scholarly journals Pituitary Metastasis Presenting With Central Diabetes Insipidus and Panhypopituitarism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A601-A601
Author(s):  
Donna Lee ◽  
Preeti Kishore
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Reference Range ◽  
Anterior Lobe ◽  
Central Diabetes Insipidus ◽  
Axillary Lymph ◽  
Posterior Lobe ◽  
Primary Tumors ◽  
Laboratory Results ◽  
Metastatic Involvement

Abstract Background: Metastatic involvement of the pituitary gland and infundibular stalk is rare, accounting for about 2% of all diagnosed pituitary masses. Although primary tumors from almost every organ have been reported, breast and lung cancers are the most common primary tumors to metastasize to the pituitary gland. The clinical presentation varies and can include headache, visual impairment, diabetes insipidus, and panhypopituitarism. The posterior lobe of the pituitary is more susceptible to metastatic involvement than the anterior lobe due to its direct blood supply from the systemic circulation, whereas the anterior lobe is supplied by the hypophyseal portal system. Additionally, the smaller posterior lobe can be destroyed with less metastatic volume, allowing for earlier manifestation of symptoms. Clinical Case: An 81-year-old woman with a history of Stage IIA ER+ IDC of the left breast status post lumpectomy and axillary lymph node dissection in 1999 followed by mastectomy in 2009 due to local recurrence presented with confusion for two weeks. At the time, she had known lung metastases and was on palliative chemotherapy. CT head showed a 1.8 cm and 2.3 cm calvarial lytic lesion in the right occipital bone and at the vertex, respectively. MRI brain/pituitary revealed a well-circumscribed, enhancing suprasellar mass measuring 9 x 10 mm likely involving the pituitary infundibulum and hypothalamus with mass effect on the optic chiasm. Laboratory results were consistent with secondary adrenal insufficiency, central hypothyroidism, and hypogonadotropic hypogonadism. Prolactin was mildly elevated due to stalk effect. The patient also had hypernatremia and inappropriately low urine osmolality, which nearly tripled after administration of desmopressin, confirming central diabetes insipidus. She was subsequently started on hydrocortisone, levothyroxine, and desmopressin. Laboratory Results: Prolactin 30.47 (reference range 4.79-23.3 mIU/mL), IGF-1 88 (17-193 ng/mL), 7am ACTH 3.4 (7.2-63.3 pg/mL), 7am cortisol 0.6 (6.2-29 µg/dL), TSH 3.03 (0.47-6.9 U/L), FT4 0.351 (0.75-2 ng/dL), FSH 0.2 (25.8-134.8 mIU/mL), LH <0.1 (7.7-58.5 mIU/mL), estradiol <5 (5-138 pg/mL); before desmopressin: Na 154 (reference range 135-145 mEq/L), urine osm 162 (50-1,200 mOsm/kg); after desmopressin: Na 143 (reference range 135-145 mEq/L), urine osm 469 (50-1,200 mOsm/kg) Conclusion: While pituitary metastases remain rare, their prevalence is expected to increase due to more sensitive biochemical tests and imaging techniques coupled with advances in cancer therapy that help patients with metastatic disease live longer. Interesting in our case is the patient’s age, which is significantly older than the median age reported in the literature, and her presentation with total anterior and posterior pituitary insufficiency after a prolonged oncologic course marked by progression of disease.

scholarly journals Metastatic Prostate Adenocarcinoma Presenting Central Diabetes Insipidus

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Hakkı Yılmaz ◽  
Mustafa Kaya ◽  
Mücteba Can ◽  
Mustafa Özbek ◽  
Bahir Keyik
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Fungal Infections ◽  
Anterior Lobe ◽  
Sudden Onset ◽  
Central Diabetes Insipidus ◽  
Electrolyte Imbalance ◽  
Posterior Lobe ◽  
Pituitary Metastases ◽  
Magnetic Resonance Imaging Mri

The pituitary gland and infundibulum can be involved in a variety of medical conditions, including infiltrative diseases, fungal infections, tuberculosis, and primary and metastatic tumors. Metastases to the pituitary gland are absolutely rare, and they are generally secondary to pulmonary carcinoma in men and breast carcinoma in women. Pituitary metastases more commonly affect the posterior lobe and the infundibulum than the anterior lobe. The posterior lobe involvement may explain why patients with pituitary metastases frequently present with diabetes insipidus. We are presenting a case report of a 78-year-old male patient who had metastatic prostate with sudden onset of polyuria and persistent thirst. He had no electrolyte imbalance except mild hypernatremia. The MRI scan of the brain yielded a suspicious area in pituitary gland. A pituitary stalk metastasis was found on magnetic resonance imaging (MRI) of pituitary. Water deprivation test was compatible with DI. A clinical response to nasal vasopressin was achieved and laboratory results revealed central diabetes insipidus. As a result, the intrasellar and suprasellar masses decreased in size, and urinary output accordingly decreased.

