Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 296
Filtrar
1.
BMC Endocr Disord ; 19(1): 143, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856773

RESUMO

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disease that mainly affects children, but this disease is significantly rarer in patients who are older than 15 years. In this disease, any organ can be involved. The skeleton, skin and lung are commonly affected, and isolated hypothalamic-pituitary (HP) involvement is relatively rare. Here we report a 17-year-old adolescent with isolated HP-LCH of enlarged pituitary stalk presented with central diabetes insipidus (CDI). CASE PRESENTATION: A 17-year-old male adolescent with polydipsia and polyuria accompanied with elevated serum sodium level and low urine osmolality for 3 weeks was referred to our hospital. After admission, hormonal evaluation showed that his growth hormone (GH) was slightly elevated, and serum osmolality and glucose were normal. The fluid deprivation-vasopressin test demonstrated CDI. Imaging examination showed an obvious thickening of the pituitary stalk. Lymphocytic hypophysitis, sarcoidosis and granulation tissue lesions were suspected. After oral 1-deamino-8-Darginine vasopressin (DDAVP) and prednisone were administered for 2 months, symptoms were relieved, and he discontinued taking the drugs by himself. On reexamination, imaging revealed changes in the size and shape of the pituitary stalk, with thickened nodules. Then, a diagnostic biopsy of the pituitary stalk lesion was performed. Immunohistochemistry confirmed the definitive diagnosis of LCH. The clinical symptoms subsided with oral hormone replacements. CONCLUSION: CDI is a rare symptom in children and adolescents. Most of the causes are idiopathic, while others are caused by central nervous system (CNS) disorders. Meanwhile, lymphocytic hypophysitis, germinoma, LCH and other CNS disorders can all present as thickening of the pituitary stalk, diffuse enlargement of the pituitary gland, and weakening of high signal intensity in the neurohypophysis on magnetic resonance imaging (MRI). The differential diagnosis among these diseases depends on immunohistochemistry evidence.


Assuntos
Diabetes Insípido Neurogênico/etiologia , Histiocitose de Células de Langerhans/complicações , Doenças Hipotalâmicas/complicações , Doenças da Hipófise/complicações , Adolescente , Hipofisite Autoimune/complicações , Hipofisite Autoimune/tratamento farmacológico , Hipofisite Autoimune/patologia , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Neurogênico/tratamento farmacológico , Diabetes Insípido Neurogênico/patologia , Histiocitose de Células de Langerhans/tratamento farmacológico , Histiocitose de Células de Langerhans/patologia , Humanos , Doenças Hipotalâmicas/tratamento farmacológico , Doenças Hipotalâmicas/patologia , Masculino , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/patologia , Prednisona/uso terapêutico
2.
Rheumatol Int ; 39(8): 1467-1476, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203400

RESUMO

GPA with pituitary involvement is a rare condition which is prone to be misdiagnosed. The aim of this study was to summarize clinical features of pituitary involvement in GPA and facilitate early diagnosis. Twelve GPA patients were retrospectively analyzed at a single hospital between 2000 and 2017. A literature review was conducted to compare previous findings with our clinical results. The incidence rate of pituitary involvement in GPA was 3.9% (12/304) without sexual predilection. Other impairments included ear, nose and throat (n = 12), oculi (n = 10), lung (n = 6), meninges (n = 4), kidney (n = 3), and skin (n = 2). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with lung or kidney involvement (n = 6/6), while ANCA were negative in almost all patients without lung or kidney involvement (n = 5/6). Endocrine abnormalities included central diabetes insipidus (CDI, n = 11/12) hypogonadotropic hypogonadism (n = 6/11), adrenocorticotropic hormone deficiency (n = 4/7), thyroid-stimulating hormone deficiency (n = 5/11), and growth hormone deficiency (n = 3/9). Enlarged pituitary gland (n = 6), absence of posterior hyperintense signal on T1-weighed images (n = 11) and hypertrophic cranial pachymeningitis (n = 4) were common radiological manifestations. After treatment, nine patients experienced remission but one died. Pituitary images of 3/4 patients showed size of pituitary lesions decreased. CDI was not alleviated and hypopituitarism remained in two patients. Pituitary involvement in GPA can occur at any time throughout the course of disease, including at the initial presentation. GPA could not be excluded based on negative-ANCA in patients with pituitary abnormality alone. CDI and hypogonadotropic hypogonadism are dominant endocrine abnormalities. Systemic diseases may alleviate and pituitary images may improve after treatment, though the recovery of pituitary function is rare.


