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Best Practice & Research. Clinical... May 2022Pituitary autoimmunity is one of the principal causes of hypopituitarism. Additionally, hypophysitis is one of the immune-related adverse events associated with... (Review)
Review
Pituitary autoimmunity is one of the principal causes of hypopituitarism. Additionally, hypophysitis is one of the immune-related adverse events associated with immunotherapy. Recent case-oriented research has revealed a novel type of autoimmune hypophysitis, anti-PIT-1 hypophysitis, related to isolated adrenocorticotropic hormone (ACTH) deficiency and immune checkpoint inhibitor-related hypophysitis, as a form of paraneoplastic syndrome. Under these conditions, the ectopic expression of pituitary antigens present in tumors evokes a breakdown of immune tolerance, resulting in the production of autoantibodies and autoreactive cytotoxic T cells that specifically harm pituitary cells. Consequently, an innovative clinical entity of paraneoplastic autoimmune hypophysitis has been purported. This novel concept and its underlying mechanisms provide clues for understanding the pathogenesis of autoimmune pituitary diseases and can be applied to other autoimmune diseases. This review discusses the etiology of paraneoplastic autoimmune hypophysitis and its future.
Topics: Adrenocorticotropic Hormone; Autoantibodies; Autoimmune Diseases; Autoimmune Hypophysitis; Endocrine System Diseases; Genetic Diseases, Inborn; Humans; Hypoglycemia; Hypophysitis; Pituitary Diseases
PubMed: 34876362
DOI: 10.1016/j.beem.2021.101601 -
Endocrinology and Metabolism Clinics of... Mar 2015Pituitary hormones have direct and indirect effects on bone remodeling, and skeletal fragility is a frequent complication of pituitary diseases. Fragility fractures may... (Review)
Review
Pituitary hormones have direct and indirect effects on bone remodeling, and skeletal fragility is a frequent complication of pituitary diseases. Fragility fractures may occur in many patients with prolactinomas, acromegaly, Cushing disease, and hypopituitarism. As in other forms of secondary osteoporosis, pituitary diseases generally affect bone quality more than bone quantity, and fractures may occur even in the presence of normal or low-normal bone mineral density, making difficult the prediction of fractures in these settings. Treatment of excess and defective pituitary hormone generally improves skeletal health, although some patients remain at high risk for fractures, necessitating treatment with bone-active drugs.
Topics: Bone Diseases; Fractures, Bone; Humans; Pituitary Diseases
PubMed: 25732653
DOI: 10.1016/j.ecl.2014.10.014 -
Best Practice & Research. Clinical... Apr 2019Pituitary incidentalomas (PIs) represent a modern clinical entity increasingly recognized due to advances and easier accessibility to imaging techniques. By definition,... (Review)
Review
Pituitary incidentalomas (PIs) represent a modern clinical entity increasingly recognized due to advances and easier accessibility to imaging techniques. By definition, PIs should be detected during brain imaging performed for investigation of a non-pituitary disease. Although anatomic variations, technical artefacts or pituitary hyperplasia might also be interpreted as PIs, the most relevant incidentally detected lesions are those that fulfill radiological criteria for a pituitary adenoma in asymptomatic patients or in the presence of subclinical diseases. The natural history of PIs is not fully determined, but there is a wealth of evidence indicating that most microincidentalomas (lesions < 10 mm) have a benign course, whereas macroincidentalomas (≥10 mm) deserve more attention due to an increased risk for hormone abnormalities and mass effects. This concept is important to keep in mind for an optimal diagnostic and therapeutic management of PIs that avoids harmful iatrogenesis and unnecessary health care costs.
Topics: Adenoma; Asymptomatic Diseases; Humans; Incidental Findings; Neuroimaging; Pituitary Neoplasms
PubMed: 31027975
DOI: 10.1016/j.beem.2019.04.002 -
Endocrinology and Metabolism Clinics of... Mar 2015In this article, an overview is presented of hypophysitis in terms of current clinical and experimental findings, with discussion of the anatomic and histopathologic... (Review)
Review
In this article, an overview is presented of hypophysitis in terms of current clinical and experimental findings, with discussion of the anatomic and histopathologic classification of primary hypophysitis and factors associated with secondary hypophysitis. In addition, discusses the pathophysiology, clinical features, management, and prognosis associated with this disease are discussed.
