scholarly journals ESE Clinical Practice Guideline on functioning and nonfunctioning pituitary adenomas in pregnancy

2021 ◽  
Vol 185 (3) ◽  
pp. G1-G33
Author(s):  
A Luger ◽  
L H A Broersen ◽  
N R Biermasz ◽  
B M K Biller ◽  
M Buchfelder ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pituitary Adenomas ◽  
Radiation Treatment ◽  
Therapeutic Option ◽  
Safety Data ◽  
Premenopausal Women ◽  
Optic Chiasm ◽  
Pituitary Hormone ◽  
Hormone Substitution ◽  
Endocrine Activity

Pregnancies are rare in women with pituitary adenomas, which may relate to hormone excess from secretory subtypes such as prolactinomas or corticotroph adenomas. Decreased fertility may also result from pituitary hormone deficiencies due to compression of the gland by large tumours and/or surgical or radiation treatment of the lesion. Counselling premenopausal women with pituitary adenomas about their chance of conceiving spontaneously or with assisted reproductive technology, and the optimal pre-conception treatment, should start at the time of initial diagnosis. The normal physiological changes during pregnancy need to be considered when interpreting endocrine tests in women with pituitary adenomas. Dose adjustments in hormone substitution therapies may be needed across the trimesters. When medical therapy is used for pituitary hormone excess, consideration should be given to the known efficacy and safety data specific to pregnant women for each therapeutic option. In healthy women, pituitary gland size increases during pregnancy. Since some pituitary adenomas also enlarge during pregnancy, there is a risk of visual impairment, especially in women with macroadenomas or tumours near the optic chiasm. Pituitary apoplexy represents a rare acute complication of adenomas requiring surveillance, with surgical intervention needed in some cases. This guideline describes the choice and timing of diagnostic tests and treatments from the pre-conception stage until after delivery, taking into account adenoma size, location and endocrine activity. In most cases, pregnant women with pituitary adenomas should be managed by a multidisciplinary team in a centre specialised in the treatment of such tumours.

scholarly journals Diagnostic Threshold for Postoperative Secondary Adrenal Insufficiency After Transsphenoidal Resection of Pituitary Adenomas

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A626-A626
Author(s):  
Massiell German ◽  
Anu Sharma
Keyword(s):  
Adrenal Insufficiency ◽  
Pituitary Adenomas ◽  
Optic Chiasm ◽  
Pituitary Hormone ◽  
Secondary Adrenal Insufficiency ◽  
Acth Stimulation ◽  
Diagnostic Threshold ◽  
Secondary Hypothyroidism ◽  
Tertiary Center ◽  
Secondary Hypogonadism

Abstract Transsphenoidal surgery (TSS) is the first line treatment for pituitary adenomas. A well-known complication of TSS is secondary adrenal insufficiency with a reported risk of 4-9% after TSS. Currently, glucocorticoid replacement is recommended if postoperative AM cortisol is < 3 ug/dL. Postoperative adrenal insufficiency is ruled out if AM cortisol is > 15 ug/dL. However, further evaluation of the adrenal axis with ACTH stimulation test is recommended for intermediate cortisol levels 3-15 ug/dL. Other studies have proposed postoperative cortisol threshold of < 4-14 ug/dL for glucocorticoid replacement. Retrospective analysis of all patients undergoing TSS at a tertiary center from January 2013 through April 2016 was performed. ACTH producing adenomas (Cushing’s disease) were excluded. Of the 97 patients included, 17.5% (n=17) had secondary adrenal insufficiency requiring glucocorticoid replacement at 1 year post operatively. Mean age at presentation was 56 ± 16 years and 52% were female. Mean adenoma size was 25.3 ± 11.3 mm. Factors associated with adrenal insufficiency at 1 year post operatively were preoperative secondary adrenal insufficiency (AM cortisol 4.5 ± 1.9 vs 11.0 ± 1.0 µg/dL; p = 0.03), and preoperative adenoma contact with optic chiasm (15.7% vs 2.1%; p = 0.01). Day 1-7 postoperative cortisol was lower in the group with adrenal insufficiency at 1 year (5.6 µg/dL (IQR 1.9-11.5) vs 19.8 µg/dL (IQR 12.75-43.2); p=0.02). Age, gender, adenoma size, and cavernous sinus involvement were not associated with adrenal insufficiency at 1 year. A day 1-7 postoperative cortisol concentration of ≥8.0 µg/dL had a sensitivity of 75% and specificity of 92% in predicting adrenal insufficiency at 1 year. In patients with secondary adrenal insufficiency at 1 year (n=17), there was a higher frequency of concomitant loss of other pituitary hormone function at 1 year: secondary hypothyroidism 82% (n=14), secondary hypogonadism 70.6% (n=12) and diabetes insipidus 17.7% (n=3). A lower postoperative cortisol threshold of 8 µg/dL can be adopted for glucocorticoid replacement on discharge after TSS.

