Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas
01 Oct 1999-The Journal of Clinical Endocrinology and Metabolism (Endocrine Society)-Vol. 84, Iss: 10, pp 3696-3700
TL;DR: Patients with hypopituitarism after neurosurgery should be reassessed after surgery without substitution therapy, because practically half the preoperative pituitary hormone deficiencies recover postoperatively, eliminating the need for life-long substitution therapy.
Abstract: Surgery is the treatment of choice for many pituitary tumors; pituitary function may suffer after operation, but relief of pressure on the normal pituitary may also favor postoperative recovery of hypopituitarism. The aim of this study was to investigate the frequency of new appearance and recovery of hypopituitarism after neurosurgery and try to identify features associated with it. Pre- and postoperative anterior pituitary functions were investigated in 234 patients with pituitary adenomas (56 nonfunctioning, 71 PRL-secreting, 66 GH-secreting, 39 ACTH-secreting, 1 LH/FSH-secreting, and 1 TSH-secreting tumors). Eighty-eight new postoperative pituitary hypofunctions appeared in 52 patients (12 NF, 14 PRL-secreting, 15 GH-secreting, 10 ACTH-secreting, and 1 LH/FSH-secreting adenomas). They corresponded to 27% ACTH deficiencies (in 29 of the 107 patients with normal preoperative ACTH in whom postoperative evaluation was complete), 14.5% (15 of 103) new GH deficiencies, 10.5% (15 of 143; P < 0.0005, significantly less than ACTH deficiency) new TSH deficiencies, 16.5% (20 of 121) new gonadotropin deficiencies, and 13% (9 of 71) new PRL deficiencies. Preoperatively, 93 were deficient in at least 1 pituitary hormone; after surgery, 45 (48%) recovered between 1 and 3 hormones. The 2 patients with LH/FSH- and TSH-secreting macroadenomas did not recover pituitary function. Factors associated with a higher probability of postoperative pituitary function recovery were: no tumor rests on postoperative pituitary imaging (P = 0.001) and no neurosurgical (P = 0.001) or pathological evidence (P = 0.049) of an invasive nature. Tumor size did not differ significantly between those who did and those who did not recover pituitary function after surgery. Even if clear hypofunction is observed at initial work-up, patients should be reassessed after surgery without substitution therapy, because practically half the preoperative pituitary hormone deficiencies recover postoperatively, eliminating the need for life-long substitution therapy.
Citations
More filters
TL;DR: GH therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD, and the risks associated with GH treatment are low.
Abstract: Growth hormone treatment can provide benefits in body composition, bone, and quality of life in adults with confirmed growth hormone deficiency.
881 citations
TL;DR: Using an evidence-based approach, this guideline addresses important clinical issues regarding the evaluation and management of hypopituitarism in adults, including appropriate biochemical assessments, specific therapeutic decisions to decrease the risk of co-morbidities due to hormonal over-replacements or under-replacement, and managing hypopitsuits during pregnancy, pituitary surgery, and other types of surgeries.
Abstract: Objective: To formulate clinical practice guidelines for hormonal replacement in hypopituitarism in adults. Participants: The participants include an Endocrine Society-appointed Task Force of six experts, a methodologist, and a medical writer. The American Association for Clinical Chemistry, the Pituitary Society, and the European Society of Endocrinology co-sponsored this guideline. Evidence: The Task Force developed this evidence-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of the Endocrine Society, the American Association for Clinical Chemistry, the Pituitary Society, and the European Society of ...
496 citations
TL;DR: This research highlights the need to understand more fully the role of Epstein-Barr virus in the development of type 2 diabetes and its role in the immune system.
Abstract: Northwestern University Feinberg School of Medicine (M.E.M.), Chicago, Illinois 60611; University of North Carolina School of Medicine (D.R.C.), Chapel Hill, North Carolina 27599; National Institute of Diabetes, Digestive and Kidney Disease (S.M.), National Institutes of Health, Bethesda, Maryland 20892; University of Washington, Veterans Affairs Puget Sound Health Care System (G.R.M.), Seattle and Tacoma, Washington 98493; Christie Hospital (S.M.S.), Manchester M20 4BX, United Kingdom; and University of Virginia Health Science Center (M.L.V.), Charlottesville, Virginia 22908
352 citations
TL;DR: The transsphenoidal route is the most widely used technique for pituitary adenoma surgery due to its rapidity, good tolerance, effectiveness and low complication rate, but tumor removal was notably superior when dealing with tumors having an extrasellar extension.
