This book presents the "bench to bedside" approach of our understanding of the genetic basis for endocrine disease. It is organized by endocrine grouping (e.g. [books.google.com]

[…] majority macroadenomas at presentation. [emedicine.medscape.com]

Rarely presentation can be catastrophic, due to pituitary apoplexy. Hormone imbalance Over half of all adenomas are secretory 2, although even when this is the case this may not be the cause of presentation. [radiopaedia.org]

Non-functioning Adenomas CLINICAL PRESENTATIONS  25-30 % of patients do not have classical hypersecretory syndromes.  May grow to a large size before they are detected.  Present due to mass effect  Visual deficits  Hormone deficiency like hypogonadism [slideshare.net]

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]

• Euthyroid

  Krassas G, Pontikides N, Dumas A, Frystyk J, Chen JW, Flyvbjerg A, 2004 The effect of long-term somatostatin analogue treatment on free and total insulin-like growth factor (IGF) -I, -II, and IGF binding protein -1, -2, and -3 serum levels in euthyroid [hormones.gr]

  […] or thyrotroph cell, adenomas are the least frequent pituitary adenomas. [59] Clinically, they may present with inappropriately elevated TSH levels and hyperthyroidism, but these tumors may also arise in the setting of hypothyroidism or in clinically euthyroid [emedicine.medscape.com]

  Somatostatin analogues, such as octreotide.[ 3, 4 ] Transsphenoidal surgery is the treatment of choice for patients with thyrotropic adenomas.[ 1 ] Adjuvant radiation therapy may be employed when surgery is known to be noncurative even if the patient is still euthyroid [cancer.gov]

• Pathologist

  SNOMED CT (R) was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO." [doctor.am]

  This case highlights the need for a pathologist to select the tissue for analysis before performing any molecular study. [journals.plos.org]

  "Practical pituitary pathology: what does the pathologist need to know?". Archives of Pathology & Laboratory Medicine. 132 (8): 1231–40. doi : 10.1043/1543-2165(2008)132[1231:PPPWDT]2.0.CO;2 (inactive 2019-02-18). [en.wikipedia.org]

• Anorexia

  In turn, neuroendocrine dysfunction due to genetic or other deficits can lead, for example, to infertility, impotence, precocious or delayed puberty, defective or excessive growth, obesity and anorexia, Cushing’s Syndrome, hypertension or thyroid disorders [books.google.com]

  Unrecognized adrenocorticotrophic hormonal deficiency in the postoperative period can cause fatigue, anorexia, nausea, vomiting, hypotension, fever, metabolic changes, and rarely death. 22 In response, different institutions have implemented disparate [cns.org]

• Loss of Appetite

  Symptoms of severe hypopituitarism include: Loss of appetite Weight loss or weight gain Fatigue Decreased energy Decreased mental function Dizziness Changes in hormonal function can cause electrolyte imbalance in the blood, typically low sodium levels [pituitary.ucla.edu]

• Sexual Dysfunction

  Acromegaly is associated with higher frequency of female sexual dysfunction: experience of a single center. Endocr J. 2013;60(6):753–61. [ojrd.biomedcentral.com]

  Clinical features of Cushing's syndrome Feature Frequency (%) Obesity 92 Moon facies 90 Hypertension 85 Glucose intolerance 80 Menstrual and sexual dysfunction 74 Hirustism and acne 70 Striae 70 Proximal muscle weakness 67 Osteoporosis 55 Easy bruising [glowm.com]

• Meningism

  The investigators reported worsening visual and pituitary functions in 2.4% and 13.7% of cases, respectively, permanent postoperative diabetes insipidus in 6.2% of cases, and postoperative meningitis in 3.3% of cases, with a strong link seen between meningitis [emedicine.medscape.com]

  A CSF leak may occur intra- or postoperatively and entails the risk of meningitis, which is a potentially fatal complication. [thamburaj.com]

• Excitement

  One of the most exciting development in medicine today is the pharmacogenomics revolution - enocrinologists and geneticists need to understand how personalized medicine will fit into the daily care of patients. [books.google.com]

• Hand Tremor

  The typical features include nervousness, irritability, increased perspiration, increased heart rate, hand tremors, anxiety, difficulty sleeping, muscular weakness, frequent diarrhoea, weight loss, and oligo-amenorrhoea. [ojrd.biomedcentral.com]

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]

[PUBMED Abstract] Pituitary Carcinomas Treatment Standard Treatment Options for Pituitary Carcinomas Standard treatment options for pituitary carcinomas include the following: Surgery. [cancer.gov]

Since the beginning of the current century, endocrine disease diagnosis and treatment have moved beyond the standard hormone measurements. [books.google.com]

In the bromocriptine group, 214 of the 236 women (91 percent) completed eight weeks of treatment and 169 (72 percent) completed the entire treatment period. [nejm.org]