Assuntos
Granulomatose com Poliangiite , Doenças da Hipófise , Adulto , Anticorpos Anticitoplasma de Neutrófilos/sangue , Biomarcadores/sangue , Biópsia , Desamino Arginina Vasopressina/uso terapêutico , Feminino , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Terapia de Reposição Hormonal , Hormônios/sangue , Humanos , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/patologia , Indução de Remissão , Estudos Retrospectivos , Tiroxina/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
3.
Domest Anim Endocrinol ; 68: 135-141, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31082785

RESUMO

Published information on the pharmacokinetic and pharmacodynamic properties of pergolide is limited. The aim of this study was to investigate the pharmacokinetic and pharmacodynamic properties of oral pergolide in horses with pituitary pars intermedia dysfunction (PPID). The study design was a nonrandomized clinical trial. Six horses with PPID diagnosed by thyrotropin-releasing hormone (TRH) stimulation tests received pergolide at 4 µg/kg for 18 d. Plasma samples for determination of pergolide and ACTH concentration were collected 0.5 h before and 2 and 12 h after each administration of pergolide. Maximum plasma concentrations after the first oral dose of pergolide (0.104-0.684 ng/mL; median 0.261 ng/mL; interquartile range [IQR] 0.184-0.416 ng/mL) were not significantly different to the maximum steady-state concentration at day 18 (0.197-0.628 ng/mL; median 0.274; IQR 0.232-0.458 ng/mL). Chronic administration was not associated with drug accumulation (R = 1.09) and pergolide concentration reached steady state within 3 d. Throughout, concentrations of pergolide fluctuated considerably, with median plasma peak concentrations more than four times higher than median trough concentrations. Plasma ACTH concentration reduced significantly within 12 h of administration with further reductions occurring up to 10 d after the initiation of treatment. Although there were parallel fluctuations in the concentrations of pergolide and ACTH, timing of ACTH measurement in relation to the administration of pergolide did not have a significant effect. Alterations in the response to TRH were identified at 8 d with no further change being identified at 18 d. A small number of horses were studied. Oral pergolide results in significant suppression of pars intermedia activity within hours. Pergolide and ACTH concentrations fluctuated in tandem although correlation was poor. Fluctuations in pergolide concentration were consistent with a terminal elimination half-life of less than 12 h. To reduce the level of fluctuation of ACTH, twice-daily dosing of pergolide may be more appropriate.


Assuntos
Doenças dos Cavalos/tratamento farmacológico , Pergolida/farmacocinética , Doenças da Hipófise/veterinária , Adeno-Hipófise Parte Intermédia/efeitos dos fármacos , Administração Oral , Hormônio Adrenocorticotrópico/sangue , Animais , Área Sob a Curva , Cavalos , Pergolida/administração & dosagem , Pergolida/sangue , Pergolida/uso terapêutico , Doenças da Hipófise/tratamento farmacológico , Hormônio Liberador de Tireotropina/administração & dosagem , Hormônio Liberador de Tireotropina/farmacologia
5.
Endocrine ; 64(1): 118-121, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30868414