Topics: Humans; Pituitary Diseases
PubMed: 25732650
DOI: 10.1016/j.ecl.2014.10.011 -
Neurologic Clinics Feb 2019Pregnancy is associated with alterations in pituitary hormonal function and enlargement of the pituitary gland. Pituitary dysfunction diagnosis can be challenging during... (Review)
Review
Pregnancy is associated with alterations in pituitary hormonal function and enlargement of the pituitary gland. Pituitary dysfunction diagnosis can be challenging during pregnancy due to known alterations in hormonal status. Pituitary disorders are relatively common; with advancements in medical care, more women with pituitary disorders are becoming pregnant. Management includes optimization of hormonal function and close monitoring for signs of tumor progression during pregnancy. Tumor-directed medical therapy is generally discontinued during pregnancy but can be reinitiated if there is evidence of tumor growth. Most women do not show aggressive tumor growth during pregnancy and can be managed conservatively until delivery.
Topics: Female; Humans; Pituitary Diseases; Pregnancy; Pregnancy Complications
PubMed: 30470276
DOI: 10.1016/j.ncl.2018.09.009 -
Endocrinology and Metabolism Clinics of... Sep 2019Diagnosis of lymphocytic hypophysitis occurring in the peripartum period is based on clinical and neuroradiological data and does not require a biopsy. Its course is... (Review)
Review
Diagnosis of lymphocytic hypophysitis occurring in the peripartum period is based on clinical and neuroradiological data and does not require a biopsy. Its course is generally spontaneously favorable in terms of mass effect but may require the administration of corticosteroids or even transsphenoidal resection. The course of pituitary deficiencies is highly variable; some cases recover over time, whereas others persist indefinitely. Sheehan syndrome is very rare in developed countries. Because agalactia and amenorrhea are often neglected, the diagnosis is generally delayed. Diabetes insipidus occurring in late pregnancy is caused by the increased placental production of vasopressinase and disappears after delivery.
Topics: Diabetes Insipidus; Female; Humans; Hypopituitarism; Pituitary Diseases; Pregnancy; Pregnancy Complications
PubMed: 31345525
DOI: 10.1016/j.ecl.2019.05.005 -
Histopathology Jan 2018The increasing recognition of pituitary disorders and their impact on quality of life and longevity has made understanding of this small gland a subject of paramount... (Review)
Review
The increasing recognition of pituitary disorders and their impact on quality of life and longevity has made understanding of this small gland a subject of paramount importance. Pituitary pathology has seen many significant studies that indicate progress in identification and classification of pituitary lesions, as well as improved management strategies for patients. In this review, we outline six major areas of advances: (i) changes in terminology from 'adenoma' to 'pituitary neuroendocrine tumour'; (ii) reclassification of hormone-negative tumours based on transcription factor expression that defines lineage; (iii) updates in new pathogenetic mechanisms, including those that underlie rare lesions such as X-LAG and pituitary blastoma; (iv) clarification of hypophysitis due to immunotherapy, xanthomatous hypophysitis due to rupture of a Rathke's cleft cyst and IgG4 disease as the cause of inflammatory pseudotumour; (v) the consolidation of pituicytoma variants, including spindle cell oncocytoma and granular cell tumour based on thyroid transcription factor-1 (TTF-1) reactivity; and (vi) the pathogenetic mechanisms that distinguish papillary from adamantinomatous craniopharyngioma. The remaining challenge is clarification of the pathogenetic mechanisms underlying the development of many of these disorders.
Topics: Humans; Pathology, Clinical; Pituitary Diseases; Pituitary Gland
PubMed: 29239033
DOI: 10.1111/his.13295 -
Best Practice & Research. Clinical... Apr 2019Decision-making in pituitary disease is critically dependent on high quality imaging of the sella and parasellar region. Magnetic resonance imaging (MRI) is the... (Review)
Review
Decision-making in pituitary disease is critically dependent on high quality imaging of the sella and parasellar region. Magnetic resonance imaging (MRI) is the investigation of choice and, for the majority of patients, combined T1 and T2 weighted sequences provide the information required to allow surgery, radiotherapy (RT) and/or medical therapy to be planned and long-term outcomes to be monitored. However, in some cases standard clinical MR sequences are indeterminate and additional information is needed to help inform the choice of therapy for a pituitary adenoma (PA). This article reviews current recommendations for imaging of PA, examines the potential added value that alternative MR sequences and/or CT can offer, and considers how the use of functional/molecular imaging might allow definitive treatment to be recommended for a subset of patients who would otherwise be deemed unsuitable for (further) surgery and/or RT.
