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2.1
Anterior Pituitary Disease
Anterior

Presentation

A 36-year-old man presented to the emergency department with substernal chest tightness of 6 hours’ duration. The chest tightness was initially intermittent but became persistent 1 hour before presentation. [nejm.org]

The dorsal sellar diaphragm presents the least resistance to soft tissue expansion from the sella; consequently, pituitary adenomas frequently extend in a suprasellar direction. Bony invasion may occur as well. [accessmedicine.mhmedical.com]

When present, they produce the same signs and symptoms of hyperthyroidism (see Chapter 11 ). [ime.acponline.org]

Symptoms may not be present and tumours can be found when imaging is performed for other reasons (incidentalomas). [labtestsonline.org.uk]

Oxytocin is present in men but has no proven function. Click here for Patient Education NOTE: This is the Professional Version. [merckmanuals.com]

Entire Body System

  • Infertility

    […] due to pituitary disorder Female infertility of pituitary origin Follicle stimulating hormone deficiency FSH - follicle stimulating hormone deficiency Gonadotroph hyperplasia Gonadotropin deficiency, isolated Gonadotropin releasing factor deficiency [icd9data.com]

    Low levels of gonadotropins cause infertility, decrease in sex drive, an inability to have an erection, and irregular menstrual cycles. [cancer.net]

    FSH measurements can aid in the evaluation of infertility and disorders of menstruation. [healthcommunities.com]

    This can lead to infertility and a decreased sex drive. Traumatic brain injury. This involves a sudden blow to your brain. [healthline.com]

    Hormone Deficiency and Infertility Infertility treatments and clinics are gaining popularity as gynecologists and obstetricians become increasingly aware of the pituitary’s effect on fertility. [fortherecordmag.com]

  • Short Stature

    Answer Growth hormone Short stature Delayed puberty ACTH Symptoms of adrenal cortical deficiency TSH Symptoms of hypothyroidism Gonadotropin Amenorrhea Diminished libido Loss of pubic and axillary hair Atrophy of breast and Testis What are the steps in [meddean.luc.edu]

    Growth hormone deficiency: in growing children, growth hormone deficiency results in short stature and/or very slow growth rates. [chw.org]

    For example, if the pituitary gland does not produce enough growth hormone in a child, they may have a permanently short stature. [healthline.com]

    Dev’tal and Genetic Causes of Hypopituitarism Pituitary Dysplasia  Result in aplastic, hypoplastic, or ectopic pituitary gland dev’t Septo-Optic Dysplasia  Pit dysfunction leads to diabetes insipidus, GH def and short stature, and, TSH def.  Mutations [slideshare.net]

    Growth hormone (GH) deficiency In children, GH deficiency may cause growth problems and short stature. [mayoclinic.org]

  • Swelling

    Swelling: It is common and in fact expected to have swelling about your hip after surgery. Icing your hip is extremely helpful. [scottfaucettmd.com]

    The excessive growth occurs first in the hands and feet, as soft tissue begins to swell. This rare pituitary disease affects mostly middle-aged adults. Untreated, the pituitary disorder can lead to severe illness and death. [northwell.edu]

    • Hallmark is edema that causes facial tissues to swell and look puffy • No mental retardation but person may be less alert. • Tx • Oral thyroid hormones reduce the Symptoms 18. [slideshare.net]

    In adults, excessive growth hormone for a long period of time produces a condition known as acromegaly, in which patients have swelling of the hands and feet and altered facial features. [yourhormones.info]

  • Surgical Procedure

    An anterior cervical discectomy, like any surgical procedure, is associated with a certain amount of risk. However, this risk is usually small. [columbiaspine.org]

    Approximately 30 min prior to surgery, you will be transferred to the operating room Surgical Procedure An incision is made over the hip to expose the hip joint The acetabulum (socket) is prepared using a special instrument called a reamer. [scottfaucettmd.com]