RESUMO

INTRODUCTION: Persistent elevation of thyroid-stimulating hormone (TSH) is common in endocrinology practice in patients undergoing replacement or suppression therapy with levothyroxine sodium (LT4). After examining the causes of this condition, LT4 absorption test is recommended. In this report, we wanted to share our results of LT4 absorption test in patients with elevated TSH levels. MATERIALS-METHODS: The files of patients who presented to our clinic between 2015 and 2018, whose TSH elevation continued despite high-dose LT4 therapy, and who underwent absorption test were reviewed retrospectively. RESULTS: Levothyroxine sodium absorption test was applied to five patients. Absorption test revealed LT4 malabsorption in two patients and pseudomalabsorption in the other three patients. DISCUSSION: When all published pseudomalabsorption cases were considered, it has been stated that at least 2.5 times increase in basal fT4 level may exclude malabsorption. The formula we used has been implemented by Cleveland Clinic since 2014. CONCLUSION: In cases where TSH normalization is not achieved despite high doses of LT4 therapy, LT4 absorption test is an easy test for administration and interpretation and prevents unnecessary medical treatments and examinations.


Assuntos
Hipotireoidismo/sangue , Doenças da Hipófise/sangue , Tireotropina/sangue , Tiroxina/uso terapêutico , Humanos , Hipotireoidismo/tratamento farmacológico , Doenças da Hipófise/tratamento farmacológico , Estudos Retrospectivos
6.
J Pharmacokinet Pharmacodyn ; 46(1): 75-87, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30673914

RESUMO

Cortisol is a steroid hormone relevant to immune function in horses and other species and shows a circadian rhythm. The glucocorticoid dexamethasone suppresses cortisol in horses. Pituitary pars intermedia dysfunction (PPID) is a disease in which the cortisol suppression mechanism through dexamethasone is challenged. Overnight dexamethasone suppression test (DST) protocols are used to test the functioning of this mechanism and to establish a diagnosis for PPID. However, existing DST protocols have been recognized to perform poorly in previous experimental studies, often indicating presence of PPID in healthy horses. This study uses a pharmacokinetic/pharmacodynamic (PK/PD) modelling approach to analyse the oscillatory cortisol response and its interaction with dexamethasone. Two existing DST protocols were then scrutinized using model simulations with particular focus on their ability to avoid false positive outcomes. Using a Bayesian population approach allowed for quantification of uncertainty and enabled predictions for a broader population of horses than the underlying sample. Dose selection and sampling time point were both determined to have large influence on the number of false positives. Advice on pitfalls in test protocols and directions for possible improvement of DST protocols were given. The presented methodology is also easily extended to other clinical test protocols.


Assuntos
Dexametasona/farmacologia , Hidrocortisona/metabolismo , Animais , Teorema de Bayes , Ritmo Circadiano/efeitos dos fármacos , Glucocorticoides/farmacologia , Cavalos , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/metabolismo
7.
Medicine (Baltimore) ; 97(42): e12703, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30334955

RESUMO

RATIONALE: A sellar mass in children is most often seen in craniopharyngeal tumors, intracranial germ cell tumors, or pituitary adenomas. However, pituitary hyperplasia secondary to primary hypothyroidism (PHPH) is not commonly seen in children. PATIENT CONCERNS: A 10-year-old girl was admitted due to growth retardation and obesity for 4 years. On physical examination, the patient had a height of 118 cm, body weight of 46 kg, body mass index (BMI) of 33.0 kg/m. DIAGNOSES: After magnetic resonance imaging (MRI) and laboratory tests, her initial diagnosis was Hashimoto's thyroiditis, primary hypothyroidism, and reactive pituitary hyperplasia. INTERVENTIONS: She was treated with oral L-thyroxine tablets. OUTCOMES: After 6 months, physical examination showed a height of 125 cm, weight of 36 kg, BMI of 23.0 kg/m. She developed well, with 12 cm of yearly growth thereafter. LESSONS: The diagnosis of PHPH in a child is very important and sometimes difficult. Based on the summary and analysis of previous cases, we can learn that the main manifestations of PHPH include growth arrest and obesity, perhaps accompanied by symptoms caused by a decreased thyroid hormone concentration and elevated prolactin (PRL) concentration. Intracranial MRI shows diffuse enlargement of the anterior lobe of the pituitary gland, with a dome-shaped blunt edge change. Thyroid hormone levels may decrease, whereas the thyroid stimulating hormone (TSH) level increases, commonly accompanied by an elevated PRL, reduced growth hormone (GH) levels, and positive findings of TPOAb and TGAb. Improvement of symptoms and the normalization of hormone levels as well as restoration of pituitary size can be achieved after treated with thyroid hormone replacement therapy. And a hasty decision on surgical resection should be avoided when the diagnosis is uncertain.