Abstract: The transsphenoidal route is the most widely used technique for pituitary adenoma surgery due to its rapidity, good tolerance, effectiveness and low complication rate. These are the parameters we utilized in comparing endoscopic with microscopic transsphenoidal surgery. We reviewed the medical records of 418 patients affected by pituitary adenomas who underwent endoscopic transsphenoidal surgery between May 1998 and December 2004, and in this paper, we present the results of 381 patients who fulfilled the follow-up criteria after a minimum period of 15 months. Our experience confirms the previous data on the rapidity and satisfactory tolerance of the endoscopic procedure. We also confirm the low complication rate, specifying that complications characteristic of the approaching phase were certainly reduced; instead, complications characteristic of tumor removal still remained similar to those reported in the microsurgical literature. The results were comparable with those of the best microsurgical series regarding endosellar lesions, but tumor removal was notably superior when dealing with tumors having an extrasellar extension. The improvement may be explained by the excellent vision of the deep surgical fields due to the endoscope and by the extreme flexibility of the surgical trajectory, mainly due to the absence of the divaricator, giving access to the ramifications of the tumor, otherwise difficult to reach.
262 citations
TL;DR: The data indicate that transsphenoidal surgery for non-functioning pituitary adenomas in expert hands is, relatively, far less detrimental to patients compared with transcranial surgery, which carries a much greater risk of post-operative deterioration in pituitsary function.
Abstract: ¶Introduction. The aim of this study was to define the impact of surgery on pituitary function in a large consecutive series of patients harbouring non-functioning pituitary adenomas.
223 citations
References
More filters
TL;DR: Two men with PRL-secreting pituitary adenomas and hypogonadism were studied before and repeatedly after transsphenoidal adenomectomy, finding clinical improvement paralleled the steady rise in the serum testosterone level.
Abstract: Two men with PRL-secreting pituitary adenomas and hypogonadism were studied before and repeatedly after transsphenoidal adenomectomy. Serum PRL levels were elevated (220 and 300 ng/ml), with no rise after perphenazine or TRH administration. Serum testosterone levels were low (180 and 155 ng/dl) but increased to 800 and 520 after hCG administration. Serum gonadotropin levels were low normal. Clomiphene treatment in patient 2 was not associated with an appreciable increase in FSH, LH, or testosterone. One patient had a normal sperm count, while the other was azospermic. One week after surgery, serum PRL levels were normal, yet serum testosterone remained low. A gradual and steady rise in the serum testosterone level was noted during the postoperative period, reaching normal levels in 8 and 10 weeks. Clinical improvement paralleled the steady rise in the serum testosterone level. Repeat clomiphene administration in patient 2 resulted in a normal rise in serum FSH, LH, and testosterone 13 weeks after surgery....
29 citations
TL;DR: Evidence is presented that cAMP is the proximal mediator of the synergism of actions of TSH and IGF-I, which may in part be due to IGF/IGF-I enhancement of T SH stimulation of adenylyl cyclase.
Abstract: We reported that TSH and insulin-like growth factor-I (IGF-I), which were known to synergistically stimulate DNA synthesis, synergize to elevate the 1,2-diacylglycerol content of FRTL-5 thyroid cells. We presented evidence that cAMP is the proximal mediator of these actions of TSH. To further define the mechanism of this interaction, we investigated the effects of IGF-I on TSH stimulation of adenylyl cyclase. Long and short term effects of IGF-I or high doses of insulin were studied in FRTL-5 cells that were maintained in serum-, hormone-, and growth factor-free medium for 4-7 days (basal cells). When cells were incubated with high doses of insulin for 7 days and acutely stimulated, a 10-fold increase in sensitivity and a 2-fold increase in maximal responsiveness of cAMP accumulation to TSH were observed. To study shorter term effects, cells were preincubated with insulin for 3 h and then exposed to TSH, cholera toxin, or forskolin. Incubation with high doses of insulin for 3 h caused 30-300% inc...
20 citations
TL;DR: The mechanisms which maintain euthyroidism in acromegalic patients despite the suppression of thyrotrophin (TSH) secretion are assessed.
Abstract: SUMMARY
objective We have assessed the mechanisms which maintain euthyroidism in acromegalic patients despite the suppression of thyrotrophin (TSH) secretion
materials Fourteen untreated patients with acromegaly were analysed. Ten patients were also studied after pituitary surgery
methods Thyroid hormones, growth hormone (GH), Insulin-like growth factor-I (IGF-I) and thyroidal uptake of radioactive iodine, thyrotrophin releasing hormone (TRH) test and basal metabolic rate (BMR) were measured before and after pituitary surgery
results Nine patients had paipable goitres. The TSH response to TRH stimulation was suppressed in eight patients, who maintained normal serum levels of total T3, T4 and free T4. The patients with normal TSH response had lower levels of free and total T4 than controls. The response of TSH to TRH correlated inversely with the serum level of total and free T4, and also with the plasma level of IGF-I (r=–0·74, P > 0·05, n= 9). After pituitary surgery, the serum levels of total and free T4 were elevated for at least up to 6 months, with a decrease in the T3/T4 ratio and the BMR.
conclusion GH may have a direct stimulatory action on the thyroid secretion of T4 possibly via increased IGF-I, despite suppressed TSH secretion. The post-operative elevation of serum T4 suggests the persistent secretion of T4 from the thyroid gland, in spite of instantaneous normalization of the accelerated conversion of T4 to T3, even after reduction of excess GH secretion
13 citations