Pituitary Disorders (eBook)

Diagnosis and Management

Edward R. Laws, Shereen Ezzat, Sylvia L. Asa, Linda M. Rio, Lorin Michel, Robert Knutzen (Herausgeber)

eBook Download: PDF

2013
John Wiley & Sons (Verlag)
9781118559390 (ISBN)

Infos

Do you want to be up to date on the latest concepts of diagnosis and treatment of patients suffering from disorders of the pituitary gland?

Are you looking for an expert guide to the best clinical management?

If so, this is the book for you, providing a full analysis of pituitary disorder management from acromegaly to Addison's Disease; from Cushing's Disease to hypopituitarism; from hormone disorders to hormone replacement.

Well-illustrated throughout, and with contributions from leading specialists in pituitary disease, inside you'll find comprehensive and expert coverage, including:

• Diagnosing pituitary disease
• Management options for each disorder
• Complications that can occur
• Psychological and psychosocial effects of pituitary disease
• What outcomes you and your patients can expect over the long term
• Current research and clinical trials related to pituitary disease

Pituitary Disorders: Diagnosis and Management is the perfect clinical tool for physicians and health care providers from many related disciplines, and an essential companion for the best quality management of pituitary patients.

Sylvia Asa, MD, PhD, Clinical Department Head, Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network and Ontario Cancer Institute, Toronto, Canada.

Edward R. Laws, MD, FACS, Director, Pituitary/Neuroendocrine Center, Department of Neurosurgery, Brigham & Women's Hospital, Harvard University, Boston, Massachusetts, USA.

Shereen Ezzat, FACO, FRCPC, MD, Professor of Medicine & Oncology Head, Endocrine Oncology Site Group, Princess Margaret Hospital, Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.

Linda Rio, MA, MFT, Pituitary Network Association, Los Angeles, California, USA.

