Endocrine Abstracts

Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome and type 2 diabetes. NAFLD is also seen in patients with endocrinopathies. However, the relationship between endocrinopathies and the development of NAFLD is not well known. Both GH and IGF1 are believed to be involved in the regulation of hepatic lipid metabolism.Objective: In this study, we set out to determine whether liver fat content (LFC) was associate...

Introduction: Cushing’s syndrome (CS) is a rare disease characterized by clinical features that show overlap with the ‘metabolic syndrome’. Pilot studies regarding the use facial image analysis software as a novel diagnostic tool in acromegaly and CS have shown promising results. Distinguishing CS patients from patients that show similar features without true hypercortisolism remains a challenge in clinical practice. To address this particular problem, we evalua...

Although surgical resection is the usual initial treatment for patients with acromegaly, it does not always lead to a remission. Gamma knife radiosurgery (GKRS) is an important additional strategy for unresected clinically active pituitary adenomas.Objective: We evaluated retrospectively pituitary hormone status as well as the efficacy of GKRS for patients with acromegaly referred to our tertiary endocrinology clinic. Prognostic factors related to outcom...

Introduction: Treatment of patients with acromegaly is complex, including surgery, pharmacotherapy and radiotherapy. The objective was to describe comorbidities and treatment patterns among patients with acromegaly in Sweden.Methods: Population-based study including all patients with a first diagnosis of acromegaly due to a pituitary adenoma in Sweden between 1 Jul 2005 and 31 Dec 2013. Data was obtained via linkage of the National Patient Register, Swed...

Purpose: Growth Hormone (GH) and Insulin-like Growth Factor 1 (IGF-I) are currently the principal biomarkers used to assess disease activity in acromegaly and any discrepancy between them renders interpretation of results inconclusive. The purpose of this study was to assess the frequency of discrepant results and identify parameters that might affect the emergence of this phenomenon.Methods: A systematic review of Medline and Scopus was performed (1987&...

The Austrian Acromegaly Registry is an initiative of the Austrian Society for Endocrinology and Metabolism. This database includes 607 patients (54% females) followed in twelve centers. Mean treatment period is 10.7 years (range 0–50 years), the total number of patient-years is 6470. Here we report gender-specific differences in the presentation, therapy and biochemical control of acromegaly in patients included in this registry.Mean age at diagnosi...

Introduction: Acromegaly is characterized by excessive secretion of GH and increased IGF-1 levels caused by benign pituitary adenoma. The ACRO-POLIS study describes symptoms and comorbidities of acromegaly at diagnosis in a large cohort of patients diagnosed between 2009 and 2014 in France.Methodology: Observational, cross-sectional, multicentre study included adult patients with acromegaly diagnosed for less than 5 years. Data were collected retrospecti...

Context: The syndrome of inappropriate antidiuresis(SIAD) is the commonest cause of hyponatraemia. Data on the aetiology of SIAD is mainly derived from retrospective studies, often with poor ascertainment of minimum criteria for correct diagnosis. Although central adrenal insufficiency(CAI) is known to cause euvolaemic hyponatraemia, the incidence of undiagnosed CAI in SIAD is unknown.Objective: To establish the incidence of CAI in SIAD.<p class="abs...

Introduction: The demand of cortisol rises during stress and to avoid acute cortisol deficiency, patients undergoing transsphenoidal surgery at Skåne University Hospital (Sweden) receive peri- and postoperative substitution with hydrocortisone (HC), even at normal ACTH function. Some anesthetics are known to affect cortisol levels.This study aimed to assess the perioperative cortisol plasma levels during transsphenoidal surgery in ACTH sufficient an...

Introduction: Apart from being individually associated with cardiometabolic health, Vitamin D and growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis are reported to interplay, with a positive correlation between IGF-1 and 25-hydroxyvitamin D (25(OH)D). These findings raise questions about the role of vitamin D for the adverse cardiovascular (CV) risk profile in hyposomatotropism. Thus, the aim of our study was to investigate the association between 25(OH)D and metabol...

Introduction: In the era of personalized patient management in acromegaly, transsphenoidal surgery remains a treatment of choice in cases where surgical cure can be expected. In order to better target these patients and to assess the risk of persistence/progression disease, we evaluated clinical, hormonal, radiological and pathological predictors of surgical outcome in acromegaly.Methods: A single-institution retrospective study from 2009 to 2015 was per...

