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Secondary hypopituitarism

Elzbieta Skowronska-Jozwiak, Stanislaw Sporny, Joanna Szymanska-Duda, Dominika Baranowska, Andrzej Lewinski
Langerhans cell histiocytosis (LCH) in adults is a rare disorder of unknown etiology characterized by monoclonal proliferation of Langerhans cells. It belongs to dendritic cell disorders and occurs in 1-2 adults per million. The most common endocrine manifestation of classical LCH is associated with the posterior pituitary, with clinical symptoms of diabetes insipidus. Less than 80 reported cases of LCH involving the thyroid gland have been published so far. We present the case of a 39 years old woman with 10 years history of diabetes insipidus and secondary amenorrhoea, which appeared after second delivery...
July 12, 2016: Neuro Endocrinology Letters
Vishal Anand Gupta, Niteen Karnik, Manish Itolikar, Ketan Vekariya
Rapid correction of hyponatremia is known to cause central pontine myelinolysis (CPM). It may concurrently involve other areas of brain as well, referred as extra-pontine myelinolysis (EPM). Isolated EPM however is a very rare occurrence. We present a case of EPM where the hyponatremia was secondary to hypothyroidism due to empty sella syndrome. Chronic hyponatremia should always be corrected slowly to avoid such osmotic myelinolysis syndromes (OMS).
October 2015: Journal of the Association of Physicians of India
Kosuke Mukai, Tetsuhiro Kitamura, Daisuke Tamada, Masahiko Murata, Michio Otsuki, Iichiro Shimomura
Non-functioning pituitary adenoma (NFPA) is often associated with hypopituitarism. Diagnosis of hypopituitarism is important because of its poor prognosis and low quality of life. Among hypopituitarism, it is difficult to diagnose secondary adrenocortical insufficiency and GH deficiency without hormone stimulation test. Therefore, the aim of our study was to identify patients with NFPA who require more careful endocrinological examination. We examined the relationship between NFPA size and the prevalence of each hypopituitarism or the response of each anterior pituitary hormone by insulin tolerance test, LHRH test and TRH test...
August 18, 2016: Endocrine Journal
Nassib Alsahwi, Delali Blavo, Harsha Karanchi
Sarcoidosis is a multisystem granulomatous disorder. The lungs are the principal organs affected, however, extrapulmonary involvement including disorders of the pituitary and thyroid glands has been reported but presentation with multiple endocrine manifestations is rare. We report the case of a 36-year-old African-American woman who presented with hypercalcaemia, abnormal thyroid function studies and secondary amenorrhoea. On workup including laboratory, radiological testing and biopsy she was diagnosed with sarcoidosis with multi-organ involvement...
2016: BMJ Case Reports
Hae Won Lee, Jin Du Kang, Chang Woo Yeo, Sung Woon Yoon, Kwang Jae Lee, Mun Ki Choi
Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism...
August 2016: Journal of Korean Medical Science
Gerival Vieira, Lucas Alverne Freitas de Albuquerque, Ariane Bernardes Camilo Castilho de Avellar, Julio Leonardo Barbosa Pereira, Marcos Dellaretti, Paulo Augusto Carvalho Miranda, Rodrigo Alvares Paiva Macedo, Laura Amaral Quintino da Silva, Sebastião Nataniel Silva Gusmão
OBJECTIVE: The aim of this study was to evaluate the prevalence of hypopituitarism in the acute stage after aneurysmal subarachnoid hemorrhage (SAH) as well at the chronic stage, at least 1 year after bleeding, to assess its implications and correlation with clinical features of the studied population. PATIENTS AND METHODS: This was a prospective cohort study that evaluated patients admitted between December 2009 and May 2011 with a diagnosis of SAH secondary to cerebral aneurysm rupture...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Allison J Pollock, Tasa S Seibert, Cristiana Salvatori, Patrizio Caturegli, David B Allen
BACKGROUND/AIMS: Autoimmune hypophysitis (AH) is a rare inflammatory disease of the pituitary gland causing varying degrees of hypopituitarism and/or sellar compression. Cranial MRI remains the best noninvasive tool to diagnose AH, although a diagnosis of certainty requires pituitary biopsy. The objective of this study was to assess the utility of detecting pituitary antibodies for the diagnosis of AH. METHODS: A 15-year-old female with Turner syndrome (TS), hypothyroidism, and ovarian failure presented acutely with hypocortisolism...
