Endocrine Abstracts

Background: Sheehan’s syndrome or postpartum pituitary necrosis though rare, is still remains one of the commonest causes of hypopituitarism in the developing parts of world like Indian subcontinent. The clinical presentation is often variable and frequently accompanied by hypogonadism which leads to low bone density due to loss of bone protective effect of oestrogen.Aims: To find out the bone mineral density and the quality of life (QoL) i...

A 17-year-old girl was referred to Endocrinology Unit by her neurosurgeon. She had complained of severe headache, palpation induced galactorrhoea on left mammary and visual abnormalities for 1–2 months. Her menstrual period was regular. On physical examination a pale face and fatigued appearance was noticed. Biochemical and hormonal analyses are as follows: fasting glucose level was 84 mg/dl, serum sodium level was 140 mmol/l (136–145), serum potassium level was 3.9 ...

Cancer metastases on pituitary gland are seen rarely. A 71-year-old male was admitted to Endocrinology Department with polydipsia, polyuria, and diplopia. Urine volume was ~5 l/day. In medical history; he had been diagnosed as having non-small cell lung carcinoma with multiple liver and bone metastases 1 year ago. He took chemotherapies with four cycles of paclitaxel, carboplatin, and zoledronic acid for bone metastases and radiation therapy (RT) was given to L4-S1 vertebras. ...

Nodular thyroid disease is frequently observed in patients with acromegaly. The aim of this study is to evaluate thyroid nodules and thyroid cancer frequency in acromegalic patients. The data of 125 acromegalic (55 males and 70 females) patients followed over 10 years were evaluated retrospectively from the recorded files. Data for gender, age, duration of acromegaly, thyroid function tests, thyroid ultrasonography (US), and thyroid fine needle aspiration biopsy (FNAB) and thy...

Introduction: A transsphenoidal adenectomy (TSFE) is primary treatment of Cushing’s disease. Pharmacological management when the disease persists after surgery is a challenge.Case report: A 47-year-old man was initially diagnosed with CD (petrosal sinus sampling with CRH testing included) after suffering from multiple organ failure in sepsis. Microadenoma 2×4 mm was suspected on the pituitary MRI. Clinical symptoms were markedly improved after ...

Introduction: Sarcoidosis is a systemic granulomatous disorder usually affects multiple organs. Approximately 10% of sarcoidosis occurs as isolated neurosarcoidosis in CNS and <10% of neurosarcoidosis develops in a restricted hypothalamic–pituitary area. Recent study has identified Propionibacterium acnes in lungs and lymph nodes of many patients with sarcoidosis using a MAB specific for this bacterium (PAB), providing strong evidence for P. acne as ...

Pituitary ACTH-secreting tumour presents with variety of clinical features: normal cortisol secretion and ACTH-immunopositive staining and mild hypercortisolism without typical features of Cushing’s disease. We present a 53-year-old male with history of hypertension. First visit (2005): visual loss, bitemporal hemianopsia in campimetry and in MRI pituitary adenoma (2.5 cm) invading cavernous sinus and suprasellar cister. Hormonal study supported panhypopituitarism. After ...

Introduction: Somatostatin analogues (SSAs) are used in the treatment of somatotropinomas. Actually, the use of these drugs in clinically non-functioning pituitary adenomas (NFPA) is raised. The aim of the study is to assess the effectiveness of SSA therapy in both groups.Materials and methods: 40 acromegalic patients and 22 patients with NFPA were treated with SSA for the total therapy duration up to 10 years. Hormonal profile, dynamics of tumour size c...

Background: Craniopharyngiomas (CP) are benign brain tumours presenting in childhood treated by tumour resection together with radiotherapy. In about half of the cured patients hypothalamic damage leading to eating disorders and obesity as well as to hypopituitarism, necessitating consequent hormone substitution therapy, is observed. Bariatric surgery is an efficient treatment strategy for morbid obesity. However, so far it is unknown, whether oral hormone substitution is hamp...

As optimal postoperative management of patients with clinically nonfunctioning pituitary adenomas (NFPA) is a matter of debate, the role of dopamine agonist (DA) therapy in this clinical setting was evaluated.Methods: Retrospective analysis of prospectively collected data was conducted at two pituitary referral centrer with different standard practices for post-operative management of NFPA: DA therapy or conservative follow up. Dopamine receptor 2 (D2R) ...

Introduction: Lymphocytic hypophysitis is a rare endocrine disease involving lymphocytic infiltration and chronic pituitary inflammation. It may result in significant morbidity by loss of pituitary functions and neurological deficits. Pituitary abscess is another rare disease which may be associated with underlying parasellar pathology. Here, we report a case of lymphocytic hypophysitis diagnosed with a pituitary abscess and recurrent suprasellar involvement after surgery....

Introduction: Neutrophil/lymphocyte ratio (NLR) is an indicative of the acute phase response. It is a significant indicator of the systemic inflammation, and considered as a poor prognosis indicator in various disease. We aimed to evaluate NLR and its determinants in acromegaly patients.Patients and methods: A retrospective chart review of 40 patients with acromegaly and 45 age and sex matched healthy individuals was performed. Patients with active infec...

Introduction: Pituitary surgery is currently considered the preferred treatment for Cushing’s disease (CD) and achieves remission in 55–85% of patients. Cortisol falls quickly after surgery, so that early post-operative cortisol level has been used as predictor of remission. There’s no agreement about optimal timing for cortisol measurement, with wide variability between centres.Objective: To assess the value of early post-operative serum ...

Introduction: Cushing’s disease (CD) is characterised by pathologic hypercortisolism caused by an ACTH-secreting pituitary adenoma. The primary modality for definitive treatment is pituitary surgery. The rarity of CD has made it difficult to establish reliable predictive factors of outcomes.Aim: Assessment of clinical, hormonal, radiological, surgical and histological findings as predictors of remission and relapse of CD.Metho...

Introduction: The purpose of this study was to evaluate and compare disease outcomes in patients with acromegaly receiving first-line and second-line (after transphenoidal surgery) somatostatin analogs (SSA) treatment.Methods: The study involved retrospective data collection from charts of 49 patients with acromegaly who were consulted by an endocrinologist in Vilnius University Hospital Santariskiu klinikos between 2007 and 2013.R...

