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Endocrinology and metabolism
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Often caused by pituitary tumours. Other causes include sarcoid, TB, autoimmune disease, Sheehan’s syndrome and iatrogenic (e.g. surgery, radiation). Hormones are normally lost in a characteristic order (as below); prolactin is rarely affected: GH deficiency: dwarfism in children; but in adults – depression and effects on bone and muscle.LH/FSH deficiency (hypogonadism): in men – lower libido, impotence, loss of body hair, loss of sperm production; in women – amenorrhoea, decreased breast size, atrophy of the genitals.TSH deficiency: hypothyroidism.ACTH deficiency: loss of skin pigmentation, adrenal failure (see Addison’s). Management: hormone replacement with thyroxine, hydrocortisone, testosterone or oestrogen +/- GH. Note that large tumours may cause ADH deficiency, i.e. diabetes inspidius, and treatment is with a vasopressin analogue DDAVP (desmopressin).
Dopamine and Tumorigenesis in Reproductive Tissues
Published in Nira Ben-Jonathan, Dopamine, 2020
Pituitary tumors, classified as adenomas, represent 10%–15% of primary intracranial neoplasms. Unlike carcinomas, which are invasive malignant epithelial cells with a capacity for metastasis, adenomas are benign epithelial tumors of glandular origin that do not metastasize. Although both malignant and benign tumors exhibit dysregulated cellular proliferation, they differ in growth rates, degree of differentiation, invasiveness, and metastasis. Senescence, a cellular defense mechanism against malignant transformation, may explain the benign nature of many pituitary tumors [3]. The occurrence, diagnosis, cellular composition, and treatment of pituitary tumors are covered in several extensive reviews [4–6], and are briefly summarized below.
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
Different etiologies are linked to hyperprolactinemia even in physiological states. It can be caused by adenomas that account for 40% of all pituitary tumors [33]. It may also arise due to pharmacological or pathological disruption of the hypothalamic-pituitary dopaminergic pathways [34]. In a multicenter study with 1,234 hyperprolactinemic patients, the most common cause of hyperprolactinemia was prolactinomas (56.2%). Clinical manifestations of prolactinomas include local tumors mass effects aside from hyperprolactinemia. On magnetic resonance imaging (MRI), microadenomas are defined as tumors with a diameter of less than 1 cm. On the other hand, tumors larger than 1 cm are labeled as macroadenomas [34]. Other causes in the study included drug-induced hyperprolactinemia (14.5%), macroprolactinemia (9.3%), nonfunctioning pituitary adenoma (6.6%), primary hypothyroidism (6.3%), idiopathic hyperprolactinemia (3.6%), and acromegaly (3.2%) [35]. Hyperprolactinemia may lead to hypogonadism and subsequent infertility regardless of any etiologies [34]. In patients with symptomatic nonphysiological hyperprolactinemia, it is important to exclude medication use, renal impairment, hypothyroidism, pituitary, and parasellar tumors [36].
Reconstruction strategies for intraoperative CSF leak in endoscopic endonasal skull base surgery: systematic review and meta-analysis
Published in British Journal of Neurosurgery, 2022
Xiangming Cai, Jin Yang, Junhao Zhu, Chao Tang, Zixiang Cong, Yuxiu Liu, Chiyuan Ma
Data extracted were: author, publication year, sample size, gender composition, mean age, numbers of intra- and post- operative CSF leaks. Subgroup data were recorded based on pathology, magnitude of intraoperative CSF leak, reconstruction hierarchy level, and materials. Pituitary tumors and other diseases were considered separately. We classified intraoperative leaks as low-flow or high-flow.3,4 Some studies categorized the magnitude of intraoperative CSF leak rate as Grade 0–3, no leak being Grade 0 and low, middle, and high leaks being Grades 1-3. We classified both Grade 1 and 2 as low-flow and Grade 3 as high-flow. As various reconstruction techniques existed, we defined a reconstruction hierarchy having seven levels: (1) fat graft, filling the lesion cavity; (2) intracranial intradural layer (inlay), underlaying the dura; (3) intracranial extradural layer (onlay), overlaying the dura but underlaying the bone floor; (4) buttress, the bone floor; (5) mucosal flap, over the bony surface; (6) nasal packing, filling the nasal cavity; (7) lumbar drainage (LD) (Figure 2). The 7 levels were selected interactively, which means one or more levels would be applied in one patient. Reconstruction materials utilized in the fat graft, inlay, onlay, buttress and mucosal flap levels were classified as artificial, allogenetic, or autogenetic materials. We also separated the materials used in mucosal flaps into pedicled nasal septal flaps (NSF) vs. other materials. The materials applied in nasal packing included balloons and tampons.0
Posterior reversible encephalopathy syndrome in carcinoid tumor
Published in Baylor University Medical Center Proceedings, 2022
Thuy-Tien Ho, Venkatesh Aiyagari
The diagnosis of Cushing syndrome includes the finding of elevated 24-hour urine cortisol, midnight plasma and salivary cortisol, and a lack of suppression of serum cortisol after administration of dexamethasone. Cushing syndrome either is caused by hypercortisolism or is ACTH independent. Abdominal CT is usually the first diagnostic test. ACTH-dependent Cushing syndrome can be due to an ACTH-secreting pituitary adenoma and rarely due to a nonpituitary source such as small cell lung carcinoma, carcinoid tumors, medullary thyroid cancer, pheochromocytoma, or poorly differentiated neuroendocrine tumors. Plasma ACTH levels are typically high, more so with ectopic ACTH production.2 Pituitary MRI with gadolinium contrast detects approximately 50% of ACTH-producing pituitary tumors. If the pituitary MRI is normal, inferior petrosal sinus sampling will determine if the pituitary is the source of the ACTH production. An alternate approach is to perform a high-dose dexamethasone suppression or a corticotrophin-releasing hormone test. If the pituitary is not the source of ACTH production, CT and MRI of the neck, chest, and abdomen as well as scintigraphy with [111In]-pentetreotide for detection of neuroendocrine tumors is recommended.3 Surgical excision of tumors producing ACTH or cortisol is the optimal treatment for Cushing syndrome. Radiotherapy is an option for treatment of pituitary tumors. If surgery is not feasible, ketoconazole or metyrapone can be used. If medical treatment fails, bilateral adrenalectomy can be considered.
A new comprehensive grading for giant pituitary adenomas: SLAP grading
Published in British Journal of Neurosurgery, 2022
Dhaval Shukla, Subhas Konar, Akshay Kulkarni, Dhananjaya I. Bhat, Nishanth Sadashiva, Bhagavatula Indira Devi, Priyadarshi Dikshit, Sarthak Mehta, Chirag Jain
We conducted a retrospective review of case files and radiological images of patients with pituitary tumours who underwent surgery at our hospital. An ethics committee waiver was obtained by the Institute’s Ethics Committee due to the retrospective character of the study, and patient consent was not required. The records of patients who underwent surgery for the pituitary adenomas from January 2010 through December 2019 by surgeons DS and DIB in a single neurosurgical unit at the tertiary referral centre were retrieved. Patients with tumour diameter >4 cm in any dimensions were defined as giant adenomas and were included in the study. The primary aim of this study was to develop a comprehensive grading system to record all possible extensions of the GPAs. The secondary aim was to relate the degree of resection to the SLAP grading.