Preoperative preparation of patients with pituitary gland disorders

This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults. Primary therapy of acromegaly is surgical, with or without associated radiotherapy. If a patient with acromegaly as comorbidity prepares for non-elective neurosurgical operation, then it requires consultation with brain surgeons for possible delays of that operation and primary surgical treatment of pituitary gland. If operative treatment of pituitary gland is carried out, the preoperative preparation (for other surgical interventions) should consider the need for perioperative glucocorticoid supplementation. Panhypopituitarism consequences are different in children and adults and the first step in diagnosis is to assess the function of target organs. Change of electrolytes and water occurs in the case of pituitary lesions in the form of central or nephrogenic diabetes insipidus as a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Preoperative preparation of patients with pituitary dysfunction should be multidisciplinary, whether it is a neurosurgical or some other surgical intervention. The aim is to evaluate the result of insufficient production of pituitary hormones (hypopituitarism), excessive production of adenohypophysis hormones (acromegaly, Cushing?s disease and hyperprolactinemia) and the influence of pituitary tumours in surrounding structures (compression syndrome) and to determine the level of perioperative risk. Pharmacological suppressive therapy of the hyperfunctional pituitary disorders can have significant interactions with drugs used in the perioperative period.

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Pituitary Metastasis from Malignant Bronchial Carcinoid

Tumori Journal ◽

10.1177/030089168807400118 ◽

1988 ◽

Vol 74 (1) ◽

pp. 101-107 ◽

Cited By ~ 13

Author(s):

Marco Lorenzo Rossi ◽

John Stuart Bevan ◽

Kenneth Anthony Fleming ◽

Felix Cruz-Sanchez

Keyword(s):

Pituitary Gland ◽

Carcinoid Tumor ◽

Pituitary Tumor ◽

Pituitary Hormones ◽

Pituitary Function ◽

Bronchial Carcinoid ◽

Partial Failure ◽

Multiple Metastases ◽

Primary Carcinoid Tumor ◽

Pituitary Metastasis

Metastases from a carcinoid tumor to the pituitary gland have, to our knowledge, not been described. We present a 49-year-old woman diagnosed as having a primary carcinoid tumor arising in the submucosa of a large bronchus who 8 years later presented with multiple metastases including one to the pituitary gland, which was in partial failure of pituitary function. This case illustrates than when confronted with a pituitary tumor resembling an adenoma but negative for pituitary hormones, the possibility of a metastasis from a carcinoid tumor should be considered.

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Endoscopic Endonasal Pituitary Transposition for a Transdorsum Sellae Approach to the Interpeduncular Cistern

Operative Neurosurgery ◽

10.1227/01.neu.0000317374.30443.23 ◽

2008 ◽

Vol 62 (suppl_1) ◽

pp. ONS57-ONS74 ◽

Cited By ~ 51

Author(s):

Amin B. Kassam ◽

Daniel M. Prevedello ◽

Ajith Thomas ◽

Paul Gardner ◽

Arlan Mintz ◽

...

Keyword(s):

Pituitary Gland ◽

Diabetes Insipidus ◽

Medical Center ◽

Pituitary Function ◽

Total Resection ◽

Endoscopic Endonasal ◽

Interpeduncular Cistern ◽

Petroclival Meningiomas ◽

Expanded Endonasal Approach ◽

Function Preservation

Abstract Objective: The interpeduncular cistern, including the retroinfundibular area, is one of the most challenging regions to approach surgically. The pituitary gland and the infundibu-lum guard the region when an endonasal route is undertaken. Superior transposition of the pituitary gland and infundibulum is described as a functional means to access this complex region through a fully endoscopic, completely transnasal route. Methods: Ten consecutive patients in whom a pituitary transposition was performed during an expanded endonasal approach at the University of Pittsburgh Medical Center for resection of retroinfundibular lesions were reviewed. The series consisted of seven men and three women with a mean age of 44.4 years. Pathology consisted of four craniopharyngiomas, four chordomas, and two petroclival meningiomas. Results: Five patients (50%) underwent total resection of the tumor, three patients (30%) underwent near total resection (>95% removal), and two patients (20%) had partial resection of petroclival meningiomas with the goal of optic apparatus decompression. All four patients with visual deficits recovered their vision completely. There was no neurological deterioration. Eight patients had normal pituitary function preoperatively, seven of whom (87.5%) had confirmed function preservation postoperatively, with one of these patients experiencing transient diabetes insipidus. The remaining patient with a hypothalamic craniopharyngioma underwent complete resection with obligatory panhypopituitarism and diabetes insipidus. Conclusion: Endoscopic endonasal transposition of the pituitary gland and its stalk can provide a valuable corridor to the retroinfundibular space and interpeduncular cistern with pituitary function preservation in the majority of patients. This approach should only be pursued once significant experience with endoscopic endonasal approaches has been acquired.

