Alcohol and anterior-pituitary secretion.
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Adult↗
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Results for “Pituitary Function Tests”
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Impact of new diagnostic methods on the differential diagnosis and treatment of secondary amenorrhoea.
The development of homologous prolactin assays, multiple pituitary stimulation, tomography, and computerised axial tomography permit more detailed investigation of patients with secondary amenorrhoea than was formerly possible. 39% of 90 patients with secondary amenorrhoea had hyperprolactinaemia. 10 patients (11% of total) had pituitary tumours. 8 of these women had galactorrhoea (27% of those with galactorrhoea). For patients with hyperprolactinaemia but no tumour, bromocriptine is the treatment of first choice rather than clomiphene or human gonadotrophins. The best treatment for patients with detectable tumour is controversial, particularly when the tumour is confined to the sella turcica. Whether or not these tumors are true neoplasms remains to be determined. Clinically, a history of secondary anemorrhoea with or without galactorrhoea following withdrawal of oral contraceptives remains the commonest presenting syndrome.
Amenorrhea↗
TSH responses to TRH in women with unipolar and bipolar depression.
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Adult↗
Autoantibodies to pituitary corticotropin-producing cells: possible marker for unfavourable outcome after pituitary microsurgery for Cushing's disease.
Circulating autoantibodies to human fetal pituitary cells were detected in 13 out of 51 patients who underwent transsphenoidal microsurgery for Cushing's disease. The absence of Fc receptors on human fetal pituitary corticotropin-producing cells allowed the detection of antibodies to these cells. In all the 13 patients, the antibodies were present before surgery, and 10 of them showed clinical and/or biochemical signs of incomplete cure of Cushing's disease after surgery. Only 3 out of 27 patients with a favourable outcome were antibody-positive. In all the antibody-positive patients, the antibodies were directed to corticotropin-producing cells and in 8 patients also to luteinising hormone or human growth hormone producing cells. A non-antigen-specific adherence of antibodies to Fc-receptors on corticotropin-cells was excluded by unchanged binding after preincubation of sections with purified rabbit Fc or Fc aggregates. The presence of pituitary corticotropin-cell antibodies in patients with Cushing's disease is associated with an unsuccessful outcome after transsphenoidal selective adenectomy.
Adenoma↗
Pituitary surgery: current status, including transsphenoidal surgery.
Advances in CT scanning and digital subtraction angiography have improved the accuracy of preoperative diagnosis of pituitary disease. Modern radioimmunoassay techniques are able to evaluate "subdivisions" and "relatives" of the classic pituitary hormones, including monomeric and oligomeric growth hormones, somatomedin C, beta-lipotropin, and beta-endorphin, as well as the alpha subunit of follicle-stimulating hormone. Pituitary pathologic states can now be identified immunologically in patients in whom results of radiologic studies are normal. Bromocriptine, a centrally active dopamine antagonist and ergot derivative, is effective in the treatment of prolactinomas, but it is not effective in the treatment of acromegaly. Transsphenoidal surgery remains the treatment of choice in adults with pituitary-dependent Cushing's disease. The surgical advantages of the sublabial, transseptal, transsphenoidal approach include wide-field pituitary accessibility via a midline exposure.
Adenoma↗
Gender-related differences in growth hormone-releasing pituitary adenomas. A clinicopathological study.