Assuntos
Doença de Hashimoto/complicações , Hipotireoidismo/complicações , Doenças da Hipófise/complicações , Criança , Feminino , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/tratamento farmacológico , Humanos , Hiperplasia/patologia , Hipotireoidismo/diagnóstico , Hipotireoidismo/tratamento farmacológico , Imagem por Ressonância Magnética , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/tratamento farmacológico , Hipófise/patologia , Testes de Função Tireóidea/métodos , Glândula Tireoide/patologia , Tiroxina/uso terapêutico
8.
J Cell Mol Med ; 22(12): 6368-6379, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30334324

RESUMO

Metformin (MET) is a diabetes drug that activates AMP-activated protein kinase (AMPK), and is suggested to have anticancer efficacy. Here, we investigated the role of AMPK signalling in prolactinoma (PRLoma), with particular respect to MET and bromocriptine (BC) as a PRLoma treatment. We analysed AMPK phosphorylation, dopamine D2 receptor (D2R), and oestrogen receptor (ER) expression in both BC-sensitive and -resistant PRLoma samples; effects of the AMPK agonist MET (alone or with BC) on in vitro proliferation and apoptosis, xenograft growth and prolactin (PRL) secretion of BC-sensitive and -resistant cells, and ER expression in xenografts. Some BC-resistant PRLomas showed high D2R expression but extremely low AMPK activation. MET significantly inhibited proliferation of cultured PRLoma cells; MET + BC notably restrained their PRL secretion. MET + BC further decreased tumour growth and serum PRL levels in xenografts than BC treatment alone. ER was down-regulated after AMPK activation in both cultured cells and xenografts. Together, we propose that the AMPK signalling pathway down-regulates ERα and ERß, and suppresses PRLoma growth as well as PRL secretion. Combined MET + BC is a potential treatment for PRLomas.


Assuntos
Metformina/administração & dosagem , Doenças da Hipófise/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Proteínas Quinases/genética , Receptores de Dopamina D2/genética , Animais , Apoptose/efeitos dos fármacos , Bromocriptina/administração & dosagem , Proliferação de Células/efeitos dos fármacos , Receptor alfa de Estrogênio/genética , Receptor beta de Estrogênio/genética , Feminino , Xenoenxertos , Humanos , Camundongos , Fosforilação/efeitos dos fármacos , Doenças da Hipófise/genética , Doenças da Hipófise/patologia , Prolactina/genética , Prolactinoma/genética , Prolactinoma/patologia
11.
Aust Vet J ; 96(7): 233-242, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29862508

RESUMO

The purpose of this article is to provide a review of the current knowledge and opinions about the epidemiology, clinical findings (including sequelae), diagnosis, treatment and monitoring of equine pituitary pars intermedia dysfunction, particularly in the Australian context. This information and the recommendations provided will assist practitioners in making informed decisions regarding the diagnosis and management of this disorder.


