Pituitary最新文献

{"title":"Correction: Utility of copeptin in predicting non-pathological postoperative polyuria in patients affected by acromegaly undergoing pituitary neurosurgery.","authors":"Emanuele Varaldo, Nunzia Prencipe, Alessandro Maria Berton, Luigi Simone Aversa, Fabio Bioletto, Raffaele De Marco, Valentina Gasco, Francesco Zenga, Silvia Grottoli","doi":"10.1007/s11102-024-01419-7","DOIUrl":"10.1007/s11102-024-01419-7","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":" ","pages":"742-743"},"PeriodicalIF":3.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic, therapeutic, and prognostic characteristics of patients with acromegaly according to tumor size at diagnosis.","authors":"Leticia Marinho Del Corso, Cleo Otaviano Mesa Junior, Vicente Florentino Castaldo Andrade, Solena Ziemer Kusma Fidalski, Cesar Luiz Boguszewski","doi":"10.1007/s11102-024-01432-w","DOIUrl":"10.1007/s11102-024-01432-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical, laboratory, radiological, therapeutic, and prognostic characteristics of patients with acromegaly according to the size of the growth hormone (GH)-secreting pituitary adenoma at diagnosis.</p><p><strong>Methods: </strong>Observational, retrospective, single-center study of patients with acromegaly followed at a tertiary center. Data were collected regarding clinical presentation, characteristics of the adenoma in the magnetic resonance imaging, GH and IGF-1 levels, and disease control after surgery or adjuvant treatment (normal IGF-1 levels). Patients were divided according to the adenoma size at diagnosis in: group I < 10 mm; II 10-19 mm; III 20-29 mm; IV 30-39 mm; and V ≥ 40 mm. Comparisons were made between the groups, and correlations of tumor size with disease parameters, ROC curves, and logistic regression analyses were performed to investigate tumor size and confounding factors that could impact the outcomes.</p><p><strong>Results: </strong>117 patients were studied [59 women, age at diagnosis 43 ± 13 years; group I = 11 patients (9%); group II 54 (46%); group III 34 (29%); group IV 10 (9%); group V 8 (7%)]. Hypopituitarism, cavernous sinus invasion, GH levels, and use of somatostatin receptor ligands had their prevalence increased according to the adenoma size. Age showed a negative correlation with tumor size. A tumor diameter around 20 mm was the best predictor for the presence of hypopituitarism, invasiveness, need of adjuvant therapies, and poorer disease control.</p><p><strong>Conclusion: </strong>Adenomas < 20 mm showed lower morbidity and better therapeutic response in acromegaly, while those ≥ 20 mm had similar clinical, therapeutic, and prognostic behavior.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":" ","pages":"537-544"},"PeriodicalIF":3.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular risk and glucocorticoids: a Dutch National Registry of growth hormone treatment in adults with growth hormone deficiency analysis.","authors":"Tessa N A Slagboom, Christa C van Bunderen, Aart Jan van der Lely, Madeleine L Drent","doi":"10.1007/s11102-024-01448-2","DOIUrl":"10.1007/s11102-024-01448-2","url":null,"abstract":"<p><strong>Purpose: </strong>Patients with hypopituitarism are at increased cardiovascular risk, in part because of growth hormone deficiency (GHD), but probably also because of the overuse of glucocorticosteroids in concomitant adrenal insufficiency (AI). We hypothesized that patients with hypopituitarism that were on glucocorticosteroid replacement therapy for concomitant AI would have worse cardiovascular outcomes than those without.</p><p><strong>Methods: </strong>Retrospective nationwide cohort study. GHD patients from the Dutch National Registry of Growth Hormone Treatment in adults were grouped by the presence (AI; N = 1836) or absence (non-AI; N = 750) of concomitant AI, and differences between groups were analyzed for baseline characteristics and cardiovascular risk, at baseline and during GHRT.</p><p><strong>Results: </strong>At baseline, AI patients had higher levels of total and LDL cholesterol (both p < 0.01). During GHRT, AI patients were more likely to use cardiovascular drugs (p ≤ 0.01), but we did not find worse outcomes for blood pressure, body composition, lipid and glucose metabolism. The risk of developing peripheral arterial disease (HR 2.22 [1.06-4.65]) and non-fatal cerebrovascular events (HR 3.47 [1.60-7.52]) was higher in AI patients, but these differences disappeared in the models adjusted for baseline differences.