June 30, 2016: Hormone Research in Pædiatrics
Badr Ratnakaran, Varghese P Punnoose, Soumitra Das, Arjun Kartha
Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided without any psychotropic drugs...
May 2016: Indian Journal of Psychological Medicine
Matthew W Dyer, Amy Gnagey, Bryan T Jones, Roger D Pula, William L Lanier, John L D Atkinson, Jeffrey J Pasternak
BACKGROUND: Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas are a rare cause of secondary hyperthyroidism. Anesthetic management of these patients has not been formally described in the literature. MATERIALS AND METHODS: Patients who underwent resection of a TSH-secreting pituitary adenoma during 1987 to 2012 at a single institution were identified. Preoperative thyroid hormone state, anesthetic management, and outcome were recorded. Hemodynamic associations with intraoperative events were compared between those who were hyperthyroid and euthyroid at the time of surgery...
June 17, 2016: Journal of Neurosurgical Anesthesiology
Martín Cuesta, Aoife Garrahy, David Slattery, Saket Gupta, Anne Marie Hannon, Hannah Forde, Karen McGurren, Mark Sherlock, William Tormey, Christopher J Thompson
OBJECTIVE: The syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of hyponatraemia. Data on SIAD are mainly derived from retrospective studies, often with poor ascertainment of the minimum criteria for the correct diagnosis. Reliable data on the incidence of adrenal failure in SIAD are therefore unavailable. The aim of the study was to describe the aetiology of SIAD and in particular to define the prevalence of undiagnosed adrenal insufficiency. DESIGN: Prospective, single centre, noninterventional, observational study of patients admitted to Beaumont Hospital with euvolaemic hyponatraemia (plasma sodium ≤ 130 mmol/l) between January 1st and October 1st 2015...
June 6, 2016: Clinical Endocrinology
Giorgio Arnaldi, Laura Trementino
Treating Cushing's syndrome is very challenging and should be tailored to the patient. Surgery is considered the gold standard treatment for both pituitary adrenocorticotropic hormone (ACTH)-secreting adenomas, ectopic ACTH-secreting tumors and adrenal tumors, as the chance to be successful is high, especially for adrenal tumors, when performed in specialized centers by expert surgeons. Pituitary radiotherapy represents a second-line treatment in patients not cured with surgery, or when medical treatment is not suitable/efficacious, although the rate of cure is largely variable and achieved only in the long term, and is associated with the risk of developing secondary hypopituitarism...
2016: Frontiers of Hormone Research
S Chiloiro, T Tartaglione, F Angelini, A Bianchi, V Arena, A Giampietro, M Mormando, M C Scianda, M E Laino, L De Marinis
INTRODUCTION: Autoimmune hypophysitis (AH) is a rare disease with a not well known natural progression Aim: To collect representative data on clinical features of AH and better characterize the disease. PATIENTS AND METHODS: A monocentric prospective study was designed. AH affected patients, evaluated at our tertiary care Pituitary Unit from 2011 were enrolled. After ruling out other pituitary mass and secondary causes of hypophysitis, AH was the exclusion diagnosis...
May 11, 2016: Neuroendocrinology
Vaibhav Ingle, Prafulla Kumar Maharana
A middle-aged woman presented with premature menopause and recurrent episodes of vomiting with hyponatraemia. Since primary causes of hormone deficiencies were the only studies initially evaluated, there was a delayed diagnosis. Pituitary tropic hormones (serum thyroid stimulating hormone/follicle stimulating hormone/luteinising hormone), inappropriately low for low-level of target hormones (free thyroxin/oestradiol), led to detailed evaluation of trophic hormone deficiencies by pituitary stimulation. The pituitary stimulation by insulin challenge test confirmed secondary (pituitary) hypofunction...
2016: BMJ Case Reports
Saranya Devi, Anita Ganger, Sanjay Sharma, Rohit Saxena
A 13-year-old boy presented with bilateral progressive proptosis, abduction deficit, optic atrophy and features suggestive of hypopituitarism secondary to a sphenoid sinus mucocele. Drainage of the mucocele along with hormone replacement therapy resulted in improvement in visual acuity and abduction.
