Presentation
He presented to the Emergency Department on post-operative day eight with nausea, vomiting, and mild epistaxis. [ncbi.nlm.nih.gov]
Hyperprolactinemia Prolactin secreting pituitary adenomas present four times as frequently in women as in men. It should be noted that both the age of presentation and symptomatology at presentation are markedly different in the sexes. [med.virginia.edu]
Case presentation A 67-year-old man was presented to the emergency department complaining of headache ongoing for 24h. He also reported ptosis of the right eye that occurred acutely 6h in advance of presentation. [edmcasereports.com]
Classification and Clinical Presentation of Pituitary Adenomas Cell type Hormone secreted Clinical syndrome Presentation Corresponding diagnostic tests Corticotroph Adrenocorticotropic hormone Cushing disease Symptoms Labile mood, proximal muscle weakness [aafp.org]
Entire Body System
- Plethora
The Cushingoid features of patients with ACTH secreting adenomas include moon facies, centripetal obesity, ‘buffalo hump’, supraclavicular fat deposition, hirsutism, hyperpigmentation, plethora, vascular fragility, and abdominal striae. [med.virginia.edu]
To sum up, gonadotropin-secreting pituitary adenoma in adult males may present with symptoms such as plethora due to erythrocytosis secondary to testosterone excess, as in the case described here. [hormones.gr]
[…] hormone Cushing disease Symptoms Labile mood, proximal muscle weakness, skin changes, changes in facial features, weight gain, depression, hirsutism, decrease in libido, menstrual changes Signs Thin skin, striae/bruising, central obesity, moon facies, plethora [aafp.org]
Musculoskeletal
- Contusion
Optic nerve injury occurred is caused by a misdirected approach and contusion of the optic nerve. Other possible causes of injury include vasospasm, a postoperative hematoma, or devascularization of the optic apparatus. [thamburaj.com]
Eyes
- Visual Impairment
We are presenting the case of a 30-year-old male patient (E.R) having a characteristic symptomatology for the pituitary macroadenoma: headaches, impaired visual acuity and reduced visual field (based on ophthalmological examination). [endocrine-abstracts.org]
If the patient develops visual impairment or the tumor begins to compress visual pathways, further surgery is indicated. [scielo.br]
His ptosis was causing particular distress, and due to a previous mechanical injury to his left eye, it was rendering him severely visually impaired. [edmcasereports.com]
Reports of headaches and visual impairments vary between 20-50% in reported series. In addition, hypogonadism and hyperprolactinemia are commonly observed, whereas complete hypopituitarism is uncommon. [endocrinologyadvisor.com]
Transsphenoidal resection is the initial treatment of choice, and can reduce endocrine dysfunction, resolve headaches, improve visual impairment, and provide tissue for detailed analysis. [ncbi.nlm.nih.gov]
Neurologic
- Difficulty Concentrating
Low T and Anxiety, Difficulty Concentrating Low testosterone can seriously hamper your daily performance at work, in your hobbies, and in your relationships by contributing to anxiety or difficulty concentrating. [tctmed.com]
Workup
Workup of the Pituitary “Incidentaloma” Pituitary tumors are among the most common brain tumors. Autopsy and radiology studies have placed the incidence between 14% and 22%. [oregonclinic.com]
GENERAL PRINCIPLES OF DIAGNOSIS AND TREATMENT Patients presenting with signs and symptoms suggestive of a pituitary adenoma require a comprehensive workup and treatment plan reflecting a strong interdisciplinary effort with endocrinologists, neurosurgeons [med.virginia.edu]
[…] adenomas show numerous enlarged mitochondria with loss of cristae and presence of electron dense tubular structures ( Brain Pathol 2012;22:443 ) Molecular / cytogenetics description No specific molecular characteristics in routine clinical diagnostic workup [pathologyoutlines.com]
While a majority of patients with endogenous Cushing syndrome have thyrotrophic adenomas (called Cushing Disease - see below), other tumors should also be considered as part of the endocrinologic workup, including adrenal tumors and especially ACTH-secreting [eyewiki.aao.org]
Serum
- Hyperprolactinemia
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]
Hyperprolactinemia from a prolactin-secreting adenoma causes hypogonadism and galactorrhea. 48 – 50 Women with hyperprolactinemia usually present with amenorrhea, galactorrhea, diminished libido, and infertility. [clinicalgate.com]
Pituitary adenoma (microadenoma, macroadenoma), hyperprolactinemia syndrome Pituitary adenoma and hyperprolactinemia syndrome — is a symptom, that develops in women and men due to prolonged increased secretion of anterior pituitary hormone prolactin and [minclinic.ru]
The most common cause of a luteal phase defect is hyperprolactinemia. Progesterone elevates the woman’s basal body temperature by about 0.5 F. [pituitaryworldnews.org]
Treatment
Surgery can also be used when drug treatment doesn't work. Radiation may be used if drug treatment and surgery do not work. [cancer.org]
A combination treatment with long-acting release (LAR) octreotide (Sandostatin LAR, 30 mg/monthly) and the dopaminergic agonist cabergoline (0.5 mg twice/weekly) was introduced, and hydroxyurea treatment was discontinued. [journals.aace.com]
Limited Class III evidence was identified for NFPA patients treated with observation (2 studies), primary radiation-based treatment (3 studies), or medical treatment (8 studies). [cns.org]