Aims: An increased risk of mortality in patients with uncontrolled acromegaly has been reported in several studies. We aimed to assess the impact of co-morbidities on the survival of patients with acromegaly after long-term treatment and follow-up.Methods: A retrospective analysis was performed for 285 patients with active acromegaly who were admitted to the Chang Gung Memorial Hospital, Taiwan between 1978 and 2012.Results: Of the...

Objective: Somatic mutations in the GNAS1 gene, which encodes the alpha-subunit of G stimulatory proteins (gsp), are frequently detected in somatotroph pituitary tumors and have been associated to specific clinical-smaller and less invasive tumors occurring in older patients- and histopathological-densely granulated adenomas- characteristics. However, the question whether the presence of a somatic gsp mutation affects the response to somatostatin analogue treatment remains unr...

Aim: Although there are some studies regarding the effects of cigarette smoking on serum total cortisol (STC) and salivary cortisol (SaC) levels, the results are still challenging. For this purpose, we aimed to determine the effects of cigarette smoking on STC and/ or SaC levels in a small group of healthy volunteers.Study design: 15 (five female and ten male) cigarette smoker with the mean age of 39.47±14.27, and 15 age and gender matched non-smoke...

Objective: Our aim was to evaluate whether multiple mild head trauma or repetitive heading of long term soccer playing causes growth hormone deficiency.Patients and methods: 28 retired previously professional male soccer players were investigated. Nine of them had sport related head injuries. Mean age: 48.7 years (range 36–70; S.D.±7.4); mean sport duration (professional and senior activity): 27.4 years (S.D.±...

Carney complex (CNC) is rare autosomal dominant disorder, which was firstly described as a combination of manifestation of myxomas, spotty skin pigmentation and endocrine overactivity in 1985. This condition affects many organs and varies in clinical manifestation. The presence of at least two clinical signs is considered as pathognomonic with regard to a sporadic form of CNC, and an evidence of at least one sign with simultaneous manifestation of CNC in any of first degree re...

Introduction: Contrary to US guidelines, recent European guidelines do not recommend tolvaptan for the treatment of SIADH.Methods: Retrospective data collection of all inpatients treated with tolvaptan for SIADH in two UK hospitals between November 2010 and February 2014. All values were calculated as mean±S.D.Results: This case series included 61 patients (33 females, 28 males) aged 74.4±15.3 years with se...

Objective: According to recent studies, impaired secretion of GH is a frequent finding after ischaemic stroke. The aim of our study was to compare various available GH stimulation tests in post-stroke patients.Design: Seventeen patients were included in the study (12 males; mean age: 60.5 years; mean BMI, 27.7 kg/m2) with a mean 19.6 (±7.3) months after stroke. For screening, glucagon and small dose (0.15 μg/kg) GHRH-arginine (sdGHRH...

Introduction: The current guidelines state that the goals of growth hormone (GH) therapy should be an appropriate clinical response and avoidance of side effects. The target level for IGF1 is commonly the upper half of the reference range, although no published studies offer specific guidance in this regard. Therefore, the aim of the present study is to investigate associations between IGF1 levels within the reference range and several efficacy and safety measures of GH treatm...

Hypopituitarism as deficiency of one or more anterior pituitary hormones, in adults can be consequence of acquired or genetic causes. Only few published studies investigated population-based aetiology of hypopituitarism. In the last 10 years new risks for hypopituitarism have been recognised (traumatic brain injury-TBI, subarachnoid haemorrhage, cranial irradiation).Aim: To present our experiences in the aetiology of hypopituitarism based on data collect...

Introduction: Increased production of vasopressin plays a key role in the development of fluid retention and hyponatremia in patients with decompensated heart failure. Antidiuretic hormone deficiency in the course of diabetes insipidus leads to the loss of water, dehydration and hypernatremia. The aim of the study was to present difficulties in successful treatment of hyponatremia in a patient with cardiomyopathy and heart failure, receiving desmopressin because of postoperati...

Background: Pituitary adenomas (PAs) in the elderly, defined as people older than 65 years, represent less than 10% of all PAs. Because of increasing life expectancy and improving health care, diagnosis PAs in this age group is increasing with time. Age-related changes and associated diseases may significantly modify the clinical presentation in these patients, delaying the diagnosis of PAs.Objective: To analyse the clinical features of PAs in elderly pa...

Introduction: Some patients complain of excessive daytime somnolence following pituitary surgery.Aim: To investigate the presence of obstructive sleep apnoea (OSA) following surgery for non functioning pituitary adenomas (NFPA).Design and methods: We assessed the prevalence of OSA in 16 routinely selected patients following surgery for NFPA and 13 obese controls attending a tertiary referral centre, by means of the Epworth Sleepine...

Introduction: Prolactin is a multifunctional pituitary hormone. The effect of prolactin on platelet activation is not well understood. Prolactinomas are the most common type of pituitary adenomas, and they are medically responsive to dopamine agonists. Mean platelet volume (MPV) is a marker of platelet function and activation. The aim of this study was to evaluate MPV values before and 6 months of cabergoline treatment when normoprolactinemia was achieved.<p class="abstext...

Introduction: Increasing evidence is available for the role of prolactin in the development of various cancers. The purpose of this study is to evaluate the frequency of thyroid cancer in patients with prolactinoma followed up at a single site.Materials and methods: Medical records of 182 patients, diagnosed with prolactinoma, were reviewed retrospectively. Out of these patients, 114 patients (103 female patients, 11 male patients, mean age 35±10.4)...

Introduction: We present a rare case of squamous cell carcinoma of the sphenoid sinus presenting as a sellar mass and panhypopituitarism.Case presentation: A 60-year-old Chinese male with schizophrenia and a 20 pack year smoking history, was admitted to our hospital with headache and diplopia without visual field loss. Brain imaging with computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 2.9 cm sellar mass based in the sphenoid sinu...