</p><p><strong>Conclusion: </strong>We found no clear evidence to support our hypothesis that patients with hypopituitarism and concomitant AI have worse cardiovascular outcomes than non-AI patients. This suggests that glucocorticoid replacement therapy in AI may be safer than previously thought. However, cardiovascular burden, events and medication use at baseline and during GHRT (in unadjusted models) were higher in AI; so the lack of power, the important role of (adjusting for) other risk factors, and the inability to distinguish between glucocorticoid treatment regimens may have influenced the outcomes.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":" ","pages":"590-604"},"PeriodicalIF":3.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does size really matter? A closer look at the absolute size of growth hormone-secreting pituitary adenomas.","authors":"Katharina Schilbach, Gérald Raverot","doi":"10.1007/s11102-024-01449-1","DOIUrl":"10.1007/s11102-024-01449-1","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":" ","pages":"440-443"},"PeriodicalIF":3.3,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term metabolic effectiveness and safety of growth hormone replacement therapy in patients with adult growth hormone deficiency: a single-institution study in Japan","authors":"Yuka Oi-Yo, Masaaki Yamamoto, Shin Urai, Hironori Bando, Yuka Ohmachi, Yuma Motomura, Masaki Kobatake, Yasutaka Tsujimoto, Yuriko Sasaki, Masaki Suzuki, Naoki Yamamoto, Michiko Takahashi, Genzo Iguchi, Wataru Ogawa, Yutaka Takahashi, Hidenori Fukuoka","doi":"10.1007/s11102-024-01459-z","DOIUrl":"https://doi.org/10.1007/s11102-024-01459-z","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>To elucidate the long-term efficacy and safety of growth hormone replacement therapy (GHRT) in Japanese patients with adult growth hormone deficiency (AGHD).</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We conducted a retrospective study. A total of 110 patients with AGHD receiving GHRT were enrolled. Clinical and laboratory data were collected annually from the beginning of the study. Statistical analysis was performed using a linear mixed-effects model.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Of all patients, 46.4% were males, 70.9% had adult-onset GHD, and follow-up was up to 196 months, with a median of 68 months. The insulin-like growth factor-1 standard deviation score increased after the start of GHRT and remained constant for more than 11 years. Seventeen patients were followed up for more than 11 years. The body mass index increased. Waist circumference decreased in the short term but increased in the long term. The diastolic blood pressure decreased 1–5 years after the start of GHRT, and the systolic blood pressure increased 11 years after GHRT. Moreover, a long-term decrease in low-density lipoprotein cholesterol, an increase in high-density lipoprotein cholesterol, and a decrease in aspartate aminotransferase and alanine aminotransferase levels were observed. The glycosylated hemoglobin level increased after 3 years. The bone mineral density in the lumbar spine and total hip increased significantly 3 years after the start of GHRT. Finally, the number of adverse events was eight.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>We demonstrated the metabolic effectiveness and safety of GHRT in Japanese patients with AGHD over a long follow-up period of 16 years.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"41 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When to decide on testosterone replacement despite dopamine agonist therapy in male prolactinomas?","authors":"Hidenori Fukuoka","doi":"10.1007/s11102-024-01457-1","DOIUrl":"https://doi.org/10.1007/s11102-024-01457-1","url":null,"abstract":"","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"14 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary apoplexy: a comprehensive analysis of 93 cases across functioning and non-functioning pituitary adenomas from a single-center","authors":"Divya C. Ragate, Saba Samad Memon, Anurag Ranjan Lila, Vijaya Sarathi, Virendra A. Patil, Manjiri Karlekar, Rohit Barnabas, Hemangini Thakkar, Nalini S. Shah, Tushar R. Bandgar","doi":"10.1007/s11102-024-01453-5","DOIUrl":"https://doi.org/10.1007/s11102-024-01453-5","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Introduction</h3><p>: Pituitary apoplexy (PA) is a rare clinical syndrome due to acute/subacute pituitary hemorrhage and/or infarction; data on PA in functioning pituitary adenoma (FPA) is scarce.