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3.
Int J Pediatr Otorhinolaryngol ; 128: 109705, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606685

RESUMO

BACKGROUND: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway obstruction in neonates. It can occur either associated with a solitary median maxillary central incisor (SMMCI) in 40-75% of cases or as an isolated morphogenic variant. Brain MRI is routinely performed in patients with CNPAS with a SCMMI due to the concomitant risks of intracranial midline defects of the hypothalamic-pituitary axis (HPA), holoprosencephaly, or associated endocrine dysfunction. However, the role of routine brain imaging and endocrinologic evaluation in patients with isolated CNPAS is not frequently studied given the assumption that isolated CNPAS is unlikely to be associated with any intracranial findings. OBJECTIVES: To evaluate intracranial findings on dual brain MRI imaging in isolated CNPAS patients and to determine if any radiologic, endocrinologic, or genetic abnormalities existed in these patients. METHODS: We performed a single-institution retrospective review and case series of patients with isolated CNPAS from 2006 to 2019. Findings from dual brain MRI imaging, cytogenetic and karyotype testing, and formal endocrinologic testing were analyzed for each patient and compared to reported findings in isolated CNPAS patients within the literature. RESULTS: From 2006 to 2019, 16/29 patients were identified at our institution with isolated CNPAS. Inpatient otolaryngologic consultation, CT, and brain MRI imaging was obtained after a mean postnatal age of 3.21 days, 13.5 days, and 35.91 days, respectively. Dual brain MRI imaging was obtained in 12/16 (75%) patients. In our patients, abnormal MRI findings included hypothalamic hamartoma, pars intermedius cyst, and grades 1 and 4 germinal matrix hemorrhages. No holoprosencephaly was found in any patient. Genetic testing was performed on 10/16 (62.5%) patients. Karyotyping was normal in all patients and microarray testing was abnormal in 2/10 patients that represented a 2p16.3 deletion in one patient and a 7q36 deletion causing an unbalanced translocation mutation of the Sonic Hedgehog gene in the second patient. In the latter patient, a hypothalamic hamartoma and panhypopituitarism was found. Endocrine evaluation was performed in 5 patients and was normal in 3/5 patients. CONCLUSIONS: Our case series of isolated CNPAS patients identified multiple abnormalities on radiologic, genetic, and endocrine testing; one of which that involved a defect of the HPA with panhypopituitarism resulting from a hypothalamic hamartoma. Based upon our findings, dedicated brain MRI imaging, endocrinologic, and genetic testing, should likely be considered for any newly diagnosed, isolated CNPAS patient given the uncommon but potential risk for associated intracranial abnormalities.


Assuntos
Constrição Patológica/congênito , Cavidade Nasal/anormalidades , Encéfalo/diagnóstico por imagem , Deleção Cromossômica , Feminino , Hamartoma/diagnóstico , Proteínas Hedgehog/genética , Humanos , Hipopituitarismo/diagnóstico , Doenças Hipotalâmicas/diagnóstico , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Obstrução Nasal/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Translocação Genética
5.
Iran J Kidney Dis ; 13(6): 417-418, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31880589

RESUMO

Sheehan syndrome (SS) is postpartum hypopituitarism resulting from pituitary gland necrosis caused by severe hypotension due to massive intra or post-partum hemorrhage. Defective NaCl transport in the distal convoluted tubule, due to mutations affecting the thiazide sensitive Na-Cl-cotransporter results in the autosomal recessive salt-losing renal tubulopathy, Gitelman syndrome (GS). These two have been rarely described together. We report the case of a middle-aged woman with both these conditions, resulting in management issues. Physicians encountering unexplained hypokalemia refractory to standard management must consider the possibility of renal tubular disorders.


