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Frontiers in Endocrinology 2020The anterior pituitary gland is comprised of specialized cell-types that produce and secrete polypeptide hormones in response to hypothalamic input and feedback from... (Review)
Review
The anterior pituitary gland is comprised of specialized cell-types that produce and secrete polypeptide hormones in response to hypothalamic input and feedback from target organs. These specialized cells arise during embryonic development, from stem cells that express SOX2 and the pituitary transcription factor PROP1, which is necessary to establish the stem cell pool and promote an epithelial to mesenchymal-like transition, releasing progenitors from the niche. Human and mouse embryonic stem cells can differentiate into all major hormone-producing cell types of the anterior lobe in a highly plastic and dynamic manner. More recently human induced pluripotent stem cells (iPSCs) emerged as a viable alternative due to their plasticity and high proliferative capacity. This mini-review gives an overview of the major advances that have been achieved to develop protocols to generate pituitary hormone-producing cell types from stem cells and how these mechanisms are regulated. We also discuss their application in pituitary diseases, such as pituitary hormone deficiencies.
Topics: Animals; Cell Differentiation; Humans; Induced Pluripotent Stem Cells; Pituitary Diseases; Pituitary Gland; Regenerative Medicine
PubMed: 33542708
DOI: 10.3389/fendo.2020.614999 -
British Journal of Neurosurgery Jun 2020Endoscopic endonasal skull base surgery has emerged as the treatment modality of choice for a range of skull base lesions, particularly pituitary adenomas. However,... (Review)
Review
Endoscopic endonasal skull base surgery has emerged as the treatment modality of choice for a range of skull base lesions, particularly pituitary adenomas. However, navigation and manipulation of the nasal corridor and paranasal sinuses requires that surgeons are aware of effective techniques to maximize patient outcomes and avoid sinonasal morbidity postoperatively. This paper is a narrative review aimed to provide an updated and consolidated report on the perioperative management of the nasal corridor and paranasal sinuses in the setting of endoscopic skull base surgery for pituitary disease. Anatomic variants and common surgical techniques are discussed. Post-operative complications are evaluated in detail. Understanding the structural implications of the endonasal approach to the sphenoid is crucial to optimization of the surgical outcomes. We propose guidelines for perioperative management of endoscopic endonasal skull base surgery for pituitary diseases. Standardized treatment algorithms can improve patient satisfaction, and increase the comparability and the quality of reported information across research studies.
Topics: Endoscopy; Humans; Nose; Paranasal Sinuses; Pituitary Neoplasms; Skull Base
PubMed: 32098510
DOI: 10.1080/02688697.2020.1731424 -
Pituitary Feb 2024
Topics: Humans; Pituitary Diseases; Pituitary Gland
PubMed: 38170373
DOI: 10.1007/s11102-023-01379-4 -
Neurosurgery Jun 2023Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and...
BACKGROUND
Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk.
OBJECTIVE
To quantify and correlate the degree of pituitary gland descent with postoperative DI.
METHODS
Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection.
RESULTS
Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017).
CONCLUSION
We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
Topics: Humans; Pituitary Neoplasms; Postoperative Complications; Pituitary Gland; Pituitary Diseases; Diabetes Insipidus; Adenoma; Retrospective Studies; Diabetes Mellitus
PubMed: 36700759
DOI: 10.1227/neu.0000000000002360 -
Journal of Veterinary Internal Medicine 2023Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in...
BACKGROUND
Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in dogs.
OBJECTIVES
To document presenting complaints, examination findings, endocrinopathies, magnetic resonance imaging (MRI), treatments, and outcomes of dogs with pituitary apoplexy.
ANIMALS
Twenty-six client-owned dogs with acute onset of neurological dysfunction.
METHODS
Retrospective case series. Dogs were diagnosed with pituitary apoplexy if MRI or histopathology documented an intrasellar or suprasellar mass with evidence of hemorrhage or infarction in conjunction with acute neurological dysfunction. Clinical information was obtained from medical records and imaging reports.