BACKGROUND/AIMS: Pituitary adenomas are the third most common primary intracranial neoplasm, after astrocytomas and meningiomas, and about 30% of them secrete growth hormone (GH). Other subtypes of pituitary tumors are characterized by well-known gender-related differences, not only in clinical presentation and other biological characteristics but also in surgical outcome. For GH-releasing pituitary adenomas, however, detailed data on gender differences of postsurgical treatment are not available. PATIENTS AND METHODS: The patient charts of a series of 18 patients with acromegaly who met strict immunohistochemical and electron microscopic criteria and who underwent surgical resection of their tumors between January 1990 and June 1999 were retrospectively reviewed. RESULTS: There were eight women and ten men; the male-to-female-ratio was 1.3:1. The men and women were equal in age at surgery. Men demonstrated higher IGF-1 and smaller GH levels pre- and postoperatively, whereas the reduction in IGF-1 was more pronounced compared to women (58% vs. 27%). The overall outcome was better in women than in men. Mixed GH- and prolactin-secreting adenomas showed a worse outcome among all other histological subtypes. Mitose- and MIB-1 labeling index was increased in men compared to women. CONCLUSION: The clinical course and tumor biology of GH-releasing pituitary adenomas appear to differ in women and men. Men demonstrated a shorter preoperative duration of symptoms, larger and more invasive tumors, and a worse clinical outcome. These findings suggest that therapy for GH-releasing adenomas should be more aggressive in men than in women. The gender-related differences in GH-releasing pituitary adenomas appear to have a basis in different biologic behavior, which warrants further investigation.
Acromegaly↗
Medical therapy of macroprolactinomas in males: I. Prevalence of hypopituitarism at diagnosis. II. Proportion of cases exhibiting recovery of pituitary function.
Hyperprolactinaemia frequently causes secondary hypogonadism through central suppression of gonadotropin secretion. Macroprolactinomas (> 1 cm diameter) are more common in males and may additionally cause more generalised hypopituitarism. Recovery of the thyrotropic and/or corticotropic axes is well described following selective adenomectomy, but remains poorly defined in relation to medical (dopamine-agonist) therapy of macroprolactinomas. We therefore performed a retrospective examination of case records of male patients who had received medical therapy alone for macroprolactinoma between 1980-2001 (n = 35) and in whom tumor shrinkage was documented by interval pituitary imaging (reported throughout by a single neuroradiologist). Mean prolactin level at baseline was 59,932 mU/L (median 31,400; range 3,215-332,000); mean period of follow up was 4.2 years (median 2.6; range: 1.0-15). Defects of the following axes were evident at diagnosis: LH/FSH-testosterone (n = 27; 77%), TSH-T4 (n = 14; 41%-not including one case with pre-existing 1 degress hypothyroidism), ACTH-cortisol (n = 8; 23%). Overall, 14 men (40%) were deficient in 1 axis, seven (20%) in 2 axes and seven (20%) in 3 axes. Growth hormone secretory status was not systematically evaluated. In all but 6 patients, prolactin levels fell to normal or near-normal levels (mean 764 mU/L; median 260; range: < 10-4,833). Of the patients in whom adequate reassessment had been performed, thyrotroph function recovered in 4/9, corticotroph function in 4/6 and gonadotroph function in 16/26 cases. In four cases (11%) previously described, development of visual impairment as a result of the chiasmal traction syndrome necessitated a dose reduction in medical therapy to allow a degree of controlled tumor re-expansion. The prevalence at diagnosis of TSH and ACTH deficiency in men with macroprolactinomas was 41% and 23%, respectively. Among eight patients with insufficiency of TSH and/or ACTH secretion who underwent complete interval reassessment over several years of treatment, recovery of at least one axis occurred in six cases (75%). This study highlights the importance of screening ACTH- and/or TSH-deficient men during dopamine agonist therapy in order to identify cases where hypopituitarism has resolved.
Adrenocorticotropic Hormone↗
Sheehan's syndrome.