    For instance, certain illnesses, accidents or surgical procedures may have adverse complications due to hypopituitarism. Gonadotropin deficiency Replacement of gonadal steroids is common treatment for LH and FSH deficiency. [medical-dictionary.thefreedictionary.com]

  • Male Hypogonadism

    In women, prolactinoma might cause: Irregular menstrual periods Lack of menstrual periods Milky discharge from the breasts In men, a prolactin-producing tumor may cause male hypogonadism. [mayoclinic.org]

    hypogonadism, and estradiol for female hypogonadism (usually with a progestogen to inhibit unwanted effects on the uterus ). [en.wikipedia.org]

Respiratoric

  • Anosmia

    Hypogonadism with anosmia Hypogonadism, anosmia Hypogonadotropic hypogonadism Hypogonadotropic hypogonadism due to follicle-stimulating hormone deficiency Hypogonadotropic hypogonadism due to isolated gonadotropin deficiency Hypogonadotropic hypogonadism [icd9data.com]

    Temporal and frontal lobe involvement may rarely lead to uncinate seizures, personality disorders, and anosmia. [accessmedicine.mhmedical.com]

    Examples are: · Septo-optic dysplasia (hypothalamic dysfunction, cleft palate, syndactyly, ear deformity, optic atrophy, microgenitals, anosmia). · Kallmann syndrome (isolated hypogonadotropic hypogonadism, associated with defects of smell, X-linked). [medicscientist.com]

    Developmental Hypothalamic Dysfunction Kallmann Syndrome Defective hypothalamic GnRH syn & is assoc with anosmia or hyposmia due to olfactory bulb agenesis Xterized by low LH and FSH levels and low conc of sex steroids (testosterone or estradiol) Repetitive [slideshare.net]

    Lieblich JM, Rogol AD, White BJ, et al: Syndrome of anosmia with hypogonadotropic hypogonadism (Kallman syndrome). Am J Med 73: 506–519, 1982 PubMed CrossRef Google Scholar 20. [link.springer.com]

Gastrointestinal

  • Failure to Thrive

    If the problem is chronic, symptoms consist of fatigue, weight loss, failure to thrive (in children), delayed puberty (in adolescents), hypoglycemia (low blood sugar levels), anemia and hyponatremia (low sodium levels). [en.wikipedia.org]

Skin

  • Hirsutism

    MICROADENOMAS include Cushings disease (small corticotrophe tumour) and most prolactinomas. a) Prolactinomas In women cause menstrual irregularities, oligo-amennorrhoea, galactorrhoea, and occasionally hirsutism, and are usually microadenomas. [anaesthesia.med.usyd.edu.au]

    […] feel depressed Loss of bone density (if left untreated over time) due to excess cortisol Extreme mood swings Weakness, possible muscle wasting Darkening of skin pigmentation Dark purple striae (similar to stretch marks on abdomen and tops of thighs) Hirsutism [pituitary.org.uk]

    However, prolactinomas frequently interfere with the production of other anterior pituitary hormones such as FSH/LH, leading to oligomenorrhea, amenorrhea, and hirsutism. [ime.acponline.org]

    Facial hair growth ( Hirsutism )<br />10. Bone resorption leads to osteoporosis<br />11. Hyperglycemia due to gluconeogeneis leads adrenal diabetes and glycosuria<br />12. Hypertension<br />13. [slideshare.net]

Musculoskeletal

  • Osteoporosis

    Men with hypogonadism develop: Decreased libido Erectile dysfunction in some cases Mood swings Muscle and hair loss Weakness and Fatigue Osteoporosis Physiologic Testosterone replacement tend to alleviate these symptoms and restore quality of life. [pacificneuroscienceinstitute.org]

    These patients often develop glucose intolerance, muscle weakness, arthritis, osteoporosis, HTN, obstructive sleep apnea (OSA), congestive heart failure, and arrhythmias. [anesth.unboundmedicine.com]

    Cushings sydrome is the clinical syndrome with features of prolonged high glucocorticoid levels, ie: Central obesity, buffalo hump, round face Striae, thinning and bruising of skin, hirsutism, acne Osteoporosis, muscle wasting, catabolism Psychiatric [anaesthesia.med.usyd.edu.au]

