-
Experimental and Clinical Endocrinology... Mar 2021The German Society of Endocrinology (DGE) has a long-standing scientific and clinical focus on the pituitary. The pituitary working group ' is an interdisciplinary...
The German Society of Endocrinology (DGE) has a long-standing scientific and clinical focus on the pituitary. The pituitary working group ' is an interdisciplinary special interest group with a focus on advancing diagnosis and treatment of pituitary conditions. On the occasion of the English publication of the S2K clinical guideline , we present here a series of 12 articles from internationally renowned authors from inside and outside of Germany.
Topics: Endocrinology; Germany; Humans; Pituitary Diseases; Pituitary Neoplasms; Societies, Medical
PubMed: 33690869
DOI: 10.1055/a-1369-8898 -
Endocrine, Metabolic & Immune Disorders... 2023This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered.
INTRODUCTION
This guideline (GL) is aimed at providing a reference for the management of prolactin (PRL)-secreting pituitary adenoma in adults. However, pregnancy is not considered.
METHODS
This GL has been developed following the methods described in the Manual of the Italian National Guideline System. For each question, the panel appointed by Associazione Medici Endocrinologi (AME) has identified potentially relevant outcomes, which have then been rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" have been considered in the systematic review of evidence and only those classified as "critical" have been considered in the formulation of recommendations.
RESULTS
The present GL provides recommendations regarding the role of pharmacological and neurosurgical treatment in the management of prolactinomas. We recommend cabergoline (Cab) vs. bromocriptine (Br) as the firstchoice pharmacological treatment to be employed at the minimal effective dose capable of achieving the regression of the clinical picture. We suggest that medication and surgery are offered as suitable alternative first-line treatments to patients with non-invasive PRL-secreting adenoma, regardless of size. We suggest Br as an alternative drug in patients who are intolerant to Cab and are not candidates for surgery. We recommend pituitary tumor resection in patients 1) without any significant neuro-ophthalmologic improvement within two weeks from the start of Cab, 2) who are resistant or do not tolerate Cab or other dopamine-agonist drugs (DA), 3) who escape from previous efficacy of DA, and 4) who are unwilling to undergo a chronic DA treatment. We recommend that patients with progressive disease notwithstanding previous tumor resection and ongoing DA should be managed by a multidisciplinary team with specific expertise in pituitary diseases using a multimodal approach that includes repeated surgery, radiotherapy, DA, and possibly, the use of temozolomide.
CONCLUSION
The present GL is directed to endocrinologists, neurosurgeons, and gynecologists working in hospitals, in territorial services or private practice, and to general practitioners and patients.
Topics: Adult; Humans; Bromocriptine; Cabergoline; Dopamine Agonists; Ergolines; Pituitary Neoplasms; Prolactin; Prolactinoma
PubMed: 37171003
DOI: 10.2174/1871530323666230511104045 -
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 -
Reviews in Endocrine & Metabolic... Apr 2022Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily... (Review)
Review
Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with coronavirus disease 2019 (COVID-19). Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy.Moreover, hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2.This review will discuss hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19. Finally, we will address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.
Topics: COVID-19; Comorbidity; Humans; Hypopituitarism; Risk Factors; SARS-CoV-2
PubMed: 34387832
DOI: 10.1007/s11154-021-09672-y -
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 -
Endocrine Aug 2021Hypophysitis is a rare pituitary inflammatory disorder classified in different ways. Immunoglobulin G4-related disease (IgG4-RD), also a rare disease is a systemic... (Review)
Review
Hypophysitis is a rare pituitary inflammatory disorder classified in different ways. Immunoglobulin G4-related disease (IgG4-RD), also a rare disease is a systemic fibro-inflammatory condition characterized by infiltration of tissue with IgG4-positive plasma cells; however prevalence of both of them probably is underestimated. In this paper, we present an Iranian patient with biopsy-proven IgG4-related hypophysitis and then review the clinical characteristics, laboratory, imaging, pathologic findings and therapeutic management as well as prognosis of 115 published cases of hypophysitis secondary to IgG4-related disease.
Topics: Autoimmune Hypophysitis; Humans; Hypophysitis; Iran; Pituitary Diseases; Pituitary Gland
PubMed: 33837927
DOI: 10.1007/s12020-021-02714-0 -
The Veterinary Clinics of North... Dec 2021Endocrinopathic laminitis (EL) primarily occurs because of insulin dysregulation (ID) mediated through downstream effects of insulin on IGF-1R in lamellar tissues. There... (Review)
Review
Endocrinopathic laminitis (EL) primarily occurs because of insulin dysregulation (ID) mediated through downstream effects of insulin on IGF-1R in lamellar tissues. There is likely contributing vascular and metabolic dysfunction within the lamellae, but EL is relatively non-inflammatory. EL is associated with lamellar stretching, proliferation, and failure, ultimately causing failure of the suspensory apparatus of the distal phalanx. Proper education regarding mitigating risk factors makes this a largely preventable cause of laminitis. Annual hoof evaluation plus screening geriatric horses for pituitary pars intermedia dysfunction and ID, and younger horses for ID, can significantly decrease the incidence of this devastating condition.