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A retrospective record-review of details of PA in non-functioning (NFPA) and FPA managed at tertiary endocrine center.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>93 patients [56 males; 33.3% FPA: 5 acromegaly, 14 prolactinoma, and 12 Cushing’s Disease (CD)] diagnosed with PA were included. Median age was 40 years, with younger age of presentation in FPA. Type A (acute) [49.5%] and headache (78.5%) were the commonest presentations, with PA being the initial manifestation in 98.4% of NFPA. Median (range) Pituitary Apoplexy Score (PAS) was 2 (0–8). Median tumor diameter was 2.5 cm, with larger tumors in FPA (3.2 cm vs. 2.3 cm). 29 (46.7%) NFPA-PA and 14 (45.2%) FPA-PA patients [71% prolactinoma, 33% in CD, and none in acromegaly] were conservatively managed. In the NFPA cohort, those managed surgically had significantly higher PAS (4 vs. 1) and larger tumor size (2.6 vs. 1.8 cm); however, both arms had comparable recovery of neuro-visual, radiological, and hormonal outcomes. In FPA cohort, CD and acromegaly required definitive treatment, whereas prolactinomas were effectively managed (clinical and biochemical recovery) with oral cabergoline and glucocorticoids. Matching PAS cohorts (to overcome allocation bias for management approach) in macroadenomas (excluding prolactinoma) showed comparable neuro-deficit and hormonal recovery between surgical and conservative approaches.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>PA in FPA has distinct features and management issues. Carefully selected patients (PAS guided) in NFPA with PA for conservative management have comparable outcomes to surgery.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"98 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desmopressin dose requirements in patients with permanent arginine vasopressin deficiency: a tertiary center experience","authors":"Emanuele Varaldo, Michela Sibilla, Nunzia Prencipe, Alessandro Maria Berton, Daniela Cuboni, Luigi Simone Aversa, Francesca Mocellini, Fabio Bioletto, Ezio Ghigo, Valentina Gasco, Silvia Grottoli","doi":"10.1007/s11102-024-01454-4","DOIUrl":"https://doi.org/10.1007/s11102-024-01454-4","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>The desmopressin daily dose requirement is highly variable among patients with arginine vasopressin (AVP) deficiency (i.e. central diabetes insipidus) and few studies to date have evaluated this topic, with often inconclusive results. The aim of our study was to identify clinical and biochemical predictors of such dose requirements in a cohort of patients with a confirmed diagnosis of permanent AVP deficiency who have good and stable control under substitutive treatment.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>We retrospectively analyzed data of all patients with permanent AVP deficiency undergoing regular follow-up at our Division. Inclusion criteria were the presence of stable disease under therapy for at least 12 months and in good biochemical and clinical control. Patients with AVP deficiency who lacked intact thirst or had a disease duration of less than 12 months were excluded from the analysis.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Out of the 132 patients initially screened, 96 patients (M/F 44/52; age 51 [37–63] years) met the inclusion criteria. Patients on nasal spray therapy (n = 8) had a significantly longer disease duration (p = 0.002) than patients treated with oral lyophilizate (n = 88). In the bivariate analysis, considering only patients treated with the sublingual formulation, the drug dose was correlated positively with estimated glomerular filtration rate (eGFR) and weight (r = 0.410, p &lt; 0.001; r = 0.224, p = 0.036, respectively) and negatively with age (r = – 0.433, p &lt; 0.001). In the multivariate regression analysis taking into account age, weight, and eGFR, only age emerged as a significant predictor of the required sublingual desmopressin dose (β = – 1.426, p = 0.044).</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Our data suggest that patient age appears to be the primary factor associated with the daily sublingual desmopressin dose required to achieve adequate clinical and biochemical control in patients with permanent AVP deficiency.