Introduction: The sequelae of surgically treated non-functioning pituitary adenomas (NFPA) is an important area of study to help plan management. The aim was to study all Maltese patients who had a surgically treated NFPA and analyse the results of surgery, risk factors for tumour recurrence/regrowth and the role of postoperative radiotherapy.Materials and methods: One hundred and seventy-five patients were identified as having a NFPA of whom 77 had unde...

Background: Inadequate glucocorticoid (GC) replacement may be associated with overexposure to GC, which can adversely influence metabolic and cardio-vascular state of hypopituitary growth hormone deficient adult patients (A-GHD). In this study we compared metabolic profile of ACTH insufficient and sufficient patients in A-GHD not treated with GH.Patients and methods: A cohort of 260 patients (age 48.6±12 years and BMI 28.7±6.6 kg/m2)...

Context: Acromegalic patients have a high-risk cardiovascular profile. However, the determinants of cardiovascular risk factors and major cardiovascular events (MACE), which may develop after diagnosis of acromegaly, are not fully understood.Objectives: To identify the predictors for systemic comorbidities and MACE, after diagnosis of disease. The role of therapy for acromegaly on the occurrence of such complications was also evaluated.<p class="abst...

Hyperprolactinaemia is a common endocrine disorder. Causes are related to physiological factors, pharmacological intervention and pathological conditions. There are a wide variety of drugs that can induce a significant hyperprolactinaemia frequently associated with clinical symptoms. The aim was to analyse clinical manifestation of hyperprolactinaemia in routine clinical practice.Material and methods: We conducted retrospective review of medical records ...

Introduction: There is scarcity of data on the recurrence and/or progression (R/P) rate in nonfunctioning pituitary adenomas (NFPAs) after surgery and the risk factors that can predict this outcome. So the aim of this study was to analyze a large series of NFPAs with a long follow-up after surgery, focusing on the evaluation of R/P rate and the risk factors associated with it.Methods: Retrospective cohort analysis of 164 patients with NFPAs from 3 differ...

Acromegaly is associated with skeletal fragility and high risk of vertebral fractures (VFs), but the determinants of such a risk are still under investigation and it is not clear whether replacement therapies of coexistent hypopituitarism may influence prevalence and incidence of VFs. In this cross sectional study, fourty acromegaly patients (24 M, 16 F; median age, 57 years; range, 25–72), 20 with active disease, were evaluated for the effects of replacement therapy of c...

Introduction: During the 22-week LINC-2 study, the potent oral 11β-hydroxylase inhibitor osilodrostat normalized UFC in 15/19 (78.9%) patients with Cushing’s disease. Most common AEs were nausea, diarrhoea, asthenia, and adrenal insufficiency. This report describes 19-month results following an extension.Methods: Patients who were receiving clinical benefit at week 22 could enter the extension. Efficacy/safety is reported for patients who enter...

Objective: Hyperprolactinemia has been reported to be associated with endothelial dysfunction, abnormalities of carbohydrate metabolism and insulin sensitivity. The aim of this study was to evaluate carbohydrate metabolism and endothelial function of our patients in outpatient clinics.Material and methods: In this cross-sectional study, currently or previously treated 87 hyperprolactinemic patients with PRL-secreting adenoma (fifty four with microadenoma...

Pituitary gigantism is a rare condition caused by growth hormone secreting lesions, where treatment is usually challenging, especially in cases with genetic predisposition. Aim: We studied a gigantism cohort from Venezuela for genetic defects and their response to treatment. Subjects: 160 somatotropinoma patients were evaluated at the University hospital (from 1985–2015); eight (6M) were diagnosed with acrogigantism and underwent genetic analysis including aCGH for Xq26.3...

Introduction: Several studies have suggested that patients with acromegaly have an increased risk of thyroid, colorectal, breast and prostate tumors. We determined the prevalence of malignant neoplasms in patients with acromegaly in a single Greek Centre during the years 1995–2015.Methods: We evaluated cancer risk in a cohort of 110 patients (M/F 48/62, age 58.63±13.8 years, range 30–86) with acromegaly. Mean age at diagnosis of acromegaly...