scholarly journals Neoadjuvant Degarelix Versus Triptorelin in Premenopausal Patients Who Receive Letrozole for Locally Advanced Endocrine-Responsive Breast Cancer: A Randomized Phase II Trial

2019 ◽  
Vol 37 (5) ◽  
pp. 386-395 ◽  
Author(s):  
Silvia Dellapasqua ◽  
Kathryn P. Gray ◽  
Elisabetta Munzone ◽  
Daniela Rubino ◽  
Lorenzo Gianni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Endocrine Therapy ◽  
Locally Advanced ◽  
Premenopausal Women ◽  
Rank Test ◽  
Neoadjuvant Endocrine Therapy ◽  
Endocrine Activity ◽  
Patient Reported ◽  
Premenopausal Patients ◽  
To Receive

PURPOSE To evaluate endocrine activity in terms of ovarian function suppression (OFS) of degarelix (a gonadotropin-releasing hormone [GnRH] antagonist) versus triptorelin (a GnRH agonist) in premenopausal patients receiving letrozole as neoadjuvant endocrine therapy for breast cancer. PATIENTS AND METHODS Premenopausal women with stage cT2 to 4b, any N, M0; estrogen receptor and progesterone receptor greater than 50%; human epidermal growth factor receptor 2–negative breast cancer were randomly assigned to triptorelin 3.75 mg administered intramuscularly on day 1 of every cycle or degarelix 240 mg administered subcutaneously (SC) on day 1 of cycle 1 then 80 mg SC on day 1 of cycles 2 through 6, both with letrozole 2.5 mg/day for six 28-day cycles. Surgery was performed 2 to 3 weeks after the last injection. Serum was collected at baseline, after 24 and 72 hours, at 7 and 14 days, and then before injections on cycles 2 through 6. The primary end point was time to optimal OFS (time from the first injection to first assessment of centrally assessed estradiol level ≤ 2.72 pg/mL [≤ 10 pmol/L] during neoadjuvant therapy). The trial had 90% power to detect a difference using a log-rank test with a two-sided α of .05. Secondary end points included response, tolerability, and patient-reported endocrine symptoms. RESULTS Between February 2014 and January 2017, 51 patients were enrolled (n = 26 received triptorelin plus letrozole; n = 25 received degarelix plus letrozole). Time to optimal OFS was three times faster for patients assigned to degarelix and letrozole than to triptorelin and letrozole (median, 3 v 14 days; hazard ratio, 3.05; 95% CI, 1.65 to 5.65; P < .001). Furthermore, OFS was maintained during subsequent cycles for all patients assigned to receive degarelix and letrozole, whereas 15.4% of patients assigned to receive triptorelin and letrozole had suboptimal OFS after cycle 1 (six events during 127 measurements). Adverse events as a result of both degarelix plus letrozole and triptorelin plus letrozole were as expected. CONCLUSION In premenopausal women receiving letrozole for neoadjuvant endocrine therapy, OFS was achieved more quickly and maintained more effectively with degarelix than with triptorelin.

Lipid disorders in pregnancy

2021 ◽  
Vol 27 ◽  
Author(s):  
Anastasios Liberis ◽  
Stamatis Petousis ◽  
Panagiotis Tsikouras
Keyword(s):  
Pregnant Women ◽  
Low Density Lipoprotein ◽  
Safety Data ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Disorders ◽  
Severe Hypertriglyceridemia ◽  
History Of ◽  
Lipid Lowering Agents ◽  
In Pregnancy

: Dyslipidemia represents a major risk factor for cardiovascular disease. In addition, severe hypertriglyceridemia is an important cause of acute pancreatitis. Accordingly, the increase in serum lipid levels that are observed during pregnancy have potentially important implications. The management of dyslipidemia in pregnancy is further complicated by the lack of safety data during this period for most of the lipid-lowering agents. In the present review, we discuss the most important lipid disorders in pregnant women and their management. Pregnancy is characterized by increases in both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, which might result in severe complications both for the mother and the fetus. Accordingly, LDL-C and triglyceride levels should be monitored during pregnancy, particularly in women with a history of dyslipidemia. Diet is the mainstay of management of dyslipidemia in pregnant women and apheresis can also be considered in patients with homozygous familial hypercholesterolemia or severe hypertriglyceridemia. However, there is a pressing need for studies that with evaluate the safety of lipid-lowering agents during pregnancy.

