-
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 -
Molecular and Cellular Endocrinology Apr 2021The pituitary gland embodies our endocrine hub and rigorously regulates hormone balances in the body, thereby ruling over vital developmental and physiological... (Review)
Review
The pituitary gland embodies our endocrine hub and rigorously regulates hormone balances in the body, thereby ruling over vital developmental and physiological processes. Pituitary dysfunction and disease strongly impact the organism's biology. Physical damage, tumour development and ageing all negatively affect pituitary state and functionality. On top of its hormone-producing cells, the pituitary contains a population of stem cells. Not only their physiological role is still largely unknown, also whether or how these stem cells are involved in pituitary disease and recovery from defective functionality remains enigmatic. Here, we summarize what is known on the phenotypical and functional behaviour of pituitary stem cells in diseased or dysfunctional gland, as particularly caused by injury, tumourigenesis and ageing.
Topics: Aging; Animals; Carcinogenesis; Humans; Models, Biological; Organoids; Pituitary Diseases; Stem Cells
PubMed: 33503464
DOI: 10.1016/j.mce.2021.111176 -
Expert Review of Endocrinology &... Jul 2019Treatment of childhood brain tumors, including surgical resection and especially external beam radiation, often results in endocrine complications manifested by... (Review)
Review
INTRODUCTION
Treatment of childhood brain tumors, including surgical resection and especially external beam radiation, often results in endocrine complications manifested by hypopituitarism, which can involve growth hormone deficiency, hypothyroidism, adrenal insufficiency, disorders of puberty, diabetes insipidus, and hypothalamic obesity.
AREAS COVERED
A comprehensive literature search was conducted on Medline (publications from the 1990s to 01/2019) including systematic reviews, meta-analyses, longitudinal controlled studies, retrospective cohort studies, and case reports. Herein, we present an up-to-date review of the current literature regarding endocrine sequellae of childhood brain tumor survivors.
EXPERT OPINION
Late endocrine sequellae can arise many years after the initial treatment of tumor, so at least annual surveillance of growth, puberty, weight, development, and endocrine status is recommended for at least 10 years after tumor therapy. This follow up should encompass childhood and adulthood among survivors. If found early, outcomes of endocrinopathies are favorable when treated appropriately. Newer tumor therapy modalities, such as proton beam radiation, offer the potential for fewer endocrine complications, but such benefit has yet to be demonstrated, and more research into short- and long-term outcomes is needed.
Topics: Adolescent; Adrenal Insufficiency; Adult; Brain Neoplasms; Cancer Survivors; Child; Child, Preschool; Female; Humans; Hypogonadism; Hypothalamic Diseases; Hypothyroidism; Male; Pituitary Diseases; Puberty, Precocious
PubMed: 31131647
DOI: 10.1080/17446651.2019.1620599 -
Endocrine Reviews Apr 2020Some endocrine disorders, including hypophysitis and isolated adrenocorticotropic hormone (ACTH) deficiency, are caused by an autoimmune response to endocrine organs.... (Review)
Review
Some endocrine disorders, including hypophysitis and isolated adrenocorticotropic hormone (ACTH) deficiency, are caused by an autoimmune response to endocrine organs. Although the pathogenesis of some autoimmune endocrine diseases has been elucidated, it remains obscure for most. Anti-PIT-1 hypophysitis (anti-PIT-1 antibody syndrome) is a newly described pituitary autoimmune disease characterized by acquired and specific growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH) deficiencies. This disorder is associated with a thymoma or neoplasm that ectopically expresses pituitary-specific transcription factor 1 (PIT-1) protein. Circulating anti-PIT-1 antibody is a disease marker, and PIT-1-reactive cytotoxic T cells (CTLs) play a pivotal role in disease development. In addition, isolated ACTH deficiency appears to be caused by autoimmunity to corticotrophs; however, the pathogenesis remains unclear. A recently described case of isolated ACTH deficiency with large cell neuroendocrine carcinoma (LCNEC) showed ectopically expressed proopiomelanocortin (POMC), and circulating anti-POMC antibody and POMC-reactive CTLs were also detected. As CTL infiltrations around corticotrophs were also observed, isolated ACTH deficiency may be associated at least in part with a paraneoplastic syndrome. Although several underlying mechanisms for pituitary autoimmunity have been proposed, these observations highlight the importance of paraneoplastic syndrome as a cause of pituitary autoimmune disease. In this review, we focus on the pathophysiology and connection of anti-PIT-1 hypophysitis and isolated ACTH deficiency and discuss the state-of-art knowledge for understanding pituitary autoimmunity.
Topics: Adrenocorticotropic Hormone; Autoimmune Diseases of the Nervous System; Autoimmune Hypophysitis; Endocrine System Diseases; Genetic Diseases, Inborn; Humans; Hypoglycemia; Paraneoplastic Syndromes; Pituitary Diseases
PubMed: 31513261
DOI: 10.1210/endrev/bnz003 -
Australian Journal of General Practice 2021Pituitary lesions are present in >10% of the population. Approximately one in 1000 people has a symptomatic pituitary tumour, which may cause clinical problems from...
BACKGROUND
Pituitary lesions are present in >10% of the population. Approximately one in 1000 people has a symptomatic pituitary tumour, which may cause clinical problems from mass effect, hormonal hypersecretion and impairment of normal pituitary function.
