SERUM PROLACTIN IN PATIENTS WITH "FUNCTIONLESS" CHROMOPHOBE ADENOMAS BEFORE AND AFTER THERAPY

1977 ◽  
Vol 84 (3) ◽  
pp. 449-460 ◽  
Author(s):  
N. A. Samaan ◽  
M. E. Leavens ◽  
J. H. Jesse
Keyword(s):  
Hormone Replacement ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Pituitary Function ◽  
Serum Prolactin ◽  
Before And After

ABSTRACT The immunoreactive serum human prolactin (PRL) level was measured before and after intravenous administration of 500 μg of thyrotrophinreleasing hormone (TRH) in 11 patients with "functionless" chromophobe adenomas before and after surgery and after radiotherapy in 6 of these patients. The results were compared to other pituitary function tests. Two of the patients studied had recurrent disease after previous pituitary surgery and radiotherapy. Five patients had pituitary surgery through the transfrontal route, while 6 had adenoma removal via the transnasal transsphenoidal route. Before surgery, the serum PRL concentration was abnormally high in 4 patients, before and after TRH administration. It was normal in 6 and subnormal in 1 patient who had had previous therapy. Two of the patients studied showed high serum thyroid-stimulating hormone (TSH) levels in the presence of low serum T3 and T4 suggesting primary hypothyroidism with a secondary TSH-producing pituitary tumour. After surgery all patients showed a significant decrease of the serum PRL level. This contrasts with more variable results in the measurements of other pituitary hormones. Post-operative radiotherapy produced no significant additional change in serum PRL levels in 5 of the 6 patients measured 6 months to 4 years after radiotherapy. Five of the 6 patients who had adenoma removed via the transsphenoidal route required no cortisol replacement and 4 remained euthyroid, whereas all 5 patients after transfrontal surgery required both cortisol and thyroid hormone replacement. These results indicate: (1) that measurement of serum PRL levels at basal and after TRH administration in patients with "functionless" chromophobe adenomas before and after treatment may be the best index for evaluating the effect of therapy; (2) that adenoma removal may be followed by preservation of normal pituitary function, but this is more likely to occur if the transsphenoidal approach is used; and (3) that primary thyroid insufficiency may be associated with a pituitary adenoma.

scholarly journals Isolated Adrenocorticotropic Hormone Deficiency Accompanied by Impaired Cognitive Function: A Case Report

2021 ◽  
Author(s):  
ATSUKO IKENOUCHI ◽  
Issei Seki ◽  
Naomichi Okamoto ◽  
Yuki Konishi ◽  
Reiji Yoshimura
Keyword(s):  
Cognitive Functions ◽  
Adrenocorticotropic Hormone ◽  
Psychiatric Symptoms ◽  
Hormone Replacement ◽  
Adjustment Disorder ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Physical Treatment

Abstract Background: Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is an adrenal insufficiency caused by a decrease in ACTH alone among the anterior pituitary hormones. IAD is often overlooked because it causes nonspecific symptoms. We report a case of IAD diagnosed after the appearance of mild cognitive impairment (MCI).Case presentation: Our department was consulted on a case of a 46-year-old man for whom dementia was suspected because he was speaking incoherently, wiped his nose with his hands and showed mild brain atrophy on MRI. He was previously diagnosed with some psychiatric diseases, such as narcolepsy and adjustment disorder. He could not continue working due to somnolence, general fatigue and appetite loss. At the examination, he had difficulty concentrating and sustaining attention, exhibited restlessness, and scored 25 points on the Mini Mental State Examination-Japanese (MMSE-J); MCI was observed. Blood tests showed decreased ACTH, cortisol and free thyroxine and increased thyroid-stimulating hormone levels. He received further evaluation, and he was diagnosed with IAD and primary hypothyroidism. Hydrocortisone (15 mg) was started, after which his physical problems and his difficulty concentrating disappeared. His MMSE-J score also increased to 30. His cognitive functions completely recovered. He returned to work and continued to work stably.Conclusion: This patient was diagnosed with IAD and treated with adrenocortical hormone replacement therapy. His cognitive functions recovered, his physical and mental disorders were alleviated, and he returned to society. It is important not to miss neurological and psychiatric symptoms that can be cured by physical treatment.

Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

2021 ◽  
Vol 4 (1) ◽  
pp. 54-59
Author(s):  
Olutomiwa Omokore ◽  
Nwachukwu Nwachukwu ◽  
Oreoluwa Fuwape ◽  
Adetomilayo Arijeniwa ◽  
Abiola Adekoya ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Elevated Serum ◽  
Signs And Symptoms ◽  
Symptomatic Improvement ◽  
Thyroid Stimulating Hormone ◽  
Pharmacological Therapy ◽  
Primary Hypothyroidism ◽  
Serum Prolactin ◽  
Low Mood ◽  
Hormonal Assay

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism.

