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Pituitary Apr 2021The coronavirus disease 2019 (COVID-19) pandemic is widely believed to have had a major impact on the care of patients with pituitary disease. The virus itself may...
PURPOSE
The coronavirus disease 2019 (COVID-19) pandemic is widely believed to have had a major impact on the care of patients with pituitary disease. The virus itself may directly result in death, and patients with adrenal insufficiency, often a part of hypopituitarism, are thought to represent a particularly susceptible subgroup. Moreover, even in patients that do not contract the virus, the diversion of resources by healthcare institutions to manage the virus may indirectly result in delays in their management. To this end, the aim of this study was to determine the direct and indirect impact of the COVID-19 pandemic on patients with pituitary disease.
METHODS
A cross-sectional study design was adopted, with all adult patients seen by our pituitary service in the year prior to the nationwide lockdown on March 23rd 2020 invited to participate in a telephone survey.
RESULTS
In all, 412 patients (412/586; 70.3%) participated in the survey. 66 patients (66/412; 16.0%) reported having suspected COVID-19 infection. Of the 10 patients in this group tested for COVID-19 infection, three received a positive test result. No deaths due to COVID-19 were identified. 267 patients (267/412; 64.8%) experienced a delay or change in the planned care for their pituitary disease, with 100 patients (100/412; 24.3%) perceiving an impact to their care.
CONCLUSIONS
Whilst only a small percentage of patients had confirmed or suspected COVID-19 infection, over half were still indirectly impacted by the pandemic through a delay or change to their planned care.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; COVID-19; Communicable Disease Control; Continuity of Patient Care; Cross-Sectional Studies; Delivery of Health Care; Female; Humans; Male; Middle Aged; Pandemics; Physical Distancing; Pituitary Diseases; Quarantine; SARS-CoV-2; Surveys and Questionnaires; Time-to-Treatment; United Kingdom; Young Adult
PubMed: 33236181
DOI: 10.1007/s11102-020-01106-3 -
Rinsho Byori. the Japanese Journal of... Oct 1991Endocrine disorders have long been diagnosed by symptoms, before hormones were able to be measured by immunoassays. Recently, as molecular biological methods developed,... (Review)
Review
Endocrine disorders have long been diagnosed by symptoms, before hormones were able to be measured by immunoassays. Recently, as molecular biological methods developed, DNA diagnosis has become available in many diseases including endocrine disorders. We present here DNA diagnosis in connection with anterior pituitary hormones. Our studies on thyrotropin (TSH) producing pituitary adenomas showed that TSH beta-subunit mRNAs of the adenomas were the same as those from normal pituitary tissues. Congenital isolated TSH deficiency is rare disease causing hypothyroidism including cretinism, severe mental and growth retardation. We have studied 3 families with consanguineous marriage and 2 families which were descendants of closed colonies. The molecular pathogenesis were elucidated in the cases of 3 Japanese families with consanguineous marriage. They had a same missense mutation in the 2nd exon of the TSH beta-subunit gene which made a restriction enzyme site, and could be analyzed either by genomic Southern blot analyses or by restriction enzyme digestion after amplification of genomic DNA by PCR. Congenital deficiency of growth hormone, prolactin, and TSH was first described in Snell dwarf mice. The gene encoding the nuclear factor Pit-1/GHF-1, which transactivates promoters of both growth hormone gene and prolactin gene, was shown to be the cause of Snell dwarf mice. A similar human case arose from a family with consanguineous marriage, and the relation with the pit-1/GHF-1 gene is now under study.
Topics: DNA; Female; Humans; Male; Pituitary Diseases; Pituitary Gland, Anterior; Polymerase Chain Reaction
PubMed: 1762181
DOI: No ID Found -
Veterinary Radiology & Ultrasound : the... Mar 2021A recent publication described pathological findings in the pituitary gland incidentally discovered during routine necropsies of the brain of dogs and cats; however,...
A recent publication described pathological findings in the pituitary gland incidentally discovered during routine necropsies of the brain of dogs and cats; however, imaging characteristics of these lesions were not reported. Aims of this retrospective, observational study were to characterize MRI variants and incidental lesions in pituitary glands of dogs with no clinical signs of pituitary disease. Cranial MRIs from dogs with no suspicion of pituitary disease, based on history and presenting clinical signs, were retrieved from a veterinary teleradiology database during the period of January 2014 to January 2016. Images were reinterpreted by two observers and pituitary lesions were described based on consensus. A total of 580 scans were evaluated and pituitary lesions were detected in 78 dogs (13.44%). Pituitary cystic lesions were the most common finding and occurred in 31 dogs (5.34%). Of these 31 dogs, the majority (74%) were of toy or brachycephalic breed. Partial or total empty sella lesions were detected in 14 dogs (2.41%), and all of these were small or toy breeds. A significantly increased incidence of the partial empty sella lesion was found in male dogs (P = .034). Pituitary lesions greater than 1 cm occurred rarely (0.69%). There was a significant association between low-field (LF) MRI strength and detection of a partial or total empty sella lesion (P = .0112), and detection of a pituitary lesion greater than 1 cm (P = .0125). A significant difference was present between the MRI field strength (FS) that identified pituitary cysts and the FS that detected an empty sella (P = .0068), with the former being a high FS and the latter a LF strength. The findings from this study indicated that up to 13% of dogs with no presenting clinical signs of pituitary disease may have MRI pituitary lesions.
