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Endocrine diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Late in the third trimester or early in the postpartum period, lymphocytic hypophysitis represents a rare cause of hypopituitarism or visual field defects. Anatomically, the disorder may be suspected by thickening of the pituitary stalk or by sellar mass, which cannot be distinguished from a pituitary tumor. The diagnosis is definitively established by surgical resection or biopsy demonstrating absence of tumor cells and diffuse lymphocytic infiltration (40). Clinically, lymphocytic hypophysitis is distinguished from Sheehan’s syndrome by the absence of obstetric hemorrhage in the former and its presence in the latter (49). If surgical biopsy is not undertaken, spontaneous resolution may occur (50,51), and attention should be given to treatment of hypopituitarism. The limited available experience suggests that ACTH deficiency is especially common (49), so assessment of the hypothalamic–pituitary–cortisol axis is especially important; identified deficiency should be treated with a cortisol agonist in standard physiologic replacement dose (e.g., hydrocortisone 20mg orally in the morning and 10mg in the late afternoon or equivalent).
The Endocrine System and Its Disorders
Published in Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss, Understanding Medical Terms, 2020
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss
The pituitary gland or hypophysis is located in a small cavity in the floor of the skull behind the bridge of the nose. It is about the size of a pea, consisting of two lobes secreting different hormones, and is connected to the hypothalamus by the pituitary stalk. Functions of the anterior (adenohypophysis) and posterior pituitary (neurohypophysis) are regulated by the hypothalamus, which also regulates thirst, appetite and caloric intake, sleep-wake behavior, emotions, autonomic balance, and cognition (a knowing or recognition).
Endocrine Glands
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Richard A. Peterson, Sundeep Chandra, Mark J. Hoenerhoff
The pituitary gland or hypophysis is situated within the sella turcica and, together with the hypothalamus, coordinates the structural integrity and functions of other endocrine glands. The pituitary stalk serves as an anatomic and functional connection to the hypothalamus (Figure 19.1a). The hypothalamus contains nerve cell bodies that synthesize hypophysiotropic-releasing and -inhibiting hormones, as well as the neurohypophyseal hormones of the posterior pituitary (arginine vasopressin [AVP] or antidiuretic hormone and oxytocin [OT]). The pituitary gland is divided into the anterior and posterior pituitary, two regions distinctive in their embryology, anatomy, and function. The anterior lobe (or adenohypophysis) is embryonically derived from an ectodermal evagination, the hypophyseal recess, or Rathke’s pouch, while the posterior lobe (or neurohypophysis) is derived from the diencephalic neuroectoderm. The anterior lobe is composed of an anterior portion (or pars distalis) and an intermediate lobe (or pars intermedia), and the pars tuberalis, which represents a dorsal projection or sleeve of cells, is situated around or along the infundibular stalk (Figure 19.1a). The median eminence of the tuber cinereum, the infundibular stalk, and the infundibular processes together make up the neurohypophysis or posterior lobe. Blood supply to the gland is from several sources.
Hypophysitis related to immune checkpoint inhibitors: An intriguing adverse event with many faces
Published in Expert Opinion on Biological Therapy, 2021
Maria V Deligiorgi, Charis Liapi, Dimitrios T Trafalis
The aforementioned mechanisms may rationalize the predilection of ir hypophysitis for the anterior pituitary. An alternative explanation for this predilection is the distinct vascularity of the anterior pituitary, which renders it more vulnerable to immunotherapy compared to the posterior pituitary. The anterior pituitary is the most richly vascularized mammalian tissue receiving 0.8 ml/gr/min from a portal circulation linking the median eminence of hypothalamus with the anterior pituitary. Arterial blood is supplied by the superior, middle, and inferior hypophysial artery branches of the internal carotid arteries. The pituitary stalk and the posterior pituitary are supplied directly from branches of the middle and inferior hypophysial arteries [27]. Contrary to the anterior pituitary that produces and secretes ACTH, LH/FSH, TSH, GH, PRL, the posterior pituitary secrets AVP stored in the distal axon terminals of the hypothalamic magnocellular neurons, the cell bodies of which synthesize AVP as a large precursor peptide [28].
Patients with true mixed growth hormone and prolactin-secreting pituitary adenoma: a case series of 12 patients
Published in British Journal of Neurosurgery, 2020
Daqiq Gulbadin, Zhiwei Li, Muhammad Shahbaz, Zeeshan Farhaj, Arzoo Shabbir, Qichao Qi, Kuanxiao Tang, Shilei Ni, Lei Sun
GH was measured using a chemiluminescence immunoassay kits (Beckman Coulter, Inc., CA, USA). The normal range of GH was 0–5.22 ng/ml. The diagnosis of acromegaly was based on an elevated IGF-1 level and failure to suppress GH in response to the 75 g oral glucose tolerance test (OGTT) to a level of <1 ng/ml.15 Remission criteria of acromegaly were (1) normal IGF-1 level, and (2) random serum GH < 1.0 ng/ml. Serum IGF-1 was measured using chemiluminescence immunoassay (AUTOBIO diagnostics Co., LTD, Zhengzhou, China), its normal range is age-related. The normal range of age (21–25 years old) is 116–358 ng/ml, age (26–30 years old) is 117–329 ng/ml, age (41–45 years old) is 101–267 ng/ml, age (46–50 years old) is 94–252 ng/ml, age (51–55 years old) is 87–238 ng/ml, and age (61–65 years old) is 75–212 ng/ml. The serum level of PRL was measured using chemiluminescence kits (Roche Diagnostics GmbH, Mannheim, Germany). To detect hormone levels the Access immunoassay system (UniCel DxI 800, Beckman Coulter, Inc., CA, USA) was used. The normal range of PRL was 2.6–18.1 ng/ml in males and 1.2–29.9 ng/ml in females. Levels up to 150 ng/ml were considered the effect of pituitary stalk compression.16 GH, PRL, and IGF-1 were measured preoperatively, postoperatively (within 24 h) and at follow-up (in the 12th month).
Childhood-onset craniopharyngioma: latest insights into pathology, diagnostics, treatment, and follow-up
Published in Expert Review of Neurotherapeutics, 2018
Agnieszka Bogusz, Hermann L. Müller
Treatment of CPs with suprasellar extension can be performed via transcranial approaches. CPs originating from the pituitary stalk and tumors involving the infundibulum with potential risk of severe surgical lesions can be approached via classical subfrontal or pterional route. There is considerable risk of surgical lesions to the pituitary stalk, as this structure frequently is imbedded in the tumor and therefore its identification is not always possible. Cystic tumor compartments can be fenestrated and decompressed for better removal of cyst wall or solid parts. Insertion of catheters into cystic compartments provides the treatment option of repeated aspiration of cyst fluid. Furthermore, catheter connection with a Rickham or Ommaya reservoir enables intracystic instillation of pharmacological agents such as interferon alpha.