Presentation
Because information on this topic has appeared in a variety of scientific and medical journals, this book: (1) reviews the results of an integrative approach presenting a comprehensive ultrastructural account of the main aspects of the field; (2) points [books.google.com]
[…] in the present case. [neurologyindia.com]
Background and case: A 38-year-old man presented acutely with left-sided retro-orbital pain, a heavy/numb sensation in his left arm and blurred vision and diplopia on left lateral gaze. [endocrine-abstracts.org]
[…] majority macroadenomas at presentation. [emedicine.medscape.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
- Goiter
A goiter may be present. Some patients may have bulging or protruding of the eye on one side if the tumor has invaded the orbital cavity. In blood tests, T4 and T3 levels are elevated in most patients. [ccpd.ucsf.edu]
Hyperthyroidism is most usually because of primary thyroid disease, such as autonomous hyperfunctioning nodular goiter or overstimulation by immunoglobulins (Graves’s disease). [link.springer.com]
[…] large mandible), carpal tunnel symptoms, hyperhidrosis, fatigue, proximal muscle weakness, decrease in libido, menstrual changes Signs Hypertension, coarse facial features, left ventricular hypertrophy, cardiomyopathy, visceromegaly, hypercalciuria, goiter [aafp.org]
Goiter, cardiovascular and metabolic disorders in patients with acromegaly. Endocr Regul. 2011;45(4):191–7. PubMed View Article Google Scholar Santos A, Resmini E, Martínez MA, Martí C, Ybarra J, Webb SM. [ojrd.biomedcentral.com]
- Galactorrhea
Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. [aafp.org]
Recurrent goiter, hyperthyroidism, galactorrhea and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 1976;43:137–143. PubMed CrossRef Google Scholar 10. [link.springer.com]
In women, the majority of prolactinomas are microadenomas and occur during the reproductive age period, presenting with oligomenorrhea or amenorrhea, galactorrhea, and infertility. [28, 29] In contrast, in men and elderly women, prolactinomas are usually [emedicine.medscape.com]
Galactorrhea: a study of 235 cases, including 48 with pituitary tumors. N Engl J Med. 1977;296(11):589–600. PubMed View Article Google Scholar Molitch ME, Reichlin S. Hyperprolactinemic disorders. Dis Mon. 1982;28(9):1–58. [ojrd.biomedcentral.com]
- Infertility
Patients with pituitary adenomas may present initially with symptoms of endocrine dysfunction such as infertility, decreased libido, and galactorrhea, or with neurologic symptoms such as headache and visual changes. [aafp.org]
Successful pregnancy in an infertile woman with a thyrotropin-secreting macroadenoma treated with somatostatin analog (octreotide). J Clin Endocrinol Metab 1996;81:1164–1168. PubMed CrossRef Google Scholar 24. Refetoff S, Weiss RE, Usala SJ. [link.springer.com]
In women, the majority of prolactinomas are microadenomas and occur during the reproductive age period, presenting with oligomenorrhea or amenorrhea, galactorrhea, and infertility. [28, 29] In contrast, in men and elderly women, prolactinomas are usually [emedicine.medscape.com]
Hyperprolactinaemia is an important cause of infertility in both women and men [ 185 ]. It can be reversed by appropriate treatment, for example with dopamine agonists [ 209, 210 ]. [ojrd.biomedcentral.com]
- Pathologist
Edited by four leading surgical pathologists - Noel Weidner, MD, Richard J. Cote, MD, Saul Suster, MD and Lawrence M. [books.google.com]
Cardiovascular
- Hypertension
Common manifestations are central weight gain, hypertension, and changes in memory, mood, and concentration. [ojrd.biomedcentral.com]
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, hypertension [aafp.org]
Eyes
- Blurred Vision
AB - A patient suffering from blurred vision in the left half of her visual field is diagnosed to determine the cause of this occurrence. CT scans, X ray of the skull and tomography is performed. [scholars.opb.msu.edu]
Background and case: A 38-year-old man presented acutely with left-sided retro-orbital pain, a heavy/numb sensation in his left arm and blurred vision and diplopia on left lateral gaze. [endocrine-abstracts.org]
- Diplopia
Background and case: A 38-year-old man presented acutely with left-sided retro-orbital pain, a heavy/numb sensation in his left arm and blurred vision and diplopia on left lateral gaze. [endocrine-abstracts.org]
Psychiatrical
- Anger
The only additional history was of anger and mood disturbance. Baseline pituitary function revealed a TSH of 4.5 mU/l with a FT 4 of 28.5 pmol/l (10–24) and FT 3 of 7.6 pmol/l (2.8–7.1). [endocrine-abstracts.org]
Urogenital
- Amenorrhea
Men may have erectile dysfunction, whereas premenopausal women often experience oligomenorrhea or amenorrhea 6, 11 ( Table 1 5 – 12 ). [aafp.org]
Recurrent goiter, hyperthyroidism, galactorrhea and amenorrhea due to a thyrotropin and prolactin-producing pituitary tumor. J Clin Endocrinol Metab 1976;43:137–143. PubMed CrossRef Google Scholar 10. [link.springer.com]
In women, the majority of prolactinomas are microadenomas and occur during the reproductive age period, presenting with oligomenorrhea or amenorrhea, galactorrhea, and infertility. [28, 29] In contrast, in men and elderly women, prolactinomas are usually [emedicine.medscape.com]
