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Hyperpituitarism

Hyperpituitarism is a disease caused by pituitary gland hypersecretion, most commonly due to adenoma, leading to a series of abnormalities such as hyperthyroidism, hypothyroidism, hypogonadism, or hyperadrenalism.


Presentation

Hyperpituitarism causes two categories of symptoms: some caused by abnormal hormone secretion and others induced by the tumor itself. The latter consist of headaches and visual impairment, caused by optic nerve compression, or even hypopituitarism. If prolactin hypersecretion occurs in a pubertal girl, she will present with pubertal arrest. Galactorrhea may also be present in this case. Pubertal boys and prepubertal children complain about growth failure, visual impairment, and headaches, but the first category also experiences pubertal arrest [1]. Medical history and physical examination reveal menstrual abnormalities, acanthosis nigricans, and gynecomastia, in addition to other traits of the disease the patients notice.

Excess growth hormone causes acromegaly in adults and gigantism in children. Gigantism presents as accelerated complete growth in children, whereas acromegaly is characterized by the growth of the extremities (fingers and toes) and facial coarsening [2], as well as occlusion changes and apertognathia [3] [4]. Additional features include macrocephaly, prognathism, frontal bossing, irregular menses in women, and hyperhidrosis. The distance between teeth increases and the lips become thicker and darker [5]. In adult patients, cardiac hypertrophy sets in during the progression of the disease. Uterine, prostate, and colon benign tumors seem to have an increased incidence in these patients. The physician must also keep in mind the fact that these patients are prone to develop diabetes mellitus and peripheral neuropathies, as well as muscular and articular disorders, and conduct an active surveillance in this area [6] [7].

If the adrenocorticotropic hormone (ACTH) is involved, patient present with symptoms of excessive glucocorticoid secretion: hypertension, hirsutism, weight gain, acne, fatigability, and sleep apnea signs [8]. The clinician is often able to highlight the presence of the typical Cushing facies, as well as a dorsal cervical fat pad and bruising.

Antipsychotic Agent
  • Agents Phase 4,Phase 3,Phase 2,Not Applicable 29 Serotonin 5-HT2 Receptor Antagonists Phase 4,Not Applicable 30 Paliperidone Palmitate Phase 4 31 Dopamine Antagonists Phase 4,Phase 3,Not Applicable 32 Tranquilizing Agents Phase 4,Phase 3,Phase 2,Not[malacards.org]
  • A prospective study of hyperprolactinemia in children and adolescents treated with atypical antipsychotic agents. J Child Adolesc Psychopharmacol. 2004. 14:350-358. [Medline]. Sakazume S, Obata K, Takahashi E, et al.[emedicine.medscape.com]
Intravenous Administration
  • A thyrotropin-releasing hormone (TRH) stimulation test can also be performed if a doubt exists, given that intravenous administration of TRH leads to an abrupt increase of prolactinemia 15 to 30 minutes later in normal individuals.[symptoma.com]

Workup

Hyperpituitarism workup should concentrate on detecting abnormal pituitary gland function based on whatever clinical findings the physician encounters. For instance, if hyperprolactinemia is suspected, serum prolactin should be measured several times if the obtained values are normal, but one determination is sufficient if a value above 200 ng/mL is found. A thyrotropin-releasing hormone (TRH) stimulation test can also be performed if a doubt exists, given that intravenous administration of TRH leads to an abrupt increase of prolactinemia 15 to 30 minutes later in normal individuals. Prolactinoma patients usually do not show this increase in prolactin serum levels.

A patient with an adrenocorticotropic hormone (ACTH) - releasing adenoma should undergo a urinary free cortisol excretion measurement, as well as a plasma cortisol determination. The first test accurately measures the cortisol secretion rate, while the second one needs to be interpreted based on the time the blood sample was drawn, keeping in mind that cortisol levels are normally highest from 6 to 8 AM and decline during the day. The lack of variation suggests Cushing disease. Additional investigations include the dexamethasone suppression testing and the corticotropin-releasing hormone (CRH) stimulation testing in uncertain cases.

When growth hormone oversecretion is suspected, the following tests should be ordered: serum insulin-like growth factor-I (IGF-I) measurement, serum insulin-like growth factor-binding protein-3 (IGFBP-3) dosage, and an oral glucose tolerance test (OGTT). After 1.75-g/kg oral glucose ingestion (maximum 75g), the serum growth hormone level should decrease to less than 5 ng/dL within 3 hours in healthy individuals.

The presence of the pituitary adenoma itself may be revealed by magnetic resonance imaging (MRI) with gadolinium administration, what is considered to be the gold standard [9] [10].

Treatment

  • Surgical Care Transsphenoidal surgery is the treatment of choice for Cushing disease in children.[emedicine.medscape.com]
  • Treatment for Hyperpituitarism Treatment can consist of pituitary microsurgery to remove tumor.[healthguidance.org]
  • Treatment (for hyperpituitarism) in the case of prolactinoma consists of long-term medical management. Dopamine agonists are strong suppressors of PRL secretion and establish normal gonadal function.[en.wikipedia.org]
  • Treatment regarding Hyperpituitarism Tips 1. Treatment can include pituitary microsurgery to take off tumor. 2.[pituitarytumors.wordpress.com]
  • Hypopituitary Treatment - Medical Treatment Medical treatment consists of hormone replacement therapy and treatment of the underlying cause. Medications Drugs used to treat hypopituitarism replace the deficient hormone.[annbyers.yolasite.com]