Topics: Animals; Autopsy; Body Size; Dog Diseases; Dogs; Empty Sella Syndrome; Female; Magnetic Resonance Imaging; Male; Pituitary Gland; Pituitary Neoplasms; Retrospective Studies
PubMed: 33350547
DOI: 10.1111/vru.12938 -
The Journal of Clinical Endocrinology... Nov 2014Central hypoadrenalism is a frequent complication of pituitary and hypothalamic pathology and is associated with increased morbidity and mortality. Optimal exogenous... (Review)
Review
CONTEXT
Central hypoadrenalism is a frequent complication of pituitary and hypothalamic pathology and is associated with increased morbidity and mortality. Optimal exogenous glucocorticoid use is dependent on the use of appropriate diagnostic tests and careful assessment of the clinical response to glucocorticoid replacement therapy.
EVIDENCE ACQUISITION
A PubMed search for the terms central hypoadrenalism, ACTH deficiency, glucocorticoid suppression, and glucocorticoid replacement was conducted; the papers identified and the references listed were used to build a reference list.
EVIDENCE SYNTHESIS
The published literature was assessed to present a summary of the available evidence with regard to etiology, diagnosis, and treatment of central hypoadrenalism.
CONCLUSIONS
A functional hypothalamic pituitary adrenal axis is essential for normal health and life expectancy; its complexity presents challenges to the clinician in the identification of patients and in the maintenance of such patients in a glucocorticoid-sufficient state. The most common cause of central hypoadrenalism remains exogenous glucocorticoid use. Further research in this field should be directed toward disease prevention by minimizing glucocorticoid exposure and toward the identification of a biomarker for glucocorticoid sufficiency that will aid clinicians in optimizing treatment.
Topics: Adrenal Insufficiency; Humans; Hypothalamic Diseases; Hypothalamo-Hypophyseal System; Pituitary Diseases; Pituitary-Adrenal System
PubMed: 25140404
DOI: 10.1210/jc.2014-2476 -
Medicine Sep 2007Hypothalamic-pituitary (HP) sarcoidosis has 2 main endocrine manifestations: diabetes insipidus and hyperprolactinemia. We conducted the current study to investigate... (Review)
Review
Hypothalamic-pituitary (HP) sarcoidosis has 2 main endocrine manifestations: diabetes insipidus and hyperprolactinemia. We conducted the current study to investigate pituitary dysfunction and perform imaging of the HP area in patients both immediately following diagnosis and after treatment. The study included 6 men and 3 women, with a mean age of 30 years at the onset of sarcoidosis. All patients had both hormonal and magnetic resonance imaging (MRI) HP disorders. All patients had anterior pituitary dysfunction, 7 of them with associated diabetes insipidus. Nine patients had gonadotropin deficiency and 3 had hyperprolactinemia. MRI revealed infundibulum involvement in 5 patients, pituitary stalk thickness abnormality in 5, and involvement of the pituitary gland in 2, associated with other parenchymal brain or spinal cord lesions in 6 patients. All patients had multiple localizations of sarcoidosis, and 5 had histologically confirmed sinonasal localizations. Mean follow-up of the HP disorder was 7.5 years. All patients received prednisone. There was no correlation between the number of hormonal dysfunctions and the area of the HP axis involved as assessed by MRI. Although corticoid treatment was associated with a reduction of radiologic lesions, only 2 patients had partial recovery of hormonal deficiency. In conclusion, hormonal deficiencies associated with HP sarcoidosis frequently include hypogonadism (all patients) and to a lesser degree diabetes insipidus (7 of 9 patients). MRI abnormalities improved or disappeared in 7 cases under corticosteroid treatment, but most endocrine defects were irreversible despite regression of the granulomatous process. Most cases presented with multivisceral localizations and an abnormally high proportion of sinonasal localizations.
