Evaluation of Anterior Pituitary Function in Patients with Posttraumatic Diabetes Insipidus

The optimum methods of testing anterior and posterior pituitary function and the interpretation of the results are subjects of continuing debate. The syndromes associated with and consequences of hypo- and hyperpituitarism, and the diagnosis and treatment of diabetes insipidus are all discussed elsewhere in this book. The intention of this chapter is to describe the physiological basis and evidence in favour of the various available tests of anterior pituitary function, discuss the limitations of using artificial assessments on which to base patient management decisions and, ultimately, endeavour to produce a rational approach to the investigation of suspected hypopituitarism.

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Diabetes insipidus is an unfavorable prognostic factor for response to glucocorticoids in patients with autoimmune hypophysitis

Acta Endocrinologica ◽

10.1530/eje-17-0123 ◽

2017 ◽

Vol 177 (2) ◽

pp. 127-135 ◽

Cited By ~ 8

Author(s):

Isabella Lupi ◽

Mirco Cosottini ◽

Patrizio Caturegli ◽

Luca Manetti ◽

Claudio Urbani ◽

...

Keyword(s):

Prognostic Factor ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Glucocorticoid Therapy ◽

Pituitary Function ◽

Pituitary Stalk ◽

Autoimmune Hypophysitis ◽

Negative Prognostic Factor ◽

Anterior Pituitary Function ◽

Design And Methods

Introduction Autoimmune hypophysitis (AH) has a variable clinical presentation and natural history; likewise, its response to glucocorticoid therapy is often unpredictable. Objective To identify clinical and radiological findings associated with response to glucocorticoids. Design and methods 12 consecutive patients with AH, evaluated from 2008 to 2016. AH was the exclusion diagnosis after ruling out other pituitary masses and secondary causes of hypophysitis. Mean follow-up time was 30 ± 27 months (range 12–96 months). Results MRI identified two main patterns of presentation: global enlargement of the pituitary gland or panhypophysitis (n = 4, PH), and pituitary stalk abnormality only, or infundibulo-neuro-hypophysitis (n = 8, INH). Multiple tropin defects were more common in PH (100%) than those in INH (28% P = 0.014), whereas diabetes insipidus was more common in INH (100%) than that in PH (50%; P = 0.028). All 4 PH and 4 out of 8 INH were treated with glucocorticoids. Pituitary volume significantly reduced in all PH patients (P = 0.012), defective anterior pituitary function recovered only in the two patients without diabetes insipidus (50%) and panhypopituitarism persisted, along with diabetes insipidus, in the remaining 2 (50%). In all INH patients, either treated or untreated, pituitary stalk diameter reduced (P = 0.008) but diabetes insipidus persisted in all. Conclusions Glucocorticoid therapy may improve anterior pituitary function in a subset of patients but has no effect on restoring posterior pituitary function. Diabetes insipidus appears as a negative prognostic factor for response to glucocorticoids.

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Anterior pituitary function and computed tomography/magnetic resonance imaging in patients with langerhans cell histiocytosis and diabetes insipidus

Medical and Pediatric Oncology ◽

10.1002/mpo.2950210908 ◽

1993 ◽

Vol 21 (9) ◽

pp. 649-654 ◽

Cited By ~ 35

Author(s):

Valerie Broadbent ◽

David B. Dunger ◽

Elizabeth Yeomans ◽

Brian Kendall

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Langerhans Cell Histiocytosis ◽

Langerhans Cell ◽

Pituitary Function ◽

Resonance Imaging ◽

Anterior Pituitary Function

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Meningoencephalitis Complicated by Pituitary Insufficiency and a Spontaneously Resolving Suprasellar Mass

Neurosurgery ◽

10.1227/00006123-198405000-00008 ◽

1984 ◽

Vol 14 (5) ◽

pp. 567-569 ◽

Cited By ~ 7

Author(s):

Katherine Jew ◽

Veronica Piziak ◽

Paul F. Gilliland ◽

Douglas L. Hurley

Keyword(s):

Antibiotic Therapy ◽

Diabetes Insipidus ◽

Anterior Pituitary ◽

Pituitary Function ◽

Pituitary Insufficiency ◽

Posterior Pituitary ◽

Bacterial Origin ◽

Anterior Pituitary Function

Abstract A 53-year-old woman presented with acute meningoencephalitis associated with anterior and posterior pituitary insufficiency. A computed axial tomogram (CT) of the head revealed a suprasellar mass. The meningoencephalitis, presumably of bacterial origin, resolved after antibiotic therapy and, on a repeat CT, the suprasellar mass had disappeared. Five months after the initial illness, the patient's diabetes insipidus had resolved, anterior pituitary function had improved, and there was no sign of the suprasellar mass. The presence of a suprasellar mass in conjunction with acute meningoencephalitis and anterior and posterior pituitary insufficiency should raise the suspicion that the mass is not neoplastic and may be infectious or inflammatory in origin.

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Surgical treatment of craniopharyngiomas. Part II. Endocrine results

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.6.6 ◽

1997 ◽

Vol 3 (6) ◽

pp. E5 ◽

Cited By ~ 3

Author(s):

Jürgen Honegger ◽

Michael Buchfelder ◽

Rudolf Fahlbusch

Keyword(s):

Diabetes Insipidus ◽

Anterior Pituitary ◽

Complete Removal ◽

Complete Recovery ◽

Pituitary Function ◽

Pituitary Stalk ◽

Primary Surgery ◽

Anterior Pituitary Function ◽

Endocrine Axis

This study aimed to elucidate the endocrine outcome of craniopharyngioma surgery. In particular, endocrine results were analyzed in relation to the surgical approach. The study includes 161 patients who underwent pre- and postoperative endocrine assessment, 143 of whom had not previously undergone surgery. Diabetes insipidus was the most common postoperative deficiency in both the transcranial and transsphenoidal groups. In the case of primary surgery (surgery as initial therapy), the overall percentage of patients with diabetes insipidus increased from 16.1% preoperatively to 59.4% postoperatively. After transcranial surgery, the rate of anterior pituitary deficiency also increased. However, normal preoperative anterior pituitary function was maintained in more than 50% of patients for each endocrine axis. Similar results were attained in the group of patients undergoing complete tumor removal. The best result was achieved for gonadal function: the incidence of hypogonadism increased only slightly from 77.4 to 79.8%. During transsphenoidal surgery, anterior pituitary function was generally preserved. An additional deficient axis was encountered postoperatively in only four (11.4%) of 35 primary surgery cases. Endocrine results were not inferior in patients with a ventrally displaced pituitary. This variant required midline incision of the gland for exposure of the craniopharyngioma. Panhypopituitarism was encountered in only one of eight patients in whom the pituitary stalk was partially resected because of tumor infiltration. None of the 88 patients who remained recurrence-free demonstrated endocrine deterioration during follow-up review, compared with the early postoperative assessment 3 months postsurgery. On the other hand, complete recovery of one endocrine axis was observed in nine of these patients during later follow-up evaluations. In five of them, diabetes insipidus had regressed. The authors conclude that it is worth preserving the pituitary stalk and gland at surgery because anterior pituitary function is more often maintained than is generally believed. Postoperative diabetes insipidus must be accepted as a consequence of complete removal of the pituitary. However, pituitary function may recover and diabetes insipidus in particular may abate with time.

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