Forearm and vertebral bone mineral in treated and untreated hyperprolactinemic amenorrhea. J Clin Endocrinol Metab. 1987;64(5):1021–6. PubMed View Article Google Scholar Ferrari C, Paracchi A, Mattei AM, de Vincentiis S, D’Alberton A, Crosignani P. [ojrd.biomedcentral.com]
Neurologic
- Neurologic Manifestation
NEUROLOGIC The most common neurologic symptoms in patients with pituitary adenomas are headaches and visual changes. [aafp.org]
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
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]
Signs and symptoms of hyperprolactinemia are not always apparent. Morphologically, the tumors are similar to GH-secreting adenomas, with an eosinophilic or chromophobic appearance. [emedicine.medscape.com]
References: [4] Diagnostics Cranial contrast MRI (initial test) : reveals an intrasellar mass Hormone assays [4] Basal prolactin levels (see “Diagnostics” in hyperprolactinemia ”) Insulin-like growth factor-1 ( IGF-1 ) (see “Diagnostics” in acromegaly [amboss.com]
View Article Google Scholar Brue T, Delemer B, French Society of Endocrinology (SFE) work group on the consensus on hyperprolactinemia. Diagnosis and management of hyperprolactinemia: expert consensus – French Society of Endocrinology. [ojrd.biomedcentral.com]
Treatment
Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography. [books.google.de]
Treatment Transsphenoidal surgery to remove the tumor is the primary treatment for TSH-secreting adenomas. [ccpd.ucsf.edu]
However, radiotherapy and medical treatment, particularly by somatostatin analogs, also belong to the therapeutic armamentarium. [journals.lww.com]
RT as a postoperative treatment option during first-line treatment appeared superior to reserving it for relapsing patients. [ro-journal.biomedcentral.com]
Prognosis
[…] is the leading international professional reference text that also serves as a bench book, describing all aspects of the pathology of brain tumours - genetics, molecular biology, epidemiology, morphology, immunohistochemistry, diagnostic criteria and prognosis [books.google.com]
[…] and responsiveness to therapy. [3] Importance of careful morphological study of clinically non-functioning pituitary adenomas (especially younger patients) by immunohistochemical and electron microscopic examination is useful in assessing prognosis and [neurologyindia.com]
We found that our patients, who represent those with a rather inferior prognosis due to either incomplete resection of extensive tumors or because of relapse after surgery, developed tumor recurrences after median latencies of 36 months with patients [ro-journal.biomedcentral.com]
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]
Incidence and late prognosis of Cushing’s syndrome: a population-based study. J Clin Endocrinol Metab. 2001;86(1):117–23. PubMed Google Scholar Invitti C, Pecori Giraldi F, de Martin M, Cavagnini F. [ojrd.biomedcentral.com]
Etiology
Etiology Most cases occur sporadically. Some cases ( ∼ 5% ) have a genetic/familial association. [amboss.com]
Etiology and Pathophysiology Monoclonal adenohypophysial cell growth Hormonal effects of functional microadenomas often prompt diagnosis before mass effect. [unboundmedicine.com]
PMID: 23899071 [Inappropriate TSH: from common etiologies to the rare TSH secreting pituitary adenoma]. Portmann L, Gomez F, Flattet A. Portmann L, et al. Rev Med Suisse. 2012 Nov 14;8(362):2187-91. Rev Med Suisse. 2012. PMID: 23240321 French. [pubmed.ncbi.nlm.nih.gov]
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]
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]
Epidemiology
This is the leading international professional reference text that also serves as a bench book, describing all aspects of the pathology of brain tumours - genetics, molecular biology, epidemiology, morphology, immunohistochemistry, diagnostic criteria [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]
[…] somatotroph adenoma (growth hormone [GH]) 15–20%, corticotroph adenoma (adrenocorticotropic hormone [ACTH]) 5–10%, thyrotroph adenoma (thyroid-stimulating hormone [TSH]) 1 )[ A ] Defined as microadenoma May secrete hormones and/or cause mass effects Epidemiology [unboundmedicine.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]
Pathophysiology
من الصفحات Werner & Ingbar’s The Thyroid: A Fundamental and Clinical Text, 10th Edition has been extensively revised and streamlined to deliver the most comprehensive coverage of the thyroid including anatomy, development, biochemistry, physiology, pathophysiology [books.google.com]
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]
Etiology and Pathophysiology Monoclonal adenohypophysial cell growth Hormonal effects of functional microadenomas often prompt diagnosis before mass effect. [unboundmedicine.com]
[…] 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]
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]
Prevention
The primary treatment of non-functioning pituitary adenomas is surgery, radiation and pharmacological agents. [12] Early diagnosis and proper treatment of TSH secreting pituitary adenomas prevent signs and symptoms of mechanical compression of adjacent [neurologyindia.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]
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]