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Acromegaly
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Acromegaly results from excessive production of growth hormone from a pituitary adenoma. It most frequently occurs in middle age with a prevalence of 30 to 50 per million of the population. Associated conditions include hypertension (20-30%), diabetes mellitus (12%), impaired glucose tolerance (25%), and a diffuse or nodular goitre (20%). Almost 50% of non-hypertensive acromegalics have a cardiomyopathy, explaining the increased incidence of cardiac failure found in this condition. If untreated, signs and symptoms of hypopituitarism may develop. Acromegaly may occur as part of a polyendocrine syndrome referred to as multiple endocrine adenomatosis (MEA) type 1 (Werner's syndrome) which is characterized by the occurrence of tumours producing peptide hormones in the parathyroid, pituitary and pancreatic glands simultaneously. It is inherited in an autosomal dominant fashion.
Primary Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Christopher M. Jones, John Ayuk
Biochemical and imaging tests used in cases of suspected hypopituitarism are complex and discussed in Chapter 83. Briefly, these investigations are employed both to identify and determine the extent of hormone deficiency, and to elucidate the cause of the hormone deficiency. Biochemical analyses to identify hypopituitarism include both the assessment of basal hormone levels and dynamic testing. Additional investigations such as angiotensin-converting enzyme (ACE), ferritin, hCG and aFP may be required to identify an underlying cause for the hypopituitarism, and imaging with MRI is mandatory. In some instances biopsy may be required to determine the aetiology of an underactive pituitary gland.
Hormone disorders
Published in Steve Hannigan, Inherited Metabolic Diseases: A Guide to 100 Conditions, 2018
Hypopituitarism is a term used to describe an underactive pituitary gland. It is caused by damage to the front and back part of the gland. The pituitary gland is located at the base of the skull and is attached to the hypothalamus, the part of the brain that controls its function. Because the pituitary gland does not work properly, some of the following hormones may not be produced: growth hormonethyroid-stimulating hormone (TSH)adrenocorticotrophic hormone (ACTH)prolactinluteinising hormone (LH)follicle-stimulating hormone (FSH)antidiuretic hormone (ADH).
Occurrence of Hypopituitarism in Tunisian Turner Syndrome patients: familial versus sporadic cases
Published in Gynecological Endocrinology, 2021
M. Mnif-Feki, W. Safi, N. Bougacha-Elleuch, G. Abid, M. Moalla, M. Elleuch, D. H. Ben Salah, N. Rekik, N. Belguith, F. Abdelhedi, T. Kammoun, M. Hachicha, N. Charfi, F. Mnif, H. Kammoun, H. Hadj Kacem, F. Hadj-Kacem, M. Abid
Turner Syndrome (TS) is a chromosomal condition resulting from a partial or complete absence of one of the two sex chromosomes (the X chromosome) in females. It affects nearly 1 per 2500–4000 female births [1,2]. Females with TS tend to have developmental abnormalities such as short stature, gonadal dysgenesis, and congenital malformations. Hypopituitarism, defined as the complete or partial insufficiency of hormone secretion from the anterior pituitary, has an incidence of approximately 1 in 10,000 individuals. It may result from either genetic conditions or acquired lesions of the hypothalamo-pituitary region. Clinical features may include short stature, impaired sexual maturation, hypothyroidism, and/or hypocortisolism. Association between TS and Hypopituitarism is an unusual finding. Only scarce cases are reported in the literature and pathophysiological mechanisms are still unknown. Thus, it was reported in two cases where a combined growth hormone, gonadotrophin, and thyrotrophin deficiency was confirmed [3]. Recently, we have reported 3 familial cases affected with both TS and Hypopituitarism [4].
The Prevalence of Brain Abnormalities in Japanese Patients with Optic Nerve Hypoplasia
Published in Neuro-Ophthalmology, 2021
Megumi Kiyokawa, Satoshi Ueki, Tetsuhisa Hatase, Takako Hanyu, Takeo Fukuchi
The prevalence of SOD in this study was 37.5% (6/16 patients); three of the six patients with SOD had pituitary hypofunction and received replacement therapy. Two out of the three patients with pituitary hypofunction had no pituitary morphological abnormalities on MRI. Three studies that performed brain MRI in ONH patients with hypopituitarism reported a prevalence of pituitary morphological abnormalities of 96%,14 88%,15 and 54%,16 respectively. This indicates that pituitary morphological abnormalities are not always detected by brain MRI in patients with hypopituitarism. ONH patients with pituitary hypofunction have demonstrated growth hormone deficiency, hypothyroidism, adrenal hormone deficiency, diabetes insipidus, and reduced gonadotropic hormone.16,17 Although most cases of growth hormone deficiency and hypothyroidism are diagnosed by age 2,17 gonadotropic hormone deficiency does not manifest until adolescence.16 Therefore, long-term follow-up is required in patients with SOD and pituitary hypofunction.
Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care
Published in Journal of Medical Economics, 2021
Antonio Ribeiro-Oliveira, Richard A. Brook, Kathryn A. Munoz, Ian A. Beren, John D. Whalen, Nathan L. Kleinman, Kevin C. J. Yuen
Patients with hypopituitarism and concurrent secondary adrenal insufficiency may be at a greater risk of developing episodes of adrenal crisis. This may prompt visits to the ED, which then subsequently drive up the ED costs30. However, we found that the ED costs for patients with acromegaly and hypopituitarism were not higher than for those without hypopituitarism. A possible explanation for this finding is that the patients with acromegaly and hypopituitarism may have a low prevalence of adrenal insufficiency, as the recovery of the hypothalamic–pituitary–adrenal axis is more frequent in these patients than patients with non-functioning adenoma after surgery31, and thus not needing to present to the ED as frequently as anticipated for possible episodes of adrenal crisis.