Inhalt

Cover 1
Title page 5
Copyright page 6
Contents 7
List of Contributors 11
Introduction 16
Abbreviations 18
SECTION 1: Overview 21
CHAPTER 1: The Endocrine System 23
Normal Development and Structure 23
Peptide Hormone-Producing Cells 23
Steroid Hormone-Producing Cells 23
Thyroid Hormone-Producing Cells 23
Endocrine Regulation 24
Endocrine Pathology 25
Endocrine Deficiencies 25
Hormone Excess: Hyperplasia and Tumor Pathology 27
Epidemiology 28
Etiology 28
References 30
CHAPTER 2: Signs and Symptoms of Pituitary Disease 33
Physical Manifestations of Pituitary Disorders 33
Emotional Manifestations of Pituitary Disorders 35
MENTAL HEALTH Aspects of Pituitary Disorders 37
References 39
SECTION 2: Disorders 41
CHAPTER 3: Acromegaly 43
Introduction 43
Methods of Diagnosis 43
Monitoring of Disease Activity 44
Treatment Objectives 44
Primary Medical Therapy 45
Specific Medications 45
Dopamine Agonists 45
Somatostatin Analogs 46
Growth Hormone Antagonism 47
Combination SA and Pegvisomant 49
Impact of Therapy on Comorbidities 49
Conclusions 50
References 50
CHAPTER 4: Secondary Adrenal Insufficiency 52
Epidemiology 52
Etiology and Pathogenesis 52
General Aspects of Pathogenesis 52
Genetic Causes of Secondary Adrenal Insufficiency 54
Lymphocytic Hypophysitis 54
Clinical Presentation 55
Diagnosis 56
Static (Basal) Testing 56
Insulin Tolerance Test 57
Cosyntropin Stimulation Testing 58
Metyrapone Testing 58
CRH Testing 59
Therapy 59
Special Considerations 61
Diagnosis and Therapy Before and After Pituitary Surgery 61
Diagnosis Following Long-Term Glucocorticoid Exposure 63
References 64
CHAPTER 5: Adult Growth Hormone Deficiency 67
Background 67
Benefits of Growth Hormone Replacement 67
Bone Density 67
Secondary Cardiac Markers/Lipids 68
Exercise Capacity/Cardiac Performance 68
Body Composition 68
Quality of Life 68
Mortality 68
Diagnosis of Adult Growth Hormone Deficiency 68
Growth Hormone Use in Children and Transition to the Adult Endocrinologist 69
Considerations Regarding Other Pituitary Hormones 69
Treatment of Adult Growth Hormone Deficiency 70
Safety Considerations 70
Conclusions 71
References 72
CHAPTER 6: Pituitary Carcinoma 75
Definition 75
Clinical Features 75
Radiologic Findings 75
Morphologic Findings 76
Pathogenesis 76
Prognosis and Therapy 76
References 77
CHAPTER 7: Craniopharyngioma 79
Epidemiology and Definition 79
Clinical Presentation and Diagnosis 79
Therapies 81
Surgical Resection 81
Radiation Therapy 83
Long-Term Sequelae 84
Conclusion 85
References 85
CHAPTER 8: Cushing’s Syndrome 87
Introduction 87
Clinical Presentation 87
Laboratory and Radiologic Investigations 88
Screening Tests 89
Diagnostic Tests 89
Differential Diagnostic Tests 90
Therapeutic Approaches 92
Pituitary Adenomas 92
Ectopic ACTH Hypersecretion 92
Adrenal Disorders 93
Approach to Patients with Residual or Recurrent Disease 93
Other Issues 94
References 95
CHAPTER 9: Empty Sella Syndrome 97
Introduction 97
Primary Empty Sella Syndrome 97
Secondary Empty Sella Syndrome 99
Clinical Symptoms 101
Treatment Strategies for Empty Sella Syndrome 102
Conclusion 104
References 104
CHAPTER 10: Familial Pituitary Adenomas 107
Introduction 107
Multiple Endocrine Neoplasia Type 1 107
Menin 109
Clinical Features 111
Multiple Endocrine Neoplasia Type 4 112
p27Kip1 112
Pituitary Adenomas 113
Clinical Features 114
Familial Isolated Pituitary Adenoma 114
AIP 114
AIP Partners 115
AIP in the Pituitary 116
Clinical Features 116
Carney Complex 119
PRKAR1A 119
Clinical Features 120
Pituitary Adenomas 122
Other Possible Familial Pituitary Adenoma Syndromes 123
Pituitary Blastoma 123
CDKIs 123
Pheochromocytoma/Paraganglioma and Pituitary Adenoma 123
Recommendations for Genetic Screening of Patients with Pituitary Adenomas 123
References 124
CHAPTER 11: Follicle Stimulating Hormone and Luteinizing Hormone Secreting Tumors 131
Physiopathology of Gonadotroph Tumors 131
Gonadotrophs 131
Regulation of FSH and LH Secretion 131
Gonadotroph Adenomas 131
Epidemiology 132
Clinical Presentation 132
Diagnosis 133
Treatment 135
References 136
CHAPTER 12: Hypopituitarism 140
Introduction 140
Physiology 140
Etiology 140
Structural Causes of Pituitary Failure 141
Mass Lesions 142
Infiltrative Diseases 142
Vascular 143
Developmental and Inheritable Causes 143
Traumatic Injury 144
Functional Causes of Pituitary Failure 144
Medications 144
Systemic Disease 146
Clinical Manifestations 146
Central Adrenal Insufficiency 147
Central Thyrotropin Deficiency 147
Hypogonadotropic Hypogonadism 147
Growth Hormone Deficiency 147
Prolactin Deficiency 148
Central Diabetes Insipidus 148
Mortality 148
References 148
CHAPTER 13: Clinically Nonfunctioning Pituitary Adenomas 150
Categorization of Clinically Nonfunctioning Pituitary Adenomas 150
Presentation 151