Objective: Nonalcoholic fatty liver disease (NAFLD) is a hallmark of the metabolic syndrome and has been shown to be an independent predictor of cardiovascular mortality. Although glucocorticoids and growth hormone are known to be implicated in its pathophysiology, it has only rarely been investigated in the context of patients with pituitary insufficiency or former cortisol excess.Design: Case-control study, including patients with biochemically control...

Objective: The goals of this study were to assess the incidence of and risk factors for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients following transsphenoidal surgery (TSS), and to validate the effectiveness of early prophylactic restriction of water intake.Design: Retrospective analysis was performed for 207 patients who had undergone TSS, including 156 patients not placed on early prophylactic water restriction. Sixty-fo...

Introduction: Traumatic brain injury (TBI) is a worldwide public health problem and has been recently documented as a cause of neuroendocrine dysfunction. It has been shown that hypopituitarism may develop nearly 10–20% of the TBI patients, and most common pituitary hormone deficiency after TBI is growth hormone deficiency (GHD). To date no study has evaluated the relation between isolated maxillofacial fractures and pituitary dysfunction. Therefore we aimed to investigat...

Introduction and aim: There are few side effects of cabergoline which is used for medical treatment of prolactinoma. For this reason, cabergoline is considered as first-line therapy of prolactinoma. However, chronic administration of high dose cabergoline in patients with prolactinoma may be associated with valvular heart disease. The aim of this study is to evaluate left ventricular systolic and diastolic functions by conventional and tissue Doppler echocardiography in patien...

Purpose: Transsphenoidal endoscopic surgery (TSS) is the first-line treatment for Cushing’s disease (CD). However, persistence and recurrence of hypercortisolism after TSS considered important problem. In this case search for CD remission predictors is actual.Aim: To study the role of preoperative oral high-dose dexamethasone suppression test (HDDST) and pituitary MRI in the prognosis of CD remission after TSS.Materials and me...

Purpose: Hypertension is an independent factor of cardiovascular morbidity in acromegaly patients. Obstructive sleep disordered breathing (SDB) is the most common respiratory impairment in acromegaly and is considered one of the mechanisms underlying the development of hypertension in this disorder.Aim: To study blood pressure parameters and prevalence of hypertension in naïve acromegaly patients depending on the presence of moderate-to-severe obstr...

Introduction and aim: The metabolic changes of lipid profiles in prolactinoma treated with cabergoline are not completely clarified. The aim of this preliminary study is to evaluate changes of lipid profile in both of patients with functional hyperprolactinemia and prolactinoma before and after cabergoline treatment.Materials and methods: Twelve patients with prolactinoma who were treated with cabergoline (mean age 33.8±7.6 years and body mass index...

Background: Acne, stria and decreased skin elasticity are dermatological features of Cushing’s syndrome (CS). Although it is known that collagen mass in skin is decreased in CS and glucocorticoids play a role in acneiform skin lesions, the dermatological findings of CS has not previously been measured by reliable methods.Objective: The aim of the present study was to measure skin elasticity, capacitance, sebum content, pH and temperature in CS befor...

Objectives: TSH-producing pituitary adenomas account for 1–2% of all pituitary tumors and there is debate wether transsphenoidal surgery or medical treatment should be recommended as first-line treatment. This study summarizes the authors surgical experience and puts it into context of literature concerning non-surgical treatment of TSHomas.Methods: A retrospective analysis of 12 patients including imaging, laboratory testing, short-term and long-te...

Background: Acromegaly is a severe systemic condition characterized by elevated circulating levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) and increased mortality and morbidity. The role of GH and IGF-I in mammary hyperplasia is well established and GH/IGF-I elevation has been hypothesized to favor neoplastic development. We recently demonstrated that premenopausal females with active acromegaly may display an increased mammographic breast density (MBD)...

Background: The Phase III PAOLA study assessed the efficacy and safety of pasireotide LAR versus continued treatment with octreotide LAR or lanreotide Autogel in patients with uncontrolled acromegaly. The current analysis investigated overall baseline characteristics and response rates to pasireotide according to co-morbidities.Methods: Patients were classified into five groups of co-morbidities related to acromegaly: glucose- (n=104), endocrine...