Diseases of the Pituitary Gland

2013 ◽  
pp. 343-364
Author(s):  
Vânia Nosé ◽  
E. Tessa Hedley-Whyte
Keyword(s):  
Pituitary Adenomas ◽  
Sellar Region ◽  
Endocrine Activity ◽  
Multiple Factors ◽  
Granulomatous Hypophysitis ◽  
Pituitary Hyperplasia ◽  
Hormonal Dysfunction ◽  
Sheehan Syndrome ◽  
Pituitary Infarction ◽  
Histology And Immunohistochemistry

A wide variety of distinct pathological conditions may affect the pituitary, causing hormonal dysfunction and/or compression of surrounding structures. This chapter describes and illustrates the main pituitary lesions. Pituitary adenomas represent 10% to 20% of intracranial neoplasms in neurosurgical series. Their classifications are based on multiple factors, including histology and immunohistochemistry, ultrastructure and endocrine activity. Pituitary carcinomas are extremely rare. Pituitary hyperplasia is a rare cause of pituitary hyperfunction. Inflammatory (lymphocytic hypophysitis, granulomatous hypophysitis) and vascular (pituitary infarction, pituitary apoplexy, Sheehan syndrome) lesions can cause hypopituitarism. Craniopharyngiomas are the second most common neoplasm of the sellar region, following pituitary adenomas, and the most common suprasellar neoplasm in children.

scholarly journals P10 Reporting of offspring data in diabetes, HIV infection and hypertension trials during pregnancy: a systematic review

2019 ◽  
Vol 104 (6) ◽  
pp. e21.1-e21
Author(s):  
B Aurich ◽  
T Martin-Montoya ◽  
D Zhang ◽  
E Jacqz-Aigrain
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Hiv Infection ◽  
Pregnant Women ◽  
Health Care Professionals ◽  
Full Text ◽  
Treatment Options ◽  
Safety Data ◽  
Chronic Medication ◽  
Neonatal Deaths

BackgroundAccording to international guidelines clinical trials are conducted during pregnancy to evaluate benefits and risks of medicines for both the mother and her offspring. Consolidated Standards of Reporting Trials (CONSORT) reporting criteria apply to these trials and should include safety data on the offspring. The safety of maternal treatments is a key issue for health care professionals and parents. Diabetes, human immunodeficiency virus (HIV) infection and hypertension are among the most frequent chronic diseases worldwide in women of child bearing potential. The objective of this systematic review was to analyse offspring data reported in clinical trials conducted in pregnant women receiving chronic drug treatment for one of these conditions.MethodsPubmed and Embase (01/01/1997–31/12/2017) were searched for drug trials in pregnant women with diabetes, HIV infection or hypertension. Titles and abstracts were screened, followed by a full text review of eligible articles. Inclusion criteria were interventional clinical trials in pregnant women treated with chronic medication and full text in English. Trial characteristics, maternal and offspring data were extracted. Data was summarised by disease and study. Twelve key items were considered for the offspring. The protocol was registered on PROSPERO (CRD42017057024).ResultsOverall, 196 articles reporting 132 clinical trials (diabetes n=55; HIV n=59; hypertension n=18) were included. The number of births were frequently not reported (diabetes 40%; HIV 24%; hypertension 56%). Congenital malformations were infrequently reported with sufficient detail (diabetes 27%; HIV 34%; hypertension 6%). Similar observations were made for other key items (e.g. foetal losses, neonatal deaths, birth weight corrected for gestational age).ConclusionsUnderreporting of key data for the offspring was frequent in publications of clinical trials in pregnant women with diabetes, HIV infection or hypertension making the assessment of the benefit-risk ratio of treatment options during pregnancy difficult.Disclosure(s)Nothing to disclose

scholarly journals A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

Oncotarget ◽  
2017 ◽  
Vol 8 (45) ◽  
pp. 79111-79125
Author(s):  
Shousen Wang ◽  
Biao Li ◽  
Chenyu Ding ◽  
Deyong Xiao ◽  
Liangfeng Wei
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Function ◽  
Pituitary Hormone

