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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
The pituitary gland increases in size during pregnancy. A prolactinoma and its enlargement in pregnant women is concerning. A review of 16 investigations and among 246 pregnant patients showed a low incidence of symptomatic microadenoma (less than 10 mm in size), an increase in size of 1.6 percent. The incidence of symptomatic macroadenoma (more than 10 mm in size) showed 15.5 percent enlargement during pregnancy (Gemzell and Wang, 1979).
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.
Case 75
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
Pituitary tumours are benign or malignant, functioning or non-functioning and symptomatic or non-symptomatic. They are predominantly asymptomatic, benign, non-functioning tumours. The benign varieties are mainly adenomas and are classified as macro or microadenoma based on their size (greater or smaller than 1 cm). The most common functioning benign tumour is the prolactinoma. Other tumours include those causing acromegaly and Cushing disease.
Spontaneous preoperative pituitary adenoma resolution following apoplexy: a case presentation and literature review
Published in British Journal of Neurosurgery, 2020
Daniel G. Eichberg, Long Di, Ashish H. Shah, William A. Kaye, Ricardo J. Komotar
Twelve patients were diagnosed to have macroadenomas and one patient was diagnosed with a microadenoma. All tumors were non-hormone secreting. Six out of 13 patients (46%) showed signs of intrasellar hemorrhage on MRI and five showed compression of the optic nerve. Seven patients (54%) showed decrease concentrations of pituitary hormones on endocrine panels. Although some patients were administered analgesics for symptom relief or placed on hormone replacement therapy, none of the patients underwent surgical intervention. However, all tumors either regressed in size or completely resolved spontaneously. Eight cases (62%) resulted in complete resolution with remission of symptoms, three cases (23%) resulted in panhypopituitarism secondary to empty sella syndrome, one case resulted in a tumor that regressed in size but was still visible on MRI, and one case – the current presented case – resulted in complete spontaneous resolution, but subsequent regrowth of the tumor four years later. Twelve cases have attributed the spontaneous resolution of the tumor to necrosis following apoplexy, while the authors of one case hypothesized a viral etiology which was not explained further. Table 2 is a statistical summary and analysis of the data collected in Table 1.
Peripheral clock system circadian abnormalities in Cushing’s disease
Published in Chronobiology International, 2020
Vinicius Reis Soares, Clarissa Silva Martins, Edson Zangiacomi Martinez, Leonardo Domingues Araujo, Silvia Liliana Ruiz Roa, Lucas Ravagnani Silva, Ayrton Custodio Moreira, Margaret De Castro
All CD patients presented ACTH-dependent Cushing syndrome, with high (n = 11) or normal (n = 1) ACTH levels (16.4 ± 6.5 pmol/L; normal range: 2.2–11 pmol/L). All patients underwent MRI, 8 out of 12 patients presented microadenoma, 3 out of 12 macroadenoma, and one showed no visible pituitary tumor. All patients, except one, presented an ACTH and/or cortisol response after DDAVP (ACTH increment of 191.8 ± 254.4% and cortisol increment of 60.9 ± 37.4%). Six out of 12 patients underwent BIPSS due to small tumors or no evidence of pituitary tumor on MRI or discordant response to DDAVP test. All of them showed central/peripheral gradient, confirming the pituitary disease. Eleven CD patients were submitted to transsphenoidal surgery and six of them are in remission of disease (54.5%), five are under treatment with ketoconazole or ketoconazole and radiotherapy. Patient 10 was last evaluated in 2019 and has been followed with no transsphenoidal surgery so far.
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
MRI was performed in 23 (85.1%) of the patients and 4 (14.9%) had pituitary CT scan. A pituitary adenoma was identified in 27 (100%) patients; of these, pituitary macroadenoma was found in 92.5% (n = 25) subjects. Precise measurement of the maximal tumour size was reported in 22 (81.4%) patients. Where the tumour size was available, the mean (± SD) was 3.0 ± 0.75 cm. Of the 25 patients with a pituitary macroadenoma, 18 (72%) demonstrated extension beyond the confines of the sella, with optic chiasm compression occurring in all these 18 patients; extension into the cavernous sinus was reported in 12 of these 18 patients. Pituitary microadenoma was diagnosed in 2 (7.4%) patients. No patients were diagnosed with ectopic GH-secreting or GHRH-secreting tumours.