Introduction: Craniopharyngiomas are rare epithelial tumors of the sellar and parasellar region, with high survival rates but with frequent tumor recurrence or persistence.Methods: Information collection from clinical records and review of the epidemiology, diagnosis, treatment and follow-up of patients with diagnosis of craniopharyngioma followed in an Endocrinology Department between 1980 and 2015. Statistical analysis using SPSS v. 22.0.<p class="...

Introduction: Acromegalic cardiomyopathy is characterized by myocardial hypertrophy and interstitial myocardial fibrosis at biopsy. We studied left ventricular hypertrophy -LVH- through echocardiography (-ECHO- 2-D standard echocardiography and Doppler analysis) and cardiac magnetic resonance (CMR) analysis. Myocardial fibrosis was studied with late enhancement technique (LE) and extracellular volume technique (ECV) at CMR.Methods: 25 patients -pts- (13 ...

Introduction: Subarachnoid haemorrhage (SAH) is associated with a mortality rate of 30% and the survivors face significant morbidity including fatigue, isolation, depression and sleep disorders; factors affecting general health related quality of life (QoL). QoL is also known to be decreased in pituitary-hypothalamic insufficiency and tends to improve after treatment. SAH has been suggested to be a common cause of hypopituitarism by some whereas not by others. We aimed to inve...

Neuroimaging techniques have improved over the last years; hence an “empty sella” is more often incidentally diagnosed. The term “empty sella” describes a missing pituitary gland in the sella turcica. Up to now, it is not known if routine endocrine assessment is necessary in patients with primary empty sella syndrome (PES) without clinical suspicion or history of neuroendocrine disorders.We performed a systematic literature research u...

Objective: Quality of life is currently considered a major factor in the assessment of disease outcome. The aim was to assess quality of life in acromegaly and the effect of somatostatin analogues on it.Design: This study included 101 patients with acromegaly, mean age 59.51±1.35 years (mean ± S.E.M.), with a disease duration of 12.88±0.96 years. All subjects completed the Acromegaly Quality of Life Questionnaire (AcroQoL) w...

Introduction and aim: Cabergoline, a long-lasting dopamine-agonist, is generally considered to be the safety drug for the treatment of prolactinoma. But, use of long time and high dose cabergoline may be a cause of cardiac valvulopathy in patient with prolactinoma. In present study, we aim to determine serum N-terminal probrain natriuretic peptide levels in patients with prolactinoma who were treated with cabergoline.Materials and methods: Thirty patient...

Introduction: Vitamin D and growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis are reported to interplay at both endocrine and paracrine levels, with a positive correlation between IGF-1 and 25-hydroxyvitamin D (25(OH)D) in healthy subjects. Hyposomatotropism is among the conditions predisposing to lower vitamin D status due to several direct and indirect mechanisms. Thus, the aim of our study was to evaluate vitamin D status in a representative sample of adults with ...

Introduction: The Nephron is a known target organ of the Growth Hormone/Insulin-like factor-1 axis. They influence glomerular and tubular function having an important physiological role in water and electrolyte balance, especially in Acromegaly. The aim of the study was to investigate renal function in acromegalic patients during active disease and remission and evaluate hormonal impact on renal function markers.Methods: A retrospective, longitudinal, ob...

Introduction and aim: Mean platelet volume (MPV) is a new important indicator of platelet activity in atherosclerosis. Elevated MPV is associated with the presence of more metabolically active platelets. The aim of our study is to evaluate whether change of MPV value is associated with cabergoline treatment in patients with prolactinoma.Materials and methods: Thirty patients with prolactinoma (mean age 33.4±8.5 years and body mass index (BMI): 28.1&...

Adrenal insufficiency is a common complication of transsphenoidal surgery (TSS) for pituitary adenoma. It is very important to identify patients requiring glucocorticoid replacement, minimising risks of adrenal insufficiency.Aim: To assess the performance of early (3° day) post-TSS 08:00 a.m. cortisol measurement to detect and exclude secondary adrenal insufficiency.Methods: We selected patients undergoing TSS in our hospital ...

Sarcoidosis is a multisystem granulomatous disease of unknown cause. The prevalence of neurosarcoidosis is about 5–15%. Hypothalamo-pituitary sarcoidosis is even rarer (<1% of cases evaluated for sellar and stalk lesions).Case Report: A 33-year-old man presented to urology department with erectile dysfunction which started six months ago. Hormonal evaluation revealed gonadotropin deficiency and hyperprolactinemia (Total testosterone: 30.5 ng/dl,...

