reported outcome measure ,medicine.disease ,humanities ,Cross-Sectional Studies ,Quality of Life ,Original Article ,business ,Short Form-12 ,030217 neurology & neurosurgery ,Pituitary tumor ,Short Form-36 - Abstract
Purpose Pituitary diseases severely affect patients’ health-related quality of life (HRQoL). The most frequently used generic HRQoL questionnaire is the Short Form-36 (SF-36). The shorter 12-item version (SF-12) can improve efficiency of patient monitoring. This study aimed to determine whether SF-12 can replace SF-36 in pituitary care. Methods In a longitudinal cohort study (August 2016 to December 2018) among 103 endoscopically operated adult pituitary tumor patients, physical and mental component scores (PCS and MCS) of SF-36 and SF-12 were measured preoperatively, and 6 weeks and 6 months postoperatively. Chronic care was assessed with a cross-sectional study (N = 431). Mean differences and agreement between SF-36 and SF-12 change in scores (preoperative vs. 6 months) were assessed with intraclass correlation coefficients (ICC) and limits of agreement, depicting 95% of individual patients. Results In the longitudinal study, mean differences between change in SF-36 and SF-12 scores were 1.4 (PCS) and 0.4 (MCS) with fair agreement for PCS (ICC = 0.546) and substantial agreement for MCS (ICC = 0.931). For 95% of individual patients, the difference between change in SF-36 and SF-12 scores varied between −14.0 and 16.9 for PCS and between −7.8 and 8.7 for MCS. Cross-sectional results showed fair agreement for PCS (ICC = 0.597) and substantial agreement for MCS (ICC = 0.943). Conclusions On a group level, SF-12 can reliably reproduce MCS in pituitary patients, although PCS is less well correlated. However, individual differences between SF-36 and SF-12 can be large. For pituitary diseases, alternative strategies are needed for concise, but comprehensive patient-reported outcome measurement.
- Published
- 2020
47. Mensuration of the rabbit pituitary gland from computed tomography
- Author
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Alexandre B. Le Roux, Katherine E. Quesenberry, and Vionna Kwan
- Subjects
Male ,Pituitary gland ,CATS ,General Veterinary ,medicine.diagnostic_test ,Pituitary disease ,business.industry ,Computed tomography ,Reference range ,Anatomy ,medicine.disease ,Sagittal plane ,Hypophysis cerebri ,medicine.anatomical_structure ,Reference Values ,Pituitary Gland ,Image Processing, Computer-Assisted ,medicine ,Animals ,Endocrine system ,Female ,Rabbits ,Tomography, X-Ray Computed ,business ,Retrospective Studies - Abstract
The aim of this retrospective reference interval observational study was to determine the mensuration of the pituitary gland (hypophysis cerebri) by analyzing CT studies in rabbits without clinical evidence of pituitary disease or central neurologic signs. Though diseases of the rabbit pituitary gland are uncommon, the pituitary gland is essential in regulation of the rabbit's endocrine system, as in other species. Currently, there are minimal published studies that detail the rabbit head anatomy on cross-sectional imaging, and even less specifically examining the pituitary gland. The pituitary gland was measured by one observer at a single time point from transverse and reconstructed sagittal CT images in a soft-tissue algorithm in 62 rabbits for a total of 66 rabbit head CT studies. The rabbits ranged from 0.84 to 14 years in age (mean ± SD: 5.46 ± 3.05 years) and 0.92 to 4.95 kg in weight (2.21 ± 0.83 kg). Linear pituitary measurements were performed using electronic calipers. The mean ± SD pituitary height was 4.22 ± 0.57 mm, width was 4.48 ± 0.71 mm, and length was 6.02 ± 0.70 mm. The pituitary gland height-to-brain area ratio was 1.10 ± 0.16 mm-1 , which is much higher than the values reported in normal dogs and cats. The age, weight, and sex of the rabbits were not found to have a significant impact on pituitary gland mensuration. These measurements could be useful as a reference range for future rabbit head CT studies and to rule out pituitary enlargement or disease when evaluating rabbit pituitary glands.
