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Pituitary insufficiency

Michael T Milano, Jimm Grimm, Scott G Soltys, Ellen Yorke, Vitali Moiseenko, Wolfgang A Tomé, Arjun Sahgal, Jinyu Xue, Lijun Ma, Timothy D Solberg, John P Kirkpatrick, Louis S Constine, John C Flickinger, Lawrence B Marks, Issam El Naqa
PURPOSE: Dosimetric and clinical predictors of radiation-induced optic nerve/chiasm neuropathy (RION) after single-fraction stereotactic radiosurgery (SRS) or hypofractionated (2-5 fractions) radiosurgery (fSRS) were analyzed from pooled data that were extracted from published reports (PubMed indexed from 1990 to June 2015). This study was undertaken as part of the American Association of Physicists in Medicine Working Group on Stereotactic Body Radiotherapy, investigating normal tissue complication probability (NTCP) after hypofractionated radiation...
January 31, 2018: International Journal of Radiation Oncology, Biology, Physics
Dimitrios Askitis, Damianos Tsitlakidis, Nicolle Müller, Albrecht Waschke, Gunter Wolf, Ulrich Alfons Müller, Christof Kloos
INTRODUCTION: We retrospectively evaluated all patients with pituitary tumours treated in our department from 1/1/1997 to 01/11/2014. PATIENTS AND METHODS: Two hundred and fifteen patients (124 females, 91 males, mean age 50.9 years) were treated because of pituitary tumours. All patients underwent basal hormonal analysis and when required dynamic testing in order to check for hormonal activity. Pituitary masses were divided into groups concerning their hormonal status and were further classified according to gender, age at diagnosis, tumour size, and the development of postoperative pituitary insufficiency when neurosurgical intervention was conducted...
March 12, 2018: Endocrine
Thierry Brue, Vincent Amodru, Frédéric Castinetti
With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2-3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease...
March 9, 2018: European Journal of Endocrinology
J P Zhang, Q H Guo, Y M Mu, Z H Lyu, W J Gu, G Q Yang, J Du, J M Ba, J M Lu
Objective: To evaluate the clinical characteristics and etiologies of central diabetes insipidus (CDI). Methods: The clinical data of 230 patients with CDI in the Department of Endocrinology of Chinese PLA General Hospital from 2008 June to 2014 December were collected and analyzed retrospectively. Results: The three most common causes of CDI were idiopathic CDI, lymphocytic hypophysitis and intracranial germ cell tumors. Among all the CDI, the idiopathic CDI accounted for 37.48%. There were significant differences in age onset and gender distribution among the different causes of CDI...
March 1, 2018: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
Mikkel Andreassen, Anders Juul, Ulla Feldt-Rasmussen, Niels Joergensen
Gonadotropins (luteinizing hormone (LH) and follicle stimulating hormone (FSH)) are released from the pituitary gland and stimulate Leydig cells to produce testosterone and initiates spermatogenesis. Little is known about how and when the deterioration of semen quality occurs in patients with adult onset gonadotropin insufficiency Design and methods: A retrospective study comprising 20 testosterone deficient men (median age 29 years) with acquired pituitary disease, who delivered semen for cryopreservation before initiation of testosterone therapy...
March 7, 2018: Endocrine Connections
Matthias K Auer, Mareike R Stieg, Alexander Crispin, Caroline Sievers, Günter K Stalla, Anna Kopczak
BACKGROUND: Empty sella is the neuroradiological or pathological finding of an apparently empty sella turcica containing no pituitary tissue. The prevalence of primary empty sella, i.e., empty sella without any discernible cause, is not precisely known; estimates range from 2% to 20%. Technical advances in neuroradiology have made empty sella an increasingly common incidental finding. It remains unclear whether, and to what extent, asymptomatic adult patients with an incidentally discovered empty sella should undergo diagnostic testing for hormonal disturbances...
February 16, 2018: Deutsches Ärzteblatt International
Elena Roca, Pier Paolo Mattogno, Teresa Porcelli, Luigi Poliani, Francesco Belotti, Alberto Schreiber, Filippo Maffezzoni, Marco Maria Fontanella, Francesco Doglietto
INTRODUCTION: Plurihormonal adenomas (PHA) represent 10-15% of all functioning pituitary adenomas. The most frequent hormonal association is represented by prolactin and growth hormone (GH). AIM: To describe a rare case of functional ACTH and GH microadenoma, together with a systematic literature review on PHA. METHODS: PubMed was searched using the terms "plurihormonal pituitary adenoma", "ACTH, GH pituitary adenoma", and "Acromegaly AND Cushing's disease"...
