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The Journal of Clinical Endocrinology... Jan 2022Hypophysitis is defined as inflammation of the pituitary gland that is primary or secondary to a local or systemic process. Differential diagnosis is broad (including... (Review)
Review
Hypophysitis is defined as inflammation of the pituitary gland that is primary or secondary to a local or systemic process. Differential diagnosis is broad (including primary tumors, metastases, and lympho-proliferative diseases) and multifaceted. Patients with hypophysitis typically present with headaches, some degree of anterior and/or posterior pituitary dysfunction, and enlargement of pituitary gland and/or stalk, as determined by imaging. Most hypophysitis causes are autoimmune, but other etiologies include inflammation secondary to sellar tumors or cysts, systemic diseases, and infection or drug-induced causes. Novel pathologies such as immunoglobulin G4-related hypophysitis, immunotherapy-induced hypophysitis, and paraneoplastic pituitary-directed autoimmunity are also included in a growing spectrum of this rare pituitary disease. Typical magnetic resonance imaging reveals stalk thickening and homogenous enlargement of the pituitary gland; however, imaging is not always specific. Diagnosis can be challenging, and ultimately, only a pituitary biopsy can confirm hypophysitis type and rule out other etiologies. A presumptive diagnosis can be made often without biopsy. Detailed history and clinical examination are essential, notably for signs of underlying etiology with systemic manifestations. Hormone replacement and, in selected cases, careful observation is advised with imaging follow-up. High-dose glucocorticoids are initiated mainly to help reduce mass effect. A response may be observed in all auto-immune etiologies, as well as in lymphoproliferative diseases, and, as such, should not be used for differential diagnosis. Surgery may be necessary in some cases to relieve mass effect and allow a definite diagnosis. Immunosuppressive therapy and radiation are sometimes also necessary in resistant cases.
Topics: Adult; Aged; Autoimmunity; Diagnosis, Differential; Female; Humans; Hypophysitis; Magnetic Resonance Imaging; Male; Pituitary Gland; Rare Diseases
PubMed: 34528683
DOI: 10.1210/clinem/dgab672 -
Current Opinion in Pediatrics Aug 2019This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism. (Review)
Review
PURPOSE OF REVIEW
This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism.
RECENT FINDINGS
Updates in the field include new guidelines and meta-analyses on the diagnosis and treatment of select hormone deficiencies, novel treatment options, and advances in next generation sequencing technology.
SUMMARY
Hypopituitarism is defined as partial or complete loss of a single or multiple pituitary hormones. The clinical presentation of hypopituitarism varies depending on the number and severity of hormone deficiencies. Treatment involves the physiologic replacement of the individual end-organ hormone deficiencies and requires close lifelong monitoring.
Topics: High-Throughput Nucleotide Sequencing; Humans; Hypopituitarism; Pituitary Gland
PubMed: 31082937
DOI: 10.1097/MOP.0000000000000779 -
Radiologic Clinics of North America Nov 2020The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and... (Review)
Review
The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.
Topics: Female; Humans; Magnetic Resonance Imaging; Male; Neuroimaging; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Sella Turcica; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 33040852
DOI: 10.1016/j.rcl.2020.07.009 -
Comprehensive Physiology Mar 2020The development of the anterior pituitary gland occurs in distinct sequential developmental steps, leading to the formation of a complex organ containing five different... (Review)
Review
The development of the anterior pituitary gland occurs in distinct sequential developmental steps, leading to the formation of a complex organ containing five different cell types secreting six different hormones. During this process, the temporal and spatial expression of a cascade of signaling molecules and transcription factors plays a crucial role in organ commitment, cell proliferation, patterning, and terminal differentiation. The morphogenesis of the gland and the emergence of distinct cell types from a common primordium are governed by complex regulatory networks involving transcription factors and signaling molecules that may be either intrinsic to the developing pituitary or extrinsic, originating from the ventral diencephalon, the oral ectoderm, and the surrounding mesenchyme. Endocrine cells of the pituitary gland are organized into structural and functional networks that contribute to the coordinated response of endocrine cells to stimuli; these cellular networks are formed during embryonic development and are maintained or may be modified in adulthood, contributing to the plasticity of the gland. Abnormalities in any of the steps of pituitary development may lead to congenital hypopituitarism that includes a spectrum of disorders from isolated to combined hormone deficiencies including syndromic disorders such as septo-optic dysplasia. Over the past decade, the acceleration of next-generation sequencing has allowed for rapid analysis of the patient genome to identify novel mutations and novel candidate genes associated with hypothalmo-pituitary development. Subsequent functional analysis using patient fibroblast cells, and the generation of stem cells derived from patient cells, is fast replacing the need for animal models while providing a more physiologically relevant characterization of novel mutations. Furthermore, CRISPR-Cas9 as the method for gene editing is replacing previous laborious and time-consuming gene editing methods that were commonly used, thus yielding knockout cell lines in a fraction of the time. © 2020 American Physiological Society. Compr Physiol 10:389-413, 2020.