On the content of prolan in the pituitary gland

1934 ◽  
Vol 30 (6) ◽  
pp. 634-634
Author(s):  
P. Badul
Keyword(s):  
Pituitary Gland ◽  
Histological Examination ◽  
Anterior Lobe ◽  
Posterior Lobe ◽  
Posterior Pituitary ◽  
Posterior Pituitary Lobe

The posterior lobe of the pituitary gland in a bull is free of prolan, while in a human it contains prolan. Only here it can be found in that part of the posterior pituitary lobe adjacent to the anterior lobe. In the bull, too, this part of the pituitary gland is completely free of prolan content. Histological examination shows that in humans, this part of the posterior lobe is crossed by bands of cells from the anterior lobe, which consist exclusively of basophilic cells.

scholarly journals Immunocytochemical demonstration of tissue-type plasminogen activator in endocrine cells of the rat pituitary gland.

1985 ◽  
Vol 101 (1) ◽  
pp. 305-311 ◽  
Author(s):  
P Kristensen ◽  
L S Nielsen ◽  
J Grøndahl-Hansen ◽  
P B Andresen ◽  
L I Larsson ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Gland ◽  
Endocrine Cells ◽  
Large Population ◽  
Cell Types ◽  
Anterior Lobe ◽  
Tissue Type ◽  
Intermediate Lobe ◽  
Posterior Lobe ◽  
Rat Pituitary

We immunocytochemically stained rat pituitary glands using antibodies against plasminogen activators of the tissue type (t-PA) and the urokinase type (u-PA). A large population of endocrine cells in the anterior lobe of the gland displayed intense cytoplasmic immunoreactivity with anti-t-PA. In some areas of the intermediate lobe we found a weak staining, and we observed weakly staining granular structures in the posterior lobe. Controls included absorption of the antibodies with highly purified t-PA. In addition, SDS PAGE followed by immunoblotting of pituitary gland extracts revealed only one band with an electrophoretic mobility similar to that of t-PA when stained with anti-t-PA IgG. No u-PA immunoreactivity was detected in the rat pituitary gland. Sequential staining experiments using antibodies against growth hormone and t-PA demonstrated that the t-PA-immunoreactive cells constitute a large subpopulation of the growth hormone-containing cells. These findings represent the first direct evidence for the presence of t-PA in cell types other than endothelial cells in the intact normal organism. In this article we discuss the implications of the results for a possible role of t-PA in the posttranslational processing of prohormones.

VASOPRESSOR AND OXYTOCIC ACTIVITIES IN HUMAN HYPOTHALAMUS, POSTERIOR AND ANTERIOR LOBES OF THE PITUITARY GLAND

1965 ◽  
Vol 48 (2) ◽  
pp. 177-185 ◽  
Author(s):  
L. Barnafi ◽  
H. Croxatto
Keyword(s):  
Sex Differences ◽  
Pituitary Gland ◽  
Individual Variation ◽  
Pathological Condition ◽  
Anterior Lobe ◽  
Posterior Lobe ◽  
Hormonal Activity ◽  
Human Hypothalamus ◽  
Vasopressor Activity

ABSTRACT The distribution and individual variation of vasopressor and oxytocic activities in the hypothalamus, posterior and anterior lobe of the pituitary gland of 13 women and 15 men were studied. The results showed great individual variation of vasopressor and oxytocic activities in the posterior and anterior lobes, whereas in the hypothalamus a relatively constant hormonal activity was found. No significant sex differences were noted with respect to the content of the vasopressor and oxytocic activities in the hypothalamus and posterior lobe. In the anterior lobe of the female, a higher vasopressor activity was found than in males. No relationship could be established between the distribution of these activities and the pathological condition preceding death.

scholarly journals Causes and Follow-Up of Central Diabetes Insipidus in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Wendong Liu ◽  
Jing Hou ◽  
Xiuqin Liu ◽  
Limin Wang ◽  
Guimei Li
Keyword(s):  
Diabetes Insipidus ◽  
Signal Intensity ◽  
Central Diabetes Insipidus ◽  
Pituitary Stalk ◽  
Control Group ◽  
Pituitary Hormone ◽  
Posterior Lobe ◽  
Healthy Children ◽  
Posterior Pituitary ◽  
Urine Testing