Topics: Animals; Endocrine System Diseases; Foot Diseases; Hoof and Claw; Horse Diseases; Horses; Inflammation; Pituitary Diseases
PubMed: 34674908
DOI: 10.1016/j.cveq.2021.08.001 -
No Shinkei Geka. Neurological Surgery Mar 2021Pituitary adenomas are the most common cause of sellar masses although there are a number of other neoplastic, infectious, inflammatory, developmental, and vascular...
Pituitary adenomas are the most common cause of sellar masses although there are a number of other neoplastic, infectious, inflammatory, developmental, and vascular etiologies that should be considered. Pregnancy promotes a physiological increase in the size of the maternal pituitary gland, especially adenohypophysis. The normal maturation sequence of the pituitary gland apparently involves a period of physiological hypertrophy in teenagers. As most incidentalomas in pediatric patients are not associated with hormonal hypersecretion or hypopituitarism, and structural progression is not common, it is hypothesized that the extensive follow-up assessment recommended for adults might not be necessary for children. Patients presenting with a pituitary lesion should undergo a complete history and physical examination that includes evaluations for evidence of hypopituitarism and hormone hypersecretion syndrome. Patients with evidence for either of these conditions should undergo an appropriately directed biochemical evaluation. All patients presenting with a pituitary lesion abutting the optic nerves or chiasm on magnetic resonance imaging should undergo a formal visual field examination. Emergencies in pituitary disease can result from the failure of the pituitary gland to secrete one or more pituitary hormones or from neuro-ophthalmological symptoms due to the mass effect of an expanding hypothalamic-pituitary lesion. Early diagnosis and prompt treatment of endocrine emergencies are mandatory.
Topics: Adenoma; Adolescent; Adult; Child; Humans; Hypertrophy; Hypopituitarism; Magnetic Resonance Imaging; Pituitary Gland; Pituitary Neoplasms
PubMed: 33762451
DOI: 10.11477/mf.1436204392 -
Surgical Pathology Clinics Jun 2020Sellar region lesions include a broad range of benign and malignant neoplastic as well as non-neoplastic entities, many of which are newly described or have recently... (Review)
Review
Sellar region lesions include a broad range of benign and malignant neoplastic as well as non-neoplastic entities, many of which are newly described or have recently revised nomenclature. In contrast to other intracranial sites, imaging features are relatively less specific, and the need for histopathological diagnosis is of paramount importance. This review will describe pituitary adenomas, inflammatory lesions, and tumors unique to the region (craniopharyngioma) as well as tumors which may occur in but are not exclusively localized to the sellar location (schwannoma, metastasis, etc.).
Topics: Adenoma; Central Nervous System Cysts; Craniopharyngioma; Diagnosis, Differential; Humans; Hypophysitis; Immunoglobulin G4-Related Disease; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms
PubMed: 32389269
DOI: 10.1016/j.path.2020.02.006 -
Handbook of Clinical Neurology 2021Hypothalamitis is a rare inflammatory disorder involving the hypothalamus and classified as primary, or isolated, and secondary hypothalamitis. Secondary hypothalamitis... (Review)
Review
Hypothalamitis is a rare inflammatory disorder involving the hypothalamus and classified as primary, or isolated, and secondary hypothalamitis. Secondary hypothalamitis although very rare is more common than the primary one and may occur in patients affected by autoimmune diseases such as autoimmune hypophysitis, systemic autoimmune diseases, infective diseases in patients affected by immune-deficit, paraneoplastic encephalitis, or in patients treated with immune checkpoint inhibitors. In accordance with the rarity of this disease, diagnosis and management of hypothalamitis prove to be challenging. The diagnosis requires a high index of clinical suspicion. The main symptoms may be: various degrees of hypopituitarism, neuropsychiatric and behavioral disorders, and disturbances of autonomic and metabolic regulation. Magnetic resonance images play a crucial role in the diagnosis of hypothalamitis and in the exclusion of a neoplastic lesion. Therapeutic management should be oriented according to the disease etiology. In most cases, after ruling out infective hypothalamitis, the mainstay of therapy consists of immunosuppressive treatment. Great attention should be paid to hormonal replacement therapy, if partial or total hypopituitarism is present, in particular in patients affected by diabetes insipidus, central hypoadrenalism and hypothyroidism. According to the complexity of this disease, a multidisciplinary approach is strongly advocated to reach an early diagnosis and an integrated therapy.
Topics: Atrophy; Autoimmune Hypophysitis; Humans; Hypopituitarism; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland
PubMed: 34238454
DOI: 10.1016/B978-0-12-820683-6.00011-7