Assuntos
Síndrome de Gitelman/diagnóstico , Hipopotassemia/etiologia , Hipopituitarismo/diagnóstico , Adulto , Comorbidade , Diagnóstico Diferencial , Feminino , Síndrome de Gitelman/fisiopatologia , Humanos , Hipopituitarismo/fisiopatologia
7.
Eur J Endocrinol ; 181(5): R199-R209, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31480013

RESUMO

Pituitary stalk interruption syndrome (PSIS) is a congenital pituitary anatomical defect. This syndrome is an antenatal developmental defect belonging to the holoprosencephaly phenotype spectrum. It is heterogeneous regarding clinical, biological and radiological presentation and is characterized by the following triad: thin (<1 mm) or interrupted pituitary stalk connecting the hypothalamus to the pituitary gland, no eutopic posterior lobe, and hypoplasia or aplasia of the anterior lobe. This review reports current knowledge about the composite pathogenesis, for which underlying mechanisms remain unclear. Current data suggest genetic origins involving early developmental gene mutations with complex inheritance patterns and environmental influence, placing PSIS at the crossroads between Mendelian and multifactorial diseases. The phenotype associated with PSIS is highly heterogeneous with a high incidence of various combinations of hormonal deficiencies, sometimes associated with extra-pituitary birth defects. The age at onset is variable, but typical presentation is evolutive combined anterior pituitary hormone deficiencies at pediatric age, which progress even during adulthood to panhypopituitarism. Therefore, patients' follow-up throughout life is essential for adequate management.


Assuntos
Hipopituitarismo/terapia , Doenças da Hipófise/terapia , Hipófise , Humanos , Hipopituitarismo/diagnóstico , Fenótipo , Doenças da Hipófise/diagnóstico , Síndrome
9.
Pan Afr Med J ; 33: 138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558936

RESUMO

The chordoma is a benign cartilaginous tumor whose sphenoidale localization is exceptional. This tumor has considerable difficulties of both diagnosis and treatment. We report the observation of a Tunisian adult who presented features of hypopituitarism set wrongly on account of a prolactinoma.


Assuntos
Cordoma/diagnóstico , Hipopituitarismo/diagnóstico , Prolactinoma/diagnóstico , Cordoma/patologia , Diagnóstico Diferencial , Humanos , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prolactinoma/patologia , Osso Esfenoide/patologia , Tunísia
10.
Pituitary ; 22(6): 594-600, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31556012

RESUMO

PURPOSE: Hypopituitarism frequently develops following vasculotoxic snake bite complicated by acute kidney injury (AKI). Well defined prospective studies of prevalence of hypopituitarism and its predictors in vasculotoxic snake bites complicated by AKI are unavailable. METHODS: Fifty-one consecutive patients of AKI following vasculotoxic snake bite were evaluated for various clinical/biochemical parameters (including Free T4, TSH, Cortisol, ACTH, total testosterone, FSH, LH, prolactin, and IGF-1). Diabetes insipidus was evaluated in relevant cases. Twenty minutes whole blood clotting time (WBCT) at presentation was measured in all. MRI of hypothalamo-pituitary region was done at 3 months in subjects with hypopituitarism to rule out structural lesion. RESULTS: 21.6% (11/51) patients developed hypopituitarism at baseline (within 7 days), 39.3% (13 /33) at 3 months developed hypopituitarism. Cortisol deficiency was the commonest abnormality. Subjects who developed hypopituitarism at baseline were younger compared to those without hypopituitarism (35.67 years vs. 46.59 years, p = 0.032) and required more sessions of hemodialysis (8 vs. 3, p = 0.041). Binary logistic regression confirmed that development of hypopituitarism could be predicted by increased number of sessions of hemodialysis (OR 1.51, p = 0.008) and 20 min WBCT (OR 1.2, p = 0.038). CONCLUSION: Hypopituitarism is common following vasculotoxic snake bite in subjects who develop AKI requiring hemodialysis. Hypopituitarism can develop as early as 7 days following snake bite and should be evaluated for particularly in younger subjects, especially those requiring increasing number of sessions of hemodialysis and in subjects with abnormal 20 min WBCT at presentation.


Assuntos
Lesão Renal Aguda/complicações , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Mordeduras de Serpentes/complicações , Lesão Renal Aguda/metabolismo , Adulto , Feminino , Humanos , Hipopituitarismo/metabolismo , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/metabolismo , Hipófise/patologia , Prevalência , Estudos Prospectivos , Diálise Renal , Mordeduras de Serpentes/metabolismo
11.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439564

RESUMO

A 56-year-old woman with a history of hypothyroidism and chronic constipation presented with an acute abdomen due to colonic pseudo-obstruction. Thyroid function tests were consistent with central hypothyroidism prompting intravenous administration of stress-dose glucocorticoids and levothyroxine. The patient then underwent emergency exploratory laparotomy with sigmoid resection and end-colostomy. The postoperative endocrine evaluation revealed that the patient had panhypopituitarism due to Sheehan's syndrome (SS). The diagnosis had been missed by physicians who had been treating her for several years for presumed primary hypothyroidism with a low dose of levothyroxine, aimed at normalising a minimally elevated thyroid-stimulating hormone (TSH) level. This is the second reported case of SS presenting with colonic pseudo-obstruction and it illustrates the potential danger of relying on measurement of TSH alone in the evaluation and treatment of thyroid dysfunction.


Assuntos
Pseudo-Obstrução do Colo/diagnóstico , Hipopituitarismo/diagnóstico , Pseudo-Obstrução do Colo/complicações , Pseudo-Obstrução do Colo/diagnóstico por imagem , Pseudo-Obstrução do Colo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Hipopituitarismo/sangue , Hipopituitarismo/complicações , Hipopituitarismo/tratamento farmacológico , Pessoa de Meia-Idade , Tiroxina/administração & dosagem , Tiroxina/uso terapêutico , Tomografia Computadorizada por Raios X
12.
Indian J Tuberc ; 66(3): 427-429, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31439193

RESUMO

Pituitary gland involvement is a very rare entity of central nervous system tuberculosis. Tubercular meningitis (TBM) is a chronic meningitis on hypothalamic-pituitary axis which causes high morbidity and mortality hence it is the most dreaded form of extra pulmonary tuberculosis. Here we report a case of 24 year old female presenting with three months history of fever and headache along with altered sensorium since four days. There was also complain of secondary amenorrhea and generalised apathy. Neuroimaging revealed subependymal tuberculomas with meningitis and obstructive hydrocephalus. Cerebrospinal fluid (CSF) examination was also suggestive of tubercular meningitis. Endocrinological investigations showed multiple hormonal deficiencies manifesting as pituitary hypothyroidism, hypocortisolism, hypogonadotropic hypogonadism, and hypoprolactinemia. Anti-tuberculosis treatment was started, and it led to significant improvement in the general condition of the patient.


Assuntos
Hipopituitarismo/diagnóstico , Tuberculose Meníngea/diagnóstico , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Humanos , Hipopituitarismo/sangue , Hipopituitarismo/complicações , Hipopituitarismo/tratamento farmacológico , Tuberculose Meníngea/complicações , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/microbiologia , Adulto Jovem
13.
Endocrinol Metab Clin North Am ; 48(3): 583-603, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31345525

RESUMO

Diagnosis of lymphocytic hypophysitis occurring in the peripartum period is based on clinical and neuroradiological data and does not require a biopsy. Its course is generally spontaneously favorable in terms of mass effect but may require the administration of corticosteroids or even transsphenoidal resection. The course of pituitary deficiencies is highly variable; some cases recover over time, whereas others persist indefinitely. Sheehan syndrome is very rare in developed countries. Because agalactia and amenorrhea are often neglected, the diagnosis is generally delayed. Diabetes insipidus occurring in late pregnancy is caused by the increased placental production of vasopressinase and disappears after delivery.


Assuntos
Doenças da Hipófise/terapia , Complicações na Gravidez/terapia , Diabetes Insípido/diagnóstico , Diabetes Insípido/epidemiologia , Diabetes Insípido/terapia , Feminino , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/epidemiologia , Hipopituitarismo/terapia , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/epidemiologia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia
14.
Medicine (Baltimore) ; 98(28): e16407, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305453

RESUMO

RATIONALE: The misdiagnosis of hypopituitarism is common due to its rarity and its nonspecific clinical manifestations. Our case report highlights the importance of critical evaluation regarding hypopituitarism as a cause of recurrent hypoglycemia, hyponatremia, and gastrointestinal symptoms in patients with T1DM, as misdiagnosis might be fatal to the patient. PATIENT CONCERNS: We herein report the case of 35-year-old female patient who presented with 18 years of history of well-controlled type 1 diabetes mellitus and a 6-month history of recurrent nausea and vomiting, generalized weakness, hyponatremia, and severe hypoglycemia, despite a reduction in the dose of insulin. She was considered as having "type 1 diabetes and gastroparesis." Four months later, she was diagnosed with hypothyroidism, and 25 µg/d of levothyroxine was prescribed. However, the levothyroxine had to be discontinued 1 week later because of frequent vomiting by the patient. DIAGNOSIS: Further evaluation in our hospital revealed low-normal adrenocorticotropic hormone, low-normal serum cortisol, and low 24-hours urinary cortisol excretion. Secondary hypothyroidism and hypogonadotropic hypogonadism were also demonstrated. Based on the endocrinological findings, she was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis. Diabetic nephropathy was another diagnosis made after kidney biopsy. INTERVENTIONS: The patient was treated with 100 mg/d of hydrocortisone intravenously for 2 weeks. After that, she continued on 15 mg/d of prednisone, and then 25 µg/d of levothyroxine was administered. OUTCOMES: The patient's insulin requirement increased to a premorbid level, the severe hypoglycemia resolved, the physical discomforts were alleviated, and blood electrolytes returned to normal. LESSONS: This uncommon case reinforced the significance of a timely diagnosis and appropriate treatment of hypopituitarism. We recommend that physicians focus their awareness on this potentially life-threatening disease, as it is a condition potentially fatal to the patient if not recognized and treated.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Hipoglicemia/etiologia , Hiponatremia/etiologia , Hipopituitarismo/complicações , Adulto , Nefropatias Diabéticas/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/tratamento farmacológico , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hipopituitarismo/diagnóstico , Hipopituitarismo/tratamento farmacológico
15.
Growth Horm IGF Res ; 46-47: 44-49, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31234055

RESUMO

OBJECTIVES: Adult growth hormone deficiency (AGHD) is a rare disease characterised by abnormal body composition, reduced strength and exercise capacity and impaired psychological wellbeing. An advisory board of leading Central and Eastern European (CEE) endocrinologists was assembled to gain insights into the status of AGHD care in the CEE region. Topics of discussion included the position of adult hypopituitarism/AGHD in health system priorities, availability and affordability of treatments, awareness of AGHD, practice guidelines used in CEE countries and provisions for long-term care of patients. DESIGN: Prior to the meeting, the advisors were asked to summarise, using an itemised survey questionnaire, the usual standards of care for patients with AGHD in their country. At the meeting, the panel of experts discussed the findings and thereby elucidated similarities and differences among CEE countries; these were compared with international guideline-recommended practices for AGHD. RESULTS: All CEE countries involved reported having some type of infrastructure in place for care of patients with GHD transitioning from adolescence to adulthood. Most countries reported having at least one specialist centre for patients with AGHD. The main variations across the region included initial entry into healthcare systems, tests required to confirm AGHD diagnosis and medication reimbursement by health authorities. Most CEE countries relied on international society-led guidelines, while some countries have developed national guidelines. CONCLUSION: The CEE Adult Endocrinology Advisory Board meeting recognised considerable diversity in the care and patient pathways for AGHD across CEE countries. Additional work is needed to optimise care of patients with AGHD in the CEE region.


Assuntos
Procedimentos Clínicos , Nanismo Hipofisário/terapia , Hormônio do Crescimento Humano/deficiência , Hipopituitarismo/terapia , Guias de Prática Clínica como Assunto/normas , Padrão de Cuidado , Adulto , Nanismo Hipofisário/diagnóstico , Nanismo Hipofisário/genética , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/genética
16.
World Neurosurg ; 130: e150-e159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203060

RESUMO

BACKGROUND: Xanthogranuloma is a chronic inflammatory mass characterized by cholesterol crystal deposition, which is rarely seen in the sellar region. The objective of this study is to identify the clinical features and cause of sellar xanthogranulomas. METHODS: We retrospectively analyzed manifestation, radiographic, and endocrinologic presentation in 9 patients (7 women and 2 men) whom we had previously treated. RESULTS: The patients were between 26 and 73 years of age (median, 56 years). The chief symptoms were visual symptoms in 3, polyuria in 3, headache in 4, and tiredness in 4 patients. Perimetry found visual field deficit in 6 patients. Anterior pituitary provocation tests disclosed impairment of ≥1 hormone in all patients: growth hormone in 8 patients and adrenocorticotropic hormone-cortisol axis in 8 patients. The lesions were suprasellar in 2 patients, intrasellar in 2 patients, and intrasuprasellar region in 5 patients. Three of the lesions were solid and 6 were single cystic to multicystic. Very low intensity area on T2-weighted magnetic resonance imaging was observed in 4 lesions. Postcontrast study performed in 7 lesions showed enhancement in solid parts or cyst walls. Surgical decompression improved visual disturbance in half of the patients but rarely improved hormonal deficits. Follow-up (median, 47 months) found no recurrence of the lesion. In addition to these 9 cases, we found 2 xanthogranulomatous lesions pathologically associated with ciliated epithelia, which also presented with severe hypopituitarism. CONCLUSIONS: Xanthogranuloma seems to be the last stage of the chronic inflammation affecting Rathke cleft cyst or craniopharyngioma presenting with severe anterior pituitary insufficiency.


Assuntos
Granuloma/complicações , Granuloma/patologia , Hipopituitarismo/complicações , Neoplasias Hipofisárias/complicações , Sela Túrcica/patologia , Xantomatose/complicações , Xantomatose/patologia , Adulto , Idoso , Feminino , Granuloma/diagnóstico por imagem , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/patologia , Masculino , Pessoa de Meia-Idade , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
17.
Recenti Prog Med ; 110(5): 255-258, 2019 05.
Artigo em Italiano | MEDLINE | ID: mdl-31140459

RESUMO

We report the case of a 67-year-old man, with a past medical history of radiotherapy for nasopharyngeal carcinoma, who presented with the classical features of a hyperthyroidism (H), due to Graves' disease, with a high TSH receptor antibodies (TRAb) titre. Thyrostatic therapy was started, with gradual improvement of the symptoms and of the thyroid function tests. Two years later, TRAb became negative and the therapy was stopped. In the following months a previously unknown anterior pituitary insufficiency became evident. Therapy with cortisone acetate, L-thyroxine and testosterone was started, resulting in prolonged normalization of the clinical picture. Six years later a short relapse of H was observed, simultaneously to a new increase of TRAb titre, requiring the transitory interruption of the L-thyroxine therapy. In a few months span H disappeared and central hypothyroidism manifested again, so that the patient is still taking replacement therapy. This case illustrates how H and hypopituitarism are not mutually exclusive diagnoses and how, even if rarely, central hypothyroidism and H could alternate in the clinical history of the same patient.


Assuntos
Hipertireoidismo/diagnóstico , Hipopituitarismo/diagnóstico , Imunoglobulinas Glândula Tireoide-Estimulantes/imunologia , Idoso , Cortisona/administração & dosagem , Doença de Graves/diagnóstico , Humanos , Masculino , Testosterona/administração & dosagem , Tiroxina/administração & dosagem
18.
Rev Chil Pediatr ; 90(2): 145-151, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-31095230