Van Wyk-Grumbach syndrome with hemangioma in an infant

2018 ◽  
Vol 31 (9) ◽  
pp. 1057-1060
Author(s):  
Moumita Biswas ◽  
Malay Kumar Sinha ◽  
Mrinal Kanti Das ◽  
Sumantra Sarkar
Keyword(s):  
Thyroid Hormone ◽  
Congenital Hypothyroidism ◽  
Hormone Replacement ◽  
Signs And Symptoms ◽  
Bone Age ◽  
Infantile Hemangioma ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Thyroid Hormone Replacement

Abstract Background Van Wyk-Grumbach syndrome (VWGS) is characterized by juvenile primary hypothyroidism, delayed bone age and isosexual incomplete precocious puberty with reversal to the prepubertal state following thyroid hormone replacement. Case presentation In this case, an 18-month-old girl presented with premature menarche since 9 months of age, delayed bone age and enlarged bilateral multicystic ovaries along with a superficial infantile hemangioma over the upper anterior chest. VWGS was diagnosed based on the clinical features. High serum thyroid stimulating hormone and low free thyroxine with the absence of any carpal bones in the wrist X-ray were suggestive of congenital hypothyroidism. Interestingly, the coexisting hemangioma could also play a role in the etiology of the hypothyroidism through “consumptive hypothyroidism”. Thyroid hormone replacement resulted in the complete resolution of signs and symptoms. Conclusions Untreated congenital hypothyroidism of short duration, onset of symptoms in infancy and association of an infantile hemangioma in VWGS were the unique features in our case.

scholarly journals The pre- and postoperative illness trajectory in patients with pituitary tumours

2019 ◽  
Vol 8 (7) ◽  
pp. 878-886 ◽  
Author(s):  
Eva Jakobsson Ung ◽  
Ann-Charlotte Olofsson ◽  
Ida Björkman ◽  
Tobias Hallén ◽  
Daniel S Olsson ◽  
...  
Keyword(s):  
Postoperative Care ◽  
Care Pathway ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Postoperative Recovery ◽  
Endocrine Treatment ◽  
Pituitary Tumours ◽  
Care And Support ◽  
Before And After ◽  
Operative Evaluation

Objective Experiences and need of support during surgery and start of replacement therapy in patients with pituitary tumours are highly unknown. This study aimed at exploring patient experiences during pre- and postoperative care and recovery after pituitary surgery in patients with a pituitary tumour. Methods Within a qualitative study design, 16 consecutive patients who underwent surgery for pituitary tumours were repeatedly interviewed. In total, 42 interviews were performed before and after surgery. Analysis was performed using qualitative interpretation. Results Suffering a pituitary tumour was overwhelming for many patients and struggling with existential issues was common. Patients expressed loneliness and vulnerability before and after surgery. How professionals handled information in connection with diagnosis greatly affected the patients. Other patients with the same diagnosis were experienced as the greatest support. Normalisation of bodily symptoms and relationships with others were reported during postoperative recovery. However, a fear that the tumour would return was present. Conclusions Patients with pituitary tumours need structured support, including peer support, which acknowledges physical, cognitive as well as emotional and existential concerns. Information related to diagnosis and surgery should be adapted in relation to the loneliness and the existential seriousness of the situation. Care and support for patients with pituitary tumours should preferably be organised based on continuity and an unbroken care pathway from the first pre-operative evaluation through to postoperative care and the start of a life-long endocrine treatment and tumour surveillance.

scholarly journals Persistence of hyperprolactinemia after treatment of primary hypothyroidism and withdrawal of long term use of estrogen: are the tuberoinfundibular dopaminergic neurons permanently lesioned?

2005 ◽  
Vol 49 (3) ◽  
pp. 468-472 ◽  
Author(s):  
Luiz Augusto Casulari ◽  
Fábio Celotti ◽  
Luciana A. Naves ◽  
Lucília Domingues ◽  
Carla Papadia
Keyword(s):  
Dopaminergic Neurons ◽  
Hormone Replacement ◽  
Hormonal Contraceptive ◽  
Primary Hypothyroidism ◽  
Trh Test ◽  
Pituitary Mass ◽  
Thyroid Hormone Replacement ◽  
Before And After ◽  
High Doses