Assuntos
Doenças dos Cavalos , Doenças da Hipófise/veterinária , Adeno-Hipófise Parte Intermédia , Hormônio Adrenocorticotrópico/sangue , Animais , Austrália/epidemiologia , Agonistas de Dopamina/uso terapêutico , Doenças dos Cavalos/diagnóstico , Doenças dos Cavalos/tratamento farmacológico , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/fisiopatologia , Cavalos , Nova Zelândia/epidemiologia , Pergolida/uso terapêutico , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/epidemiologia , Adeno-Hipófise Parte Intermédia/fisiopatologia , Guias de Prática Clínica como Assunto , Fatores de Risco , Sociedades Científicas
12.
Neuro Endocrinol Lett ; 39(1): 43-48, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29803206

RESUMO

Lymphocytic hypophysitis (LH) is a rare inflammatory disorder involving the pituitary gland, often with other autoimmune diseases combined. The coexistence of LH and Behçet\'s disease (BD) is a rare combination and only one case was reported in the previous literatures. A 50-year-old man was admitted into Sir Run Run Shaw Hospital presented with frontal headache and fatigue which had lasted for four months. Endocrinological inspection indicated anterior pituitary dysfunction. Magnetic resonance imaging (MRI) revealed homogeneous pituitary enlargement and thickened pituitary stalk. Administration of glucocorticoids could effectively relieve headache and reduced pituitary mass volume. Oral aphthosis, skin lesions and positive pathergy tests were recognized later, which were characteristic features of BD. Although the diagnosis of BD is mainly dependent on clinical manifestations, PT is still a useful diagnostic tool 0f high specificityfor BD. And this male patient was diagnosed with both LH and BD afterwards. Then he was treated with cyclophosphamide and medium doses of methylprednisolone and remained in good conditions at the follow-up. LH and BD might share a common underlying autoimmune pathogenesis. The presentation of endocrinologic disturbances such as anterior pituitary dysfunction with typical features of skin lesions should prompt further investigation of possible comorbid autoimmune disease involving multiple organ systems. Early diagnosis and close monitoring are vitally important to ensure a stable endocrinologic status.


Assuntos
Hipofisite Autoimune/complicações , Síndrome de Behçet/complicações , Doenças da Hipófise/complicações , Hipofisite Autoimune/diagnóstico por imagem , Hipofisite Autoimune/tratamento farmacológico , Síndrome de Behçet/diagnóstico por imagem , Síndrome de Behçet/tratamento farmacológico , Fadiga/tratamento farmacológico , Fadiga/etiologia , Glucocorticoides/uso terapêutico , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/tratamento farmacológico , Hipófise/diagnóstico por imagem , Adeno-Hipófise , Hormônios Hipofisários/sangue
13.
Endocr Rev ; 39(4): 440-488, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29684108

RESUMO

Neuroendocrinology of bone is a new area of research based on the evidence that pituitary hormones may directly modulate bone remodeling and metabolism. Skeletal fragility associated with high risk of fractures is a common complication of several pituitary diseases such as hypopituitarism, Cushing disease, acromegaly, and hyperprolactinemia. As in other forms of secondary osteoporosis, pituitary diseases generally affect bone quality more than bone quantity, and fractures may occur even in the presence of normal or low-normal bone mineral density as measured by dual-energy X-ray absorptiometry, making difficult the prediction of fractures in these clinical settings. Treatment of pituitary hormone excess and deficiency generally improves skeletal health, although some patients remain at high risk of fractures, and treatment with bone-active drugs may become mandatory. The aim of this review is to discuss the physiological, pathophysiological, and clinical insights of bone involvement in pituitary diseases.


Assuntos
Fraturas Ósseas , Osteoporose , Doenças da Hipófise , Animais , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/tratamento farmacológico , Fraturas Ósseas/etiologia , Fraturas Ósseas/metabolismo , Humanos , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Osteoporose/metabolismo , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/metabolismo
14.
Vet J ; 235: 60-62, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29704940

RESUMO

Pituitary pars intermedia dysfunction (PPID) has been associated with diminished immune response in aged horses. This prospective study hypothesised that this may result in increased strongyle egg shedding in affected animals and that horses treated with pergolide would have reduced fecal egg counts (eggs per gram, EPG) compared to placebo-treated animals. Adrenocorticotropic hormone (ACTH) concentrations and EPG were tested in 48 horses. There were no significant differences in baseline EPG between horses with pre-clinical PPID and healthy controls. There was no significant difference in EPG between horses with PPID after treatment with pergolide and placebo-treated animals. Using EPG as a marker of immune function, these results did not support a proposed decrease in immune function in horses with pre-clinical PPID.