Sheehan's syndrome occurs as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage. It may be rarely seen without massive bleeding or after normal delivery. Improvement in obstetric care and availability of rapid blood transfusion coincided with a remarkable reduction in the frequency of Sheehan's syndrome particularly in western society. But it has recently been reported more often from well-developed countries. It is one of the most common causes of hypopituitarism in underdeveloped or developing countries. Enlargement of pituitary gland, small sella size, disseminated intravascular coagulation and autoimmunity have been suggested to play a role in the pathogenesis of Sheehan's syndrome in women who suffer from severe postpartum hemorrhage. The patients may seek medical advice because of various presentations ranging from non-specific symptoms to coma and the clinical manifestation may change from one patient to another. Failure of postpartum lactation and failure to resume menses after delivery are the most common presenting symptoms. Although a small percentage of patients with Sheehan's syndrome may cause abrupt onset severe hypopituitarism immediately after delivery, most patients have a mild disease and go undiagnosed and untreated for a long time. It may result in partial or panhypopituitarism and GH is one of the hormones lost earliest. The great majority of the patients has empty sella on CT or MRI. Lymphocytic hypophysitis should be kept in mind in differential diagnosis. In this review, the old and recent data regarding Sheehan's syndrome are presented.
Diagnosis, Differential↗
[Hypophyseal incidentaloma in a patient with autosomal dominant polycystic kidney disease].
The prevalence of incidentally discovered lesions within the pituitary (pituitary incidentalomas) is about 10%. The most common form of sellar mass are clinically nonfunctioning adenomas (less than 10 mm); functioning adenomas, however, are rare. Incidentally discovered pituitary microadenomas causing growth hormone hypersecretion are uncommon. In addition, the association of autosomal dominant polycystic kidney disease with acromegaly is exceptional and has not yet been reported to our knowledge.
Acromegaly↗
Corticotrophic macroadenoma of the pituitary associated with hypoadrenalism.
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Adenoma↗
Too much of a good thing.
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ACTH Syndrome, Ectopic↗
Growth and endocrine disorders in multisystem Langerhans' cell histiocytosis.
INTRODUCTION: Langerhans' cell histiocytosis is a rare disorder, with diabetes insipidus occurring in up to half of patients. Causes of growth failure include the illness itself, treatments used and growth hormone insufficiency. PATIENTS AND METHODS: We identified all patients with an endocrinopathy secondary to Langerhans' cell histiocytosis (LCH). Growth data were analysed from all patients with multisystem involvement. RESULTS: Of 144 patients with multisystem LCH, 50 had an endocrinopathy, 49 of whom had diabetes insipidus. Growth hormone insufficiency (GHI) was present in 21 patients, seven of whom had other anterior pituitary deficiencies as well (gonadotrophin deficiency + GHI n = 2, gonadotrophin deficiency + TSH deficiency + GHI n = 2, panhypopituitarism n = 3). GH insufficiency, the development of which appeared to be independent of pituitary radiation, occurred at a median age of 8.3 years (4.7-18 years) and at a median interval of 3.5 years (0-11.8 years) after diagnosis of LCH. The median height SDS at diagnosis of growth hormone insufficiency was -2.9. Thirteen of the patients with growth hormone insufficiency attained final height with a median height SDS of -1.2. The final height SDS of 15 patients without GH insufficiency was closer to target height SDS, but not statistically different from that of the GH insufficient group. CONCLUSIONS: GH therapy significantly improves growth in GH insufficient patients with Langerhans' cell histiocytosis. Early institution of GH therapy may further improve height outcome. However, most children with Langerhans' cell histiocytosis regardless of endocrine function, failed to reach target height.
Adolescent↗
Clinical presentation and outcome of pituitary adenomas in teenagers.