Long term use of high doses of estrogen and the presence of chronic hyperprolactinemia may, at least in the rat, provoke lesions in the tuberoinfundibular dopaminergic (TIDA) neurons responsible for the control of prolactin (Prl) secretion. This occurrence, which is not yet well documented in humans, may have taken place in a patient on chronic oral hormonal contraceptive (OC) treatment who was seen for primary hypothyroidism, hyperprolactinemia and a pituitary mass. After thyroid hormone replacement, OC withdrawn and bromocriptine treatment, this patient could not maintain normal Prl levels, unless continuously treated with a dopaminergic agonist even when MRI was indicative of a normal situation. Function of TIDA neurons was investigated by TRH test (200µg IV) performed before and after treatment with 25mg carbidopa plus 250mg L-dopa every 4 hours for one day. Basal TSH was normal (3.9µU/mL) whereas basal Prl was high (67.5 ng/mL); both TSH and Prl levels appropriately increased after TRH: peaks 31.8µU/mL and 157.8 ng/mL, respectively. After treatment with carbidopa/L-dopa, basal TSH (1.6µU/mL) and Prl (34ng/mL) decreased and the response to TRH was partially blocked (10.3µU/mL and 61ng/mL, respectively). In spite of a normal response, we discuss the possibility that the persistence of hyperprolactinemia is due to lesion of the TIDA neurons produced by the long term use of high doses of estrogens and by the presence of chronic hyperprolactinemia.

EFFECT OF THYROTROPHIN RELEASING HORMONE (TRH) IN PATIENTS WITH PITUITARY DISORDERS

1977 ◽  
Vol 85 (3) ◽  
pp. 479-487 ◽  
Author(s):  
J. Lindholm ◽  
H. Dige-Petersen ◽  
L. Hummer ◽  
P. Rasmussen ◽  
O. Korsgaard
Keyword(s):  
Pituitary Tumour ◽  
Thyroid Stimulating Hormone ◽  
Trh Test ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
Basal Serum ◽  
Chromophobe Adenoma ◽  
Before And After ◽  
Hypothyroid Patients ◽  
Serum Tsh

ABSTRACT The secretion and biological activity of thyroid stimulating hormone (TSH) were studied in 22 patients with a pituitary tumour (17 acromegalics and 5 patients with a chromophobe adenoma) and in 36 hypophysectomized patients (16 acromegalics and 20 with a chromophobe adenoma). Thyroid function was assessed by serum thyroxine (T4), serum triiodothyronine (T3), and thyroxine-binding globulin (TBG) concentration. Serum TSH was measured before and after injection of TSH releasing hormone (TRH), and in 19 hypophysectomized patients the T3 response after TRH was measured. In addition a TRH test was performed 1–2 weeks after surgery in 11 patients. The basal serum TSH did not differ from euthyroid control values in any of the groups and no late effect of hypophysectomy was observed. Subnormal peak TSH values were seen in 10 out of 37 euthyroid patients, whereas 9 out of 11 hypothyroid patients responded normally. Hypophysectomy caused an immediate but transient decrease in peak TSH in patients with a chromophobe adenoma only. The rise in serum T3 after TRH was significantly lower in hypophysectomized patients than in controls. An increase in TSH was followed by a T3 response in all patients except in 4 out of 8 euthyroid acromegalics. In patients operated on for a chromophobe adenoma the T3 response was correlated with serum T4, whereas this was not the case in acromegalics.

The clinical and biochemical features in 26 patients with prolactinoma before and after transsphenoidal microresection

1980 ◽  
Vol 94 (4) ◽  
pp. 450-458 ◽  
Author(s):  
Naguib A. Samaan ◽  
George E. Elhaj ◽  
Milam E. Leavens ◽  
Robert R. Franklin
Keyword(s):  
Luteinizing Hormone ◽  
High Serum ◽  
Serum Prolactin ◽  
Plasma Testosterone ◽  
Pituitary Fossa ◽  
Thyrotrophin Releasing Hormone ◽  
Releasing Hormone ◽  
Serum Luteinizing Hormone ◽  
Before And After ◽  
The Difference

Abstract. Twenty-six women, 16 to 40 years of age, with amenorrhoea with or without galactorrhoea and abnormal pituitary fossa tomogram were studied before and after transsphenoidal resection of their pituitary adenomas. The immunoreactive serum prolactin (Prl) was abnormally high both before and after intravenous (iv) administration of thyrotrophin-releasing hormone (TRH) but the rise was blunted. The serum Prl level returned to normal post-operatively in 20 patients, but the subnormal rise after TRH persisted in 23 patients. The basal serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were normal before and after surgery. The peak serum level of LH after administration of the luteinizing hormone-releasing hormone (LRH) was normal but the peak FSH was significantly high before surgery (P < 0.001) and returned to normal post-operatively. Plasma oestradiol (Oe2) was significantly low compared to that after surgery (P < 0.001). Plasma testosterone (T) was significantly higher before surgery than that found in normal women (P < 0.001) and the level fell post-operatively. Plasma androstenedione (A) was higher before surgery than found in normals, but the difference was not significant (P < 0.2). Post-operatively, 23 patients regained their normal menses. Three of these 23 patients continued to have high serum Prl but the serum Oe2 returned to normal. Sixteen of 20 patients who desired pregnancy became pregnant post-operatively. None of the patients required hormonal replacement after surgery. These data indicate that the measurement of LH or FSH at basal and after LRH stimulation, may not be of significant prognostic importance compared with serum Prl and plasma Oe2. Regular menses and pregnancy can occur in some patients in spite of moderately high serum Prl but normal plasma Oe2 levels. Surgical resection of prolactinoma has low morbidity with a high incidence of success resulting in return of normal menses and fertility. The persistent subnormal rise of Prl after TRH post-operatively in the majority of the patients suggests that long-term follow-up for evidence of recurrence is indicated.