Assuntos
Doenças dos Cavalos/imunologia , Contagem de Ovos de Parasitas , Pergolida/uso terapêutico , Doenças da Hipófise/veterinária , Adeno-Hipófise Parte Intermédia , Strongyloidea , Hormônio Adrenocorticotrópico/sangue , Animais , Fezes/parasitologia , Doenças dos Cavalos/tratamento farmacológico , Doenças dos Cavalos/parasitologia , Cavalos , Pergolida/efeitos adversos , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/imunologia , Estudos Prospectivos , Infecções Equinas por Strongyloidea/complicações
15.
Clin Endocrinol (Oxf) ; 88(6): 908-919, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29566437

RESUMO

BACKGROUND: Bimagrumab is a human monoclonal antibody inhibitor of activin type II receptors (ActRII), with anabolic action on skeletal muscle mass by blocking binding of myostatin and other negative regulators of muscle growth. Bimagrumab is under evaluation for muscle wasting and associated functional loss in hip fracture and sarcopenia, and in obesity. Bimagrumab also blocks other endogenous ActRII ligands, such as activins, which act on the neurohormonal axes, pituitary, gonads and adrenal glands. AIM: To evaluate the effect of bimagrumab on the pituitary-gonadal and pituitary-adrenal axes in humans. METHODS: Healthy men and women, aged 55 to 75 years, received bimagrumab intravenously 10 mg/kg or placebo on Day 1 and Day 29. Pituitary-gonadal and pituitary-adrenal functions were evaluated with basal hormone measurement and standard gonadotropin-releasing hormone (GnRH) and adrenocorticotropic hormone (ACTH) stimulation tests at baseline, Week 8 and at the end of study (EOS)-Week 20. RESULTS: At Week 8, follicle-stimulating hormone (FSH) levels were reduced by 42.16 IU/L (P < .001) and luteinizing hormone (LH) levels were increased by 2.5 IU/L (P = .08) over placebo in response to bimagrumab in women but not in men. Effects that were reversible after bimagrumab was cleared. Gonadal and adrenal androgen levels were not affected by exposure to bimagrumab. CONCLUSION: Bimagrumab alters the function of pituitary gonadotroph cells, consistent with blockade of activin on local ActRII. This effect is reversible with clearance of bimagrumab. Bimagrumab did not impact gonadal and adrenal androgen secretion.


Assuntos
Receptores de Activinas Tipo II/metabolismo , Anticorpos Bloqueadores/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Hormônio Adrenocorticotrópico/sangue , Idoso , Androgênios/sangue , Anticorpos Monoclonais Humanizados , Cromatografia Líquida , Método Duplo-Cego , Estradiol/sangue , Feminino , Voluntários Saudáveis , Humanos , Hidrocortisona/sangue , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/sangue , Doenças da Hipófise/tratamento farmacológico , Efeito Placebo , Pós-Menopausa , Espectrometria de Massas em Tandem , Testosterona/sangue
16.
Endocrine ; 60(2): 203-218, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29417370

RESUMO

Adult-onset growth-hormone (GH) deficiency (GHD) is a rare disorder, which most commonly results from pituitary or peripituitary tumors and their treatment, and is characterized by alterations in body composition, carbohydrate and lipid metabolism, bone mineral density, cardiovascular risk profile and quality of life, all of which may contribute to an increased morbidity and mortality. Since recombinant human GH (rhGH) became available in 1985, several studies have provided evidence of its beneficial effects, despite the potential risk of developing adverse effects, and much clinical experience has been accumulated. However, in adults, the precise therapeutic role of GH replacement therapy and the individual response to it remains highly variable and is still a matter of debate. In this article, we present a critical review of the available evidence on rhGH replacement therapy in GHD adults, emphasizing the pitfalls clinicians encounter in the diagnosis of GHD and monitoring of rhGH replacement therapy. We will cover all the relevant aspects regarding the potential usefulness of GH treatment, including the hot topic of mortality.