Objective. To identify the causes of central diabetes insipidus (CDI) by evaluating the values of magnetic resonance imaging (MRI) in the diagnosis of pediatric CDI, providing evidence for the clinical diagnosis and treatment of CDI. Methods. Seventy-nine patients with CDI (CDI group) hospitalized from July 2012 to March 2017 and 43 healthy children (control group) were enrolled in this study. All cases underwent MRI examination including T1-weighted three-dimensional magnetization-prepared rapid gradient-echo (T1WI-3D-MP RAGE) imaging sequences. The pituitary volume, the signal intensity of posterior pituitary, and the morphology of pituitary stalk were measured between two groups. The medical history, urine testing, imaging of hypothalamic-pituitary region, and hormone levels were also recorded. Results. Age and gender were matched between the CDI and control groups. The height and BMI in the CDI group were less and the urine volume in 24 h was higher than those in the control group. The signal intensity of the posterior pituitary was higher in the control group, whereas the pituitary volume was smaller in the CDI group. In the CDI group, 44 cases presented with morphological changes of the pituitary stalk. Clinical symptoms mainly included polydipsia, polyuria, short stature, and vomiting. All patients were confirmed by water deprivation vasopressin test. Forty-four CDI children were associated with hypopituitarism, including 33 cases of PSIS with multiple pituitary hormone deficiencies (MPHD) and 11 cases of growth hormone deficiency (IGHD). The pituitary volume in the cases of pituitary stalk interruption syndrome (PSIS) with MPHD was smaller than that in the IGHD patients. Conclusions. The signal intensity ratio of the posterior lobe, pituitary volume, and the morphology of pituitary stalk on T1WI-3D-MP RAGE image contribute to the diagnosis of CDI.

scholarly journals A case of central diabetes insipidus associated with a congenital cyst of the sella turcica in a young cat

2020 ◽  
Vol 6 (2) ◽  
pp. 205511692093501
Author(s):  
Cyril Duperrier ◽  
Marion Fusellier ◽  
Hendrik Lenaerts ◽  
Amandine Drut ◽  
Juan Hernandez
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Brain Mri ◽  
Previous History ◽  
Sella Turcica ◽  
Plasma Osmolality ◽  
Central Diabetes Insipidus ◽  
Cns Lymphoma ◽  
First Case ◽  
Pituitary Cyst

Case summary A 1-year-old neutered male domestic shorthair cat was presented for polyuria and polydipsia which had progressed since adoption, 7 months previously. On admission, clinical examination did not reveal any remarkable features. Urinalysis showed marked hyposthenuria and calculated plasma osmolality was high, suggesting diabetes insipidus. A positive response to desmopressin administration appeared to confirm pituitary dysfunction. Brain MRI revealed a lesion compatible with a cyst or a neoplasm compressing the pituitary gland. A follow-up MRI performed 9 months later showed that the lesion was stable, which at first argued in favour of a congenital pituitary cyst. Intranasal administration of desmopressin was then used to achieve a long-term clinical response. Relevance and novel information Central diabetes insipidus (CDI) is a rare cause of polyuria and polydipsia in cats, resulting from inadequate or impaired secretion of antidiuretic hormone from the posterior pituitary gland. Recognised causes include head trauma, central nervous system (CNS) neoplasia, idiopathic CDI and congenital pituitary cysts. Apart from one cat with CNS lymphoma, the few previously reported feline cases have described CDI in young cats with a previous history of trauma, but brain imaging has rarely been performed to look for underlying anatomical abnormalities. This report describes the first case of CDI in a cat with a confirmed congenital pituitary cyst and, as in previous cases, demonstrates successful treatment with desmopressin.

Endocrine Outcomes In Central Diabetes Insipidus: the Predictive Value of Neuroimaging “Mismatch Pattern”

2020 ◽  
Vol 105 (11) ◽  
Author(s):  
Deborah Bianco ◽  
Flavia Napoli ◽  
Giovanni Morana ◽  
Angela Pistorio ◽  
Anna Elsa Maria Allegri ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Contrast Enhancement ◽  
Anterior Pituitary ◽  
Magnetic Resonance Images ◽  
Central Diabetes Insipidus ◽  
Pituitary Hormone ◽  
Gland Size ◽  
Pituitary Dysfunction

