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Pituitary incidental adenomas
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Central hyperthyroidismTreatment of central hyperthyroidism is necessary to reduce the risk of maternal and fetal complications.Minimal data exist to provide optimal recommendations during pregnancy.For a macroadenoma, transsphenoidal surgery to remove or reduce the tumor size is the optimal treatment and can be offered during pregnancy.If surgery is not possible or if the patient opts to defer surgery until after delivery, medical management of hyperthyroidism with a β-blocker and propylthiouracil during the first trimester or methimazole during the second and third trimesters can temper the thyroidal production of thyroid hormone and symptoms of thyrotoxicosis.8,9If surgery is not performed, regular assessment of visual fields and monitoring of compressive symptoms are essential.
Dopamine and Tumorigenesis in Reproductive Tissues
Published in Nira Ben-Jonathan, Dopamine, 2020
In view of these conflicting findings, an integrated hypothesis that reconciles the two theories has emerged. It stipulates an occurrence of a certain genomic alteration (the identity of which is unknown) that transforms a single lactotroph as the initial step. The transformed cell escapes normal cell cycle regulation and starts proliferating in response to local growth factors that are abundant in the pituitary, e.g., fibroblast growth factor (FGF), epidermal growth factor (EGF), transforming growth factor alpha (TGFα), or TGFβ. Because transformed cells proliferate faster than normal cells, they are at an increased risk of additional genetic alterations, further promoting tumor progression. Among these could be loss of responsiveness to DA due to mutations in the D2R or its signaling pathways. Although some reduction in D2R expression and receptor density has been reported in prolactinomas, this applies only to the 10%–15% of those tumors that are resistant to bromocriptine therapy and does not offer a universal mechanism that explains the pathogenesis of prolactinomas. It is also important to emphasize that micro-prolactinomas grow very slowly in most patients and do not normally progress to become macroprolactinomas. In fact, the risk of progressing from a microadenoma to a macroadenoma is estimated to be no more than 4%–7% [18]. This suggests that aggressive macroadenoma represent a different and distinct entity, indicating a different etiology of the two types of tumors.
Medical Treatment of Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Marlon P. Martinez, Mohamed Arafa, Haitham Elbardisi
The Endocrine Society has formulated a Clinical Practice Guideline for the diagnosis and treatment of hyperprolactinemia [36]. Prolactin measurement of more than 500 ug/L is consistent with macroprolactinoma, although presence of prolactinoma may be evident in a prolactin level greater than 250 ug/L. Likewise, even a slight increase in the level of prolactin may indicate the presence of prolactinoma. Treatment with dopamine agonist is recommended to decrease prolactin level and tumor size. This results in subsequent restoration of gonadal functions for those patients with symptomatic microadenoma or macroadenoma. Due to superior outcomes in normalization of prolactin level and greater reduction of tumor size, cabergoline is the preferred dopamine agonist over bromocriptine. For those patients presenting with positive outcomes, discontinuation of the medication can be considered after at least 2 years of treatment.
Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years
Published in Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2018
Abdurraouf Masaud Elbueishi, Fraser J Pirie, Ayesha A Motala
The presenting features of patients in the current study related primarily to tumour mass effect and this was corroborated by the finding of pituitary macroadenoma on MRI in all but two of the patients. In other studies, a lower prevalence of these symptoms has been reported: headache in 47% and visual field defects in 18–21% and, in these studies, 79.6% of patients had macroadenoma.5 The high prevalence of macroadenoma at the time of diagnosis in the current study reflects presentation with advanced disease and delayed diagnosis in many patients. This may be due to the insidious nature of the disease, low index of suspicion in peripheral hospitals and clinics and the specifics of the referral system in KwaZulu-Natal.
Post-treatment heterogeneity of cardiometabolic risk in patients with acromegaly: The impact of GH and IGF-1
Published in Endocrine Research, 2022
Mahshid Heydari, Nahid Hashemi-Madani, Zahra Emami, Alireza Khajavi, Mohammad Ghorbani, Mojtaba Malek, Manizhe Ataei Kachuee, Mohammad E. Khamseh
The studied population consisted of 102 patients of whom 51.0% (n = 52) were men. The mean age of the participants was 40.8 (±12.2) years. Table 1 depicts the clinical, biochemical, and radiologic characteristics of the patients at the time of diagnosis. The acral enlargement was the most common clinical presentation (84.2%) followed by headache (59.4%), arthralgia (57.4%), and diaphoresis (40.6%). MRI revealed macroadenoma in 75% (n = 57) of the patients, with the mean tumor size of 18.9 (±11.3) mm. The mean levels of basal GH and IGF-1 were 18.2 ng/ml (± 19.7) and 750.1 ng/ml (± 318.9), respectively. The mean IGF-1 level was shown to be 3.0 (± 1.3) times ULN.
Specific FSTL1 polymorphism may determine the risk of cardiomyopathy in patients with acromegaly
Published in Acta Cardiologica, 2022
Suleyman Nahit Sendur, Tuncay Hazirolan, Busra Aydin, Incilay Lay, Mehmet Alikasifoglu, Tomris Erbas
Thirty-five (81.4%) patients had macroadenoma. Except one (2.2%), all had a history of surgery (only one patient had both transcranial and transsphenoidal surgery, rest had transsphenoidal surgery). Radiotherapy was performed to ten patients (three had conventional, seven had cyberknife). Most subjects (73.9%) were on somatostatin receptor ligand therapy. None of the patients was using cabergoline or pegvisomant. The most frequent pituitary hormone deficiency was hypogonadotropic hypogonadism in 18 (39.1%). Only two (4.3%) patient had diabetes insipidus. Diabetes mellitus and hypertension were the most common metabolic comorbidities, 32.6 and 54.3%, respectively (Table 1).