Topics: Adenoma; Diagnosis, Differential; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Neuroimaging; Pituitary Diseases; Pituitary Neoplasms
PubMed: 31208872
DOI: 10.1016/j.beem.2019.05.002 -
European Journal of Endocrinology Feb 2023The aim of the study is to assess the distinguishing features of pregnancy-related hypophysitis (PR-Hy) compared to non-pregnancy autoimmune hypophysitis and to evaluate...
OBJECTIVE
The aim of the study is to assess the distinguishing features of pregnancy-related hypophysitis (PR-Hy) compared to non-pregnancy autoimmune hypophysitis and to evaluate the changing therapeutic approaches and outcomes in PR-Hy over time.
DESIGN
Retrospective analysis of all published cases with PR-Hy and 6 own cases.
METHODS
A PubMed search was performed and abstracts screened for publications with information on cases with PR-Hy from which full-text review was performed. Clinical features, diagnostic findings, and outcome in relation to treatment modalities in PR-Hy were assessed.
RESULTS
One hundred and forty-eight cases with PR-Hy were identified. PR-Hy was significantly delimited from non-PR-Hy by the frequent occurrence of the chiasmal syndrome (50% vs 13%, P < .0001), higher rate of intrasellar origin (94% vs 74%, P = .0005), lower rate of pituitary stalk involvement (39% vs 86%, P < .0001), and low rate of diabetes insipidus (12% vs 54%, P < .0001). The role of surgery in PR-Hy decreased over time while noninvasive treatment modalities increased. The recurrence rate after high-dose glucocorticoid therapy (33%) was high and exceeded that of surgery (2%) and conservative management (2%). In contrast to initial reports on PR-Hy, recent literature regarding outcome of mother's and child's health was positive. The frequency of spontaneous preterm delivery was not increased. Recurrent PR-Hy in a subsequent pregnancy was reported in only two females.
CONCLUSION
PR-Hy has distinct features that delineate the disorder from non-PR-Hy. With increasing experience in diagnosis, availability of adequate replacement therapy, and improved treatment modalities, PR-Hy has lost its threat and the outcome is encouraging.
Topics: Female; Child; Infant, Newborn; Humans; Pituitary Diseases; Retrospective Studies; Pituitary Gland; Diabetes Insipidus; Hypophysitis; Autoimmune Hypophysitis; Hypopituitarism; Magnetic Resonance Imaging
PubMed: 36655394
DOI: 10.1093/ejendo/lvad003 -
Neuroendocrinology 2020Over the last 2 decades, advances in the diagnosis and management of pituitary diseases have made it possible to attain an endocrine "cure" in a large proportion of... (Review)
Review
Over the last 2 decades, advances in the diagnosis and management of pituitary diseases have made it possible to attain an endocrine "cure" in a large proportion of patients. In other words, tumors can be excised or controlled with drugs, mass effects of the lesion on surrounding structures can be solved, and pituitary deficiencies can be substituted with all relevant hormones. While this is considered a satisfactory outcome for health care providers, patients often suffer from an aftermath of prior endocrine dysfunction exposure, with irreversible effects, both physically and psychologically, which have a great impact on their everyday life. Diagnostic delay, often of several years, adds a negative impact on health perception. This affects their social, professional, and family domains and determines their future life. Understanding that this may occur is important, and health care providers should offer information to prepare the patient for this difficult journey, especially in the case of acromegaly, Cushing disease, or hypopituitarism. In order to maintain a good quality of life (QoL) in the long-term, patients need to adapt to this new situation, something that may be difficult, since they often cannot continue with all the activities and rhythm they used to do. Depression is often the consequence of maladaptation to the new situation, leading to impaired QoL.
Topics: Acromegaly; Humans; Hypopituitarism; Patient Outcome Assessment; Pituitary ACTH Hypersecretion; Quality of Life
PubMed: 32101858
DOI: 10.1159/000506809