DiISCUSSION The treatment of acromegaly constitutes a real challenge for the endocrinologist. [hormones.gr]

[…] of macroadenomas. [23] In 12 of the patients, FSRT was employed following tumor resection, while in 1 patient, it served as primary treatment. [emedicine.medscape.com]

Also, the prognosis can be predicted based on this. In our study, we used a licensed device approved by KFDA (Korea Food and Drug Administration) to measure heart rate variability in patients with pituitary adenoma. [bioportfolio.com]

Prognosis Recurrent symptoms requiring further intervention is relatively common, with 18% of patients with non-functioning tumors and 25% of patients with prolactinomas eventually needing further treatment 6 . [radiopaedia.org]

[…] endoscopic endonasal approach (EEEA), concluding that it is a potentially viable option but additional study is needed. [18] Following transsphenoidal decompression of the anterior optic pathways, a correlation exists between intraoperative MRI results and prognosis [emedicine.medscape.com]

This fact has prompted the development of classifications that tailor the prognosis of the PA to the subtype, size, degree of invasiveness and the result of the immunostaining of Ki-67 and p53 [ 17 ]. [journals.plos.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]

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]

PATHOGENESIS: Two main theories dominate current concepts of the pathogenesis of pituitary tumors (Reichlin, 1991): Hypothalamic etiology suggests that adenomas arise as a consequence of target gland feed back or hypothalamic dysregulation. [thamburaj.com]

Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status. J Clin Endocrinol Metab. 2006;91(5):1779–84. PubMed View Article Google Scholar Feelders RA, Hofland LJ. [ojrd.biomedcentral.com]

Acromegaly: an epidemiological study. J Endocrinol Invest. 1993;16(3):181–7. PubMed View Article Google Scholar Holdaway IM, Rajasoorya C. Epidemiology of acromegaly. Pituitary. 1999;2(1):29–41. [ojrd.biomedcentral.com]

Epidemiology of acromegaly. Pituitary 1999; 2 (01) 29-41 3 John A, Kamal T, Edward R. Pituitary tumors-functioning and Nonfunctioning. In: Richard WH., ed. Youmans Neurological Surgery. 6th ed, Vol 2. Philadelphia, PA: Elsevier Saunders; 2011. [thieme-connect.de]

Epidemiology 12% of the US population has adenomas by the 5th decade of life, of which 25% are high-risk (high-grade dysplasia) lesions; the risk of future carcinoma is increased if there is a positive family history and a “high-risk” diet—e.g., high [medical-dictionary.thefreedictionary.com]

Epidemiology  Pituitary adenomas are most common cause of pituitary hormone hypersecretion and hyposecretion syndromes in adults.  They account for 15% of intracranial neoplasm.  At autopsy up to one quarter of all pituitary glands harbor an unsuspected [slideshare.net]

Improved knowledge of GH physiology, the analysis of retrospective epidemiological data and advances in GH assay have rendered the criteria for diagnosis and cure of acromegaly more stringent. [hormones.gr]

Hofland LJ, Lamberts SW, 2003 The pathophysiological consequences of somatostatin receptor internalization and resistance. Endocr Rev 24: 28-47. 19. [hormones.gr]

[…] syndrome Symptoms from mass effect; hypopituitarism; silent (nonfunctioning) No specific corresponding test Pituitary carcinoma None No specific syndrome Symptoms from mass effect; hypopituitarism; silent (nonfunctioning) No specific corresponding test Pathophysiology [aafp.org]

It also suggests, however, that pituitary adenomas may arrive by different pathophysiologic pathways. Non-hormone-secreting pituitary tumors tend to grow slowly and insidiously. [glowm.com]

Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Endocrinol Metab. 1999;84(2):440–8. [ojrd.biomedcentral.com]

Disease Management A broad approach to appropriate coordination of the entire disease treatment process that often involves shifting away from more expensive inpatient and acute care to areas such as preventive medicine, patient counseling and education [bioportfolio.com]

In addition, accurate diagnosis prevents improper thyroid ablation in those patients with central hyperthyroidism in whom the clinical manifestations of TSH-omas would not be prevented [ 220 ]. [ojrd.biomedcentral.com]

 Estrogen replacement is indicated to prevent bone loss and other consequences of hypoestrogenemia.  For symptomatic microadenomas, therapeutic goals include : • Control of hyperprolactinemia. • Reduction of tumor size. • Restoration of menses and [slideshare.net]

At present, most patients are treated as having a clinically nonfunctioning adenoma, and the therapeutic goals are restoration of visual deficits, preservation of pituitary function, and prevention of recurrence. [15] Null cell adenomas and oncocytomas [emedicine.medscape.com]

Prophylactic antibiotic drugs are used by most surgeons in an attempt to prevent meningitis but the effectiveness of these prophylactic medications has never been proven. [thamburaj.com]