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"12 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep disruption in patients with active and treated endogenous Cushing’s syndrome","authors":"Eliza B. Geer, Isabelle Grillo, Qing Li, Hannah Robins, Vanessa Cohen, Hannah Baratz, Christine Garcia, Maria Sazo, Andrew Lin, Marc Cohen, Viviane Tabar, Jun Mao, Sheila N. Garland","doi":"10.1007/s11102-024-01450-8","DOIUrl":"https://doi.org/10.1007/s11102-024-01450-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Context</h3><p>The hypothalamic-pituitary-adrenal axis is a critical regulator of circadian rhythm in humans. Impaired sleep adversely affects metabolic, emotional, and cognitive health.</p><h3 data-test=\"abstract-sub-heading\">Objective</h3><p>To characterize sleep disturbances in patients with active and treated Cushing’s syndrome (CS), and identify factors associated with impaired sleep in treated patients.</p><h3 data-test=\"abstract-sub-heading\">Design</h3><p>Single-center cross-sectional study.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>Patients with pituitary or adrenal CS enrolled in an observational study completed Nottingham Health Profile (NHP), CushingQoL, and Hospital Anxiety and Depression assessments. Cross-sectional analysis was conducted including patients with active and treated disease.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>113 (94 female) patients with CS were included, 104 pituitary and 9 adrenal, with mean age at diagnosis of 43.9 ± 13.4 years. Mean and maximum duration of follow up was 5.1 and 23 years. Mean NHP sleep score was lower (i.e., improved) in patients with treated vs. active disease (29.6 ± 30.2 vs. 51.9 ± 30.9, <i>p</i> = 0.0005), as was CushingQoL sleep score (<i>p</i> = 0.015), but 41.5% of patients with treated disease stated they often or always had trouble sleeping. The proportion of treated vs. active patients taking medication for sleep, mood, or pain was not different. Neither NHP nor CushingQoL pain scores were lower in treated vs. active patients (<i>p</i> = 0.39 and 0.53). In patients with treated CS, anxiety and depression correlated with worse sleep scores.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Patients with treated CS report improved sleep quality compared to those with active disease, but almost half of treated patients still report sleep challenges. The need for sleep medications, reported by one third of patients, was not different after CS treatment. Ongoing mood disturbances may play a role in persistent sleep disruption. Further work should focus on determinants of sleep impairments in treated CS patients.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"6 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142205689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroendocrinology of bone","authors":"Se-Min Kim, Farhath Sultana, Funda Korkmaz, Satish Rojekar, Anusha Pallapati, Vitaly Ryu, Daria Lizneva, Tony Yuen, Clifford J. Rosen, Mone Zaidi","doi":"10.1007/s11102-024-01437-5","DOIUrl":"https://doi.org/10.1007/s11102-024-01437-5","url":null,"abstract":"<p>The past decade has witnessed significant advances in our understanding of skeletal homeostasis and the mechanisms that mediate the loss of bone in primary and secondary osteoporosis. Recent breakthroughs have primarily emerged from identifying disease–causing mutations and phenocopying human bone disease in rodents. Notably, using genetically–modified rodent models, disrupting the reciprocal relationship with tropic pituitary hormone and effector hormones, we have learned that pituitary hormones have independent roles in skeletal physiology, beyond their effects exerted through target endocrine glands. The rise of follicle–stimulating hormone (FSH) in the late perimenopause may account, at least in part, for the rapid bone loss when estrogen is normal, while low thyroid–stimulating hormone (TSH) levels may contribute to the bone loss in thyrotoxicosis. Admittedly speculative, suppressed levels of adrenocorticotropic hormone (ACTH) may directly exacerbate bone loss in the setting of glucocorticoid–induced osteoporosis. Furthermore, beyond their established roles in reproduction and lactation, oxytocin and prolactin may affect intergenerational calcium transfer and therefore fetal skeletal mineralization, whereas elevated vasopressin levels in chronic hyponatremic states may increase the risk of bone loss.. Here, we discuss the interaction of each pituitary hormone in relation to its role in bone physiology and pathophysiology.</p>","PeriodicalId":20202,"journal":{"name":"Pituitary","volume":"21 1","pages":""},"PeriodicalIF":3.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141882451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}