    Patients may also have high blood pressure, diabetes mellitus, and osteoporosis. Many of these problems are non-specific, meaning that people who have them usually do not have Cushing's syndrome. [neurosurgery.emory.edu]

    Hypercortisolism also causes insulin resistance (which can lead to the development of type 2 diabetes mellitus ), excessive bone resorption (which can lead to osteoporosis ), and hypertension. [courses.washington.edu]

Eyes

  • Visual Impairment

    Treatment is essential if the adenoma is large enough to cause neurologic symptoms, such as visual impairment or headache. [ime.acponline.org]

    Surgery should be opted if patient has visual impairment. Transsphenoidal surgery may require to confirm diagnosis and to relieve symptoms of compression. There are a few reported cases of lymphocytic hypophysitis from India. [ijem.in]

Neurologic

  • Headache

    Hydrocephalus Psychosis Dementia Laughing seizures Headaches are common features of small intrasellar tumors, even with no demonstrable suprasellar extension. [accessmedicine.mhmedical.com]

    Furthermore, headaches are common in the general population and there is no guarantee that surgery will alleviate the headaches and all patients with hyperplasia because the headaches might be due to some other pathophysiological mechanism. [pituitaryworldnews.org]

    Benign but may put pressure on the pituitary, causing delayed growth in children, visual disturbances / headaches in adults and hypopituitarism. [labtestsonline.org.uk]

    CONSUMERS: Click here for the Consumer Version Patients with hypothalamic-pituitary lesions generally present with some combination of Symptoms and signs of a mass lesion: headaches, altered appetite, thirst, visual field defects—particularly bitemporal [merckmanuals.com]

    If these symptoms go unrecognized and progress, headaches and vision problems can occur. Pituitary adenomas These tumors are the most common type of tumor and pituitary disorder. [northwell.edu]

  • Stroke

    (Updated October 26, 2010).NINDS Pituitary Tumors Information Page.National Institute of Neurological Disorders and Stroke [On-line information].Available online at http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm.Accessed on October [labtestsonline.it]

    National Institute of Neurological Disorders and Stroke [On-line information]. Available online at http://www.ninds.nih.gov/disorders/pituitary_tumors/pituitary_tumors.htm. Accessed on 1/4/09. Kattah, J. (2006 March 30). Pituitary Tumors. [labtestsonline.org]

    […] other possible causes of hypopituitarism include: sarcoidosis (a chronic lung disease) hemochromatosis (a hereditary disease characterized by too much iron in the body) histiocytosis X (a rare autoimmune disorder where immune cells attack the organs) stroke [healthline.com]

    Examples include: Head injuries Brain surgery Radiation treatment to the head or neck Lack of blood flow to the brain or pituitary gland (stroke) or bleeding (hemorrhage) into the brain or pituitary gland Certain medications, such as narcotics, high-dose [mayoclinic.org]

  • Apathy

    Symptoms of ACTH and cortisol deficiency With gradual onset of deficiency over days or weeks, symptoms may include: Weight loss Fatigue Weakness Depression Apathy Nausea Vomiting Loss of appetite Abdominal pain As ACTH deficiency becomes more severe or [pacificneuroscienceinstitute.org]

    […] deficiencies) Flu type feelings low or no cortisol in body, regular colds and/or infections 'hung over’ type feeling without having drunk alcohol No body temperature control either feeling too hot, or too cold Nausea Mood swings feelings of depression, apathy [pituitary.org.uk]

  • Ataxia

    […] pituitary gland Approximate Synonyms Abnormal prolactin Anterior pituitary disorder Anterior pituitary hormone deficiency Atypical ichthyosis vulgaris with hypogonadism Decreased hormone secretion Disorder of anterior pituitary Early onset cerebellar ataxia [icd9data.com]