Aim: To establish the local Guidelines for management of SIADH.Methods: The European and NIH Guidelines are considered.Discussion: Diagnosis: Patients admitted with hyponatraemia are first assessed clinically for their hydration status. Those who are euvolaemic should have their urine sodium checked (if <30 mmol/l, hypothyroidism is suspected and if >30 mmol/l either SIADH or Addison’s disease is suspected). Hypothyroi...

Introduction: Acromegaly is a chronic disease caused by growth hormone (GH) oversecretion. A pituitary macroadenoma is found in mostly of cases, but the secretion pattern of GH and insulin-like growth factor 1 (IGF-1) and the natural history of somatotropinomas are heterogeneous. The objective of the present study was to evaluate the relationship between tumor size, GH and IGF-1 levels in patients diagnosed with acromegaly.Methods: A cross-sectional, obs...

Introduction: Inferior petrosal sinus sampling for ACTH is the current gold standard test for the differentiation of pituitary Cushing disease from the ectopic ACTH syndrome. Early studies with İPSS reported a diagnostic sensitive and specificity approaching 100%, additional experience has shown a false negative rate of 1-10%. This has been due to either technical problem with unsuccessful petrosal sinus catheterization or anomalous venous drainage of the pituitary. The ...

Objective: Acromegaly is characterized by chronic hypersecretion of growth hormone (GH) with increased concentration of IGF-1. There have been controversial debates over the question whether elevated GH levels indicate high risk of developing colorectal neoplasm. There is no clear guideline indicating the need for colorectal cancer screening for acromegalics. We evaluated the colonoscopic findings in our series of patients to analyze the prevalence of risk. Should patients wit...

Introduction: Prolactinomas are thought to arise from the proliferation of a mutated pituitary stem cell which is subjected to the growth stimuli of several permissive factors, although the pathogenetic mechanisms underlying the tumorigenesis still remain unclear. The present study aimed to investigate the role of p16 (540C→G and 580C→T) and MDM2 (SNP309T→G) gene polymorphisms in tumorigenesis and characteristics of prolactinoma.Methods...

Prevalence of macroprolactin in serum (>40%) can be a cause of asymptomatic hyperprolactinemia. However, there is still lack of evidence how to manage with symptomatic patients with macroprolactinemia.We analyzed clinical data and monomeric prolactin levels in 85 women of reproductive age with hyperprolactinemia: NonTumor hyperprolactinemia (NT, n=31), MIcroadenomas (MI, n=32), MAcroadenomas (MA, n=22). Prolactin levels 171...

Introduction: Acromegaly is known to be associated with obstructive sleep apnea syndrome (OSAS) in about 60–70% of the cases. Both OSAS and acromegaly are thought to be responsible from cardiovascular diseases and endothelial dysfunction. The aim of the present study was to investigate the role of OSAS on cardiovascular effects of acromegaly.Materials and Methods: 25 patients with acromegaly and 7 healthy volunteers were enrolled into the study. Car...

Introduction: Acromegalic patients (AP) often report fatigue and chronic subjective complaints. We aimed to investigate in more detail these aspects in AP, dependent on disease activity, age, gender, medication and pituitary insufficiency (PI).Patients/methods: Cross sectional, 124 patients (M/W 51/73, age 58.3±14.7 years, 49/75–active/controlled disease). The patients completed the Multidimensional Fatigue Inventory (MFI-20) and the Giessen Su...

Background: Post traumatic Hypopituitarism (PTHP) is common, its prevalence is about 30%.Aim: The aim is firstly to assess the frequency and predictive factors of hypopituitarism 3 and 12 months following Brain injury (BI) in a simple of 133 victims of moderate to severe BI in two neighbors’ hospitals in the east of Algiers. Secondly is to evaluate the quality of life and neurocognitive status of this cohort.Method: Hypopituit...

Our Pituitary Tumour Registry includes data about 346 patients with pituitary macroadenomas: 142 non-functional adenomas (NFA) including 18 (12.7%) giant, 62 macroprolactinomas – 6 (9.7%) giant, 141 somatotropinomas – 6 (4.3%) giant. We analysed clinical features of these 30 giant pituitary tumors (<40 mm at least one of the sizes): 18 NFA (11 Females; 7 Males), 6 prolactinomas (3 Females; 3 Males), 6 somatotropinomas (3 Females; 3 Males). Patients with giant NFA...