Prognosis

  • Prognosis The prognosis for an individual with either gigantism or acromegaly depends on how far the condition has advanced before successful treatment. Gigantism is generally not life-threatening, and the prognosis is usually good.[m.body-disease.com]
  • Prognosis The prognosis for hyperfunctioning pituitary tumors in children is very good. Medical therapy or transsphenoidal surgery are preferred methods of treatment. Radian S, Diekmann Y, Gabrovska P, et al.[emedicine.medscape.com]
  • Outlook If hormone replacement therapy is adequate, the prognosis is good. Complications are often related to the underlying disease.[annbyers.yolasite.com]

Etiology

  • […] builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital diagnosis diagnostic imaging diet therapy drug therapy economics embryology enzymology epidemiology ethnology etiology[ncbi.nlm.nih.gov]
  • Etiology The hypersecretion of hGH that produces gigantism and acromegaly is typically due to benign, slow-growing glandular tumors, or adenomas, in the anterior pituitary.[m.body-disease.com]
  • (See Etiology.) Regulation of the development of the mammalian anterior pituitary gland by transcription factors.[emedicine.medscape.com]
  • Etiology Most cases occur sporadically. Some cases ( 5% ) have a genetic/familial association.[amboss.com]
  • (See Pathophysiology and Etiology.) GH acts indirectly, by stimulating the formation of IGF hormones (also called somatomedins).[emedicine.medscape.com]

Epidemiology

  • 1965) PubMed search builder options Subheadings: analysis anatomy and histology blood cerebrospinal fluid chemically induced classification complications congenital diagnosis diagnostic imaging diet therapy drug therapy economics embryology enzymology epidemiology[ncbi.nlm.nih.gov]
  • Among the many highlights of the Fifth Edition are: * An extensively updated chapter on the cellular and molecular biology of the neuron* An expanded chapter on the epidemiology and genetics of neuropsychiatric disorders* An extensively revised and expanded[books.google.com]
  • Epidemiology Pituitary adenomas account for about 15% of primary intracranial tumors. Peak incidence : 35–60 years Prevalence : 80 cases per 100,000 individuals References: [1] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • The epidemiology of prolactinomas. Pituitary. 2005. 8:3-6. [Medline]. Colao A, Loche S, Cappabianca P. Pituitary adenomas in children and adolescents. Clinical presentation, diagnosis, and therapeutic strategies.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Multiple endocrine neoplasia type 1 Carney syndrome Isolated familial acromegaly References: [2] Pathophysiology Pituitary adenomas are well circumscribed, intrasellar tumors with monomorphic, polygonal cells arranged in sheets or cords without any connective[amboss.com]
  • (See Pathophysiology and Etiology.) GH acts indirectly, by stimulating the formation of IGF hormones (also called somatomedins).[emedicine.medscape.com]
  • Pathophysiology Hypothalamic dysfunction clearly may promote tumor growth, but overwhelming evidence indicates intrinsic pituicyte genetic disruption leads to pituitary tumorigenesis.[emedicine.medscape.com]

Prevention

  • Prevention There is no specific prevention for hyperpituitarism. Early treatment helps to prevent complications.[m.body-disease.com]
  • Prevention No way is known for preventing hyperpituitarism. Diagnosis Physical examination (to include visual-field exams) and patient history.[azsymptoms.com]
  • […] imaging diet therapy drug therapy economics embryology enzymology epidemiology ethnology etiology genetics history immunology metabolism microbiology mortality nursing organization and administration parasitology pathology physiology physiopathology prevention[ncbi.nlm.nih.gov]
  • Treatment and Prevention Treatment can consist of pituitary microsurgery to remove tumor ; pituitary radiation if surgery fails; gamma knife radiation treatment (a special type of focused radiation); bromocriptine (helps decrease growth hormone in some[diagnose-me.com]
  • Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses.[niddk.nih.gov]

References

Article

  1. Ciccarelli A, Daly AF, Beckers A. The epidemiology of prolactinomas. Pituitary. 2005;8:3-6.
  2. Chanson P, Salenave S. Acromegaly. Orphanet J Rare Dis. 2008;3:17.
  3. Sarment DP, Weisgold AS. The importance of dentistry in the differential diagnosis of a medical disorder. Compend Contin Educ Dent. 1998;19:124–126.
  4. Cohen RB, Wilcox CW. A case of acromegaly identified after patient complaint of apertognathia. Oral Surg Oral Med Oral Pathol. 1993;75:583–586.
  5. Lima DL, Montenegro RM, Jr, Vieira AP, et al. Absence of periodontitis in acromegalic patients. Clin Oral Investig. 2009;13:165–169.
  6. Ayuk J, Sheppard MC. Growth hormone and its disorders. Postgrad Med J. 2006;82:24–30.
  7. Nabarro JD. Acromegaly. Clin Endocrinol. 1987;26:481–512.
  8. Colao A, Loche S, Cappabianca P. Pituitary adenomas in children and adolescents. Clinical presentation, diagnosis, and therapeutic strategies. The Endocrinologist. 2000;10:314-327.
  9. Chaudhary V, Bano S. Imaging of pediatric pituitary endocrinopathies. Indian J Endocrinol Metab. 2012;16(5):682-691.
  10. Lonser RR, Ksendzovsky A, Wind JJ, et al. Prospective evaluation of the characteristics and incidence of adenoma-associated dural invasion in Cushing disease. J Neurosurg. 2012;116(2):272-279.

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Last updated: 2018-06-22 08:37