Assuntos
Hormônio do Crescimento/deficiência , Hormônio do Crescimento Humano/uso terapêutico , Doenças da Hipófise/tratamento farmacológico , Idade de Início , Biomarcadores , Humanos , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/mortalidade , Resultado do Tratamento
17.
World Neurosurg ; 113: e138-e145, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29425985

RESUMO

OBJECTIVE: Pituitary abscess (PA) is a rare but serious intrasellar disorder with potentially high disability and mortality. Secondary PA after transsphenoidal surgery (TS) is extremely rare, and only a few case reports have been identified in the literature. This study explored the salient clinical manifestations and etiologies to determine appropriate treatment. METHODS: A retrospective review of 6832 consecutive patients who had undergone TS for pituitary diseases in Peking Union Medical College Hospital between 2003 and 2017 was performed. Demographics, previous medical and surgical history, clinical presentation, imaging features, and treatment details of 23 patients who had been diagnosed with secondary PA after TS among the cohort were reviewed. RESULTS: Among these patients, the original pituitary lesion before TS included Rathke's cleft cyst (8 patients, 34.8%), nonfunctioning pituitary adenoma (11 patients, 47.8%), and somatotropic adenoma (4 patients, 17.4%). The diameter of the original pituitary lesion ranged from 11 to 47 mm. About 52% of secondary PAs occurred within a half a year after surgery. Based on the history of TS, clinical presentation, biochemical testing, and typical imaging features, the preoperative diagnosis rate was as high as 78%. CONCLUSIONS: Although rare, secondary PA should be included in the differential diagnosis of intrasellar lesions after TS. Patients with an initial diagnosis of Rathke's cleft cyst or pituitary macroadenoma were more likely to have PA after TS. Adequate surgical drainage combined with microbiology-guided antibiotic therapy is the first choice for treatment.


Assuntos
Abscesso Encefálico/etiologia , Hipofisectomia/efeitos adversos , Doenças da Hipófise/etiologia , Infecção da Ferida Cirúrgica/etiologia , Adenoma/cirurgia , Adulto , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Terapia Combinada , Craniofaringioma/cirurgia , Drenagem , Feminino , Humanos , Hipofisectomia/métodos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Reoperação , Estudos Retrospectivos , Osso Esfenoide/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Adulto Jovem
18.
Medicine (Baltimore) ; 97(2): e9084, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29480822

RESUMO

Pituitary stalk interruption syndrome (PSIS) is associated with simultaneous or subsequent pituitary hormone deficiencies (PHDs). Although the clinical features of multiple PHDs are well known, the status of the thyrotrophic axis in PSIS has not been thoroughly investigated.The clinical data of 89 PSIS patients and 34 Sheehan syndrome (SS) patients were retrospectively analyzed.The prevalence of central hypothyroidism in the PSIS patients and the SS patients was 79.8% and 70.6%, respectively. The thyroid-stimulating hormone (TSH) levels in the PSIS patients were significantly higher in comparison with the SS patients (5.13 ±â€Š3.40 vs 1.67 ±â€Š1.20 mU/L, P < .05). TSH elevation (8.79 ±â€Š3.17 mU/L) was noticed in 29 of 71 (40.85%) hypothyroid PSIS patients but not in the 24 hypothyroid SS patients. The TSH levels in the hypothyroid PSIS patients were significantly higher in comparison with the euthyroid PSIS patients (5.42 ±â€Š3.67 vs 3.66 ±â€Š1.50 mU/L). Thyroid hormone replacement significantly reduced the TSH levels in the PSIS patients with elevated TSH levels from 7.24 ±â€Š0.98 to 1.67 ±â€Š1.51 mU/L (P < .05). The logistic regression analysis suggested that TSH level was not significantly associated with pituitary stalk status and height of the anterior pituitary gland.PSIS is a newly recognized cause of central hypothyroidism. The proportion and amplitude of TSH elevations are higher in PSIS than in other causes of central hypothyroidism.