OBJECTIVE
The aim of this article is to outline the potential causes of a sellar and parasellar mass, with an emphasis on the presenting clinical features and screening investigations that are applicable to doctors working in the primary care setting.
DISCUSSION
There is a broad range of causes of a sellar/parasellar mass. Pituitary adenomas and Rathke's cleft cysts are the most frequently encountered. Prolactinomas are the most common functioning tumour and tend to present as macroadenomas in men, while hyperprolactinaemia is associated with 15% of secondary amenorrhoea in women. Acromegaly and Cushing's disease are rare but important diagnoses to detect. Pituitary disease is optimally managed in a specialist centre in the context of an established multidisciplinary team.
Topics: Central Nervous System Cysts; Female; Humans; Male; Pituitary Diseases; Pituitary Neoplasms
PubMed: 33543159
DOI: 10.31128/AJGP-10-20-5688 -
Australian Family Physician May 1999Pituitary disease is relatively uncommon, but because failure to recognise and manage it correctly has such severe repercussions, it has an importance out of proportion... (Review)
Review
BACKGROUND
Pituitary disease is relatively uncommon, but because failure to recognise and manage it correctly has such severe repercussions, it has an importance out of proportion to its prevalence.
OBJECTIVE
Pituitary disease may result in findings due to hormone excess or hormone deficiency. This article revisits the main clinical findings, investigations and treatment options for pituitary disease.
DISCUSSION
The clinical presentation of pituitary disease varies from asymptomatic to severe features of endocrine disturbance. Establishing the diagnosis is not easy and requires a strong clinical suspicion supported by radiology and specific biochemical tests. Treatment is directed toward both the underlying pathology and the endocrine disturbances present.
Topics: Adult; Dopamine Agonists; Female; Hormone Replacement Therapy; Hormones; Humans; Magnetic Resonance Imaging; Male; Pituitary Diseases; Pituitary Gland; Tomography, X-Ray Computed
PubMed: 10376369
DOI: No ID Found -
Pituitary Aug 2020Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare... (Review)
Review
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced 'lockdowns' are the new 'norm' as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with pituitary disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Delivery of Health Care, Integrated; Health Services Accessibility; Health Status; Host-Pathogen Interactions; Humans; Pandemics; Patient Care Team; Pituitary Diseases; Pneumonia, Viral; Prognosis; Risk Factors; SARS-CoV-2
PubMed: 32556793
DOI: 10.1007/s11102-020-01059-7 -
Cellular and Molecular Life Sciences :... Mar 2021The pituitary plays a pivotal role in maintaining systemic homeostasis by secreting several hormones. During fetal development, the pituitary develops from the oral... (Review)
Review
The pituitary plays a pivotal role in maintaining systemic homeostasis by secreting several hormones. During fetal development, the pituitary develops from the oral ectoderm in contact with the adjacent hypothalamus. This process is regulated by the fine-tuned expression of transcription and growth factors. Impairments of this process result in congenital pituitary hypoplasia leading to dysfunction of the pituitary. Although animal models such as knockout mice have helped to clarify these underlying mechanisms, the developmental processes of the human pituitary gland and the mechanisms of human pituitary disorders have not been fully understood. This is because, at least in part, of the lack of a human pituitary developmental model. Recently, methods for in vitro induction of the pituitary gland from human pluripotent stem cells were developed. These models can be utilized not only for regenerative medicine but also for human pituitary studies on developmental biology and for modeling of pituitary disorders, such as hypopituitarism and pituitary tumors. In this review, we provide an overview of recent progress in the applications of pluripotent stem cells for pituitary research and discuss further perspectives for pituitary studies.
Topics: Animals; Cell Culture Techniques; Cell Differentiation; Cells, Cultured; Humans; Induced Pluripotent Stem Cells; Pituitary Diseases; Pituitary Gland; Pluripotent Stem Cells; Regenerative Medicine
PubMed: 33206204
DOI: 10.1007/s00018-020-03692-8 -
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 -
Pituitary Sep 2013During the last 20 years a tremendous improvement in the care of patients with pituitary tumors and of hypopituitarism has been achieved. If we resolve most of the... (Review)
Review
During the last 20 years a tremendous improvement in the care of patients with pituitary tumors and of hypopituitarism has been achieved. If we resolve most of the possible causes of the increased cardiovascular disease and stroke mortality a normal survival is expected in these patients. Recently, a large population based study showed a decline in the risk of non-fatal stroke and of non-fatal cardiac events in GH deficient patients. This improvement was achieved by complete hormone replacement, including long term GH replacement, together with prescription of cardio protective drugs. If we follow the latest achievements in pituitary imaging, surgery techniques, hormone substitutions, cardio protective medications, we would expect a normal longevity in these patients. This review will focus on; (1) pituitary insufficiencies and hormone substitutions, (2) modes of cranial radiotherapy, and (3) new techniques in the surgery of a pituitary adenoma.
Topics: Cardiovascular Diseases; Endoscopy; Female; Human Growth Hormone; Humans; Hypopituitarism; Male; Pituitary Diseases; Pituitary Neoplasms; Stroke
PubMed: 23400812
DOI: 10.1007/s11102-013-0469-1