A 49 year old gentleman was diagnosed with a pituitary macroprolactinoma at Leicester Royal Infirmary (LRI) (Baseline prolactin 8000 mU/l). He was treated with Cabergoline 0.5 mg twice/week. He developed CSF rhinorrhoea shortly after treatment was commenced and was listed for repair under the neurosurgical team at Queen’s Medical Centre (QMC). Six weeks later, while visiting Wales, he was admitted to Bangor hospital with headaches and vomiting. CSF cultures were positive ...

Acromegaly is caused by growth hormone-secreting adenoma in more then 95% cases. Ectopic secretion of GH-RH is a rare cause of acromegaly accounting for less than 1% of all cases. The most frequent source of ectopic GHRH is bronchial carcinoid. Clinical and biochemical findings are similar in both conditions. A distinction of pituitary vs extrapituitary acromegaly is important in planning effective management and both reasons should be considered in the diagnostic process....

Macroprolactin is a collective term for a heterogenous group of high molecular mass forms of prolactin with minimal bioactivity in vivo. Objective: to determine prevalence of macroprolactinemia (macroPRL) and clinical characteristics of patients with hyperprolactinemia (hyperPRL) who underwent assessment for macroPRL in Endocrinology outpatient clinic.Methods: We reviewed the medical records of 54 patients who were evaluated for macroPRL between...

Introduction: Giant cell granulomatous hypophysitis is a rare chronic inflammatory disorder of the pituitary gland. It is generally presents with a clinic of sellar mass lesion with pituitary insufficiency. Histologically it is characterized by composites of histiocytes, plasma cells and giant cells with or without areas of necrosis. Tuberculosis is a very rare cause of secondary granulomatous hypophysitis. We report a case presented with hypopituitarism symptoms due to tuberc...

Introduction: Data on transsphenoidal surgery (TSS) and effect of somatostatin analog therapy (SSA) in acromegaly different among medical centers. We analyzed the data on TSS, SSA and their combination in acromegalic patients of Moscow region.Design: In this study 117 acromegalic patients (25 males and 92 females, 55.0 (IQR 44 – 62) years) were eligible for participation, of whom 34 were newly-diagnosed aromegaly (NA group) (macroadenoma (macro)- 80...

Aim: To evaluate calcium and bone metabolism in a monocentric series of acromegaly patients (pts), treated with pegvisomant (PEG) alone or in association to long acting somatostatine analogs.Patients and methods: All pts with at least 24 consecutive months PEG treatment (alone or in combination with SSA) were enrolled. All pts had been tested at least twice/year for biochemical acromegaly-disease evaluation and annually for calcium metabolism and for bon...

Teratomas comprise 0.5% of all intracranial tumors. 15 cases of sellar teratoma have been described in the last 24 years (yrs). A 29-yrs female pan-hypopituitaric patient (pt) was admitted to our Pituitary Unit. At 6-yrs age, for polyuria and growth delay, an endocrine evaluation revealed diabetes insipidus and hypopituitarism. Cranial contrasted-MRI (cc-MRI) showed pituitary stalk thickening and a low intensity suprasellar lesion. Histological examination (HE) was suggestive ...

Introduction: Pituitary macroincidentalomas are rare, being found in only 0.2%–0.3% of the patients that undergo imaging studies for an unrelated reason. The majority of them are non-functioning adenomas.Case Report: Woman, 77 years-old, with type 2 diabetes mellitus, hypertension and primary hypothyroidism. She was referred to Endocrinology due to a pituitary incidentaloma (18 mm of maximal diameter, with extension to the cavernous sinus and to the...

Craniopharyngeoma patients have reduced quality of life and increased cardiovascular mortality because of severe obesity present in about 50% of patients. In the present study we analysed postoperative body mass index (BMI) in craniopharyngeoma patients depending on the presence of the diabetes insipidus (DI).We retrospectively analyzed 19 craniopharyngeoma patients (male:female=12:7, age 31.2 years, range 9–67) treated at our Department since 2001....