Topics: Adolescent; Adult; Diabetes Insipidus; Female; Follow-Up Studies; France; Glucocorticoids; Humans; Hyperprolactinemia; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Diseases; Pituitary Gland; Pituitary Hormones, Anterior; Prednisone; Radiography; Research Design; Retrospective Studies; Sarcoidosis; Thyrotropin-Releasing Hormone; Treatment Outcome
PubMed: 17873755
DOI: 10.1097/MD.0b013e31815585aa -
The Overseas Post-graduate Medical... Jan 1951
Topics: Humans; Hypopituitarism; Pituitary Diseases; Pituitary Gland
PubMed: 24539792
DOI: No ID Found -
Endocrine Journal Dec 2003A previous study reported a high prevalence of autoantibodies to alpha-enolase in lymphocytic hypophysitis and these antibodies efficiently distinguished lymphocytic...
A previous study reported a high prevalence of autoantibodies to alpha-enolase in lymphocytic hypophysitis and these antibodies efficiently distinguished lymphocytic hypophysitis from pituitary tumors. To confirm this, we examined autoantibodies to alpha-enolase in patients with lymphocytic hypophysitis (n = 17), pituitary non-functioning adenoma (n = 13), other pituitary diseases (n = 17) and other autoimmune diseases (n = 30), and compared to healthy controls (n = 46). Autoantibodies were found in 41.2%, 46.2%, 23.5%, 20.0% and 4.3%, respectively. Our findings indicate that detection of anti-alpha-enolase antibodies is not suitable for specific diagnosis of lymphocytic hypophysitis.
Topics: Adenoma; Adult; Autoantibodies; Autoimmune Diseases; Biomarkers, Tumor; DNA-Binding Proteins; Diagnosis, Differential; Female; Humans; Inflammation; Lymphocytes; Male; Middle Aged; Phosphopyruvate Hydratase; Pituitary Diseases; Pituitary Neoplasms; Tumor Suppressor Proteins
PubMed: 14709840
DOI: 10.1507/endocrj.50.697 -
European Journal of Endocrinology Mar 2010Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. The pituitary gland is...
Major hormonal changes emerge during pregnancy. The pituitary gland is one of the most affected organs with altered anatomy and physiology. The pituitary gland is enlarged as a result of lactotroph hyperplasia. Due to physiological changes in the pituitary and target hormone levels, binding globulins, and placental hormones, hormonal evaluation becomes more complex in pregnant women. As a consequence of physiological hormonal changes, the evaluation of pituitary functions in pregnant women is quite different from that done in the prepregnant state. Pituitary adenomas may cause problems by their hormone secretion that affects the mother and the fetus besides causing an increased risk of tumor growth. Furthermore, diagnosis, course, and treatment of pituitary diseases point out differences. The changes in anatomy and physiology of the pituitary gland during pregnancy are reviewed. Pituitary disorders namely Cushing's disease; acromegaly; prolactinoma; TSH-secreting, gonadotropin-producing, and clinically nonfunctioning adenomas; craniopharyngioma; and Sheehan's syndrome, which is one of the most common causes of hypopituitarism, lymphocytic hypophysitis, and hypopituitarism, in relation to pregnancy are discussed. Being aware of all this information will prevent any serious problems which mother and child will be exposed to.
Topics: Female; Humans; Pituitary Diseases; Pituitary Gland; Pregnancy; Pregnancy Complications
PubMed: 19934270
DOI: 10.1530/EJE-09-0923 -
Journal of Clinical Neuroscience :... May 2006The anaesthetic care of patients undergoing pituitary surgery involves an understanding of the varied presentations of pituitary disease and their implications for the... (Review)
Review
The anaesthetic care of patients undergoing pituitary surgery involves an understanding of the varied presentations of pituitary disease and their implications for the patient's perioperative condition and management. The neuroanaesthetist must also have an appreciation of the issues relevant to the surgical approach (either transsphenoidal or, less commonly, transcranial) and be able to anticipate and manage them accordingly.
Topics: Anesthesia; Humans; Neurosurgical Procedures; Operating Rooms; Pituitary Diseases; Pituitary Gland
PubMed: 16678718
DOI: 10.1016/j.jocn.2005.11.028 -
Endocrinology and Metabolism Clinics of... Dec 2011The pituitary gland undergoes much anatomic and physiologic variation during pregnancy. Pituitary disease may have a significant impact on a patient prior to conception...
The pituitary gland undergoes much anatomic and physiologic variation during pregnancy. Pituitary disease may have a significant impact on a patient prior to conception as well as throughout her pregnancy. It is imperative to provide care to patients affected by pituitary disease with a multidisciplinary approach involving endocrinologists, obstetricians and, when appropriate, neurosurgical care, as this group of disorders can represent a substantial level of morbidity and mortality for both mother and fetus.
Topics: Acromegaly; Female; Humans; Hypopituitarism; Pituitary ACTH Hypersecretion; Pituitary Apoplexy; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Prolactinoma
PubMed: 22108282
DOI: 10.1016/j.ecl.2011.08.007