-
The Journal of Clinical Endocrinology... May 2022
Topics: Humans; Hypophysitis; Pituitary Diseases; Pituitary Gland
PubMed: 35037041
DOI: 10.1210/clinem/dgac025 -
Journal of Equine Veterinary Science May 2023Equine endocrine disease is an important area for equine research, requiring an appropriate case definition for inclusion and criteria for exclusion from disease.... (Review)
Review
Equine endocrine disease is an important area for equine research, requiring an appropriate case definition for inclusion and criteria for exclusion from disease. Defining a case for research may be different from criteria for clinical diagnosis. Further, clinical diagnosis recommendations have been changing regularly, making this area challenging for equine scientists. This review discusses the diagnosis of major equine endocrine diseases, pituitary pars intermedia dysfunction, equine metabolic syndrome and insulin dysregulation, focusing on the most appropriate diagnostic methods for research case definitions. Different diagnostic methods, including use of reference intervals and clinical decision limits, will be discussed with their relative merits for use in case definition for research.
Topics: Horses; Animals; Endocrine System Diseases; Pituitary Diseases; Metabolic Syndrome; Horse Diseases; Insulin
PubMed: 37236726
DOI: 10.1016/j.jevs.2023.104491 -
Frontiers in Endocrinology 2023To evaluate the value of the thyrotropin-releasing hormone (TRH) test in the diagnosis of central hypothyroidism (CH) in patients with pituitary disease.
OBJECTIVE
To evaluate the value of the thyrotropin-releasing hormone (TRH) test in the diagnosis of central hypothyroidism (CH) in patients with pituitary disease.
METHODS
Systematic evaluation of 359 TRH tests in patients with pituitary disease including measurements of thyroxine (T4), TBG-corrected T4 (T4), baseline TSH (TSH) and relative or absolute TSH increase (TSH, TSH).
RESULTS
Patients diagnosed with CH (n=39) show comparable TSH (p-value 0.824) but lower T4 (p-value <0.001) and lower TSH increase (p-value <0.001) compared to patients without CH. In 54% (42 of 78 cases) of patients with low T4, the CH diagnosis was rejected based on a high TSH. In these cases, a spontaneous increase and mean normalization in T4 (from 62 to 73 nmol/L, p-value <0.001) was observed during the follow-up period (7.6 ± 5.0 years). Three of the 42 patients (7%) were started on replacement therapy due to spontaneous deterioration of thyroid function after 2.8 years. Patients diagnosed with CH reported significantly more symptoms of hypothyroidism (p-value 0.005), although, symptoms were reported in most patients with pituitary disease. The TRH test did not provide clinical relevant information in patients with normal T4 or patients awaiting pituitary surgery (78%, 281 of 359). There were only mild and reversible adverse effects related to the TRH test except for possibly one case (0.3%) experiencing a pituitary apoplexy.
CONCLUSION
The TRH test could be reserved to patients with pituitary disease, low T4 levels without convincing signs of CH. Approximately 50% of patients with a slightly decreased T4 were considered to have normal pituitary thyroid function based on the TRH test results.
Topics: Humans; Hyperthyroidism; Hypothyroidism; Pituitary Diseases; Thyrotropin; Thyrotropin-Releasing Hormone; Thyroxine
PubMed: 37850100
DOI: 10.3389/fendo.2023.1226887 -
The Journal of Clinical Endocrinology... May 2022
Topics: Autoimmune Hypophysitis; Humans; Hypophysitis; Magnetic Resonance Imaging; Pituitary Diseases; Pituitary Gland
PubMed: 35259231
DOI: 10.1210/clinem/dgac134 -
Endocrine Pathology Mar 2014The history of pituitary pathology is a long one that dates back to biblical times, but the last 25 years have represented an era of "coming of age." The role of the...
The history of pituitary pathology is a long one that dates back to biblical times, but the last 25 years have represented an era of "coming of age." The role of the pituitary in health and disease was the subject of many studies over the last century. With the development of electron microscopy, immunoassays, and immunohistochemistry, the functional alterations associated with pituitary disease have been clarified. The additional information provided by molecular genetic studies has allowed progress in understanding the pathogenesis of pituitary disorders. Nevertheless, many questions remain to be answered. For example, pathologists cannot morphologically distinguish locally aggressive adenomas from carcinomas when tumor is confined to the sella. Sadly, basal cell carcinoma, the most common carcinoma of skin, usually causes less morbidity than pituitary adenomas, which occur in almost 20 % of the general population, can cause significant illness and even death, and yet are still classified as benign. The opportunity to increase awareness of the impact of these common lesions on quality of life is the current challenge for physicians and patients. We anticipate that ongoing multidisciplinary approaches to pituitary disease research will offer new insights into diseases arising from this fascinating organ.
Topics: Animals; History, 17th Century; History, 19th Century; History, 20th Century; History, 21st Century; History, Ancient; Humans; Pituitary Diseases; Pituitary Gland
PubMed: 24318770
DOI: 10.1007/s12022-013-9284-5 -
The Journal of Clinical Endocrinology... Nov 2014Pituitary involvement in granulomatosis with polyangiitis (GPA) has been described in case reports. The aim of this study was to describe the clinical presentation and...
CONTEXT
Pituitary involvement in granulomatosis with polyangiitis (GPA) has been described in case reports. The aim of this study was to describe the clinical presentation and outcomes of pituitary disease in patients with GPA evaluated at a tertiary referral center.
SETTING
A retrospective review of patients with GPA-related pituitary disease seen at the Mayo Clinic in Rochester, Minnesota.
PATIENTS
A total of 637 patients with antineutrophil cytoplasmic antibodies-associated vasculitis were followed at our institution from 1996 through 2011. Eight patients (1.3%) with clinically confirmed pituitary involvement formed the basis of this study.