Atypical and “Malignant” Nonfunctioning Adenomas 152
Clinical Evaluation 152
Treatment 152
Summary 153
References 154
CHAPTER 14: Prolactinoma 158
Incidence and Prevalence 158
Etiology 158
Natural History 158
Clinical Presentation and Physiopathology 158
Diagnosis 159
Treatment 160
Onset of Action 160
Efficacy 161
Resistance 161
Adverse Effects 161
Cabergoline vs. Bromocriptine 162
How Long Should the Treatment Last? 162
Surgical Treatment and Radiotherapy 162
Treatment of Associated Hormonal Deficiencies 163
Prolactinoma and Pregnancy 163
References 163
CHAPTER 15: Rathke’s Cleft Cysts 166
Introduction 166
Tissue Origin of Rathke’s Cleft Cysts 166
Clinical Presentation 167
Imaging of Rathke’s Cleft Cysts and Differential Diagnosis 167
Natural History of Untreated Rathke’s Cleft Cysts 169
Surgical Management 170
Morbidity of Surgery 170
Long-Term Recurrence Rates 170
Conclusion 170
References 171
CHAPTER 16: Thyroid Hormone Deficiency 173
Introduction 173
Etiology 173
Clinical Presentation 175
Diagnosis 175
Treatment 176
Summary 177
References 177
CHAPTER 17: Thyroid Stimulating Hormone Secreting Tumor 179
Introduction 179
Epidemiology 179
Pathogenesis 180
Pathology 181
Clinical Manifestations 181
Diagnosis 182
Treatment 183
References 184
CHAPTER 18: Pituitary Disorders – Specific Issues for Women 187
Pituitary Disorders and the Menstrual Cycle 187
Acromegaly 187
Cushing’s Disease 187
Prolactinomas 188
Infertility and Pituitary Disorders 188
Pituitary Disease During Pregnancy 188
Anatomic and Physiologic Pituitary Changes During Pregnancy 188
Pituitary Tumors During Pregnancy 190
Other Pathologies 193
Pituitary Hormone Replacement Therapy – Pearls Specific to Women (Not Pregnancy Related) 195
Thyroid Hormone Replacement in Patients on Growth Hormone Replacement 195
Thyroid Hormone Replacement in Patients on Estrogen Replacement 195
Growth Hormone Replacement in Women on Estrogen Treatment 195
Androgen Replacement – Testosterone and Dehydroepiandrosterone for Women 195
Psychosocial Effects 196
Acromegaly, Prolactinomas 196
Cushing’s Disease 196
Hypopituitarism 196
Summary 196
References 197
CHAPTER 19: Hypogonadism and Male Sexual Function 199
Introduction 199
Hypothalmic–Pituitary–Gonadal Axis and Male Sexual Function: Physiology and Development 199
Etiology of Hypogondatotropic Hypogonadism 202
Acquired Causes of Hypogondatotropic Hypogonadism 202
Congenital Causes of Hypogondatotropic Hypogonadism 204
Diagnosis of Hypogonadotrophic Hypogonadism and Decreased Male Sexual Function 205
Signs, Symptoms and Laboratory Diagnosis of Hypogonadotrophic Hypogonadism 205
Sexual Function 206
Subfertility 208
Treatment of Hypogonadotropic Hypogonadism and Male Sexual Function 208
Reversible Causes of Hypogonadotropic Hypogonadism 208
Testosterone Replacement Therapy 208
Treatment of Congenital Hypogonadotrophic Hypogonadism and Induction of Puberty 209
Male Sexual Function 209
Induction or Re-initiation of Spermatogenesis 209
Acknowledgement 211
References 211
CHAPTER 20: Pituitary Disorders Specific to Children 213
Panhypopituitarism 213
Etiology 213
Clinical Presentation 213
Diagnosis 213
Treatment 214
Pituitary Tumors 214
Etiology 214
Clinical Presentation 215
Diagnosis 215
Treatment 215
Prognosis 216
Growth Hormone Deficiency 216
Etiology 216
Clinical Evaluation and Diagnosis 216
Treatment 217
Prognosis 217
Precocious Puberty 217
Etiology 218
Clinical Signs/Symptoms 218
Diagnosis 218
Treatment 219
Delayed/Absent Puberty 219
Etiology 219
Clinical Evaluation 220
Treatment 220
References 221
SECTION 3: Diagnosing Pituitary Disorders 225
CHAPTER 21: Physical Examination 227
Introduction 227
Hypopituitarism 227
Physical Manifestations Specific To Hormone Deficiency 227
Growth Hormone Deficiency 227
ACTH Deficiency 227
TSH Deficiency 228
Gonadotropin (LH/FSH) Deficiency 228
Posterior Pituitary Gland Deficiency 228
Pituitary Tumors 228
Cushing’s Disease 228
Acromegaly 230
Directed Physical Examination for Acromegaly 230
Prolactinoma 231
TSH-Secreting Pituitary Adenoma 231
Conclusion 232
References 232
CHAPTER 22: Pituitary Endocrine Function Testing 233
Introduction 233
Assessment of Anterior Pituitary Function 233
Pituitary Corticotroph-Adrenal Assessment 233
Pituitary–Thyroid Assessment 235
Basal Thyroid Function Tests 235
Thyrotropin releasing HormoneStimulation Test 235
Prolactin Assessment 236
Basal Levels 236
Normal Responses to TRH Stimulation 236
Pituitary Growth Hormone Assessment 236
Basal Levels 236
Dynamic Testing 236
Gonadotropin Assessment 238
Basal Levels 238
Dynamic Testing 238
Assessment of Posterior Pituitary Function 239
Baseline Measurements 239
References 240
SECTION 4: Treatment of Pituitary Disorders 245
CHAPTER 23: Medical Management of Pituitary Adenomas 247
Introduction 247