2016: BMJ Case Reports
Rohan Parikh, Varun Buch, Mitesh Makwana, Harit N Buch
We describe a case of a 48-year-old woman who presented with a 15-year history of recurrent episodes of hypoglycemia and hyponatremia leading to altered behavior and generalized seizures. She underwent full clinical assessment, endocrine tests, and a pituitary magnetic resonance scan that showed pananterior hypopituitarism secondary to postpartum pituitary necrosis (Sheehan's syndrome). She was commenced on appropriate hormone replacement therapy, which led to significant improvement in lethargy, anorexia, muscle weakness, and episodes of hypoglycemia...
April 2016: Proceedings of the Baylor University Medical Center
C Pelusi, D I Gasparini, N Bianchi, R Pasquali
Hereditary hemochromatosis (HH) is a genetic disorder of iron overload and subsequent organ damage. Five types of HH are known, classified by age of onset, genetic cause, clinical manifestations and mode of inheritance. Except for the rare form of juvenile haemochromatosis, symptoms do not usually appear until after decades of progressive iron loading and may be triggered by environmental and lifestyle factors. Despite the last decades discovery of genetic and phenotype diversity of HH, early studies showed a frequent involvement of the endocrine glands where diabetes and hypogonadism are the most common encountered endocrinopathies...
August 2016: Journal of Endocrinological Investigation
V Munro, B Tugwell, S Doucette, D B Clarke, A Lacroix, S A Imran
OBJECTIVE: Previous studies have reported recovery of secondary adrenal insufficiency (SAI) in patients with pituitary disorders, generally immediately after pituitary surgery; however, data regarding recovery of long-term SAI are lacking. We conducted a study to assess the longer term recovery rate of SAI in patients with pituitary disorders. METHODS: We identified all SAI patients in the Halifax Neuropituitary Database from 1 November 2005 to 30 September 2014, who had required glucocorticoid therapy for ≥3 months, and had a minimum follow-up of 6 months...
August 2016: Clinical Endocrinology
Peter Wolf, Yvonne Winhofer, Sabina Smajis, Renate Kruschitz, Karin Schindler, Alois Gessl, Michaela Riedl, Greisa Vila, Wolfgang Raber, Felix Langer, Gerhard Prager, Bernhard Ludvik, Anton Luger, Michael Krebs
OBJECTIVE: Craniopharyngiomas (CPs) are benign brain tumors presenting frequently in childhood and are treated by surgery with or without radiotherapy. About 50% of cured patients suffer from eating disorders and obesity due to hypothalamic damage, as well as hypopituitarism, necessitating subsequent hormone substitution therapy. Gastric bypass surgery has been reported to be an efficient treatment strategy for morbid hypothalamic obesity. However, so far it is unknown whether oral hormone substitution is affected by impaired intestinal drug absorption, potentially leading to severe hypopituitarism or pituitary crisis...
May 2016: Endocrine Practice
Giulia Izzo, Assunta Tirelli, Elisabetta Angrisani, Giovanni Cannaviello, Lucio Cannaviello, Alessandro Puzziello, Alessandro Vatrella, Mario Vitale
BACKGROUND: Traumatic brain injury (TBI) is a major cause of death and disability and may cause transient or persistent, isolated or multiple hypopituitarism in a variable percentage of cases. OBJECTIVES: The primary aim of this study was to determine the incidence of isolated and multiple anterior pituitary hormone deficiency in subjects with TBI in a single institution. The secondary aim was to determine a correlation between pituitary deficiency and quality of life (QOL) after TBI...
April 2016: International Journal of Surgery
S Chiloiro, A Giampietro, A Bianchi, L De Marinis
Intracranial teratomas are rare and comprise about 0.5 % of all intracranial tumours. Actually, a total of 15 cases of sellar-suprasellar teratoma have been described in the last 24 years. Although rare, hypothalamic-pituitary teratomas should be taken into account in the differential diagnosis of hypothalamic-pituitary region tumours. The current review focuses on the clinical and therapeutic management of pituitary region teratomas. Teratomas occur more frequently in children and young adults than in the older population and in males as compared to females...
September 2016: Endocrine
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