Objective: Growth hormone treatment (GHT) is a widely accepted treatment in growth hormone deficient (GHD) adults with nonfunctioning pituitary adenoma (NFPAs). However, concerns remain about the safety of GHT, because of its potentially stimulating effect on tumour (re)growth. The aim of this study was to evaluate tumour progression in NFPA patients using GHT.Patients and methods: From the Dutch National Registry of growth hormone treatment in adults, a...

Introduction: Acromegaly is characterised by chronic, excessive secretion of GH and increased IGF1 levels caused by benign pituitary adenoma. This study aimed at describing the symptoms and comorbidities of acromegaly at diagnosis, in a large cohort of patients diagnosed between 2009 and 2014.Methods: Observational, cross-sectional, multicentre study conducted in France between September 2013 and June 2014. Adult patients with acromegaly diagnosed for &#...

Context: The economic and logistic burden of screening for hypopituitarism following moderate/severe traumatic brain injury (TBI) is considerable. Published guidelines suggest prioritisation for screening of patients with symptoms of pituitary dysfunction.Objective: To evaluate the implementation of targeted symptom-based screening for hypopituitarism after moderate/severe TBI, compared with routine consecutive screening.Design: Gr...

Performing water deprivation test (WDT) and prolonged water deprivation test (PWDT) is some of the roles undertaken by endocrine nurse in specialist endocrine units. These tests need to be done in a safe and control environment.Objectives: To provide safe information to patients to avoid fluids overload when they arrive for the tests. Can the specialist endocrine nurse make clinical decision to terminate the test base on clinical evidence and at what poi...

Background: The use of intra-articular (IA) glucocorticoids for reducing pain and inflammation in patients with osteoarthritis, rheumatoid arthritis, and other inflammatory arthropathies is widespread among primary care physicians, specialists and non-specialists in the United States. Injectable glucocorticoids have anti-inflammatory and analgesic properties which can be effective in improving clinical parameters such as pain, range of motion, and quality of life. After inject...

Objective: To study the effect of age and gender on manifestation of hyperprolactinaemia.Methods: Patients were examined using generally accepted methods of diagnosis. 207 patients with prolactinomas were divided into two groups: before and after 50 years. It was a retrospective study with no interventions to generally accepted methods of diagnosis and treatment. The outcomes were measured by frequency of hyperprolactinaemia symptoms according to age and...

Background: Successful pituitary surgery in patients with Cushing disease (CD) can result in long term remission and sustained weight loss. We examined rates of body weight changes in the post-operative period (within 6 months) in patients with active CD who underwent transsphenoidal surgery (TSS) and the relationship of weight loss to remission status.Methods: Clinical data was obtained from a CD database in addition to an online patient medical record ...

Background: An increasing number of studies assess quality of life (QoL) in patients with pituitary diseases. At present, available disease-specific QoL questionnaires do not completely cover the patient perspective of QoL. Furthermore, there are no disease-specific questionnaires available which inventories patient’s needs for help for impairments in QoL.Objective: To develop and validate a disease-specific QoL questionnaire for patients with pitui...

Introduction: Dopamine agonists are the mainstay treatment for prolactinomas, but clinical characteristics that predict their effects on prolactin (PRL) suppression and tumour shrinkage are missing. Our study aimed to find measures in early follow-up of men harbouring macroprolactinomas, that will predict dynamics of PRL decrease and adenoma shrinkage.Methods: A single centre historical prospective study, including a consecutive group of 71 men with pitu...

Introduction: In the past 10 years, endoscopic resection of pituitary adenomas has become an alternative to microsurgical resection with the additional advantage of increasing the patient’s postoperative comfort. This analysis explored whether endoscopic resection can reduce the risk of postoperative neurohypophyseal dysfunction.Material and methods: We rated and compared the need to administer desmopressin during the first four postoperative days a...

Introduction: In acromegalic patients, the increased mortality and morbidity are generally due to cardiovascular, metabolic, respiratory and cerebrovascular diseases, so early diagnosis and treatment of cardiovascular lesions may save lives. The aim of this study is to find out the any possible difference in terms of carotid intima media thickness (CIMT), indices of arterial stiffness, soluble CD40 ligand (sCD40L) and some echocardiographic parameters between active and inacti...

Introduction and objective: Clinically nonfunctional pituitary adenomas are relatively an uncommon disease. The aim of this work is to describe the clinical characteristics and to review the results of transsphenoidal surgery (TS) of pituitary adenomas in a reference centre.Methods: A retrospective study (1995–2014) of 66 patients (50% men) diagnosed with pituitary adenomas by a magnetic resonance imaging (MRI) was conducted. demographic, clinical, ...

Introduction: ACTH-secreting pituitary carcinomas are rare neoplasms but there are not factors till now to predict their aggressive evolution nor a standard practice to their management.Case report: We report a 43-year-old female patient presented in 1990 with Cushing’s syndrome due to ACTH-secreting pituitary microadenoma who had been submitted on trans-sphenoidal surgery with cure as defined by post-operative cortisol serum levels <50 nmol/l. ...

Introduction: Data on the mortality of patients with non-functioning pituitary macroadenoma (NFA) are very limited.Aim: To assess the mortality of patients with NFA and factors predicting it.Patients and methods: All patients presenting to our department with NFA between 1963 and 2011 were studied. Status was recorded as either dead or alive, as of 31st December 2011.Results: 546 patients (333 males) were ide...

Introduction: The enlarged pituitary gland of pregnancy is susceptible to any compromise to its blood supply. Sheehan’s syndrome (SS) occurs as a result of post-partum pituitary infarction or haemorrhage and usually leads to hypopituitarism. It can be fatal but clinical manifestations may change from one patient to another and symptoms may not occur for many years.Methods: We analysed retrospectively five cases of women with SS aged 26&#150...

Introduction: An improvement of survival in patients with acromegaly was claimed in the last years, with multimodal new therapies.Aims: To assess cure rates of different therapeutic protocols and the impact of these therapies on survival.Methods: 334 patients (224 F/110 M, mean age 48.1±0.7 years) with acromegaly admitted in a single Neuroendocrinology Department between Jan 2001 and Dec 2013 were retrospectively studied by GH...

