China
Africa
Explore chapters and articles related to this topic
Cushing's Syndrome
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Nelson's syndrome formerly occurred as a complication of bilateral adrenalectomy for Cushing's disease. Over a 10-year period 10% to 20% of patients treated in this way will develop the syndrome. This is now less common due to the treatment of choice now being surgical resection of the pituitary adenoma by the trans-sphenoidal approach. The mechanism is very straightforward: in the absence of the negative feedback effect of cortisol, the ACTH secreting pituitary adenoma expands, causing headaches, visual problems and, if not treated, hypopituitarism. The characteristic increased pigmentation is secondary to a melanocyte stimulating component of the ACTH precursor molecule, pro-opiomelanocortin. In cases where an adenoma is not radiologically demonstrable, exploration of the pituitary fossa with or without venous sampling is carried out in those patients with a positive high dose dexamethasone suppression test. If no adenoma is found, a hypophysectomy is often performed. In those centres where bilateral adrenalectomy is performed in the absence of pituitary irradiation, then over a period of time a proportion may develop Nelson's syndrome.
Oncology
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
Surgical treatment options for excision of breast cancer include mastectomy (radical, extensive radical, modified radical, simple [total], or subcutaneous), and lumpectomy (tylectomy). Oophorectomy (removal of the ovaries) is another surgical procedure sometimes used to reduce the level of endogenous ovarian hormones and temporarily regress hormone-dependent tumors. Adrenalectomy and hypophysectomy (excision of the adrenal and pituitary glands, respectively) are also utilized to decrease hormone secretions. Radiation therapy has been used for all types of breast cancer as primary, adjuvant, and palliative treatment. A number of chemotherapeutic agents are used successfully in treatment, particularly in multidrug regimens. Hormonal manipulation has also been a significant addition to treatment options. Use is determined by the presence of estrogen receptor protein (ERP) in the tumor tissue.
Prolactin and Non-Neoplastic and Neoplastic Lesions of the Prostate: On Clinical Problems
Published in Nagasawa Hiroshi, Prolactin and Lesions in Breast, Uterus, and Prostate, 2020
PRL might increase the concentration gradient by so increasing either the magnitude or affinity of the cytosolic or nuclear receptors as to more aggressively deplete free DHT within the cell. The androgen levels are 30 to 50% lower in prostatic nuclei from testosterone-treated hypophysectomized rats than in those from castrated rats perfused with the same concentration of testosterone.64 This suggests that there may be fewer androgen receptors after hypophysectomy with its consequent elimination of PRL. In further support of this idea, administration of oPRL (ovine PRL) to testosterone-treated, hypophysectomized-cas-trated rats increased the androgen level in the prostatic nuclei. Baker et al.64 noted that the effects of hypophysectomy and PRL treatment could alter either the number of androgen receptors in individual cells or the proportion of androgen-responsive cells. The latter is a possibility because PRL treatment caused proliferation of the epithelium of the prostate. Moreover, Coert et al.65 and Baranao et al.66 found that hyperprolactinemia causes an increase in nuclear androgen receptors and a decrease in cytosolic androgen receptors in the rat ventral prostate.67
Acute severe Cushing’s disease presenting as a hypercoagulable state
Published in Baylor University Medical Center Proceedings, 2021
Maria Mohammed Fariduddin, Wajihuddin Syed, Vidita Divan, Prashant Nadkarni, Ruban Dhaliwal
The refractory and profound hypokalemia, wide excursions in blood glucose, and vertebral compression fractures in the setting of a hypercoagulable state raised suspicion of hypercortisolism. Laboratory testing revealed elevated random cortisol, loss of circadian rhythm with elevated midnight cortisol, and failure of a low-dose dexamethasone suppression test (DST) (Table 1). A high-dose DST showed a response with relative decline of cortisol and ACTH. No masses were seen on CT imaging of the chest, abdomen, and pelvis. No pituitary enlargement or intracranial masses were seen on magnetic resonance imaging (MRI). A corticotropin-releasing hormone stimulation test showed an immediate rise in ACTH and cortisol. Subsequently, inferior petrosal venous sinus sampling showed lateralization to the right, confirming a pituitary microadenoma as the source of excessive ACTH. A transsphenoidal hypophysectomy was planned. In the midst of investigations, the patient developed another pulmonary embolism complicated by bacterial pneumonia, resulting in significant deterioration of her clinical status, and she unfortunately succumbed to the disease.
Very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor
Published in Pediatric Hematology and Oncology, 2020
Diana M. Fridlyand, Frank G. Keller, Himalee S. Sabnis, Briana C. Patterson, Judith A. Gadde, Jason H. Peragallo, Valérie Biousse, Daniel S. Wechsler
Although fewer than 10 percent of pituitary lesions are non-adenomatous,17,18 a broad differential diagnosis must be considered in patients with a history of ALL who present with neurologic symptoms, visual changes, or pituitary hormone abnormalities. As suggested in the aforementioned cases, patients with a history of malignancy warrant special attention with consideration of leukemic infiltrate of the pituitary when presenting with symptoms or imaging findings consistent with a pituitary lesion. A pituitary lesion in a patient with a history of hematologic malignancy should prompt thorough evaluation with MRI, evaluation of hypothalamic-pituitary hormones, and evaluation of peripheral blood, bone marrow, and cerebrospinal fluid for evidence of malignancy. While hypophysectomy was a consideration in our patient, the constellation of other findings consistent with recurrent ALL prompted initiation of systemic and CNS-directed chemotherapy that resulted in complete resolution of the pituitary mass. This case highlights the importance of recognizing that relapsed or recurrent ALL can manifest as pituitary infiltration that can mimic a pituitary adenoma. Treatment with ALL-directed chemotherapy led to resolution of the pituitary mass and avoided unnecessary hypophysectomy and risk of acute surgical hypopituitarism, although the patient requires ongoing close endocrine follow-up for late development of radiation associated endocrine deficiencies.
FSH/AMH Ratio and Adipocyte Size are Linked to Ovarian Dysfunction
Published in Endocrine Research, 2020
Jackson A. Roberts, Ryann M. Carpenter, Sarah N. Blythe, Natalia Toporikova
The FSH/AMH ratio presents a possible clinical marker of ovarian health because the two hormones regulate follicle recruitment in tandem. AMH secretion begins after a follicle is selected from primordial to primary status, with maximal levels of expression in small antral follicles.45 This process of initial recruitment drives the continuous selection of primordial follicles for subsequent growth and relies primarily on local factors within the ovary.46 Interestingly, an absence of FSH achieved through hypophysectomy results in decreased initial recruitment.47 However, it is important to note that follicles are not sensitive to gonadotropins until after initial recruitment has occurred.48 Instead, AMH may indirectly inhibit the initial recruitment of primordial follicles and decreases the sensitivity of antral follicles to FSH-stimulated differentiation required for cyclic recruitment.13