Topics: Animals; Humans; Morphogenesis; Pituitary Diseases; Pituitary Gland; Transcription Factors
PubMed: 32163208
DOI: 10.1002/cphy.c150043 -
The Lancet. Child & Adolescent Health Sep 2021Unexplained or idiopathic pituitary stalk thickening or central diabetes insipidus not only harbours rare occult malignancies in 40% of cases but can also reflect benign... (Review)
Review
Unexplained or idiopathic pituitary stalk thickening or central diabetes insipidus not only harbours rare occult malignancies in 40% of cases but can also reflect benign congenital defects. Between 2014 and 2019, a multidisciplinary, expert national guideline development group in the UK systematically developed a management flowchart and clinical practice guideline to inform specialist care and improve outcomes in children and young people (aged <19 years) with idiopathic pituitary stalk thickening, central diabetes insipidus, or both. All such cases of idiopathic pituitary stalk thickening and central diabetes insipidus require dynamic pituitary function testing, specialist pituitary imaging, measurement of serum β-human chorionic gonadotropin and alpha-fetoprotein concentrations, chest x-ray, abdominal ultrasonography, optometry, and skeletal survey for occult disease. Stalk thickening of 4 mm or more at the optic chiasm, 3 mm or more at pituitary insertion, or both, is potentially pathological, particularly if an endocrinopathy or visual impairment coexists. In this guideline, we define the role of surveillance, cerebrospinal fluid tumour markers, whole-body imaging, indications, timing and risks of stalk biopsy, and criteria for discharge. We encourage a registry of outcomes to validate the systematic approach described in this guideline and research to establish typical paediatric stalk sizes and the possible role of novel biomarkers, imaging techniques, or both, in diagnosis.
Topics: Adolescent; Child; Consensus; Diabetes Insipidus, Neurogenic; Humans; Organ Size; Patient Care Management; Pituitary Gland; Practice Guidelines as Topic
PubMed: 34214482
DOI: 10.1016/S2352-4642(21)00088-2 -
Vitamins and Hormones 2021The anterior pituitary is derived from Rathke's pouch precursors, which differentiate into specific hormone-secreting cell lineages. Sustained low postnatal and adult...
The anterior pituitary is derived from Rathke's pouch precursors, which differentiate into specific hormone-secreting cell lineages. Sustained low postnatal and adult pituitary cell turnover is governed by stem/progenitor cells that undergo slow mitotic activity and give rise to hormone-secreting cells in response to physiological demands and feedback loops. Pituitary cell populations exhibit stem cell properties, which include stem cell marker expression, non-hormone expression, and the ability to self-renew and to potentially differentiate into any of five hormone-secreting cell lineages. Specific signaling pathways underlie differentiated pituitary cell development and regulation. Several validated pituitary stem cell models have been reported and have the potential for functional regeneration of pituitary hormone-secreting cell functions.
Topics: Cell Differentiation; Pituitary Gland; Stem Cells
PubMed: 33752816
DOI: 10.1016/bs.vh.2021.02.008 -
JPMA. the Journal of the Pakistan... Sep 2021The concept of thymic endocrinology describes a bidirectional effect: the thymic hormones which circulate and significantly affect the immunomodulatory function of the... (Review)
Review
The concept of thymic endocrinology describes a bidirectional effect: the thymic hormones which circulate and significantly affect the immunomodulatory function of the body and the action of the other hormones derived from the pituitary, adrenal, gonads and thyroid gland on the thymocytes, thymic epithelial cells and the thymic stromal cells. Apart from this there is also an extensive paracrine and autocrine endocrine signal network within the Intra-thymic environment involving interleukins and thymic peptides. This review attempts to delve into the understanding of this intrinsic relationship between the thymus gland and the endocrine system at large.