RESULTS
Common presenting complaints included altered mentation (16/26, 62%) and gastrointestinal dysfunction (14/26, 54%). Gait or posture changes (22/26, 85%), mentation changes (18/26, 69%), cranial neuropathies (17/26, 65%), cervical or head hyperpathia (12/26, 46%), and hyperthermia (8/26, 31%) were the most frequent exam findings. Ten dogs (38%) lacked evidence of an endocrinopathy before presentation. Common MRI findings included T1-weighted hypo- to isointensity of the hemorrhagic lesion (21/25, 84%), peripheral enhancement of the pituitary mass lesion (15/25, 60%), brain herniation (14/25, 56%), and obstructive hydrocephalus (13/25, 52%). Fifteen dogs (58%) survived to hospital discharge. Seven of these dogs received medical management alone (median survival 143 days; range, 7-641 days) and 8 received medications and radiation therapy (median survival 973 days; range, 41-1719 days).
CONCLUSIONS AND CLINICAL IMPORTANCE
Dogs with pituitary apoplexy present with a variety of acute signs of neurological disease and inconsistent endocrine dysfunction. Dogs that survive to discharge can have a favorable outcome.
Topics: Dogs; Animals; Pituitary Apoplexy; Pituitary Neoplasms; Retrospective Studies; Hydrocephalus; Infarction; Magnetic Resonance Imaging; Dog Diseases
PubMed: 37084035
DOI: 10.1111/jvim.16703 -
No Shinkei Geka. Neurological Surgery Jul 2023The hypothalamus is part of the diencephalon and regulates not only endocrine functions but also various physiological functions, including controlling sleep and...
The hypothalamus is part of the diencephalon and regulates not only endocrine functions but also various physiological functions, including controlling sleep and wakefulness, eating and drinking, and regulating body temperature. The pituitary gland can be divided into the adenohypophysis and neurohypophysis based on its developmental origin. The hypothalamus and pituitary gland play important roles in maintaining homeostasis by closely coordinating hormones. In the treatment of hypothalamic and pituitary diseases, it is important to understand the functions of the hypothalamus and pituitary gland, preserve hypothalamic function, evaluate the endocrine function, and follow up appropriately throughout life, including hormone replacement without excess or deficiency. Additionally, when interpreting hormone data, it is necessary to understand the factors that influence test values.
Topics: Humans; Pituitary Gland; Hypothalamus; Pituitary Diseases; Hormones
PubMed: 37491054
DOI: 10.11477/mf.1436204790 -
Endocrine, Metabolic & Immune Disorders... 2021Several different proteins regulate, directly or indirectly, the production of growth hormones from the pituitary gland, thereby complex genetics is involved. Defects in... (Review)
Review
Several different proteins regulate, directly or indirectly, the production of growth hormones from the pituitary gland, thereby complex genetics is involved. Defects in these genes are related to the deficiency of growth hormones solely, or deficiency of other hormones, secreted from the pituitary gland including growth hormones. These studies can aid clinicians to trace the pattern of the disease between the families, start early treatment and predict possible future consequences. This paper highlights some of the most common and novel genetic anomalies concerning growth hormones, which are responsible for various genetic defects in isolated growth and combined pituitary hormone deficiency disease.
Topics: Dwarfism, Pituitary; Human Growth Hormone; Humans; Hypopituitarism; Pediatrics; Pituitary Diseases
PubMed: 32621723
DOI: 10.2174/1871530320666200704144912 -
Journal of the American Animal Hospital... Mar 2021Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical... (Review)
Review
Medical management is currently the most common treatment for pituitary-dependent hyperadrenocorticism and hypersomatotropism/acromegaly in veterinary medicine. Medical management does not provide a cure for either disease process, and rarely is pituitary imaging a part of initial diagnostics. Early pituitary imaging in animals with clinically functional pituitary tumors provides a baseline assessment, allows monitoring of tumor changes, and permits radiation and surgical planning. Surgery is the only treatment for pituitary tumors that has curative intent and allows for a definitive diagnosis. Surgical removal of pituitary tumors via transsphenoidal hypophysectomy is an effective treatment for clinical pituitary tumors in patients exhibiting endocrine abnormalities associated with pituitary-dependent hyperadrenocorticism and hypersomatotropism. Surgery, however, is rarely pursued until patients have failed medical management, and often not until they are showing neurologic signs, making surgical success challenging. It is well documented that dogs surgically treated when the pituitary mass is small have a lower mortality, a lower recurrence rate, and a longer survival than those with larger pituitary masses. Providing owners with the option of early pituitary imaging in addition to medical, surgical, and radiation treatment options should be the standard of care for animals diagnosed with pituitary-dependent hyperadrenocorticism or hypersomatotropism.