Aim: Clinical guidelines recommend the cancellation of dopamine agonists after confirmation of pregnancy as because further their use is unnecessary. However, an implementation of these recommendations in real clinical practice is unknown which became the aim of our present research.Materials and methods: The study included 21 patients with prolactinomas who had 26 pregnancies ended in childbirth. These patients were found archived medical records of End...

Introduction: Alterations in the hypothalamic–pituitary–thyroid axis have been reported following GH replacement, with a decline in circulating T4 concentration the most consistent finding. However, the clinical significance of GH-induced alterations in circulating levels of thyroid hormone is unclear.Aim: To examine the relationship between changes in serum concentration of thyroid hormones and known biological markers of thyroid ho...

Background: Acromegaly is associated with increased risk of coronary atherosclerosis and cardiovascular mortality. Changes in coagulation and fibrinolysis markers in acromegalic patients have been shown to indicate increase in the risk of developing cardiovascular disease. Mean platelet volume (MPV) is a marker of platelet functions and activity, and increased MPV is an independent risk factor of myocardial infarction and thrombotic events. In this study, we examined the level...

Introduction: Differentiated thyroid carcinoma (DTC) rarely represents with distant organ metastasis. Cerebral metastasis is seen in 0.4–1.2% of patients with distant organ metastasis. There are only 14 patients of DTC with pituitary metastasis reported in the literature. Here, we report a papillary thyroid carcinoma (PTC) patient represented with pituitary metastasis.Case: A 68-year-old male patient has admitted to our hospital with a growing tumou...

Background: Errors made with critical medicines such as desmopressin and hydrocortisone used in the treatment of endocrine conditions in hospitalised patients can undermine patient safety but are largely preventable.Methods: Retrospective audit of adult patients admitted at the University Hospitals of Leicester NHS Trust between January 2013 and June 2014, prescribed desmopressin for cranial diabetes insipidus (CDI) or other medical conditions using elec...

Introduction: Pregnancy in a patient with acromegaly is uncommon, as the enlarging pituitary adenoma suppresses gonadotropin secretion rendering the patient amenorrhoeic and infertile. About 40% of the women with pituitary adenomas also have hyperprolactinaemia, which further decreases the likelihood of pregnancy.Case report: A 32-year-old woman was sent to our centre in the first trimester of pregnancy with the diagnostic of gestational diabetes. Clinic...

Background: Pituitary adenoma (PA) is an under-investigated pathology in the elderly.Objective: To review our case records of patients >70 years with PA, in order to evaluate presentation symptoms, hormonal results, and pituitary morphology.Patients: 48 patients aged 70 years or older (21 females/27 males) were identified from the group of 610 patients with PA (7.9%) diagnosed at Neuroendocrine Unit, Clinic for Endocrinology, B...

Introduction: Somatostatin analogues (SSA) present the treatment of choice in patients with previously poorly controlled acromegaly.Methods: We conducted a retrospective analysis of acromegalic patients enrolled in the Network of Excellence for Neuroendocrine Tumors Munich and treated with the SSA lanreotide.Results: Fifty-six acromegalic patients (25 females; mean age 59 years; 33 with macroadenoma) switched to lanreotide from pre...

Context: Angiopoietin-like protein 4 (Angptl4) is a protein involved in lipolysis, that is regulated by non-esterified free fatty acids (FFA). GH promotes lipolysis and increases circulating FFA. Hypothesis: GH increases circulating Angptl4 levels by modulating its expression and secretion from fat and muscle. Angptl4 might be of metabolic relevance for the insulin resistance associated with GH/IGF1 excess or deficiency.Objective: To evaluate Angptl4 in ...

Introduction: Surgery is the primary therapy in most acromelagic patients. When persistent disease is observed, adjuvant medical therapy is used. Pasireotide is a somatostatin analogue (SSA) not approved for acromegaly therapy yet, but with a potentially better response, given that it binds to four out of five somatostatin receptors.Materials and methods: We present the case of an acromegalic patient with resistance to many therapies and response to trea...

In GH deficiency (GHD), which is a medical condition caused by problems in the pituitary gland, the body does not produce sufficient amount of GH, resulting in short stature in children. The treatment of GHD short children with exogenous GH increases linear growth velocity (LGV). The present study determined the effect of exogenous GH treatment on LGV, the dose(s) of exogenous GH that effectively impacts LGV and the stage(s) of puberty at which the effect of exogenous GH treat...

Introduction: Cushing’s disease (CD) is a rare endocrine disorder characterized by endogenous hypercortisolism, which is associated with metabolic and psychiatric disorders. It is essential to understand the impact of normalization of serum cortisol in the evolution of these comorbidities.Aims: To evaluate the evolution of metabolic and psychiatric disorders after biochemical control of hypercortisolism in patients with CD.Met...

Introduction: Cushing’s disease (CD) presents a marked female preponderance, with a female-to-male ratio of 3–8:1, but whether this skewed gender distribution has any relevance to the presentation and outcomes of CD is not well understood.Aim: To evaluate sex-related differences in the presentation of CD, as regards: biochemical indices of hypercortisolism; complications of disease and outcomes.Methods: Observational, ret...

Introduction: Endocrinological and metabolic changes can occur in critically ill patients, which may affect the prognosis and outcome. The hypothalamic–anterior–pituitary axis (HPA) plays a crucial role in the endocrine regulation of metabolic and immunological homeostasis. In this prospective study, we evaluated the pituitary–adrenal–gonadal–thyroid axis in the adult Intensive Care Unit (ICU) patients,their outcome, the association between these hormo...

Introduction: Definitive diagnosis of lymphocytic hypophisitis (LH) lacks a pathological analysis. The detection of pituitary antibodies (PAB) with the current methods presents variable results and its clinical utility is therefore limited. Recently, new methods were released for the interpretation of indirect immunofluorescence (IIF), which can increase the specificity for detection of PAB.Methods: We evaluated four patients followed in endocrinology co...

Acromegaloidisms are usually reported as isolated cases that are not well characterised clinically. Indeed, most such cases were reported several decades ago, part of the reason why our knowledge about this entity is scarce. By contrast, clinical situations suggestive of acromegaly are not so infrequent, in which basal GH and IGF1 levels lie within a normal range, the GH responses to OGTT challenge are conserved and there is no radiological (MRI) evidence of hypothalamic-pitui...