Assuntos
Doenças da Hipófise/metabolismo , Tireotropina/metabolismo , Adulto , Feminino , Terapia de Reposição Hormonal , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/epidemiologia , Hipófise/diagnóstico por imagem , Hipófise/efeitos dos fármacos , Hipófise/metabolismo , Prevalência , Estudos Retrospectivos , Tireotropina/administração & dosagem , Adulto Jovem
19.
Intern Med ; 57(3): 367-375, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29093382

RESUMO

We herein report the case of a 25-year-old woman who presented with severe headache and visual field defects after childbirth. Magnetic resonance imaging revealed marked swelling of the pituitary gland, and an endocrinological examination revealed panhypopituitarism and diabetes insipidus. An immunohistological analysis of a transsphenoidal biopsy sample of the pituitary gland showed the significant accumulation of an immunogloblin G4 (IgG4)-positive population, leading to the diagnosis of IgG4-related hypophysitis. The patient was treated with prednisolone, which markedly reduced the swelling of the pituitary gland, in association with recovery of the pituitary function. This is a rare case of biopsy-proven IgG4-related hypophysitis with a postpartum onset.


Assuntos
Hipofisite Autoimune/diagnóstico , Hipofisite Autoimune/tratamento farmacológico , Imunoglobulina G/análise , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/tratamento farmacológico , Hipófise/diagnóstico por imagem , Prednisolona/uso terapêutico , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Doenças da Hipófise/patologia , Hipófise/patologia , Período Pós-Parto , Resultado do Tratamento
20.
Pituitary ; 20(5): 594-601, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28540625

RESUMO

PURPOSE: Granulomatosis with polyangiitis (GPA) is a multisystem disease, characterized by necrotizing small-vessel vasculitis, which mainly affects the respiratory tract and the kidneys. Pituitary involvement in GPA is rare, present in about 1% of all cases of GPA. To date, only case reports or small case series have been published. Herein we report clinical features, imaging findings, treatment and outcomes in three patients with GPA-related pituitary dysfunction (PD). METHODS: A retrospective analysis of three cases of GPA-related PD was conducted, followed by systematic review of the English medical literature using PubMed. RESULTS: The three cases include three women aged between 32 and 37 years. PD was the presenting feature in one and two developed PD in the course of the disease. All patients had a pituitary lesion on MRI. Conventional treatment with high doses of glucocorticoids and cyclophosphamide led to resolution or improvement of the MRI abnormalities, whereas it was not effective in restoring PD. A systematic review identified 51 additional patients, showing that GPA can lead to partial or global PD, either at onset or, during the course of the disease. Secondary hypogonadism is the predominant manifestation, followed by diabetes insipidus (DI). Sellar mass with central cystic lesion is the most frequent radiological finding. CONCLUSION: GPA should be carefully considered in patients with a sellar mass and unusual clinical presentation with DI and systemic disease. Although conventional induction-remission treatment improves systemic symptoms and radiological pituitary abnormalities, hormonal deficiencies persist in most of the patients. Therefore, follow-up should include both imaging and pituitary function assessment.


Assuntos
Granulomatose com Poliangiite/metabolismo , Granulomatose com Poliangiite/patologia , Hipófise/metabolismo , Hipófise/patologia , Adulto , Ciclofosfamida/uso terapêutico , Diabetes Insípido/metabolismo , Diabetes Insípido/patologia , Feminino , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/metabolismo , Doenças da Hipófise/patologia , Hipófise/efeitos dos fármacos , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA