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Familial Isolated Pituitary Adenoma
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Cushing disease results from ACTH hypersecretion and excess cortisol secretion, and displays central obesity, moon facies, diabetes, “buffalo hump,” hypertension, fatigue, easy bruising, depression, and reproductive disorders, in addition to increased morbidity and mortality as a result of cardiovascular or cerebrovascular disease and infections [2,3].
Diseases of the Nervous System
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Adrenal cortical hyperfunction is also connected with mental disturbances. Such changes have been found in patients with Cushing syndrome and in patients being treated with adrenocortical steroids or adrenocorticotropin. In Cushing disease, the psychiatric disorders and underlying mental symptoms represent wide variations. Nevertheless, the psyche alterations induced by adrenocorticotrophic hormone and 17-hydroxysteroids are similar to those observed in association with adrenal cortical hyperfunction. The overall view of both disorders suggests that mental derangements and psychological symptoms are linked with the corticosteroids metabolism.
Endocrinology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Mehul Dattani, Catherine Peters
In untreated patients, the mortality and morbidity from this condition is high, with osteoporosis, glucose intolerance and hypertension accounting for this. Following surgical treatment of Cushing disease, there is a strong possibility that the condition either does not remit, or relapses. In this case, further exploration of the pituitary with a possible total hypophysectomy may be indicated. Radiotherapy can be used as a second-line treatment. In these situations, the child will have panhypopituitarism and therefore will need replacement hydrocortisone, thyroxine, gonadotrophins or sex steroids, growth hormone and DDAVP treatment. However, the outlook is nevertheless better than that following a bilateral adrenalectomy with consequent Nelson syndrome. If the Cushing syndrome is due to an adrenal carcinoma or an ectopic source (usually a lung carcinoid), the prognosis is much worse.
Drug design strategies for Cushing’s syndrome
Published in Expert Opinion on Drug Discovery, 2019
S. A. Usanov, A. V. Kliuchenovich, N. V. Strushkevich
Cushing’s syndrome (CS) denotes a set of clinical signs that evolve due to pathological exposure to cortisol as a consequence of its endogenous overproduction or corticosteroid treatment. ACTH-dependent endogenous cortisol excess due to a pituitary adenoma is called Cushing disease and account for ~70% of cases [1]. The disease was first described by Harvey Cushing in 1932 [2] and the treatment is still challenging for endocrinologists worldwide due to diverse etiologies, leading to hypercortisolism. ACTH-independent autonomous adrenal overproduction of cortisol caused by an adrenal cancer or by an adrenal adenoma leads to CS. Cortisol is a steroid hormone of the glucocorticoid class produced by the adrenal cortex. It is released in response to stress and low blood-glucose concentration and regulates metabolism and immune response. As a result, CS is associated with hypertension, weight gain, truncal adiposity, impaired glucose tolerance or diabetes, insomnia, cognitive impairment, mood changes ranging from anxiety and depression to psychosis, infections, and fractures [3,4]. Uncontrolled CS and severe hypercortisolism could lead to life-threating conditions, including mortality mainly due to cardiovascular disease [5,6].
Correlations between clinical hormone change and pathological features of pituicytoma
Published in British Journal of Neurosurgery, 2018
Ting-Wei Chang, Ching-Yi Lee, Shih-Ming Jung, Hung-Yi Lai, Chun-Ting Chen, Mun-Chun Yeap, Chi-Cheng Chuang, Peng-Wei Hsu, Chen-Nen Chang, Po-Hsun Tu, Shih-Tseng Lee
Pituitary adenomas originate from pituitary gland cells and exhibit a wide range of hormonal and proliferative behaviours. The pathogenesis of pituitary adenoma is unknown, although some genetic diseases have been found to be associated with pituitary adenoma.24–26 No literature describes pituitary adenoma being induced by other tumours, although pituitary adenomas can occur in conjunction with other sellar tumours, such as Rathke cleft cysts, craniopharyngioma, colloid cysts, arachnoid cysts, epidermoid cysts, and intrasellar Schwannoma, as well as with other pituitary adenomas.27 There is only one reported case of synchronous pituitary adenoma and pituicytoma, which was described by Marian et al in 2016.28 The patient presented with a 6-month history of increasing visual impairment and headaches; no symptoms of endocrine dysfunction were noted and no association between the two tumours was disclosed following a histopathological exam and DNA methylation profiling.28 In the present study, one patient with Cushing disease was found to have coexisting pituicytoma and ACTH adenoma. Given the association between pituicytoma and the hormonal change that is induced in the affected pituitary gland region, we argue that pituicytoma could trigger pituitary gland cell proliferation and transformation into pituitary adenoma. However, because of the differences between our patient (who presented with Cushing disease) and the patient described by Marian et al28 (who presented with no endocrine dysfunction), the chronological order of glandular hyperactivity and adenoma transformation is uncertain.
CyberKnife for the management of Cushing’s disease: our institutional experience and review of literature
Published in British Journal of Neurosurgery, 2021
Ashraf Abdali, Pavel L. Kalinin, Yuriy Y. Trunin, Ludmila E. Astaf’Eva, Alexey N. Shkarubo, Gennady E. Chmutin, Vishal Chavda, Andrey Golanov, Badshazar Abdali, Ilya V. Chernov, Atul Vats, Bipin Chaurasia
The use of radiosurgery as an adjoining or alternative option is considered the next better option for the treatment of Cushing disease in cases when there is no biochemical remission after one or multiple surgical resections. CK could be used in both radiosurgery and fractionated radiosurgery regimes with preservation of sufficient pituitary functions. Risk of radiation induced hypopituitarism and other complication is relatively low and tumour growth control is significantly higher. However, to assess the radiation induced adverse effects and the rates of recurrence, studies with longer periods of follow up are required.