Introduction: Despite the commonality of hyponatraemia in everyday clinical medicine it is often a poorly management condition in acute medical patients. A European guideline for diagnosis and management was published in 2014 to address such problems.Aims: To assess the standard of management of patients with hyponatraemia admitted to the medical departments in a rural District General Hospital. To improve investigation, diagnosis, and management of thes...

Introduction: Congenital pituitary stalk interruption syndrome (PSIS) is a rare condition, characterized by the triad (not always complete): absence/hypoplasia of the pituitary stalk, hypoplasia/aplasia of the anterior pituitary and absence or ectopy of the posterior pituitary high signal intensity, on magnetic resonance imaging (MRI). PSIS implies a permanent GH deficiency, in 77% associated with other pituitary hormones deficiencies. The aetiology remains uncertain, but some...

Introduction: In 7–20% of cases, Cushing’s disease is due to ACTH-producing macroadenoma. Aim of the study was to present our observations concerning etiologic, clinical, and therapeutic diversity of Cushing’s disease in patients with macrocorticotropinomas.Material and methods: Retrospective analysis of medical records of nine patients (5F; 4M) hospitalized in 2002–2015.Results: Four of the patients (2F; 2M) we...

Aim: To assess the size changers of prolactinomas after pregnancy and lactation.Material and methods: We have analyzed the Russian register of tumors of the hypothalamic–pituitary region and conducted additional surveys of patients with prolactinomas who had pregnancy. We obtained data from 33 patients with prolactinomas who had 45 pregnancies and MRI studies prior and during/after pregnancy and lactation. Five patients had macroadenomas and 40 micr...

Introduction: Pituicytoma is a low-grade glioma of the suprasellar and sellar regions that is rarely described (about 60 cases in the literature). The clinical, laboratory, and neuroradiological findings are not pathognomonic, and therefore definitive diagnosis is only possible after surgery and histopathological study. Total resection is the treatment of choice, since subtotal removal can often lead to recurrence or progression.Case report: We report th...

Background: Cushing’s disease is a condition rarely encountered during pregnancy. It is known that hypercortisolism is associated with increased maternal and foetal morbidity and mortality.Aims and methods: A comprehensive search of the literature was performed for cases of Cushing’s disease in pregnancy including our own case. Analysis was performed of all pregnant patients with Cushing’s disease who were treated with surgery compared to ...

Introduction: The effects of sex steroids on lymphocytes count and functions are well known and it is propounded that autoimmune diseases more common in women. NLO index is an indicator of inflammative situation. In this study, it has been aimed that neutrophil/lymphocytes ratio (NLO) calculation by determining neutrophil/lymphocytes values in patients who diagnosed as hypogonadotropic hypogodanism and searching that whether there is significant difference between healthy grou...

Childhood onset GH deficiency (CO-GHD) usually presents with aberrant growth. Treatment is recombinant GH (r-GH) to attain target height. The 2005 European Consensus statement on management of CO-CHD at transition indicates that most adolescents will require repeat GH testing at completion of linear growth. Patients with persistent GHD will require continuation of r-GH for wellbeing, optimal body composition and metabolism. However, there is little data supporting predictors o...

Several studies have pointed to increased morbidity and mortality in patients with hypopituitarism, particularly from cardiovascular diseases, regardless of the application of the substitution therapy. The aim of this study was to present clinical characteristics and cardiovascular risk of our patients with hypopituitarism during 20 years of follow-up.Methods: Sixty patients with hypopituitarism without patients with acromegaly and Cushing disease were a...

Object: Nonfunctioning pituitary adenomas can experiment recurrence and/or progression (R/P) several years after surgery in about 15–50% of patients. There is few evidence about risk factors that could predict R/P. The aim of this study is to identify them and describe our experience through a long term of follow-up in pituitary macroadenomas.Methods: Retrospective cohort analysis of 64 patients who underwent surgery between 1990 and 2013. The main ...

Germline AIP mutations (AIPmut) predispose to young onset somatotroph pituitary adenomas (GHPA) and gigantism. AIPmut GHPA are often aggressive and resistant to pharmacological treatment, which may be especially challenging in the paediatric setting. We report our experience with two young Italian AIPmut male patients with incipient gigantism due to childhood pituitary macroadenomas, who both experienced recurrent ...

Background: Following pituitary surgery, dynamic testing with insulin tolerance (ITT) or glucagon stimulation testing (GST) is used to identify patients with secondary hypocortisolism who require glucocorticoids. High glucocorticoid replacement doses are associated with adverse effects, and the optimal replacement dose is unknown.Aim: We aimed to assess the interpretation of dynamic testing post pituitary surgery in clinical practice and its relation wit...

Introduction: We report a patient with hypokalaemia secondary to Cushing’s syndrome (CS) to reinforce this commonly forgotten association.Case report: A 57 years old lady with newly diagnosed hypertension, hyperlipidaemia and diabetes mellitus presented with persistent hypokalaemia for evaluation. She had tinea corporis but otherwise did not look Cushingoid. Investigations: K 2.6 (RI: 3.50–5 mmol/l), HCO3 35 (RI: 19–31 mmol/l), ...

Prolactinoma predominantly occurred in young women of reproductive age. But there are limited data about the effect of pregnancy and lactation on prolactinoma progression. We evaluated the safety of dopamine agonists including bromocriptine and cabergoline and pregnancy outcome in prolactinoma patients. Patients diagnosed with prolactinoma who experienced pregnancies were included. Sellar MRI and serum prolactin levels were performed before and after pregnancy and lactation. T...

For the purpose to compare sleep breathing disorders (SBD) in untreated and treated patients with acromegaly, we examined 55 patients with acromegaly (18 men and 37 women): 27 patients with newly diagnosed acromegaly, age 56.0 (47.0; 64.0) y.o., BMI 30.2 (27.8; 34.4) kg/m2, GH levels 12.8 (4.6; 23.0) ng/ml, IGF-1 245 (106; 331) % of upper normal limit (UNL), hypertension duration 6.5 (1.0; 14.8) years; 28 patients with treated acromegaly, age 57.0 (47.3; 64.8) y.o., BMI 30.7 ...