February 28, 2018: World Neurosurgery
Manal Elnenaei, Derek Minney, David B Clarke, Andrew Kumar-Misir, Syed Ali Imran
OBJECTIVE: The clinical presentation of pituitary dysfunction is typically variable and may often be insidious, resulting in delayed diagnosis by up to decades. The complexity of presentation and difficulty in pattern recognition of first line hormone tests result in challenges in early diagnosis of this condition. The aim of this study was to determine the impact of reflective testing and interpretive commenting on the early detection and management of such cases from primary care. METHODS: Prospective audit over 12 months in which first line pituitary target organ hormones were identified via a reflex algorithm in the laboratory information system...
February 24, 2018: Clinical Biochemistry
Saranya George, Anita Balan
Topical corticosteroids are some of the most common drugs used in oral medicine for treating atrophic and erosive lesions that affect the mucosa. Adverse effects of these drugs include oral candidiasis with associated burning mouth and hypogeusia, hypersensitive reactions to the drug, and inhibition of the hypothalamic-pituitary-adrenal axis and secondary adrenal insufficiency. The ocular side effects of oral topical steroids are less documented. This short communication describes a case of central serous retinopathy that developed following administration of oral topical steroid...
January 2018: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
Abdulrazag Ajlan, Khadeejah A Almufawez, Abdulrahman Albakr, Laurence Katznelson, Griffith R Harsh
INTRODUCTION: Hormonal insufficiency of one or more pituitary axes can appear after pituitary surgery. Adrenal axis impairment after surgery can lead to serious consequences if not identified and treated. OBJECTIVE: Assess early and late post-operative adrenal insufficiency (AI) and identify the risk factors predicting their occurrence after endoscopic transsphenoidal resection of pituitary adenomas. METHOD: Retrospective review identified 176 pituitary adenomas resected using an endoscopic transsphenoidal approach...
February 5, 2018: World Neurosurgery
Avital Perry, Christopher Salvatore Graffeo, Christopher Marcellino, Bruce E Pollock, Nicholas M Wetjen, Fredric B Meyer
Background  Pediatric pituitary adenoma is a rare skull base neoplasm, accounting for 3% of all intracranial neoplasms in children and 5% of pituitary adenomas. Compared with pituitary tumors in adults, secreting tumors predominate and longer disease trajectories are expected due to the patient age resulting in a natural history and treatment paradigm that is complex and controversial. Objectives  The aims of this study were to describe a large, single-institution series of pediatric pituitary adenomas with extensive long-term follow-up and to conduct a systematic review examining outcomes after pituitary adenoma surgery in the pediatric population...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Troy Sukhu, Sherry Ross, R Matthew Coward
BACKGROUND: Urological survivorship issues encompass an area that may potentially be overlooked after treatment of childhood cancer in adolescent boys and young men. Side effects of cancer therapy may include subsequent development of erectile dysfunction (ED), hypogonadism, and infertility in adulthood. AIM: The purpose of this review is to focus on the etiology and prevalence of the range of sexual and gonadal dysfunction in adolescent boys and young men who are cancer survivors, while discussing current recommendations for evaluation and treatment...
January 27, 2018: Sexual Medicine Reviews
Hui-Chun Huang, Shao-Jung Hsu, Ching-Chih Chang, Ming-Hung Tsai, Fa-Yauh Lee, Ming-Chih Hou, Shou-Dong Lee
Critical illness is accompanied by hypothalamic-pituitary-adrenal axis activation, but adrenal insufficiency characterized by inadequate glucocorticoid synthesis is common in critically ill cirrhotic patients, the 'hepato-adrenal syndrome'. Adrenal cortex also synthesizes androgen (dehydroepiandrosterone, DHEA). DHEA maintains microcirculation by enhancing vascular endothelial nitric oxide synthase (eNOS) activity. In critical patients of other disease entities, a shift of adrenal steroidogenesis away from androgens towards glucocorticoid has been noted, arousing interests in androgen replacement in critical settings...
February 1, 2018: Shock
Gerard Ruiz-Babot, Mariya Balyura, Irene Hadjidemetriou, Sharon J Ajodha, David R Taylor, Lea Ghataore, Norman F Taylor, Undine Schubert, Christian G Ziegler, Helen L Storr, Maralyn R Druce, Evelien F Gevers, William M Drake, Umasuthan Srirangalingam, Gerard S Conway, Peter J King, Louise A Metherell, Stefan R Bornstein, Leonardo Guasti
Adrenal insufficiency is managed by hormone replacement therapy, which is far from optimal; the ability to generate functional steroidogenic cells would offer a unique opportunity for a curative approach to restoring the complex feedback regulation of the hypothalamic-pituitary-adrenal axis. Here, we generated human induced steroidogenic cells (hiSCs) from fibroblasts, blood-, and urine-derived cells through forced expression of steroidogenic factor-1 and activation of the PKA and LHRH pathways. hiSCs had ultrastructural features resembling steroid-secreting cells, expressed steroidogenic enzymes, and secreted steroid hormones in response to stimuli...