Introduction: There is great variation in management of perioperative cortisol management in patient’s undergoing pituitary surgery across UK Hospitals. We evaluated safety and effectiveness of standards followed in ARI. The aim of audit was to confirm safety, improve knowledge and change practice for better patient care if needed based on information gained from the available data.Description of methods/design: We evaluated 30 patients who have und...

Introduction: Patients with large non-functioning pituitary macroadenomas often have symptoms due to varying degree of hypopituitarism and/or mass effect on visual structures, while presentation with hydrocephalus is extremely uncommon.Case report: We describe an 82-year-old man who was referred to the Neurology department of our hospital because of rapidly progressive memory loss. The patient was in good health until ten weeks earlier, when he insidious...

Introduction: Acromegaly is a chronic disorder caused by growth hormone (GH) hyperproduction which leads to significant morbidity and mortality primarily due to cardiovascular and respiratory complications. Pituitary adenoma is the main cause of GH’s hyperproduction. By current guidelines transsphenoidal surgery (TSS) is the first-line treatment in acromegaly patients.Aim: To evaluate the results of TSS in acromegaly patients 6 months after surgery....

Background and aim: Lymphocytic hypophysitis is heterogeneous inflammatory processes of the pituitary gland and may cause isolated hormone deficiency, but rarely occurs as panhypopituitarism. We aim to present a rare case of ulcerative colitis coexisting with lymphocytic hypophysitis.Case report: A 42-years old woman with ulcerative colitis was applied for our department of internal medicine with hypoglycemia. Her capillary blood glucose levels were foun...

Introduction: Nelson’s syndrome (NS) is an exceptionally rare condition diagnosed sometimes after bilateral suprarenalectomy for Cushing’s disease (CS) involving rapid enlargement of a pre-existing ACTH-secreting pituitary tumor. The clinical picture varies from hyperpigmentation, headache and visual disturbance to diabetes insipidus and hypopituitarism if the hypothalamic-pituitary portal system is disrupted or normal pituitary tissue is destroyed by the adenoma. Th...

Background: Osilodrostat is an oral inhibitor of 11β-hydroxylase (CYP11B1), the enzyme that catalyses the final step in cortisol biosynthesis. In a 22-week, phase II study, osilodrostat treatment normalised mean urinary free cortisol (mUFC) in 78.9% (15/19) of patients with uncontrolled Cushing’s disease and was well tolerated. The present phase 3 study is designed to confirm the safety and efficacy of osilodrostat in patients with uncontrolled Cushing’s disease...

Introduction: Tolosa Hunt syndrome (THS) is described as unilateral orbital pain associated with paresis of one or more of the third, fourth and/or sixth cranial nerves caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. Pituitary gland is rarely involved in this syndrome. Herein we represented a case with hypophysitis with Tolosa Hunt who was operated with the suspicion of pituitary adenoma.Case: A 63-year-o...

Introduction: Thyrotropin-secreting pituitary adenomas (TSHomas) are a rare cause of hyperthyroidism and represent <1% of all pituitary adenomas. The majority of TSHomas (70%) secrete TSH alone, while mixed adenomas are not infrequent.Design: Herein, we reported the findings of six patients with TSHoma (mean age 44 yr, 4 female, 2 male). Mean TSH value was 15.1 mIU/L (3.3–38.0) who were followed-up in our department.Result...

Introduction: Although the syndrome of inappropriate antidiuretic hormone (SIADH) has connection with various malignant tumors, the pituitary metastasis of malignant tumors are generally associated with diabetes insipidus.Case report: A 59 years old male patient presented to emergency service with frequent syncope attacks, nausea, loss of appetite and fatigue that began 2 weeks prior to admission. Marked obtundation was found on physical examination. The...

Introduction: Diabetes insipidus (di) is a water metabolism disorder caused by antidiuretic hormone pathologies. In this study, we evaluated, retrospectively, pituitary hormone profiles and pituitary magnetic resonance imaging (mri) findings of patients with di.Material and methods: After local ethic committee approval, 300 patients were evaluated retrospectively. Patients with a history of pituitary surgery and/or radiotherapy were excluded. Luteinizing...

Background and aim: Acromegaly is a rare endocrine disease and is associated with an increased prevalence of colorectal cancer and pre-malignant tubular adenomas, and also may be associated with other organ malignancies such as breast and thyroid. We report a rare case of acromegaly concomitant with adenocarcinoma arising from pancreas.Case report: A 52-year-old man who was diagnosed with acromegaly two years ago referred our outpatient clinic. After dia...

