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Primary Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Oestrogen and testosterone replacement are the usual method of sex hormone replacement for males and females, respectively, with gonadotropin deficiency. Gonadal steroid replacement will not, however, induce fertility. Patients who are seeking to conceive must therefore receive gonadotropin therapy.
Late Effects of Treatment for Childhood Brain and Spinal Tumors
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Ralph Salloum, Katherine Baum, Melissa Gerstle, Helen Spoudeas, Susan R. Rose
Gonadotropin deficiency can occur after hypothalamic–pituitary irradiation ≥30 Gy (occurring less frequently than GHD).93,101 Of females who have survived a brain tumor and received >50 Gy, 10.6% had late menarche.93 Brain tumor survivors were less likely than normal women to become pregnant after being exposed to ≥30 Gy.101 Patients with gonadotropin deficiency can have delayed, interrupted, or absent puberty.45
Endocrinology and diabetes
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Treat gonadotropin deficiency with sex-appropriate hormones. In men, testosterone replacement is used and modified if the patient desires fertility. In women, oestrogen replacement is used with or without progesterone as appropriate.
Pediatric pituitary adenoma with mixed FSH and TSH immunostaining and FSH hypersecretion in a 6 year-old girl with precocious puberty: case report and multidisciplinary management
Published in International Journal of Neuroscience, 2022
Marco Ceraudo, Diego Criminelli Rossi, Natascia Di Iorgi, Armando Cama, Gianluca Piatelli, Alessandro Consales
The overall prevalence of precocious puberty, independently of etiology, is estimated in females around 20–23 per 10,000 cases, 0.2% in girls and less than 0.05% in boys [21], with a reported prevalence of precocious puberty secondary to intracranial tumor around 1,9% between the ages of 6 and 8 years in females [22]. The prevalence of central precocious puberty was reported to be slightly higher in patients with tumors of the hypothalamic-pituitary region [23]. Differential diagnosis includes different brain tumors, arachnoid cysts, hypothalamic hamartomas, hydrocephalus, radiation therapy on the central nervous system and genetic disorders [20]. A condition of central precocious puberty induced by pituitary adenoma with FSH hypersecretion is not common in pediatric age, even less in childhood. This condition can lead to obesity, gonadotropin deficiency, incomplete growth and final height. The primal goal was to remove the pituitary tumor in order to save the visual function and restore normal values of FSH. Surgery and Triptorelin therapy were fundamental to improve clinical conditions and resume the normal growth curve. Later, however, the girl developed a GHD secondary to pituitary damage due to mass effect as already revealed by the diagnosis of multiple pituitary defects before surgery. Endoscopic transsphenoidal approach was performed in children as standard surgery for pituitary lesions like in adult patients, confirming the advantages described by Locatelli et al. [2], also in extremely young patients like ours. To obtain optimal results, these complex cases should be managed by a muldisciplinary “pituitary team” composed by endocrinologist, neuroradiologist, neuroncologist and neurosurgeon. This strategy is fundamental in order to achieve early and correct diagnosis, aimed treatments and tailored follow up.
Hypopituitarism 3 and 12 months after traumatic brain injury and subarachnoid haemorrhage
Published in Brain Injury, 2018
Asta Dogg Jonasdottir, Petur Sigurjonsson, Ingvar Hakon Olafsson, Sigurbergur Karason, Gudmundur Sigthorsson, Helga Agusta Sigurjonsdottir
Somatotrophic and corticotrophic function were assessed using an insulin tolerance test (ITT). A GHRH-Arginine test and a Synachten test were performed if an ITT was contraindicated. ITT was performed by administering 0.10–0.20 U/kg soluble insulin i.v. (Actrapid) to induce hypoglycaemia (defined as blood glucose <2.1 mmol/l). Blood was collected for measurement of serum glucose, GH and cortisol as well as plasma ACTH at −10 min, 0 min, +10 min, +20 min, +30 min, +40 min, +60 min, +90 min, +120 min. GHD was defined as a peak value of serum GH < 3 µg/l. Corticotropin deficiency was defined as a peak serum cortisol < 500 nmol/l (33). When the target blood glucose value was not achieved (measured via capillary blood glucose levels) an additional insulin bolus was administrated in an attempt to achieve hypoglycaemia. All but one ITT were performed by the same staff. The GHRH + Arginine was performed by administering 1.0 µg/kg of GHRH at 0 min and 0.5 g/kg (max 30 g) Arginine from min 0 to min 30 by an infusion. Blood samples were drawn for serum GH analysis at −30 min, −15 min, 0 min, +15 min, +30 min, +45 min, +60 min, +90 min. GHD was defined as a peak GH below BMI dependent cut-off levels (34). The Synacthen test was performed by intramuscular injection of 250 µg Synachten. Blood samples for serum cortisol were collected at baseline, +30 min and +60 min. Corticotropin deficiency was defined as a peak cortisol <500 nmol/L (33). Gonadotropin deficiency in men was defined as serum testosterone below the reference range in the presence of inappropriately low gonadotropins. Gonadotropin deficiency was defined as oligomenorrhoea/amenorrhoea in premenopausal women and in postmenopausal women as gonadotropins in premenopausal range. Thyrotropin deficiency was defined as fT4 below the reference range in the presence of inappropriately low TSH.
Testosterone, sex steroids, and aging in neurodegenerative disease after acquired brain injury: a commentary
Published in Brain Injury, 2020
Popovic et al. compared male individuals with moderate-to-severe TBI (GCS) who were at least 1 year after injury to healthy control subjects matched on age and BMI (11). The authors found 9% had gonadotropin deficiency as defined by low testosterone (undefined by authors) and 5% were hyperprolactinemic.