January 30, 2018: Cell Reports
Yoshinori Yasuda, Shintaro Iwama, Atsushi Kiyota, Hisakazu Izumida, Kohtaro Nakashima, Naoko Iwata, Yoshihiro Ito, Yoshiaki Morishita, Motomitsu Goto, Hidetaka Suga, Ryoichi Banno, Atsushi Enomoto, Masahide Takahashi, Hiroshi Arima, Yoshihisa Sugimura
Autoimmune hypophysitis (AH) is thought to be an autoimmune disease characterized by lymphocytic infiltration of the pituitary gland. Among AH pathologies, lymphocytic infundibulo-neurohypophysitis (LINH) represents infiltration of the neurohypophysis and/or the hypothalamic infundibulum, causing central diabetes insipidus due to insufficiency of arginine vasopressin (AVP) secretion. The pathophysiological and pathogenetic mechanisms underlying LINH are largely unknown. Clinically, differentiating LINH from other pituitary diseases accompanied by mass lesions, including tumors, has been often difficult because of similar clinical manifestations...
January 29, 2018: Journal of Pathology
Sandra Shenouda, Khaled Al-Farawi, Jenna Dolan, Susan L Flesher
Idiopathic intracranial hypertension is a diagnosis of exclusion defined by elevated intracranial pressure without mass lesions or hydrocephalus. Causes of idiopathic intracranial hypertension include obesity, vitamin derangements, antibiotics, corticosteroids, and autoimmune disorders. Cushing's disease and Addison's disease have been associated with idiopathic intracranial hypertension. Secondary adrenal insufficiency following withdrawal of inhaled corticosteroids has been found to be a relatively common phenomenon...
2018: SAGE open medical case reports
Sii Hoe Leong, Shubash Shander, Jeyakantha Ratnasingam
OBJECTIVE: Prolonged exposure to glucocorticoids lead to hypothalamic-pituitary-adrenal (HPA) axis suppression that recovers after cessation of treatment. We aimed to identify the predictive factors for HPA axis recovery after prolonged glucocorticoid use. METHODS: Retrospective review of patients who had undergone first short Synacthen test (SST) to assess HPA axis recovery after prolonged use of glucocorticoids. RESULTS: A total of 61% (20/33) of patients had adequate SST response at a median time of 2 years after diagnosis of adrenal insufficiency...
January 2018: Endocrine Practice
Ken Takeshima, Hiroyuki Ariyasu, Tatsuya Ishibashi, Shintaro Kawai, Shinsuke Uraki, Jinsoo Koh, Hidefumi Ito, Takashi Akamizu
Myotonic dystrophy type 1 (DM1) is an autosomal dominant multisystem disease affecting muscles, the eyes and the endocrine organs. Diabetes mellitus and primary hypogonadism are endocrine manifestations typically seen in patients with DM1. Abnormalities of hypothalamic-pituitary-adrenal (HPA) axis have also been reported in some DM1 patients. We present a case of DM1 with a rare combination of multiple endocrinopathies; diabetes mellitus, a combined form of primary and secondary hypogonadism, and dysfunction of the HPA axis...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Kohtaro Nakashima, Seiji Takeuchi, Shintaro Iwama, Atsushi Kiyota, Yoshinori Yasuda, Naoko Iwata, Atsushi Enomoto, Hiroshi Arima, Yoshihisa Sugimura
The molecular mechanism involved in the exocytosis of arginine vasopressin (AVP) is not fully known. Rabphilin-3A has been suggested as a novel autoantigen in infundibulo-neurohypophysitis (LINH), which leads to central diabetes insipidus through insufficient secretion of AVP. However, the role of rabphilin-3A in the pathogenesis of LINH remains unclear. Thus, the aim of the present study was to identify proteins binding rabphilin-3A in the posterior pituitary. Using glutathione S-transferase (GST)-pulldown assays and proteomic analyses, cullin-associated NEDD8-dissociated protein 1 (CAND1) was identified as a rabphilin-3A-binding protein in the posterior pituitary...
January 23, 2018: Endocrine Journal
Keitaro Kanie, Genzo Iguchi, Hironori Bando, Yasunori Fujita, Yukiko Odake, Kenichi Yoshida, Ryusaku Matsumoto, Hidenori Fukuoka, Wataru Ogawa, Yutaka Takahashi
Cancer immunotherapy has emerged as treatment of multiple advanced cancer types. Immune checkpoint inhibitors, namely anticytotoxic T-lymphocyte antigen-4 (CTLA-4), antiprogrammed cell death-1 (PD-1), and antiprogrammed cell death-1 ligand 1 (PD-L1) antibodies, have been used for treatment of various cancers. Classified as immune-related adverse events, several endocrinopathies, including hypophysitis, are associated with these agents. Although anti-CTLA-4-induced hypophysitis has been frequently observed, hypophysitis upon use of anti-PD-1 and anti-PD-L1 antibodies is rare...
January 1, 2018: Journal of the Endocrine Society
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