Introduction: This study aimed to determine the timeframe to achieve hormonal normalization considering dosing patterns of Somatuline Autogel (SOM, lanreotide) used in clinical practice.Methods: From March 2013 to October 2013 clinical data from 62 patients with active acromegaly treated with SOM for &gE;4 months who achieved hormonal control (GH levels <2.5 ng/ml and/or normalised IGF1 on &gE;two evaluations) at 17 Spanish hospitals were collected i...

There are some data concerning high prevalence of infrasellar extension of somatotropinomas. To reveal any differences expansion of pitutary macroadenomas with various hormonal secretion, we have analyzed MRI data of 175 pituitary macroadenomas: 87 non-functioning adenomas (NFAs), 48 prolactinomas, 43 somatotropinomas. The sizes of pituitary tumour (vertical, sagittal, frontal): NFAs 24 (17.5; 34.5)mm, 23 (17.4; 28) mm, 23 (18; 30) mm; prolactinomas 21 (15; 31) mm, 20 (16; 30)...

Introduction: Acromegaly is a chronic disease that affects morphology and organ functions. These changes lead to clinically relevant comorbidities. Untreated acromegaly reduces life expectancy by 10 years, mostly due to cardiovascular events, malignancies and respiratory disorders. We present the results of a series of 109 acromegalic patients at a single institution.Methods: Lung function tests were performed under standardized conditions in patients wi...

Introduction: Acromegaly is a disease caused by excessive secretion of growth hormone and subsequently insulin growth factor 1. It is believed that this oversecretion can cause increased prevalence of nodular goiter and thyroid cancer. However, the amount of studies comparing acromegalic patients with control groups is low. The aim of the study was to assess the prevalence of thyroid lesions in patients with acromegaly in comparison with age and sex-matched control group.<...

Introduction: Primary empty sella (PES) is often found incidentally during neuroradiological studies. Although pituitary function is usually normal in patients with PES, it could be associated with serious clinical conditions including different degrees of hypopituitarism. Post-operative empty sella (POES), the most common group, results from pituitary adenoma and their treatments. Our aim is to compare anterior pituitary functions and quality of life (QoL) with Short Form-36 ...

Introduction: The diagnostical and therapeutical management of GH-secreting pituitary adenomas has been modified in many aspects in the last decade, and the guidelines also have been considerably changed.Objective: To evaluate the management of acromegaly applied in an endocrinological clinical unit from Romania, and the efficiency of different therapeutical schemes.Materials and methods: 23 patients with acromegaly, treated and fo...

Introduction: Pituitary apoplexy results from haemorrhagic infarction of a pre-existing pituitary adenoma or within physiologically enlarged gland. Pituitary apoplexy during pregnancy is rare but serious event with significant morbidity and mortality if not recognised in time. Pituitary apoplexy is characterised by sudden onset of headache, nausea, vomiting, visual disturbances, eye movements restricted and varying degrees of pituitary insufficiency and accompanied by change o...

Background: The water deprivation test as the accepted gold standard in the differential diagnosis of polyuria polydipsia syndrome can be associated with a decrease in extracellular fluid volume in patients with diabetes insipidus (DI). We herein evaluated mid-regional pro-atrial natriuretic peptide (MR-proANP) as marker of extracellular body volume in patients with diabetes insipidus compared to primary polydipsia (PP), at baseline and after water deprivation.<p class="ab...

Introduction: GH deficiency in adulthood is associated with increased cardiovascular risk, which is attributed to unfavorable changes in body composition and in metabolic parameters.Aim: We evaluated haemodynamic, metabolic, inflammatory and coagulation indices that may contribute to the increased cardiovascular risk in GH deficient subjects.Methods: Twenty-four patients diagnosed with GH deficiency (13 male), with a mean (S...

Introduction: Acromegaly is associated with increased bone turnover and skeletal fragility. Although the GH/IGF1 system plays an important role in bone homeostasis, effects of GH excess on the Wnt signalling pathway are to be determined. Bone quantitative CT (QCT) provides a volumetric, tridimensional measure of bone mass at the trabecular and cortical level.Aim: i) To compare volumetric bone density (vBMD) using QCT in patients with acromegaly vs gender...

Introduction: Growth response in GH deficient children during GH replacement therapy rarely fulfil our projections and patient’s expectations. We here report three cases with outstanding growth response.Case reports: First patient was diagnosed as gluten enteropathy in early childhood, but the diet didn’t improve his growth. At age of 7 years the diagnosis of isolated GH deficiency (GHD) was established and GH substitution therapy introduced. N...

Introduction: High affinity binding of pasireotide for both sst2 and sst5 leads to its enhanced efficacy in treatment of acromegaly but results in decreased secretion of insulin, incretins (GLP-1 and GIP) and, to a lesser extent, glucagon. Metformin may be a good option in patients with acromegaly experiencing hyperglycaemia with pasireotide as it improves GLP-1 secretion. We analysed data from a 12-month, Phase III, randomised study in medically naï...

Introduction: Hypopituitarism is commonly acquired in adult life and its main causes are pituitary tumors and/or their treatments, empty sella syndrome and etc.Patients and methods: A double centre, cross-sectional database study was performed in Turkish population for last 10 years to investigate the etiology of hypopituitarism. One-hundred forty nine patients were included (53% female and 47% male) with a mean age of 47.9±15.6 years (ranging from ...

Idiopathic granulomatous hypophysitis is a very rare inflammatory disease of the pituitary gland. Primary hypophysitis represents a difficult diagnostic challenge because it can imitate pituitary adenomas clinically and radiologically. The diagnosis is usually made histologically by hypophysectomy. We herein present a rare case of idiopathic granulomatous hypopysitis diagnosed primarily by pituitary biopsy.Case: A 50-year-old female patient presented wit...