Introduction: Wegener granulomatosis is a necrotizing granulomatous small-vessel vasculitis. It typically affects the upper respiratory tract, lungs, and kidneys but can involve virtually any organ including the pituitary. Pituitary involvement in wegener granumatosis is rare.Case: A 50-year-old woman was admitted to the hospital with severe dyspne for 2 years and stridor for a month. During her hospitalization, her sodium level was noted to be persisten...

Introduction: Hypopituitarism is characterized by the absence of pituitary hormones. Depending on what pituitary hormones are missing and what is the etiology of hypopituitarism, its clinical manifestation varies. Apart from evident symptoms and signs of hypopituitarism due to hormonal insufficiencies, several studies reveal that long-standing hypopituitarism, including particularly absence of GH, is related to higher risk of metabolic syndrome.Objective...

Introduction: Hypophysitis is a chronic inflammatory condition of the pituitary gland which typically presents with hypopituitarism and a pituitary mass. The disease is rare, with an estimated incidence of 1/9000000. Most reported cases are in women during peripartum period and only approximately 15% of reported cases occur in males.Case report: Male patient, aged 57, smoker, with a history of hypertension, just returned from India, presented with anorex...

Pituitary apoplexy is a rare and life-threatening disorder often requiring emergency neurosurgical intervention to preserve vision and prevent cerebral herniation syndrome. Infarction or hemorrhage of an enlarged pituitary gland or pituitary tumor is the most common cause of pituitary apoplexy. Early recognition of this disorder is essential for preventing permanent visual loss or death; however, pituitary apoplexy often mimics subarachnoid hemorrhage, which in some cases may ...

Introduction: Acromegaly is a chronic endocrine disorder caused by excess growth hormone (GH) secretion. Hypersecretion of GH causes increased IGF-1 secretion from the liver which in turn leads to a series of multisystemic complications including somatic overgrowth and multiple comorbidities.Case report: Thirty-nine-year-old female patient was seen in ophthalmology outpatient clinic with the complaint of a mass inside the right upper eyelid. On ophthalmo...

Background: Biological diagnosis of adrenal insufficiency (AI) is very difficult in the setting of critical illness like in traumatic brain injury (TBI), and the cut off defining AI need more precision.Aim: The aim is to assess the frequency and predictive factors of AI in a simple of 277 victims of moderate to severe BI in two neighbors’ hospitals in the east of Algiers.Method: Between November 2009 and December 2013, 277 pat...

Aim: In a previous study, we demonstrated elevated mean platelet volume in isolated hypogonadotrophic hypogonadism (IHH) is associated with high cardiovascular risk. Monocyte count/HDL-cholesterol ratio (MHR) is a new inflammatory marker showing cardiovascular risk. The purpose of this study is to evaluate (MHR) in men with hypogonadotrophic hypogonadism.Method: This study includes 31 men with isolated hypogonadotrophic hypogonadism without previous trea...

Background: Transphenoidal surgery is still the best initial therapy for Cushing’s disease (CD), with a high probability of cure and few risks or complications. However, pharmacotherapy has a role as primary or adjunctive therapy: when surgery is delayed, in case of postoperative persistence or recurrence of hypercortisolism, or while waiting for radiotherapy effectiveness. Ketoconazole, a steroidogenesis inhibitor, is nowadays the main drug used to CD control by reducing...

Introduction: Empty sella syndrome is a condition in which sella turcica is partially or completely filled with CSF resulting in a displacement of normal pituitary gland. Primary empty sella is due to inherent weakness of diaphragm sella or to an increase in intracranial pressure which promotes herniation of arachnoid membranes in to pituitary fossa. More common in middle aged obese female and headache is the most common presenting symptom. It may be associated with one or mor...

Pitüitary ACTH deficiency is one cause of secondary adrenal insufficiency. Genetic factors, autoimmunity, infiltrative disease, cranial trauma can cause ACTH deficiency. Hyperpigmented skin lesions are expected in primary adrenal insufficiency while they are very rare in secondary adrenal insufficiency. Striae are characterized by linear smooth bands of atrophic appearing skin. They are mostly associated with obesity, pregnancy, hypercortisolism/Cushing syndrome. Striae a...