Trials are often designed to treat a certain stage of cancer, either as the first form of treatment offered, or as an option for treatment after other treatments have failed to work. [oncolink.org]
However, early diagnosis and effective treatment minimizes morbidity and mortality. [scielo.br]
Prognosis
[…] secretory granules and that a majority of them synthesize FSH, LH, and the α-subunit, with a smaller subset producing other anterior pituitary hormones that do not show clinical manifestations. 63 However, no clear and consistent difference in treatment or prognosis [ncbi.nlm.nih.gov]
Learn more People with pituitary tumors generally have a good prognosis, but even the most benign forms can regrow after treatment and become problematic. In rare cases, pituitary tumors can become cancerous. [mskcc.org]
Prognosis Usually favourable. Truly malignant metastatic behaviour is extremely rare. The unresponsiveness to pharmacological treatment is associated with more aggressive behaviour. [atlasgeneticsoncology.org]
"Expression of estrogen receptor alpha is associated with prolactin pituitary tumor prognosis and supports the sex-related difference in tumor growth.". Eur J Endocrinol 172 (6): 791-801. doi : 10.1530/EJE-14-0990. [librepathology.org]
Diagnosis, management, and prognosis of pituitary tumors. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, eds. Diagnosis and Management of Pituitary Tumors. Totowa, N.J.: Humana Press; 2001:165–172. 7. [aafp.org]
Etiology
J Clin Endocrinol Metab 92: 10–25 CrossRef PubMed Google Scholar Brito VN, Latronico AC, Arnhold IJ et al. (2008) Update on the etiology, diagnosis and therapeutic management of sexual precocity. [springerlink.com]
Hyperprolactinemia Present Biologically inactive form of prolactin, with no pathologic association Useful to check in patients with hyperprolactinemia who have moderate elevations (100 to 300 mcg per L [4,348 to 13,043 pmol per L]) of serum prolactin with unknown etiology [aafp.org]
Hypogonadism is detected in up to 96% of patients with pituitary macroadenomas (> 1 cm) and is usually associated with inappropriately normal or decreased serum gonadotropin levels, indicating central hypogonadism The etiology of hypogonadism in this [pituitary.mgh.harvard.edu]
[…] of somatotrophs, lactotrophs and thyrotrophs SF-1 (steroidogenic factor 1): gonadotroph cell differentiation T-PIT (T-box family member TBX19): proopiomelanocortin (POMC) lineage with differentiation of corticotrophs ( Acta Neuropathol 2017;134:521 ) Etiology [pathologyoutlines.com]
Epidemiology
Dtsch Arztebl Int 106: 377–382 PubMedCentral PubMed Google Scholar Gravholt CH (2004) Epidemiological, endocrine and metabolic features in Turner syndrome. [springerlink.com]
Epidemiology of pituitary macroadenomas Frequency of pituitary macroadenomas Pituitary tumors found at autopsy in 25% of cases. [minclinic.ru]
Each entity is extensively discussed with information on clinicopathological, epidemiological, immunophenotypic and genetic aspects of these diseases. The book is an authoritative, concise reference, prepared by 150 authors from 20 countries. [books.google.com]
Epidemiologic estimates indicate an annual incidence of 8.2 to 14.7 cases per 100,000 people. [2] Approximately 30% of pituitary adenomas are clinically nonfunctional, as defined by the absence of excessive hormone secretion found by various endocrinological [neurologyindia.com]
PMID 12763000 The epidemiology of endocrine tumours. Monson JP Endocrine-related cancer. 2000 ; 7 (1) : 29-36. PMID 10808194 Incidence, Pathology, and Recurrence of Pituitary Adenomas: Study of 647 Unselected Surgical Cases. [atlasgeneticsoncology.org]
Pathophysiology
Pathophysiology of pituitary macroadenomas Pituitary macroadenoma is a benign epithelial neoplasm composed of adenohypophysial cells. Primary malignant tumors of the pituitary gland are quite rare. [minclinic.ru]
[…] tumor patients Differential diagnosis of thyrotropin-secreting pituitary tumor versus thyroid hormone resistance Differential diagnosis of constitutional delay of puberty versus hypogonadotrophic hypogonadism Clinical Information Discusses physiology, pathophysiology [mayomedicallaboratories.com]
[…] pituitary gland C75.1 Sites Majority occur in sella turcica within the adenohypophysis / anterior pituitary lobe Rare examples occur in extrasellar region on pituitary stalk Rare prolactinomas as part of ovarian teratoma ( Endocr Pathol 2014;25:321 ) Pathophysiology [pathologyoutlines.com]
N Engl J Med 358: 709–715 CrossRef PubMedCentral PubMed Google Scholar Themmen APN, Huhtaniemi IT (2000) Mutations of gonadotropins and gonadotropin receptors: Elucidating the physiology and pathophysiology of pituitary-gonadal function. [springerlink.com]
Case Reports, MD 1 ; Georgios Nikolopoulos, MD 1 ; Denise Kolomodi, MD 2 ; Dimitra Rontogianni, MD 3 ; Krystallenia Alexandraki, MD 1 ; Georgios Boutzios, MD 1 ; Gregory Kaltsas, MD, FRCP 1 1 From the Department of Pathophysiology, Section of Endocrinology [journals.aace.com]
Prevention
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]
Large tumours can also prevent normal hormone secretion by other parts of the pituitary gland causing symptoms of hormone deficiency. Sometimes they are more difficult to control. [pituitary.org.uk]
Consequent hypogonadism reduces testosterone, preventing or slowing prostate cancer cell proliferation. [edmcasereports.com]
RT is highly effective in preventing tumor regrowth, but it is associated with significant long-term complications. [scielo.br]