Introduction: The number of studies on the incidence and outcomes of surgical treatment for pituitary adenomas is still limited, despite that pituitary tumours are one of the most frequent intracranial tumours.The aim of this study: To evaluate clinical features of transsphenoidaly operated pituitary adenomas (PA) and perioperative results of the treatment.Materials and methods: This is a retrospective single institution study of 4...

Introduction: A 24-week, PhIII, randomised study (PAOLA) demonstrated superior efficacy of pasireotide long-acting release (PAS-LAR; 40 and 60 mg) vs continued treatment with octreotide LAR 30 mg or lanreotide Autogel 120 mg (15.4%, 20.0% vs 0%) at providing biochemical control (GH<2.5 μg/l and normalized IGF-1) in patients with acromegaly inadequately controlled on first-generation somatostatin analogues. Results from PK/PD analyses of PAS-LAR are reported here.<...

Background: Pituitary apoplexy (PitApo) has significant associated-morbidity and its management is not yet standardised.Aim: To describe prevalence and characteristics of PitApo patients in GH deficient (GHD) patients compared with two control populations.Patients and methods: Patients with ‘infarction-apoplexy’ GHD aetiology code were identified from Pfizer International Metabolic Database (KIMS). Baseline characteristic...

Reduced health-related quality of life (HRQoL) and impairment in neurocognitive functions are a possible complaint in patients with pituitary adenoma. Psychiatric comorbidities in Cushing’s disease are well known. However recent studies showed HRQoL reduction and psychiatric symptoms in patients with pituitary disease with or without hormonal excess. Aim of this study is to analyse HRQoL, psychiatric symptoms and neurocognitive functions in patients with pituitary adenoma...

Background: Orolactin-producing tumours are the most frequent pituitary tumours, representing 40% of these tumours, with an annual incidence of 6–10 cases/million. <10% are macroprolactinomas, which vary by age and gender, with female to male ratio of 10:1, however, less diagnosed in this population group.Objective: To describe clinical features and therapeutic response of 30 women with invasive macroprolactinoma.Methods: ...

Introduction: The present study is designed to evaluate the efficacy and safety of pasireotide-long-acting release (LAR) in patients with acromegaly inadequately controlled after &gE;3 mo treatment with the maximal approved doses of first-generation SSAs.Methods: Phase IIIb, multicentre, single-arm, open-label study.Patients: Adults (N~112) with inadequately controlled acromegaly (mean GH>1 μg/l and IGF-1>1.3xULN) desp...

Thyrotropinoma is a very rare cause of hyperthyroidism. In October 2014 a 41-year-old male patient was examined for anaemia and diarrhoea. Abdomen CT scan, gastroscopy, colonoscopy and parasite tests did not reveal any abnormalities. The patient had lost 18 kg 7 years ago and his weight had been stable since then (BMI 21.3 kg/m2). The laboratory tests revealed high TSH, normal fT4 and low cortisol level. The patient referred to our department presented wi...

Introduction: The PAOLA study in patients with inadequately-controlled acromegaly (n=198) demonstrated superior efficacy of pasireotide long-acting release (LAR; 40 mg/60 mg) in biochemical control (GH <2.5 μg/l and normalized IGF-1) vs continued treatment with octreotide LAR 30 mg/lanreotide Autogel 120 mg (15.4% and 20.0% vs 0%). Here we report preliminary data from the extension phase of PAOLA at wk28.Methods: Pasireotide-LAR (40 mg/...

Background: Pasireotide (Signifor®), a multireceptor-targeted somatostatin analogue, was initially approved in Europe and the USA in 2012 for treating adult patients with Cushing’s disease for whom surgery is not an option/has failed. This ‘expanded-access’ study allowed patients to receive pasireotide until regulatory approval was obtained in their country, and collected further safety/efficacy data. Here we report an interim analysis of this on...

Recent Endocrine Society guidelines advocate IGF-1, random GH and nadir GH after oral glucose tolerance test (OGTT) for assessment in acromegaly. In our regional centre the 24 h GH profile has also been used partly because of changing IGF-1 assay methodology but also because of concerns that IGF-1 may not adequately reflect partial therapeutic success. We evaluated 58 GH profiles in 35 patients from April 2008 to November 2012 when both GH and IGF-1 assays remained unchanged. ...

Over the last years, there has been evidence that acromegaly may cause skeletal fragility with high risk of vertebral fractures. The diagnostic approach to this complication is still a matter of uncertainty, since DXA measurement of bone mineral density (BMD) does not provide reliable information on fracture risk in acromegaly. The cone beam computed tomography (CBCT) technique offers three-dimensional images for the radiographed area with the advantage to use non-dedicated eq...

Objective: To determine if the response to one single dose of 0.5 mg cabergoline (CAB) can be used as predictor for choosing personalized therapy of hyperprolactinaemia. Although CAB is a selective, long half-life D2-receptor agonist some patients proved to be resistant with minimum to no response in serum prolactin and tumour shrinkage, even after a few months of treatment.Patients and methods: A dose of 0.5 mg CAB was administered orally to a number of...

Introduction: Acromegaly is a rare disease resulting from GH excess mostly due to pituitary adenomas. It is associated with changes of most organ systems and multiple comorbidities. The impact of GH and IGF-I excess on renal function in acromegaly is unclear.Methods: We investigated 66 acromegalic patients from our outpatient clinic (32 female, 34 male, mean age 61.5±12.9 years, women 10 years older than men). The renal function was assessed by bloo...

Introduction: The mixed tumor which secretes an excess of both GH and TSH causing acromegaly and hyperthyroidism is rare. The main problem is the late diagnosis, especially in men, even 10 years after the occurrence of the first symptoms.Case report: A 53-year-old men, was admitted to the our department, with complaints of excessive sweating and enlargement of the hands. His medical history included arterial hypertension. Past medical history revealed th...

Introduction: Cushing’s disease (CD) is an uncommon condition of excess endogenous glucocorticoids caused by ACTH secreting pituitary corticotroph adenoma. The purpose of this study is to review therapeutic outcomes and comorbidity of patients with CD in a single centre.Methods: We conducted a retrospective study of 33 patients with CD undergoing transsphenoidal surgery from January 2007 to February 2014. (27 female and six male, median age 38 years...