Autoimmune Hypothyroidism Coexisting with a Pituitary Adenoma Secreting Thyroid-Stimulating Hormone, Prolactin and α-Subunit

2001 ◽  
Vol 38 (5) ◽  
pp. 566-571 ◽  
Author(s):  
Jyothi M Idiculla ◽  
Geoff Beckett ◽  
Patrick F X Statham ◽  
James W Ironside ◽  
Stephen L Atkin ◽  
...  
Keyword(s):  
Anterior Pituitary ◽  
Elevated Serum ◽  
Pituitary Tumour ◽  
Thyroid Stimulating Hormone ◽  
Serum Prolactin ◽  
Residual Tumour ◽  
Mri Scan ◽  
Α Subunit ◽  
Autoimmune Hypothyroidism ◽  
Stimulating Hormone

A 44-year-old woman presented to her GP with excessive tiredness. She had positive thyroid microsomal and thyroglobulin autoantibodies and was found to have an elevated serum thyroid-stimulating hormone (TSH) concentration of 8.37 (normal = 0·15–3·5) mU/L and a low normal total thyroxine (T4) of 86 (reference range 60–145) nmol/L. She was rendered symptom free on a dose of 150μg of thyroxine per day. However, her TSH failed to return to normal, and following a further increase in her thyroxine dose she was referred to the endocrine clinic for further assessment. Her TSH at this stage was 14mU/L, free T4 (fT4) 28 (normal = 10–27) pmol/L and free T3 (fT3) 10 (normal = 4·3–7·6) pmol/L. She denied any problems with adherence to her medication. Her serum prolactin was elevated at 861 (normal = 60–390) mU/L. A pituitary tumour was suspected and an MRI scan showed a macroadenoma of the right lobe of the pituitary, extending into the suprasellar cistern. The tumour was resected trans-sphenoidally. Electron microscopy showed a dual population of neoplastic cells compatible with a thyrotroph cell and prolactin-secreting adenoma. Immunocytochemistry and cell culture studies confirmed the secretion of TSH, prolactin and α-subunit. Postoperative combined anterior pituitary function tests did not demonstrate any deficiency of anterior pituitary hormones. A repeat MRI scan showed no significant residual tumour; however, her serum TSH and prolactin levels remained high and she was given a course of pituitary irradiation. This case illustrates the difficulty of diagnosing a TSHoma when it coexists with autoimmune hypothyroidism. We believe the combination of pathologies reported here is unique.

SOMATOTROPHIC AND CORTICOTROPHIC FUNCTIONS IN PRIMARY HYPOTHYROIDISM BEFORE AND AFTER THYROXINE TREATMENT

1973 ◽  
Vol 74 (3) ◽  
pp. 483-491 ◽  
Author(s):  
M. Minozzi ◽  
M. Faggiano ◽  
G. Lombardi ◽  
C. Carella ◽  
T. Criscuolo ◽  
...  
Keyword(s):  
Primary Hypothyroidism ◽  
Pituitary Function ◽  
Plasma Acth ◽  
Arginine Infusion ◽  
Hypothalamic Pituitary Adrenal ◽  
Thyroxine Treatment ◽  
Before And After ◽  
Pituitary Adrenal Axis ◽  
Different Levels ◽  
Multiple Interference

ABSTRACT In 12 patients with primary hypothyroidism the somatotrophic and corticotrophic functions were evaluated before and after thyroxine treatment. The results confirm a significant decrease, reversible by treatment, of plasma HGH responses to insulin-induced hypoglycaemia and to arginine infusion. Moreover, the results indicate that the impairment of the hypothalamic-pituitary function may also involve the response of plasma ACTH after provocative tests (insulin-induced hypoglycaemia and metyrapone). It must be stressed that the impairment of the corticotrophic function can be revealed only when the responses to provocative tests are evaluated by a direct assay of plasma ACTH and not by plasma corticosteroid modifications. These different responses may account for the conflicting results obtained by other investigators and may be justified by the multiple interference of the thyroid deficiency with the hypothalamic-pituitary-adrenal axis at different levels.

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