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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
There are a wide range of pathologies of the pituitary gland, the clinical manifestations of which reflect the complexity of a diverse organ formed of two constituent parts and various different cell types. Broadly, anterior pituitary diseases include congenital hypopituitarism and isolated growth hormone deficiencies, in addition to the development of functioning and non-functioning pituitary adenomas. This chapter will focus on clinical presentations arising from the development of anterior pituitary adenomas. Disease of the posterior pituitary tends to be acquired and will also be discussed, albeit in less detail.
Replacement therapy in adult hypopituitarism
Published in Philip E. Harris, Pierre-Marc G. Bouloux, Endocrinology in Clinical Practice, 2014
Anna G. Nilsson, Gudmundur Johannsson
Hypopituitarism is a complex endocrine disease, often with serious underlying conditions, such as a tumor and a complex multiple pituitary hormone insufficiency. Data demonstrate that although endocrine replacement therapy is performed, outcome in terms of morbidity and mortality is compromised. These patients have high frequency of the metabolic syndrome and compromised quality of life. There is an increased knowledge of individualized management of each of the hormone axes and of their hormone–hormone interactions. There is also an increasing trend of managing patients in multidisciplinary teams, including endocrinologists with special interest in pituitary diseases, neuroradiology, and neurosurgery. A core feature in the management of hypopituitarism is also patient education, particularly concerning their glucocorticoid replacement for adrenal insufficiency and desmopressin therapy for DI. All the above-mentioned changes and trends are likely to contribute to the improvements in outcome of patients with hypopituitarism as seen in more recent studies.
Clinical relevance of insulin-like growth factor-1 to cardiovascular risk markers
Published in The Aging Male, 2020
Ko Harada, Yoshihisa Hanayama, Mikako Obika, Koichi Itoshima, Ken Okada, Fumio Otsuka
After being categorized into three groups, 64 patients (15.0%) had functional pituitary diseases including prolactinomas and Cushing’s disease, 98 patients (23.0%) had nonfunctional pituitary diseases including pituitary adenomas, Rathke’s cleft cysts, and panhypopituitarism, and 265 patients (62.1%) did not have pituitary diseases, and were categorized as “non-pituitary cases”. The average IGF-1 levels in pituitary disease, nonfunctional pituitary disease, and non-pituitary cases were 168.8 ± 122.4, 94.8 ± 51.5 and 113.0 ± 49.0, respectively (Figure 3(A)). The group with functional pituitary diseases had significantly higher IGF-1 levels than those in other groups (p < .01). Laboratory data, including the levels of IGF-1, Hb, Hct, CRP, PCT, D-dimer and FDP, of all the cases and each group are shown in Supplemental Table 1. Among the non-pituitary cases requiring IGF-1 estimation, symptoms related to acromegaly including hypertension (18%), diabetes (8%), and sleep apnea (6%), and symptoms associated with adult growth hormone deficiency such as fatigue (30%) and depression (7%) were common; anorexia nervosa (4%) was also observed; comparison of IGF-1 levels between these groups demonstrated significantly lower IGF-1 levels in patients with anorexia nervosa than in those with any other symptoms (p < .05) (Figure 3(B)).
Sheehan’s syndrome and sickle cell disease: the story of Natasha*
Published in Neuropsychological Rehabilitation, 2018
Barbara A. Wilson, Anita Rose, Gerhard Florschutz
The majority of papers published on SS do not mention psychological or neuropsycholgical sequelae. Of those that do, mood disorders are sometimes reported. One paper describes major depression in a Turkish woman with SS (Tıkır, Göka, Aydemir, & Gürkan, 2015). Looking at pituitary diseases in general, Weitzner, Kanfer, and Booth-Jones (2005) state there is a clear link between pituitary disease and psychiatric disturbance including anxiety, depression, personality change and behavioural problems. In addition, there are a few reports of psychoses in women with SS. These include a 23-year-old Indian woman (Kale, Nihalani, Karnik, & Shah, 1999), a 48-year-old Korean woman (Hong, Cho, Kang, Chung, & Chung, 2006), and a 31-year-old Iranian woman (Shoib et al., 2013). All improved with treatment. It is interesting to note here that psychiatric complications have been reported following treatment with corticosteroids (Dubovsky, Arvikar, Stern, & Axelrod, 2012; McGrath, Pun, James, & Holewa, 2007).
Perioperative nasal and paranasal sinus considerations in transsphenoidal surgery for pituitary disease
Published in British Journal of Neurosurgery, 2020
Lisa Caulley, Ravindra Uppaluri, Ian F. Dunn
Several anatomic and pathologic features must be considered in the endonasal approach to the skull base. We provide a series of recommendations for management of the paranasal sinuses and endonasal corridor to optimize surgical outcomes and patient quality of life (Table 1). Further studies are needed to determine standardized perioperative measures to be taken in endoscopic skull base surgery for pituitary diseases. In order to further advance transsphenoidal management of pituitary diseases, standardized algorithms and outcome metrics are needed to ensure quality assurance. The implementation of a standardized treatment algorithms, as proposed in this manuscript, will improve surgical and patient-reported outcomes, and increase comparability across research studies.