    Insulinomas in MEN1 syndrome are usually small and multiple and present early in second to fourth decade.112 Other syndromic associations There are multiple other syndromes, such as Bardet-Biedl syndrome, Friedreich ataxia, Alström syndrome and Berardinelli-Seip [touchendocrinology.com]

  • Cerebellar Ataxia

    ataxia with hypogonadism Female hypogonadotropic hypogonadism Female infertility due to pituitary disorder Female infertility of pituitary origin Follicle stimulating hormone deficiency FSH - follicle stimulating hormone deficiency Gonadotroph hyperplasia [icd9data.com]

Workup

Dynamic pituitary MRI has high sensitivity and specificity for diagnosis of mild Cushing's syndrome and should be part of the initial workup. Horm Metab Res. 2007;39(6):451–456. 22. Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. [aafp.org]

Serum

  • Hyperprolactinemia

    In some cases hypersecretion gives rise to a typical clinical syndrome involving acromegaly, hyperprolactinemia, and excess corticotropin (ACTH). [ncbi.nlm.nih.gov]

    While a prolactinoma is the most common cause of hyperprolactinemia, not all patients with hyperprolactinemia have prolactinomas. Table 2 lists the many physiologic, pathologic, and medication-induced causes of hyperprolactinemia. [ime.acponline.org]

    Occasionally, the hyperprolactinemia is sufficiently large because visual field deficit’s and even headaches. Treatment of pituitary hyperplasia depends on the underlying cause. [pituitaryworldnews.org]

    HORMONAL A pituitary adenoma may present as a distinct syndrome of hormone hypersecretion, the most common of which are hyperprolactinemia, acromegaly, and Cushing disease ( Table 1 5 – 12 ). [aafp.org]

    Symptoms result from too much prolactin in the blood (hyperprolactinemia) or pressure from the tumor on surrounding tissues (if the tumor is large). [emoryhealthcare.org]

  • Testosterone Decreased

    In adults it can lead to muscular weakness, fatigue, decreased bone mass, and obesity. LH and FSH (gonadotrophin deficiency): Causes low testosterone, decreased libido, and erectile dysfunction in males and menstrual disorders in females. [labtestsonline.org.uk]

Treatment

Treatment involves the transsphenoidal resection of the pituitary. [ime.acponline.org]

The treatment may be medical by taking medicine to slow the pituitary gland down or may be more involved with surgical or radiation treatment. [chw.org]

Treatment of Central Diabetes Insipidus Treatment is provided with a targeted fluid balance, intravenous fluids and desmopressin (DDAVP) replacement. [pacificneuroscienceinstitute.org]

What treatments are available? Treatment options vary, depending on the type, grade, size, and location of the tumor, and your age and general health. [mayfieldclinic.com]

Prognosis

Prognosis of left anterior fascicular block (LAFB) Isolated LAFB is considered a benign conduction defect. [ecgwaves.com]

Prognosis The prognosis for most patients with hypopituitarism is excellent. As long as therapy is continued, many experience normal life spans. [medical-dictionary.thefreedictionary.com]

Outlook If hormone replacement therapy is adequate, the prognosis is good. Complications are often related to the underlying disease. For More Information Visit the Pituitary Network Association web site. [webmd.com]

LCH can be classified according to system involvement as unisystem disease (US), which can be uni- or multifocal and is usually associated with a good prognosis and might require no treatment, or as multisystem disease (MS), which has a poorer prognosis [karger.com]

Etiology

The etiology of acromegaly is a growth hormone (GH)-secreting pituitary tumor in the vast majority of cases. [ncbi.nlm.nih.gov]

Etiology Pituitary adenomas are the most common pituitary disorder. They are classified by size and function. [unboundmedicine.com]

[…] cardiomyopathy with arrhythmia, LVH, diastolic dysfunction, and hypertension most is surgery due to pitutiary adenoma octreotide (somatostatin analog) may be used if can't do surgery; radiation or gamma knife plus medical therapy What are the various etiologies [quizlet.com]

When considering pathology related to the pituitary itself, the most common etiology of either over- or under-production of pituitary hormones in adults is a pituitary lesion. [cancertherapyadvisor.com]