Topics: Endocrinology; Epithelial Cells; Hormones; Pituitary Gland; Thymus Gland
PubMed: 34580532
DOI: No ID Found -
Otolaryngologic Clinics of North America Apr 2022
Topics: Adenoma; Humans; Pituitary Gland; Pituitary Neoplasms; Treatment Outcome
PubMed: 35256165
DOI: 10.1016/j.otc.2022.01.005 -
Pituitary Jun 2021Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to... (Review)
Review
BACKGROUND
Despite COVID-19 being identified as severe respiratory viral infection, progressively many relevant endocrine manifestations have been reported greatly contributing to the severity of the clinical presentation. Systemic involvement in COVID-19 is due to the ubiquitous expression of angiotensin-converting enzyme 2 (ACE2) receptor, responsible for the entry in the cells of SARS-CoV-2, Several reports in humans and animal models showed a significant ACE2 mRNA expression in hypothalamus and pituitary cells. Moreover, higher mortality and poorer outcomes have been widely described in COVID-19 patients with obesity, diabetes and vertebral fractures, which are all highly prevalent in subjects with pituitary dysfunctions.
AIM
To review the main endocrine manifestations of COVID-19 with their possible implications for pituitary diseases, the possible direct and indirect involvement of the pituitary gland in COVID-19, the impact of COVID-19 on the management of established pituitary diseases which can be already at increased risk for worse outcomes and on neurosurgical activities as well as vaccination.
CONCLUSIONS
Our review underlines that there could be a specific involvement of the pituitary gland which fits into a progressively shaping endocrine phenotype of COVID-19. Moreover, the care for pituitary diseases need to continue despite the restrictions due to the emergency. Several pituitary diseases, such as hypopituitarism and Cushing disease, or due to frequent comorbidities such as diabetes may be a risk factor for severe COVID-19 in affected patients. There is the urgent need to collect in international multicentric efforts data on all these aspects of the pituitary involvement in the pandemic in order to issue evidence driven recommendations for the management of pituitary patients in the persistent COVID-19 emergency.
Topics: Angiotensin-Converting Enzyme 2; Animals; COVID-19; Comorbidity; Host-Pathogen Interactions; Humans; Pituitary Diseases; Pituitary Gland; Prognosis; Receptors, Virus; Risk Assessment; Risk Factors; SARS-CoV-2; Virus Internalization
PubMed: 33939057
DOI: 10.1007/s11102-021-01148-1 -
Endocrinologia, Diabetes Y Nutricion Mar 2021Pregnancy results in a significant change in both pituitary gland size and function. Due to this physiological adaptation, the diagnosis and management of pituitary... (Review)
Review
Pregnancy results in a significant change in both pituitary gland size and function. Due to this physiological adaptation, the diagnosis and management of pituitary diseases during pregnancy represents a particularly complex challenge. The presence of a functioning pituitary adenoma may be harmful to the health of the mother and fetus, and scientific evidence regarding the safety of drugs normally used to control hormone excess during pregnancy is scarce. In addition, pregnancy may be associated with the risk of the growth of a pre-existing pituitary adenoma. This review focuses on the diagnostic challenges in pregnant women with adenomas secreting prolactin, growth hormone, or adrenocorticotropic hormone. Some evidence-based recommendations for the treatment of these conditions during pregnancy are provided, and algorithms that could help monitor a pituitary adenoma during pregnancy are examined. Mention is also made of how hormone replacement therapy can be optimised in pregnant women with hypopituitarism. Finally, differential diagnosis between Sheehan's syndrome and lymphocytic hypophysitis, two pituitary disorders that may occur during pregnancy or delivery, is discussed.
Topics: Adenoma; Female; Human Growth Hormone; Humans; Hypopituitarism; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Pregnancy; Pregnancy Complications
PubMed: 34167698
DOI: 10.1016/j.endien.2020.07.002