- Published
- 2020
48. Diagnosis and Management of pituitary disease with focus on the role of Magnetic Resonance Imaging
- Author
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Dennis D. Spencer, Sacit Bulent Omay, Richard A. Bronen, Silvio E. Inzucchi, Amit Mahajan, and Ali Mian
- Subjects
Pituitary gland ,medicine.medical_specialty ,Focus (geometry) ,Pituitary disease ,Pituitary Diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,medicine ,Humans ,Pituitary Neoplasms ,Sella Turcica ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Magnetic Resonance Imaging ,Treatment management ,Management strategy ,medicine.anatomical_structure ,Pituitary Gland ,030220 oncology & carcinogenesis ,Treatment decision making ,Radiology ,business - Abstract
Magnetic resonance (MR) imaging is an essential tool in the diagnosis and management of pituitary diseases, indispensable for making correct treatment decisions. Successful management and follow-up of pituitary pathology requires an understanding of the MR appearance of normal and abnormal structures in the sellar region. This review will describe the MR appearance of the normal and abnormal pituitary gland and proposes an algorithm for the management strategy of some of the most common abnormalities in or around the sella.
- Published
- 2020
49. Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease
- Author
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Lisa Caulley, Ravindra Uppaluri, Ian F. Dunn, and Epidemiology
- Subjects
medicine.medical_specialty ,Pituitary disease ,medicine.medical_treatment ,Nose ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Pituitary adenoma ,Paranasal Sinuses ,otorhinolaryngologic diseases ,Medicine ,Humans ,Pituitary Neoplasms ,Sinus (anatomy) ,Transsphenoidal surgery ,Skull Base ,business.industry ,Endoscopy ,General Medicine ,Perioperative ,medicine.disease ,Surgery ,Skull ,medicine.anatomical_structure ,Paranasal sinuses ,030220 oncology & carcinogenesis ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Endoscopic endonasal skull base surgery has emerged as the treatment modality of choice for a range of skull base lesions, particularly pituitary adenomas. However, navigation and manipulation of the nasal corridor and paranasal sinuses requires that surgeons are aware of effective techniques to maximize patient outcomes and avoid sinonasal morbidity postoperatively. This paper is a narrative review aimed to provide an updated and consolidated report on the perioperative management of the nasal corridor and paranasal sinuses in the setting of endoscopic skull base surgery for pituitary disease. Anatomic variants and common surgical techniques are discussed. Post-operative complications are evaluated in detail. Understanding the structural implications of the endonasal approach to the sphenoid is crucial to optimization of the surgical outcomes. We propose guidelines for perioperative management of endoscopic endonasal skull base surgery for pituitary diseases. Standardized treatment algorithms can improve patient satisfaction, and increase the comparability and the quality of reported information across research studies.
- Published
- 2020
50. Congenital pituitary hypoplasia model demonstrates hypothalamic OTX2 regulation of pituitary progenitor cells
- Author
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Hidetaka Suga, Hironori Bando, Wataru Ogawa, Genzo Iguchi, Satoshi Narumi, Takashi Aoi, Tomonobu Hasegawa, Hidenori Fukuoka, Keiko Muguruma, Yutaka Takahashi, and Ryusaku Matsumoto
- Subjects
0301 basic medicine ,Pituitary disease ,Pituitary Diseases ,Induced Pluripotent Stem Cells ,Ectoderm ,Haploinsufficiency ,Biology ,Models, Biological ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Progenitor cell ,Induced pluripotent stem cell ,Orthodenticle homeobox 2 ,Otx Transcription Factors ,General Medicine ,medicine.disease ,Cell biology ,030104 developmental biology ,medicine.anatomical_structure ,Gene Expression Regulation ,Hypothalamus ,Pituitary Gland ,030220 oncology & carcinogenesis ,LHX3 ,Fibroblast Growth Factor 10 ,Research Article - Abstract
Pituitary develops from oral ectoderm in contact with adjacent ventral hypothalamus. Impairment in this process results in congenital pituitary hypoplasia (CPH); however, there have been no human disease models for CPH thus far, prohibiting the elucidation of the underlying mechanisms. In this study, we established a disease model of CPH using patient-derived induced pluripotent stem cells (iPSCs) and 3D organoid technique, in which oral ectoderm and hypothalamus develop simultaneously. Interestingly, patient iPSCs with a heterozygous mutation in the orthodenticle homeobox 2 (OTX2) gene showed increased apoptosis in the pituitary progenitor cells, and the differentiation into pituitary hormone-producing cells was severely impaired. As an underlying mechanism, OTX2 in hypothalamus, not in oral ectoderm, was essential for progenitor cell maintenance by regulating LHX3 expression in oral ectoderm via FGF10 expression in the hypothalamus. Convincingly, the phenotype was reversed by the correction of the mutation, and the haploinsufficiency of OTX2 in control iPSCs revealed a similar phenotype, demonstrating that this mutation was responsible. Thus, we established an iPSC-based congenital pituitary disease model, which recapitulated interaction between hypothalamus and oral ectoderm and demonstrated the essential role of hypothalamic OTX2.
- Published
- 2019
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