Hypothalamic & Ant Pit Insufficiency Etiology of Hypopituitarism • Development/structural • Transcription factor • Pituitary dysplasia/aplasia • Congenital CNS mass, encephalocele • Primary empty sella • Congenital hypothalamic disorders (septo-optic [slideshare.net]

Epidemiology

In addition, IGFBP1 and IGFBP2 levels are low while IGFBP3 is elevated in T2DM.89 Epidemiological studies on the connection between IGF proteins and the incidence of T2DM report conflicting results and most fail to show any association.90,91 Low levels [touchendocrinology.com]

Fries H, Nillius SJ, Pettersson F: Epidemiology of secondary amenorrhea. II. A retrospective evaluation of etiology with special regard to psychogenic factors and weight loss. Am J Obstet Gynecol 118: 473–479, 1974 PubMed Google Scholar 23. [link.springer.com]

Guyot-Goubin A, Donadieu J, Barkaoui M, Bellec S, Thomas C, Clavel J: Descriptive epidemiology of childhood Langerhans cell histiocytosis in France, 2000-2004. Pediatr Blood Cancer 2008;51:71-75. [karger.com]

Epidemiology [ edit ] There is only one study that has measured the prevalence (total number of cases in a population) and incidence (annual number of new cases) of hypopituitarism. [1] This study was conducted in Northern Spain and used hospital records [en.wikipedia.org]

Epidemiologic aspects of postpartum pituitary hypofunction (Sheehan's syndrome). Fertil Steril 2005;84:523-8. 86. Dejager S, Gerber S, Foubert L, Turpin G. Sheehan's syndrome: Differential diagnosis in acute phase. J Intern Med 1988;244:261-6. 87. [ijem.in]

Pathophysiology

Furthermore, headaches are common in the general population and there is no guarantee that surgery will alleviate the headaches and all patients with hyperplasia because the headaches might be due to some other pathophysiological mechanism. [pituitaryworldnews.org]

The pathophysiology, symptoms, diagnosis, and treatment of deficiency of 5 of the anterior pituitary hormones are discussed below. [ime.acponline.org]

Pathophysiology [ edit ] The pituitary gland is located at the base of the brain, and intimately connected with the hypothalamus. [en.wikipedia.org]

Tolis G, Labrie, F, Martin JB, et al (eds): Clinical Neuroendocrinology: A Pathophysiological Approach. New York, Raven Press, 1979 Google Scholar 9. Rimoin DL, Schimke RN: Genetic Disorders of the Endocrine Glands. [link.springer.com]

Sweeten TL, Posey DJ, Shekhar A, McDougle CJ: The amygdala and related structures in the pathophysiology of autism. Pharmacol Biochem Behav. 2002, 71: 449-455. 10.1016/S0091-3057(01)00697-9. 22. [molecularautism.biomedcentral.com]

Prevention

These ligaments wrap tightly around the femur and the tibia of the leg to form a crisscross pattern in the knee, which prevents the joint from moving too far forward or backward. Injuries to the ACL are usually sports-related. [msdmanuals.com]

[…] exam CURRENT PHARMACY TABLES that highlight indications, toxic effects, and drug interactions sections that present TYPICAL INDICATION CLINICAL SCENARIOS EXTENSIVELY EDITED CHAPTERS on cardiology, pulmonology, nephrology, critical care, geriatrics, preventive [books.google.com]

It helps your body conserve water and prevent dehydration. Oxytocin. This hormone stimulates the release of breast milk. It also stimulates contractions of the uterus during labor. [healthline.com]

Prevention Pituitary adenomas are not associated with any known lifestyle or environmental risk factors, so there are no available methods to prevent the condition. [innerbody.com]

[…] wound has healed If you have increasing redness or swelling in the wound or temperatures over 100.5° you should call your doctor If you are having any procedures such as dental work or any other surgery you should take antibiotics before and after to prevent [scottfaucettmd.com]

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