INTERVENTIONS
None.
MEASUREMENTS
Pituitary function was assessed with hormonal testing, including TSH, free T4, cortisol, ACTH, prolactin, FSH, LH, estradiol, T, IGF-1, and simultaneous serum and urine osmolalities.
RESULTS
Secondary hypogonadism and diabetes insipidus were the predominant manifestations of pituitary disease (87.5 and 75% of patients, respectively). All patients had abnormal pituitary imaging. A sellar mass with central cystic change and peripheral enhancement was the commonest imaging finding. Pituitary disease was managed with glucocorticoids in combination with cyclophosphamide or rituximab, achieving disease remission in all but one patient. However, permanent anterior pituitary dysfunction was noted in 63% of the patients. Diabetes insipidus was more often reversible, with resolution in 66.7% of the patients.
CONCLUSIONS
Pituitary involvement in GPA is rare, but it needs to be recognized to avoid unnecessary biopsies of sellar lesions encountered in the context of GPA, and to minimize the risk of irreversible pituitary function loss by prompt implementation of definitive medical therapy for the vasculitis.
Topics: Adult; Aged; Female; Granulomatosis with Polyangiitis; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Diseases; Pituitary Function Tests; Pituitary Gland; Retrospective Studies
PubMed: 25077899
DOI: 10.1210/jc.2014-1962 -
European Journal of Endocrinology Oct 2019The transition age is the period between childhood to adulthood; it refers to a broad set of physical, cognitive and sociocultural modifications, arbitrarily defined as... (Review)
Review
INTRODUCTION
The transition age is the period between childhood to adulthood; it refers to a broad set of physical, cognitive and sociocultural modifications, arbitrarily defined as starting in late puberty and ending with full adult maturation. Pituitary disorders in adolescence represent a challenge that requires careful management during the transition to adult care.
METHODS
Given the complexity of care of pituitary disorders in the transition age, we have reviewed the relevant medical literature focusing on aetiology, clinical manifestations, treatment strategies of GH deficiency (GHD), hypogonadotrophic hypogonadism (HH) in male and female adolescents, central hypothyroidism (CH), central adrenal insufficiency (CAI) and cranial diabetes insipidus (CDI) at this time. The objective of the present review is to provide an up-to-date evaluation of the transition period to evaluate the specific needs of adolescents with chronic pituitary disease in order to optimise their management.
RESULTS
We provide an overview of current clinical management of GHD, HH, CH, CAI and CDI in the transition age.
CONCLUSIONS
Specific changes occur in pituitary function during the transition period. A holistic approach including discussion of patients' concerns and emotional support should constitute a key component of managing pituitary disorders in adolescence. Special transition clinics where paediatric and adult endocrinologists work together, should be increasingly created and strengthened to bridge care, to promote continuity and adherence to treatment and to limit potential negative development, metabolic, skeletal and cardiovascular sequelae of discontinuity of care among adolescents with pituitary disorders.
Topics: Adolescent; Age Factors; Child; Human Growth Hormone; Humans; Patient Transfer; Pituitary Diseases; Sexual Maturation; Young Adult
PubMed: 31370006
DOI: 10.1530/EJE-19-0298 -
The Journal of Clinical Endocrinology... Apr 2022
Topics: Humans; Hypophysitis; Pituitary Diseases; Pituitary Gland
PubMed: 35037055
DOI: 10.1210/clinem/dgac026 -
Critical Care Nursing Quarterly Nov 1990
Topics: Critical Care; Humans; Pituitary Diseases; Pituitary Gland, Anterior
PubMed: 2224567
DOI: 10.1097/00002727-199011000-00010 -
Endocrine Oct 2020Pituitary diseases severely affect patients' health-related quality of life (HRQoL). The most frequently used generic HRQoL questionnaire is the Short Form-36 (SF-36)....
PURPOSE
Pituitary diseases severely affect patients' health-related quality of life (HRQoL). The most frequently used generic HRQoL questionnaire is the Short Form-36 (SF-36). The shorter 12-item version (SF-12) can improve efficiency of patient monitoring. This study aimed to determine whether SF-12 can replace SF-36 in pituitary care.
METHODS
In a longitudinal cohort study (August 2016 to December 2018) among 103 endoscopically operated adult pituitary tumor patients, physical and mental component scores (PCS and MCS) of SF-36 and SF-12 were measured preoperatively, and 6 weeks and 6 months postoperatively. Chronic care was assessed with a cross-sectional study (N = 431). Mean differences and agreement between SF-36 and SF-12 change in scores (preoperative vs. 6 months) were assessed with intraclass correlation coefficients (ICC) and limits of agreement, depicting 95% of individual patients.
RESULTS
In the longitudinal study, mean differences between change in SF-36 and SF-12 scores were 1.4 (PCS) and 0.4 (MCS) with fair agreement for PCS (ICC = 0.546) and substantial agreement for MCS (ICC = 0.931). For 95% of individual patients, the difference between change in SF-36 and SF-12 scores varied between -14.0 and 16.9 for PCS and between -7.8 and 8.7 for MCS. Cross-sectional results showed fair agreement for PCS (ICC = 0.597) and substantial agreement for MCS (ICC = 0.943).
CONCLUSIONS
On a group level, SF-12 can reliably reproduce MCS in pituitary patients, although PCS is less well correlated. However, individual differences between SF-36 and SF-12 can be large. For pituitary diseases, alternative strategies are needed for concise, but comprehensive patient-reported outcome measurement.
Topics: Adult; Cross-Sectional Studies; Humans; Longitudinal Studies; Patient Reported Outcome Measures; Pituitary Diseases; Quality of Life; Surveys and Questionnaires
PubMed: 32562182
DOI: 10.1007/s12020-020-02384-4