OBJECTIVE: Pituitary adenomas rarely occur in childhood and adolescence, but their mass effect and endocrine abnormalities can compromise both quality and length of life. In this study we evaluated the symptoms at onset and the long-term consequences induced in teenagers by functioning or nonfunctioning pituitary adenomas. DESIGN AND PATIENTS: Clinical, biochemical and neuroradiological data of 44 young patients (12 males and 32 females, aged 16.3 +/- 1.9 years at diagnosis) with pituitary adenomas were evaluated retrospectively at baseline and after therapy. Patients underwent surgery, radiotherapy and/or medical treatment depending on clinical history and endocrine secretion of the tumour. Follow-up ranged from 8 to 252 months (median 55 months). MEASUREMENTS: Baseline and dynamic pituitary function were evaluated in all cases at diagnosis and after treatments. Magnetic resonance imaging (MRI) or computed tomography (CT) scan were performed before therapy and during follow-up. Hormone levels were measured using commercial radioimmunologic or immunoradiometric methods. RESULTS: Pituitary macroadenomas (group 1) or microadenomas (group 2) were found in 61% and 39% of cases, respectively. Overall, 68% were PRL-secreting, 7% GH-secreting, 5% ACTH-secreting and 20% nonfunctioning. The most frequent symptoms at onset were oligoamenorrhoea (62%) and galactorrhoea (59%) in the girls, and headache (58%) in the boys. Pubertal development was delayed in 12/27 (44%) cases with macroadenoma. Growth failure was observed in 4/44 (9%) patients (3 in group 1 and 1 in group 2). At diagnosis, hypopituitarism was detected in 10/27 (37%) patients with macroadenoma. Surgery alone cured 4/18 (22%) and 4/9 (44%) patients in group 1 and group 2, respectively. Adjuvant therapies (second surgery and/or radiotherapy and/or medical treatment) cured the disease in 2/13 (15%) patients with macroadenoma and allowed a persistent normalization in other 4/13 (31%) and 2/4 (50%) cases in group 1 and group 2, respectively. Medical treatment alone cured 2/9 (22%) patients with PRL-secreting macroadenoma and normalized PRL levels in another six (66%) with macroprolactinoma and in 2/7 (28%) patients with microprolactinoma. CONCLUSION: Delay of growth was rarely observed in teenagers with pituitary adenomas. At the onset of the disease, many girls complained of oligoamenorrhoea and galactorrhoea, while headache and delay of pubertal development were the symptoms more frequently referred by boys. Surgery alone was effective in a minority of patients and adjuvant therapies were helpful to obtain the remission of the disease in many cases. In patients with PRL-secreting pituitary adenoma, medical treatment, both as first choice or as adjuvant therapy, normalizes serum PRL levels in 14/27 (52%) cases.
Adenoma↗
Primary low cerebrospinal fluid pressure syndrome with galactorrhea: findings at MR imaging.
A case of primary low cerebrospinal fluid (CSF) pressure syndrome with galactorrhea is reported. Magnetic resonance imaging demonstrated diffusely enhanced meninges, edematous brain, and enlarged pituitary gland. Coincidental enlargement of pituitary gland and edematous brain due to low CSF pressure compressed the pituitary portal system. The low-perfused anterior lobe of pituitary gland would be the mechanism of galactorrhea.
Adult↗
[Adrenocortical insufficiency as a result of isolated corticotropin-releasing hormone (CRH) deficiency (author's transl)].
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17-Hydroxycorticosteroids↗
[Clinical symptoms in 35 children and adolescents with craniopharyngeoma at the time of diagnosis].
AIM: Hormonal deficiencies, visual disturbances, or cerebral symptoms are often the symptoms through which craniopharyngiomas (CP) first become clinically manifest. As these symptoms can exist for a long period of time various specialists are often consulted before the final diagnosis is made. PATIENTS AND METHODS: Between the years 1970 and 1998, 37 children and adolescents with CP were treated in Erlangen. The documents of 35 patients (22 male, 13 female) were evaluated retrospectively. RESULTS: The median age of the children at diagnosis was 9,3 years (1,3 - 15,6 years). The most frequently documented symptoms were: headache 57 % (median duration 7 months; varying from 1 week to 6 years), visual disturbances 45 % (median duration 2 months, range 2 weeks to 10 years), and reduced growth 40 % (median duration 1 year, range 3 months to 5 years). On average the reported symptoms were present for 15 months (median 5 months, time span 1 week to 10 years). CONCLUSION: The clinical symptoms of CP are non-specific and highly varied. Endocrine disturbances are the primary objective finding. Correct interpretation of the symptoms are required for the early diagnosis of CP.
Adolescent↗