Introduction: Cushing’s disease (CD) is characterized by increased secretion of ACTH often as a result of a pituitary adenoma. The surgical success rates after transsphenoidal pituitary surgery (TSS) range from 53 to 96% in different centres. Postoperative cortisol levels have been proposed as the standard criteria for prediction of surgical remission however, this variable is subject of a variety of interferences.Objectives: Evaluate the potential ...

Introduction: Langerhans cell histiocytosis (LCH) is a rare disorder characterized by proliferation/accumulation of cells phenotypically similar to skin Langerhans cells. Clinical presentation and aggressiveness are very heterogeneous, from benign to disseminated forms that cause significant morbi-mortality, particularly endocrine failures.Case 1: A 15-year-old Caucasian woman presented with a 14-month history of headaches, secondary amenorrhea. She repo...

We analysed BMI of 270 female patients: 148 with hyperprolactinaemia (non-tumoural hyperprolactinaemia, n=46; microadenomas, n=56; and macroadenomas, n=46), 55 with isolated central hypogonadism, 67 with hypopituitarism. Additionally, 53 healthy women of reproductive age and 51 postmenopausal women were examined. In patients with hyperprolactinaemia median prolactin levels were 1547 (1124; 2185), 1490 (1050; 2280), and 3100 (1790; 18840) mE/l, accord...

Introduction: The prolactinoma is the most common functioning pituitary tumour. There are few long-term studies on the optimal duration of treatment with dopamine agonists prolactinoma to ensure healing without recurrence after stopping the medication and do not provide a consensus on it or on withdrawal criteria treatment.Objectives: To establish the prevalence of withdrawal of treatment macroprolactinomas and evaluate criteria prolactinoma cure medical...

Introduction: Idiopathic hypogonadotropic hypogonadism (IHH) is a rare disorder characterised by delayed or absent sexual maturation and infertility associated with inappropriately low gonadotropin and sex steroid levels. Insulin resistance (IR) is defined as an impaired biologic response to both endogenous and exogenous insulin. IR is a common precursor to the development of glucose intolerance, including diabetes, hypertension, and cardiovascular disease. Dyslipidaemia, apol...

Introduction: Disease control in acromegaly can be achieved by surgery, medical treatment, and radiotherapy either alone or in combination. The acromegaly patients whom tumour shrinkage cannot be provided or growth hormone levels do not decrease under multiple treatment modalities are designated as resistant acromegaly. We aimed in our study to evaluate the clinical features of resistant acromegaly patients and determine their responds to different treatment modalities.<p ...

Introduction: Mucolipidoses II/III (ML) are rare autosomal recessive lysosomal storage disorders (incidence: 1/325 000 live births). They have overlapping clinical phenotypes with mucopolysaccharidosis disorders and include growth retardation, facial dysmorphism, skeletal abnormalities, respiratory and heart diseases, hepatosplenomegaly and abdominal hernias. There is no specific treatment and the management has been limited to supportive care.Case prese...

Background: After pituitary surgery patients require HPA axis assessment, that is achieved with postoperative cortisol measurements and, in selected patients whose post-operative cortisol measurements are inconclusive, with the insulin tolerance test (ITT) and the glucagon stimulation test (GST).Aim: We aimed to assess the performance of the day 2/3 post-operative cortisol in predicting the HPA axis sufficiency as assessed by the ITT and the GST.<p c...

Introduction: Empty sella in male patients is a very rare situation. It could be diagnosis in acquired male hypogonadotropic hypogonadism or hypopituitarism.Case report: A 55-year-old type 2 diabetes male was referred to our hospital with erectile dysfunction (ED). He has three children. His secondary sex characteristics, sexual function, and ejaculation were previously normal but for the last 3 years he had ED. His genital stage was Tanner V, and pubic ...

Accurate assessment of the hypothalamic–pituitary–adrenal (HPA) axis is important for the appropriate management of patients with pituitary tumours after transsphenoidal surgery. The aim of our study was to evaluate the clinical relevance of the early postoperative basal cortisol level in assessing postoperative HPA axis function. We performed a retrospective analysis of 68 patients (male:female=36:32, age 59.5 years, range 21–77) treated by transsphenoidal surg...

A 42-year-old man undergoing ipilimumab therapy for stage IV metastatic melanoma presented after his third dose with vomiting, abdominal pain, hypotension, and pyrexia. He was treated as a presumed line sepsis. Four days prior to admission, thyroid function test showed T4 of 7.9 pmol/l and TSH 0.02 mU/l and he was treated with levothyroxine. A pituitary profile was carried out on admission and the results were as follows, cortisol was 24 nmol/l, testosterone <0....

Introduction: Cushing’s disease (CD) leads to glucose homeostasis alterations, obesity, unfavorable changes in body composition and cardiovascular complications.Aim of study: i) Prospective evaluation of the frequency of pre-diabetes and diabetes. ii) Assessment of insulin resistance (IR) indices in CD. iii) Analysis of the influence of family history of type 2 diabetes (T2D) on the anthropometry in CD.Methods: The study group...

Introduction: Cortisol excess in Cushing’s disease (CD) leads to glucose homeostasis alterations and increased cardiovascular risk.Aim of the study: i) To assess the reversibility of glucose homeostasis alterations and dynamics of inflammatory and coagulation parameters after the successful transsphenoidal surgery (TSS) for CD. ii) Analysis of the early improvement in insulin resistance (IR) indices following TSS.Methods: The ...

Introduction: It has been described that early post-operative cortisol value <2 μg/dl might predict long-term remission while ACTH value has been less described.Objective: To study early post-operative ACTH and cortisol levels in Cushing’s disease patients as predictor factor of long-term remission.Patients: 61 consecutive patients (12 men/49 women), mean age 42.6 years (17–86 years) undergoing transphenoidal hyp...

The definitive treatment for Cushing’s disease is curative surgery. Patients with severe disease burden will likely require pre-operative medical blockade to reduce the risk of peri- and post-operative complications. The threshold for deciding when to medically block excess cortisol is currently based on clinical judgment. Expert centres may use a different criteria to determine this. There is no widely adopted tool for evaluating the clinical severity of Cushing’s d...