Topics: Adrenocortical Hyperfunction; Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Hypophysectomy; Neoplasm Recurrence, Local; Pituitary Neoplasms
PubMed: 33450023
DOI: 10.5326/JAAHA-MS-7009 -
Child's Nervous System : ChNS :... Mar 2021Pituitary hyperplasia following primary hypothyroidism in pediatric age group population is considered rare with reports of unnecessary neurosurgical intervention for... (Review)
Review
INTRODUCTION
Pituitary hyperplasia following primary hypothyroidism in pediatric age group population is considered rare with reports of unnecessary neurosurgical intervention for this medically treatable condition. Given the paucity of information on this topic, it is timely to provide clinicians with a comprehensive summary of available research.
METHODS
A search of published studies in Pubmed, PsychInfo and Cochrane Database with the terms "pituitary hyperplasia" or "pituitary hypertrophy" and "hypothyroidism" was performed and the results filtered for English language, pediatric (0-18 years) population and CT or MRI confirmed findings. 55 studies met the inclusion criteria. Data for a total of 110 patients with pituitary hyperplasia following primary hypothyroidism were extracted. The study population included 29 males and 81 females (M: F= 0.35:1). Patient age varied from 3 weeks to 18 years with a mean age of 10.22 years.
RESULTS
The most common clinical presentations included growth retardation, constipation and features of myxedema which were present in 78, 36 and 18 percent of children included in our review. Neuroimaging showed the mean (SD) pituitary height being 13.48 mm (4.72 mm). All of the patients achieved resolution of their pituitary mass and clinical as well as biochemical abnormalities 1 to 26 months after initiation of thyroid hormone replacement therapy, with an average time interval of 7.22 months. Our review has tried to delve in the pathophysiology as well as clinical, biochemical and radiological aspects of pediatric pituitary hyperplasia secondary to primary hypothyroidism and provide recommendations for treatment and follow-up. This may help anyone concerned gain a substantial knowledge on this topic.
Topics: Child; Female; Hormone Replacement Therapy; Humans; Hyperplasia; Hypothyroidism; Male; Pituitary Diseases; Pituitary Gland
PubMed: 33404718
DOI: 10.1007/s00381-020-05014-6 -
Revista Espanola de Patologia :... 2022Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous...
Hypophysitis is a rare disease of pituitary gland, which, although it is usually a primary lesion, can also occur secondary to systemic conditions. Granulomatous hypophysitis is an inflammatory disease condition which accounts for less than 1% of all cellular lesions and can mimic adenoma. A 32-year-old woman presented with weight gain, galactorrhea and blurred vision. The MRI showed a cystic, nodular lesion in the intermediate lobe of the pituitary gland and the initial diagnosis was adenoma. She underwent surgery and the histopathology revealed granulomas composed of epithelioid histiocytes, multinuclear giant cells and mononuclear inflammatory cells. Inflammatory diseases of the pituitary gland are much less frequent than pituitary adenomas and idiopathic granulomatous hypophysitis is extremely rare. Histopathology and the ruling out of a systemic cause are the gold standards for its diagnosis.
Topics: Adenoma; Adult; Autoimmune Hypophysitis; Female; Galactorrhea; Humans; Hypophysitis; Pituitary Neoplasms; Pregnancy
PubMed: 35779888
DOI: 10.1016/j.patol.2019.11.005