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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 -
British Medical Journal Nov 1970
Review
Topics: Acromegaly; Adult; Child; Cushing Syndrome; Dwarfism, Pituitary; Female; Gonadotropins, Pituitary; Growth Disorders; Growth Hormone; Humans; Middle Aged; Pituitary Diseases; Pituitary Irradiation; Radiography; Yttrium Isotopes
PubMed: 4921233
DOI: 10.1136/bmj.4.5733.449 -
Endocrine Jun 2020Magnetic resonance (MR) imaging is an essential tool in the diagnosis and management of pituitary diseases, indispensable for making correct treatment decisions.... (Review)
Review
Magnetic resonance (MR) imaging is an essential tool in the diagnosis and management of pituitary diseases, indispensable for making correct treatment decisions. Successful management and follow-up of pituitary pathology requires an understanding of the MR appearance of normal and abnormal structures in the sellar region. This review will describe the MR appearance of the normal and abnormal pituitary gland and proposes an algorithm for the management strategy of some of the most common abnormalities in or around the sella.
Topics: Humans; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland; Pituitary Neoplasms; Sella Turcica
PubMed: 32162185
DOI: 10.1007/s12020-020-02242-3 -
Minerva Endocrinologica Dec 2018Pregnancy-related hypophysitis (PR-Hy) that typically occurs during late pregnancy and the early postpartum period is considered an autoimmune disorder. Knowledge and... (Review)
Review
Pregnancy-related hypophysitis (PR-Hy) that typically occurs during late pregnancy and the early postpartum period is considered an autoimmune disorder. Knowledge and awareness of characteristic clinical symptoms and specific endocrine and neuroradiological features mostly enables a correct diagnosis and guarantees best possible management. In the presence of mild clinical symptoms, a "wait-and-watch" approach is recommended. Transsphenoidal surgery or glucocorticoid therapy is indicated if progressive clinical signs or severe visual symptoms are observed. Reported cases indicate that transsphenoidal surgery performed during pregnancy can reverse visual symptoms and has a minimal risk to the health of the fetus and mother. Glucocorticoid therapy has a high initial response rate, but recurrence can occur after discontinuation. In late-pregnancy hypophysitis, the options of delaying therapy until the child is born or, if symptoms are severe, of inducing delivery prior to therapy have to be considered. Sheehan's syndrome (SS) is characterized by irreversible, partial or complete hypopituitarism due to pituitary infarction. The predominating causative event is massive peripartum hemorrhage (PPH). A considerable diagnostic delay is mostly observed. PPH and the typical postpartum findings of agalactia and amenorrhea should alert for the diagnosis of SS and prompt endocrine evaluation. Timely hormone replacement therapy is paramount to reduce morbidity and mortality and improve quality of life of afflicted women. Adrenal failure is a major endocrinological risk both of hypophysitis and of Sheehan syndrome. Early recognition and treatment is paramount to avoid life-threatening adrenal crisis.
Topics: Acute Disease; Adult; Female; Humans; Hypopituitarism; Pituitary Diseases; Pregnancy; Pregnancy Complications
PubMed: 29463076
DOI: 10.23736/S0391-1977.18.02814-6 -
Minerva Endocrinologica Dec 2018
Topics: Adult; Female; Humans; Pituitary Diseases; Pregnancy; Pregnancy Complications
PubMed: 29546742
DOI: 10.23736/S0391-1977.18.02835-3 -
European Journal of Endocrinology Jul 2017In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the last few years, quality of life (QoL) has become an outcome measure in patients with pituitary diseases.
OBJECTIVE
To describe the available data on QoL impairment evaluated with questionnaires in patients with pituitary diseases.
DESIGN
Critical review of the pertinent literature and pragmatic discussion of available information.
METHODS
Selection of relevant literature from PubMed and WOK, especially from the last 5 years and comprehensive analysis.
RESULTS
QoL is impaired in all pituitary diseases, mostly in acromegaly and Cushing's disease (similar to other causes of Cushing's syndrome), but also in non-functioning pituitary adenomas and prolactinomas, especially in the active phase of the disease. Nevertheless, even after endocrine 'cure', scores tend to be below normative values, indicative of residual morbidity after hormonal control. The presence of hypopituitarism worsens subjective QoL perception, which can improve after optimal substitution therapy, including recombinant human growth hormone, when indicated.