Abstract Context The etiology of central diabetes insipidus (CDI) in children is often unknown. Clinical and radiological features at disease onset do not allow discrimination between idiopathic forms and other conditions or to predict anterior pituitary dysfunction. Objective To evaluate the evolution of pituitary stalk (PS) thickening and the pattern of contrast-enhancement in relation with etiological diagnosis and pituitary function. Methods We enrolled 39 children with CDI, 29 idiopathic and 10 with Langerhans cell histiocytosis (LCH). Brain magnetic resonance images taken at admission and during follow-up (332 studies) were examined, focusing on PS thickness, contrast-enhancement pattern, and pituitary gland size; T2-DRIVE and postcontrast T1-weighted images were analyzed. Results Seventeen of 29 patients (58.6%) with idiopathic CDI displayed “mismatch pattern,” consisting in a discrepancy between PS thickness in T2-DRIVE and postcontrast T1-weighted images; neuroimaging findings became stable after its appearance, while “mismatch” appeared in LCH patients after chemotherapy. Patients with larger PS displayed mismatch more frequently (P = 0.003); in these patients, reduction of proximal and middle PS size was documented over time (P = 0.045 and P = 0.006). The pituitary gland was smaller in patients with mismatch (P < 0.0001). Patients with mismatch presented more frequently with at least one pituitary hormone defect, more often growth hormone deficiency (P = 0.033). Conclusions The PS mismatch pattern characterizes patients with CDI, reduced pituitary gland size, and anterior pituitary dysfunction. The association of mismatch pattern with specific underlying conditions needs further investigation. As patients with mismatch show stabilization of PS size, we assume a prognostic role of this peculiar pattern, which could be used to lead follow-up.

scholarly journals Hes1 and Hes5 Control the Progenitor Pool, Intermediate Lobe Specification, and Posterior Lobe Formation in the Pituitary Development

2007 ◽  
Vol 21 (6) ◽  
pp. 1458-1466 ◽  
Author(s):  
Aya Kita ◽  
Itaru Imayoshi ◽  
Masato Hojo ◽  
Masashi Kitagawa ◽  
Hiroshi Kokubu ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Progenitor Cells ◽  
Anterior Lobe ◽  
Intermediate Lobe ◽  
Posterior Lobe ◽  
Endocrine Organ ◽  
Pituitary Development ◽  
Proliferation And Differentiation ◽  
Pituitary Hypoplasia ◽  
Multiple Signaling

Abstract The pituitary gland is composed of two distinct entities: the adenohypophysis, including the anterior and intermediate lobes, and the neurohypophysis, known as the posterior lobe. This critical endocrine organ is essential for homeostasis, metabolism, reproduction, and growth. The pituitary development requires the control of proliferation and differentiation of progenitor cells. Although multiple signaling molecules and transcription factors are required for the proper pituitary development, the mechanisms that regulate the fate of progenitor cells remain to be elucidated. Hes genes, known as Notch effectors, play a crucial role in specifying cellular fates during the development of various tissues and organs. Here, we report that mice deficient for Hes1 and Hes5 display severe pituitary hypoplasia caused by accelerated differentiation of progenitor cells. In addition, this hypoplastic pituitary gland (adenohypophysis) lacks the intermediate lobe and exhibits the features of the anterior lobe only. Hes1 and Hes5 double-mutant mice also lack the neurohypophysis (the posterior lobe), probably due to incomplete evagination of the diencephalon. Thus, Hes genes control not only maintenance of progenitor cells but also intermediate vs. anterior lobe specification during the adenohypophysis development. Hes genes are also essential for the formation of the neurohypophysis.

scholarly journals Endometrial adenocarcinoma metastatic to the pituitary gland: a case report and literature review

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092451
Author(s):  
Hongquan Du ◽  
Aihua Jia ◽  
Yuan Ren ◽  
Mingyong Gu ◽  
Haomin Li ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Oral Fluid ◽  
Fluid Intake ◽  
Endometrial Adenocarcinoma ◽  
Posterior Lobe ◽  
Laboratory Findings ◽  
Pituitary Metastases ◽  
Pituitary Metastasis

Pituitary metastases are rare, and metastatic pituitary lesions originating from endometrial adenocarcinoma are extremely rare. These lesions can be mistaken for pituitary adenomas and their diagnosis can be very difficult. Pituitary metastases mostly affect the posterior lobe and patients may develop diabetes insipidus. Patients with endometrial cancer complicated with diabetes, including poor glycemic control, may also suffer from thirst, making it more difficult to diagnose diabetes insipidus. A 68-year-old woman who was being followed-up for primary endometrial adenocarcinoma was admitted for gradually worsened polyuria and polydipsia. Her laboratory findings were compatible with diabetes insipidus. Magnetic resonance imaging revealed thickening of the pituitary stalk, involvement of the superior pituitary gland, and disappearance of hyperintensity in the posterior lobe, indicating pituitary metastasis. Increased urine output and oral fluid intake in a patient with a diagnosis of carcinoma may indicate possible pituitary metastasis, and the hormonal insufficiency should be corrected to improve the patient’s quality of life.

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