HYPOFRACTIONATED CYBERKNIFE RADIOSURGERY FOR PERICHIASMATIC PITUITARY ADENOMAS

Neurosurgery ◽  
2009 ◽  
Vol 64 (suppl_2) ◽  
pp. A19-A25 ◽  
Author(s):  
Brendan D. Killory ◽  
John J. Kresl ◽  
Scott D. Wait ◽  
Francisco A. Ponce ◽  
Randall Porter ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Field Testing ◽  
Optic Chiasm ◽  
Conformity Index ◽  
Tumor Control ◽  
Cyberknife Radiosurgery ◽  
The Mean

Abstract OBJECTIVE Radiation therapy is recommended for pituitary tumors that are refractory to surgical and medical therapies. The efficacy of single-fraction radiosurgery is established for these lesions, but lesions within 3 mm of the optic pathway cannot be safely treated with doses higher than 8 to 10 Gy. We hypothesized that the optic nerve will tolerate 5 consecutive daily radiosurgery fractions of 500 cGy with effective tumor control. METHODS We reviewed our first 20 patients with recurrent or residual pituitary adenomas within 3 mm of the optic chiasm treated with the CyberKnife radiosurgery system (Accuray, Inc., Sunnyvale, CA). Tumors were treated with a mean coverage of 97 ± 2.2% (range, 89.8–99.7%), a mean conformity index of 1.3 ± 0.2 (range, 1.1–1.6), and a mean treatment isodose line of 74.5 ± 6.6% (range, 60–86%). The primary end point was an interim analysis of visual preservation, and secondary end points were radiographic and endocrinological tumor control. RESULTS The mean follow-up period for visual field testing was 26.6 ± 10.5 months (range, 10.6–41 months). The vision of all 14 patients with intact preoperative vision remained intact. Of the 5 patients with impaired vision, 2 remained stable, and 3 improved. No patient's vision deteriorated. The mean radiographic follow-up was 29.3 ± 8.6 months (range, 10.2–40.5 months). On magnetic resonance imaging, 12 tumors were stable, 8 were smaller, and none enlarged. CONCLUSION This preliminary study establishes that the optic nerve and chiasm tolerate CyberKnife hypofractionated radiosurgery of 5 × 500 cGy to perichiasmatic pituitary adenomas. Early data suggest that this dosing paradigm may achieve satisfactory radiographic and endocrinological tumor control for these challenging lesions, but longer follow-up is necessary to confirm these results.

Giant Hemorrhagic Prolactinoma with Sparse Prolactin Expression Presenting with Thalamic Infarction—A Case Report

2014 ◽  
Vol 10 (02) ◽  
pp. 124
Author(s):  
Ali GENC ◽  
Halil Ibrahim SUN ◽  
Burcu KASAPOGLU ◽  
Pinar Oz ◽  
Murat Aydın SAV ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Expression Patterns ◽  
Pituitary Tumors ◽  
Mass Effect ◽  
Immunocytochemical Staining ◽  
Cerebral Stroke ◽  
Cell Adenoma ◽  
Endocrine Activity ◽  
Intracranial Neoplasms ◽  
Thalamic Infarction

Pituitary tumors are the most common form of intracranial neoplasms. However, clinically relevant pituitary tumors presenting with disturbances of hormonal secretion or mass effect are rare and they only represent about 10 % of all surgically resected intracranial neoplasms. Prolactinomas are the most common types of pituitary adenomas. Generally, hormonal expression patterns provided by immunohistochemistry (IHC) studies are correlated with the clinical features and endocrine activity of the patients. Nonetheless, exceptions occur where the immunocytochemical staining is not concordant with the clinical picture. Pituitary adenomas presenting with apoplexy are well known. However, pituitary adenomas causing cerebral stroke and resulting in hemiplegia are unusual. Here, we report an unusual case of prolactinoma with cerebral stroke and sparse prolactin (PRL) expression. A 25-year-old woman complaining of amenorrhea, dysphasia, and left hemiplegia presented with serum PRL level in excess of 4,700 ng/ml. Pre-operational radiology images revealed a giant macroadenoma and a thalamic infarct due to carotid compression. Transcranial surgery was performed. IHC study of the adenoma revealed no hormonal expression other than sparse PRL immunoreactivity. Therefore, a sparsely granulated PRL cell adenoma was diagnosed. The patient is still under follow-up with continuing cabergoline treatment.

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