CONCLUSIONS
To improve the long-term outcome of pituitary patients, helping them to attain the best possible health, it appears desirable to include subjective aspects captured when evaluating QoL, so that the affected dimensions are identified and if relevant treated. Additionally, being aware that treatment outcome may not always mean complete normalisation of physical and mental issues related to QoL can be a first step to adaptation and conforming to this new status.
Topics: Humans; Pituitary Diseases; Psychometrics; Quality of Life; Surveys and Questionnaires
PubMed: 28351913
DOI: 10.1530/EJE-17-0041 -
Current Topics in Developmental Biology 2013Many aspects of pituitary development have become better understood in the past two decades. The signaling pathways regulating pituitary growth and shape have emerged,... (Review)
Review
Many aspects of pituitary development have become better understood in the past two decades. The signaling pathways regulating pituitary growth and shape have emerged, and the balancing interactions between the pathways are now appreciated. Markers for multipotent progenitor cells are being identified, and signature transcription factors have been discovered for most hormone-producing cell types. We now realize that pulsatile hormone secretion involves a 3D integration of cellular networks. About a dozen genes are known to cause pituitary hypoplasia when mutated due to their essential roles in pituitary development. Similarly, a few genes are known that predispose to familial endocrine neoplasia, and several genes mutated in sporadic pituitary adenomas are documented. In the next decade, we anticipate gleaning a deeper appreciation of these processes at the molecular level, insight into the development of the hypophyseal portal blood system, and evolution of better therapeutics for congenital and acquired hormone deficiencies and for common craniopharyngiomas and pituitary adenomas.
Topics: Animals; Gene Expression Regulation, Developmental; Humans; Models, Genetic; Mutation; Pituitary Diseases; Pituitary Gland; Pituitary Hormones; Signal Transduction; Stem Cells
PubMed: 24290346
DOI: 10.1016/B978-0-12-416021-7.00001-8 -
Clinical Endocrinology Dec 2013Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus... (Review)
Review
Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus invasion, traction or displacement of intracranial pain-sensitive structures such as blood vessels, cranial nerves and dura mater, and hormonal hypersecretion are implicated causes. The present review attempts to systematically review the literature for any combination of headache and pituitary or hormone overproduction or deficiency. Most data available are retrospective and/or not based on the International Headache Society (IHS) classification. Whereas in pituitary apoplexy a mechanical component explains the almost universal association of the condition with headaches, this correlation is less clear in other forms of pituitary disease and a positive impact of surgery on headaches is not guaranteed. Similarly, invasion into the cavernous sinus or local inflammatory changes have been linked to headaches without convincing evidence. Some studies suggest that oversecretion of GH and prolactin may be important for the development of headaches, and treatment, particularly with somatostatin analogues, has been shown to improve symptoms in these patients. Otherwise, treatment rests on general treatment options for headaches based on an accurate clinical history and a precise classification which includes assessment of the patient's psychosocial risk factors.
Topics: Adenoma; Biomechanical Phenomena; Dopamine Agonists; Headache; Human Growth Hormone; Humans; Pituitary Apoplexy; Pituitary Diseases; Pituitary Neoplasms; Prolactin; Somatostatin
PubMed: 23941570
DOI: 10.1111/cen.12314 -
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 -
Endocrine Reviews Jun 2010Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular... (Review)
Review
Pituitary disease is associated with increased mortality predominantly due to vascular disease. Control of cortisol secretion and GH hypersecretion (and cardiovascular risk factor reduction) is key in the reduction of mortality in patients with Cushing's disease and acromegaly, retrospectively. For patients with acromegaly, the role of IGF-I is less clear-cut. Confounding pituitary hormone deficiencies such as gonadotropins and particularly ACTH deficiency (with higher doses of hydrocortisone replacement) may have a detrimental effect on outcome in patients with pituitary disease. Pituitary radiotherapy is a further factor that has been associated with increased mortality (particularly cerebrovascular). Although standardized mortality ratios in pituitary disease are falling due to improved treatment, mortality for many conditions are still elevated above that of the general population, and therefore further measures are needed. Craniopharyngioma patients have a particularly increased risk of mortality as a result of the tumor itself and treatment to control tumor growth; this is a key area for future research in order to optimize the outcome for these patients.
Topics: Acromegaly; Cohort Studies; Craniopharyngioma; Female; Humans; Hypopituitarism; Male; Pituitary ACTH Hypersecretion; Pituitary Diseases
PubMed: 20086217
DOI: 10.1210/er.2009-0033