RESUMO

INTRODUCTION: The diagnosis of growth hormone deficiency (GHD) is difficult to determine, and could be associated with severe complications, especially in the neonatal period. The stimulation test of growth hormone (GH) secretion is considered the gold standard for diagnosis, but it has methodological complications and is associated with adverse effects. Neonates present physiological increased secretion of GH, representing a diagnostic window. OBJECTIVE: To evaluate if the dried blood spot on filter paper obtained in the neonatal period, as part of a neonatal screening for con genital hypothyroidism and phenylketonuria, allows differentiating patients with GHD from those who do not have it. PATIENTS AND METHOD: Study of cases and controls by measuring the GH concen tration in dried blood spot on filter paper obtained in the neonatal period, comparing controls with GHD with cases with discarded deficiency. The sample was extracted from the filter paper, obtaining two 0.125 inch discs per each patient from the center of the blood spot on the paper, for a highly sen sitive ELISA assay for human GH based on the use of polyclonal antibodies against 22 kDa recom binant human GH. RESULTS: Seven cases of GHD and ten controls were obtained. The median GH concentration of the dried blood spot in the cases is 2.0 ng/ml (Interquartile range 3.6 ng/ml) and 2.05 ng/ml (Interquartile range 2.0 ng/ml) in the controls, Mann-Whitney U test 30.5 (p = 0.68). The two cases with multiple pituitary-hormone deficiency (MPHD) present concentrations lower than 1 ng/ml. CONCLUSION: The dried blood spot sample did not differentiate GHD patients from control cases, although MPHD cases present much lower concentrations compared to isolated growth hor mone deficiency (IGHD).


Assuntos
Teste em Amostras de Sangue Seco , Transtornos do Crescimento/diagnóstico , Hormônio do Crescimento Humano/deficiência , Hipopituitarismo/diagnóstico , Triagem Neonatal , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Nanismo Hipofisário/sangue , Nanismo Hipofisário/diagnóstico , Feminino , Transtornos do Crescimento/sangue , Transtornos do Crescimento/etiologia , Hormônio do Crescimento Humano/sangue , Humanos , Hipopituitarismo/sangue , Hipopituitarismo/complicações , Lactente , Recém-Nascido , Masculino
19.
Best Pract Res Clin Endocrinol Metab ; 33(2): 101276, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31078416

RESUMO

Hypophysitis is a rare entity characterized by inflammation of the pituitary gland and its stalk that can cause hypopituitarism and/or mass effect. Etiology can be categorized as primary or secondary to systemic disease, but may also be classified according to anatomical and hispathological criteria. Newly recognized causes of hypophysits have been described, mainly secondary to immunomodulatory medications and IgG4-related disease. Diagnosis is based on clinical, laboratory and imaging data, whereas pituitary biopsy, though rarely indicated, may provide a definitive histological diagnosis. For the clinician, obtaining a broad clinical and drug history, and performing a thorough physical examination is essential. Management of hypophysitis includes hormone replacement therapy if hypopituitarism is present and control of the consequences of the inflammatory pituitary mass (e.g. compression of the optic chiasm) using high-dose glucocorticoids, whereas pituitary surgery is reserved for those unresponsive to medical therapy and/or have progressive disease. However, there remains an unmet need for controlled studies to inform clinical practice.


Assuntos
Hipofisite/etiologia , Hipofisite Autoimune/diagnóstico , Hipofisite Autoimune/imunologia , Hipofisite Autoimune/terapia , Glucocorticoides/uso terapêutico , Humanos , Hipofisite/diagnóstico , Hipofisite/epidemiologia , Hipofisite/terapia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/terapia , Imunoglobulina G/efeitos adversos , Imunoglobulina G/sangue , Inflamação/complicações , Inflamação/diagnóstico , Inflamação/terapia , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/terapia , Hipófise/imunologia , Hipófise/metabolismo
20.
Curr Opin Pediatr ; 31(4): 531-536, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31082937

RESUMO

PURPOSE OF REVIEW: This review summarizes pituitary function, and the clinical presentation and treatment of hypopituitarism. RECENT FINDINGS: Updates in the field include new guidelines and meta-analyses on the diagnosis and treatment of select hormone deficiencies, novel treatment options, and advances in next generation sequencing technology. SUMMARY: Hypopituitarism is defined as partial or complete loss of a single or multiple pituitary hormones. The clinical presentation of hypopituitarism varies depending on the number and severity of hormone deficiencies. Treatment involves the physiologic replacement of the individual end-organ hormone deficiencies and requires close lifelong monitoring.


Assuntos
Hipopituitarismo/diagnóstico , Hipopituitarismo/terapia , Hipófise/fisiopatologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos
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