Pituitary apoplexy and panhypopituitarism following acute leptospirosis

Pituitary - Leptospirosis is a common tropical febrile illness which may manifest with the hepatorenal syndrome and systemic hemorrhagic manifestations. Pituitary apoplexy is a rare but...     

Pituitary stalk interruption syndrome: phenotype,predictors, and pathophysiology of perinatal events

Pituitary - There is limited data regarding Pituitary Stalk Interruption Syndrome (PSIS) from India. Moreover, the pathophysiological link between perinatal events and PSIS is unclear. We aim to...     

Common tools for pituitary adenomas research: cell lines and primary cells

Pituitary - Pituitary tumor is the common primary brain tumor in humans. For further studying the pathogenesis and new therapeutic targets of pituitary adenoma, cell lines and primary cells are...     

Acute elevation of interleukin 6 and matrix metalloproteinase 9 during the onset of pituitary apoplexy in Cushing’s disease

Pituitary - Pituitary apoplexy is a rare endocrine emergency. The purpose of this study is to characterize physiological changes involved in pituitary apoplexy, especially during the acute phase. A...     

Association of NM23 polymorphisms and clinicopathological features and recurrence of invasive pituitary adenomas

Pituitary - Pituitary adenomas (PAs) are intracranial tumors, deriving from anterior pituitary cells. Previously, expression of non-metastasis-23 (NM23) gene has been shown to correlate with the...     

Typing of inflammatory lesions of the pituitary

Pituitary - Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical...     

Double adenomas of the pituitary reveal distinct lineage markers,copy number alterations,and epigenetic profiles

Pituitary - Pituitary adenoma (PA) constitutes the third most common intracranial neoplasm. The mostly benign endocrine lesions express no hormone (null cell PA) or the pituitary hormone(s) of the...     

Pituitary and bilateral adrenal enlargement: an unusual presentation of hepatocellular carcinoma

Pituitary metastases account for about 1% of operated pituitary lesions. Most derive from primaries in the breast or lung. Pituitary metastases from hepatocellular carcinoma (HCC) have rarely been reported. We describe a patient in whom headache and left external ophthalmoplegia were the only presenting signs of a clinically silent and radiographically undetectable HCC, that had metastasized to the pituitary and both adrenal glands. Pituitary histology and adrenal needle biopsy failed to establish the final diagnosis, which was reached only after surgical exploration of the abdomen. This case illustrates the difficulties encountered in the histopathological diagnosis of pituitary metastasis and the need for good clinical judgment when confronting pituitary tumors with atypical features.     

Guidelines of the Pituitary Society for the diagnosis and management of prolactinomas

In June 2005, an ad hoc Expert Committee formed by the Pituitary Society convened during the 9th International Pituitary Congress in San Diego, California. Members of this committee consisted of invited international experts in the field, and included endocrinologists and neurosurgeons with recognized expertise in the management of prolactinomas. Discussions were held that included all interested participants to the Congress and resulted in formulation of these guidelines, which represent the current recommendations on the diagnosis and management of prolactinomas based upon comprehensive analysis and synthesis of all available data.     

Ontogenesis of pituitary prolactin in the human fetus

To study the ontogenesis of PRL synthesis and secretion in the human fetus, PRL mRNA was measured in 12 pituitaries from fetuses of 16-27 weeks of gestation by hybridization of cytosol RNA with 125I-labeled single stranded complementary DNA (cDNA). Pituitary PRL content and serum PRL concentration were assessed by RIA. Pituitary weight increased with fetal age, ranging from 12 mg at 16 weeks of gestation to 41 mg at 27 weeks. The increased weight was due to an increase in cell number. PRL mRNA content did not change during weeks 16-20 of gestation. However, it increased rapidly after 21 weeks, reaching 11.5 times the 16-20 week value at 27 weeks. Pituitary PRL content was constant at a low level until 21 weeks, but thereafter it increased markedly. The increase was greater than that in PRL mRNA, and therefore, the PRL to PRL mRNA ratio was 10-fold greater at 27 weeks of gestation. Serum PRL concentrations also gradually increased after 21 weeks of gestation. These results indicate that marked increases in fetal pituitary PRL synthesis and release occur after 21 weeks of gestation.     

Apoplexy in nonfunctioning pituitary adenomas

Pituitary apoplexy is an uncommon event, occurring due to the infarction and/or haemorrhage usually of a previously unknown pituitary adenoma. It can occur in all adenoma subtypes but is more common in nonfunctioning pituitary adenomas. The physiopathology is not completely clear, and precipitating factors, such as major surgeries, anticoagulant use or pituitary dynamic tests, can be found in up to 40% of patients. The clinical presentation is characterized by a rapid onset with a headache as the main symptom, but visual disturbances can also be present as well as meningism and intracranial hypertension. The diagnosis is based on imaging evaluations, mainly using magnetic resonance imaging, which can show various patterns depending on the timeframe following the occurrence of the apoplectic event. Pituitary hormonal deficits are also common, and the evaluation of hormonal levels is mandatory. Pituitary apoplexy can be managed by surgery or conservative treatment, and a multidisciplinary team is essential for the decision-making process. The outcome is usually positive with both surgical and conservative approaches, but surveillance is needed due to the risk of re-bleeding or tumour recurrence.     

Correction to: Rathke’s cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis

Pituitary - The original version of this article unfortunately contained errors in legend numbers of Figure 2 caption.     

BOOK REVIEWS

Book Reviewed in this article:
The Thyroid and its Diseases, 4th edn. By L. J. D e G root and J. B. S tanbury
Principles of Thyroid Surgery. By J ohn M. B eaugie
Steroid Hormones. Edited by R. 1. D orfman
Perinatal Thyroid Physiology and Disease. Edited by DELBERTA. FISHERand GERARDN. BURROW.
Studies of the Hypothalamus and the Pituitary Gland with Special Reference to the Effects of Transection of the Pituitary Stalk. By Peter M. D aniel and M arjorie M. L. P ritchard
Radioimmunoassay of Hormones for Clinical Trials of Fertility Regulating Agents in Deve-loping Countries. Report of a WHO Meeting of Experts.     

Differences between immunotherapy-induced and primary hypophysitis—a multicenter retrospective study

Pituitary - Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis...     

Progress in transsphenoidal hypophysectomy for treatment of pituitary-dependent hyperadrenocorticism in dogs and cats

Cushing's disease or pituitary-dependent hyperadrenocorticism (PDH) is common in dogs and rare in cats. PDH is caused by a pituitary tumor producing adrenocorticotropin (ACTH). Pituitary imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is required to assess the size and location of the pituitary adenoma in relation to the surgical landmarks. In a specialized veterinary institution, microsurgical transsphenoidal hypophysectomy has proven to be a safe and effective treatment for dogs (n=84) and cats (n=7) with Cushing's disease. Pituitary surgery requires a team approach and the neurosurgeon performing hypophysectomies must master a learning curve. The surgical results compared favorably with those for dogs with PDH treated medically with mitotane at the same institution. The recurrence rate after initially successful surgery increases with longer follow up-times. Pituitary function testing in 39 dogs with PDH treated with hypophysectomy revealed that, much more so than the other adenohypophyseal cell types, residual corticotropes present in the sella turcica after surgery are functional. Such normal ACTH secreting cells may maintain normocorticism whereas residual adenoma cells may lead to mild recurrence after relatively long periods of remission. Microsurgical transsphenoidal hypophysectomy is an effective treatment for canine and feline Cushing's disease.     

Von Hippel-Lindau disease and aggressive GH-PRL pituitary adenoma in a young boy

Von Hippel-Lindau disease is an autosomal dominant disorder involving the development of specific tumours in multiple organs, both benign and malignant. In the CNS, the syndrome is characterized by haemangioblastomas of the retina, spinal cord and brain. We report the case of a 15-year-old boy with the diagnosis of aggressive GH-PRL pituitary macroadenoma and a family history of VHL disease. Pituitary resection was performed, although complete excision of the lesion could not be confirmed by the neurosurgeon. A control MRI was done 6 months after surgery and the pituitary lesion was similar to the presurgical image. A second operation allowed partial resection of the tumour followed by targeted radiotherapy. Pituitary adenomas are rare benign tumours in children with macroadenomas observed mainly in boys. These tumours in adolescents often occur in a familial setting or in the context of known genetic defects. Angiogenesis is an important feature of pituitary adenomas and a possible inhibitory role of pVHL in pituitary angiogenesis has been suggested. This GH-PRL pituitary macroadenoma with a VHL mutation might be of particular aggressiveness. Pituitary adenomas are not classically described in VHL syndrome and the medical community should be alerted to its rare occurrence in this location.     

Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system

Pituitary - Hypophysitis can clinically and radiologically mimic other nonfunctioning masses of the sella turcica, complicating preoperative diagnosis. While sellar masses may be treated...     

Radiological and endocrinological evaluations with grading of hypothalamic perifocal edema caused by craniopharyngiomas

Pituitary - Hypophysial and hypothalamic dysfunction caused by craniopharyngioma is a serious problem despite the progress of surgical approaches and techniques. Perifocal edema induced by...     

Prevalence of comorbidities and concomitant medication use in acromegaly: analysis of real-world data from the United States

Pituitary - Patients receiving treatment for acromegaly often experience significant associated comorbidities for which they are prescribed additional medications. We aimed to determine the...     

National trends in hospital readmission following transsphenoidal surgery for pituitary lesions

Pituitary - Several institutions recently published their experiences with unplanned readmissions rates after transsphenoidal surgery for pituitary lesions. Readmission rates on a national level,...