Growth-Hormone-Producing Tumors 247
Somatostatin Analogs 247
Dopamine Agonists 249
Growth Hormone Receptor Antagonist 249
TSH-Producing Tumors (TSH-oma) 251
ACTH-Producing Tumors (Cushing’s Disease) 251
Central-Acting Drugs 251
Glucocorticoid Receptor Antagonists 252
Steroidogenesis Inhibitors 252
LH/FSH-Producing Tumors (Gonadotropic Adenomas) and Nonfunctioning Pituitary Adenomas 253
Prolactinomas 253
Epidemiology 254
Clinical Presentation 254
Diagnosis 254
Treatment 255
References 258
CHAPTER 24: Surgical Management of Pituitary Disorders 263
Pure Endoscopic Transsphenoidal Surgery 263
Open Transcranial Approaches to the Sella 265
Endoscopic Skull Base Approaches 267
Transnasal Endoscope-Assisted Transsphenoidal Approach for Pituitary Tumors 268
References 272
CHAPTER 25: Stereotactic Radiosurgery for Pituitary Adenomas 275
Introduction 275
Stereotactic Radiosurgery Concept and Techniques 275
Stereotactic Radiosurgery for Pituitary Adenomas 276
Nonfunctioning Pituitary Adenomas 276
Stereotactic Radiosurgery and Cushing’s Disease 276
Stereotactic Radiosurgery and Acromegaly 277
Biochemical Remission and Late Recurrence Induced by Stereotactic Radiosurgery 278
Adverse Events After Stereotactic Radiosurgery 280
Conclusions 281
References 281
CHAPTER 26: Hormone Replacement Therapy 285
Growth Hormone Deficiency in Adults 285
Growth Hormone Deficiency in Children and Adolescents 289
Pituitary Hormone Replacement in Women 292
References 294
SECTION 5: Complications that Accompany Pituitary Disease 297
CHAPTER 27: Complications of Pituitary Disease 299
Cardiac Complications 299
Cognitive Dysfunction 300
Diabetes Insipidus 301
Headaches 302
Obesity 303
Osteoporosis 304
Permanent Hormone Deficiency 305
Visual Deficits Caused By Pituitary Tumors 306
References 309
SECTION 6: General Psychological and Psychosocial Effects 311
CHAPTER 28: General Psychological and Psychosocial Effects of Pituitary Disorders 313
Introduction: Scope of Psychiatric and Psychosocial Effects in Pituitary Disorders 313
Psychological Symptoms Linked to Specific Type of Pituitary Tumor 313
Cushing’s Disease 313
Acromegaly 314
Prolactinomas 314
Nonfunctioning Pituitary Adenomas 314
Major Psychological Symptoms Linked to Pituitary Disease 314
Psychological Aspects Relating to Diagnosis and Treatment 315
Depression, Anxiety, and Body Image Concerns 316
Residual Symptoms May Persist After “Successful” Treatment 317
Directions for Future Research 317
Conclusion 318
References 318
SECTION 7: Long Term: What You and Your Patients Can Expect 321
CHAPTER 29: Living with Pituitary Disease 323
Introduction 323
Long-term Mortality in Patients with Pituitary Disease 323
Quality of Life in Patients with Pituitary Disease 323
Nonfunctioning tumors 324
Functioning Tumors 325
Contribution of Hormone Replacement Regimens to Quality of Life and Long-Term Morbidity 326
Assessing Apathy in Patients with Pituitary Disease 327
Conclusions 328
Disclaimer Statement 328
References 328
Section 8: Research and Clinical Trials 331
Chapter 30: Research and Clinical Trials 333
Introduction 333
Genetic and Familial Pituitary Tumors 333
Factors Implicated in Sporadic Pituitary Tumors 333
Pituitary Tumor Initiation 333
Cell Cycle Regulators 334
Signal Transduction Pathways 334
Cytokine, Growth, and Angiogenic Factors/Receptors 335
Hormones and Their Receptors 335
Clinical Research in Pituitary Disorders 335
Prolactinoma 336
Acromegaly 336
Cushing’s Disease 337
Hypopituitarism and Related Diseases 337
Growth Hormone Deficiency 338
Antidiuretic Hormone Deficiency 338
Adrenocorticotropin Deficiency 338
Prolactin Deficiency 338
Conclusion 339
References 339
Section 9: Resources 343
Chapter 31: Fundamentals of Pituitary Pathology 345
Introduction 345
Importance of Clinical Information 345
At the Time of Surgery 345
Histology 346
Primary Adenohypophysial Cell Proliferations 347
Adenoma or Hyperplasia? 347
Pituitary Adenoma Classification 347
Pathology of Hormone Excess Syndromes 348
Clinically Nonfunctioning Adenomas 351
The Question of Plurihormonality 351
The Role of Electron Microscopy 351
Prognosis 352
Conclusion 352
References 352
Glossary 353
Index 367

Produkt-Details

• Erscheint lt. Verlag: 19.2.2013
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Endokrinologie
• Themenwelt: Studium ► 1. Studienabschnitt (Vorklinik) ► Biochemie / Molekularbiologie
• Schlagworte: Acromegaly • Addisons • Analysis • Best • Book • Clinical • Contributions • cushings • Diagnosis • Disease • disorder • disorders • endocrinology • Endokrinologie • Expert • full • Guide • Hormone • latest concepts • Medical Science • Medizin • Metabolic disease • patients suffering • pituitary • replacement • specialists • Stoffwechselkrankheiten • Treatment
• ISBN-13: 9781118559390 / 9781118559390