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Primary Amenorrhoea with Pituitary Dwarfism: A rare case report

Research in Pharmacy and Health Sciences ◽

10.32463/rphs.2016.v02i02.28 ◽

2016 ◽

Vol 2 (2) ◽

pp. 145-147

Author(s):

Siva S ◽

Divya Gopineni ◽

Shafi P ◽

Chandra Sekhar

Keyword(s):

Pituitary Gland ◽

General Medicine ◽

Pituitary Hormones ◽

Thyroid Stimulating Hormone ◽

Primary Amenorrhea ◽

Pituitary Dwarfism ◽

Primary Amenorrhoea ◽

Sexual Characteristics ◽

Loss Of Appetite ◽

Secondary Sexual

Females with pituitary dwarfism and a multiple deficiency of pituitary hormones show ovarian dysfunction due to hypogonadotropism. Primary amenorrhea can be diagnosed if a patient has normal secondary sexual characteristics but no menarche by 16 years of age. A 16 year-old female patient admitted in general medicine department with chief complaints of shortness of breath on exertion since 15 days, swelling of both legs since 10 days, loss of weight since 5 months, loss of appetite since 3 months, history of pain during swallowing. Pelvis scan examination reveals that uterus measures 3.2×0.5×0.5cm; uterus is hypo plastic, ovaries not visualized. Patient parents reveled that from patient birth to 11years of age her growth and other developments were normal, after that her growth is stopped and no changes were observed in development since 5 years. Patient has hypothyroidism so pituitary gland make an important role to maintain hormone levels, pituitary gland produces thyroid stimulating hormone (TSH) which stimulates thyroid gland to produce thyroid hormones. Primary Amenorrhea, short stature and poorly developed secondary sexual characters which could have been contributed and should be subjected for karyotyping. This type of Pituitary Dwarfism is very difficult to manage.

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Frequency and structure of cases of increased risk of cardiovascular complications in perioperative period in patients before age-related cataracts surgery. Possibilities of their timely detection for preoperative preparation

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2019-2-171-174 ◽

2019 ◽

pp. 171-174

Author(s):

M.A. Esina ◽

◽

E.E. Filimonova ◽

Keyword(s):

Perioperative Period ◽

Cardiovascular Complications ◽

Preoperative Preparation ◽

Age Related ◽

Increased Risk

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Gamma knife surgery of the pituitary: new treatment for thalamic pain syndrome

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0038 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 38-41 ◽

Cited By ~ 6

Author(s):

Motohiro Hayashi ◽

Takaomi Taira ◽

Taku Ochiai ◽

Mikhail Chernov ◽

Yuichi Takasu ◽

...

Keyword(s):

Pituitary Gland ◽

Diabetes Insipidus ◽

Gamma Knife ◽

Pain Syndrome ◽

Pain Reduction ◽

Gamma Knife Surgery ◽

Content Type ◽

Thalamic Pain Syndrome ◽

Thalamic Pain ◽

Fine Print

Object. Although reports in the literature indicate that thalamic pain syndrome can be controlled with chemical hypophysectomy, this procedure is associated with transient diabetes insipidus. It was considered reasonable to attempt gamma knife surgery (GKS) to the pituitary gland to control thalamic pain. Methods. Inclusion criteria in this study were poststroke thalamic pain, failure of all other treatments, intolerance to general anesthetic, and the main complaint of pain and not numbness. Seventeen patients met these criteria and were treated with GKS to the pituitary. The target was the pituitary gland together with the border between the pituitary stalk and the gland. The maximum dose was 140 to 180 Gy. All patients were followed for more than 3 months. Conclusions. An initial significant pain reduction was observed in 13 (76.5%) of 17 patients. Some patients experienced pain reduction within 48 hours of treatment. Persistent pain relief for more than 1 year was observed in five (38.5%) of 13 patients. Rapid recurrence of pain in fewer than 3 months was observed in four (30.8%) of 13 patients. The only complication was transient diabetes insipidus in one patient. It would seem that GKS of the pituitary might have a role to play in thalamic pain arising after a stroke.

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Melatonin Modulates Lactation by Regulating Prolactin Secretion Via Tuberoinfundibular Dopaminergic Neurons in the Hypothalamus- Pituitary System

Current Protein and Peptide Science ◽

10.2174/1389203721666200511093733 ◽

2020 ◽

Vol 21 (8) ◽

pp. 744-750 ◽

Cited By ~ 1

Author(s):

Hongyang Li ◽

JingyaWei ◽

Fengtao Ma ◽

Qiang Shan ◽

Duo Gao ◽

...

Keyword(s):

Pineal Gland ◽

Pituitary Gland ◽

Antioxidant Capacity ◽

Dopaminergic Neurons ◽

Growth And Development ◽

Endocrine System ◽

Mammary Glands ◽

Prolactin Secretion ◽

The Body ◽

Stimulation Of

In-depth studies have identified many hormones important for controlling mammary growth and maintaining lactation. One of these is melatonin, which is synthesized and secreted by the pineal gland to regulate circadian rhythms, improve antioxidant capacity, and enhance immunity. Prolactin is secreted by the pituitary gland and is associated with the growth and development of mammary glands as well as initiation and maintenance of lactation. The hypothalamus-pituitary system, the most important endocrine system in the body, regulates prolactin secretion mainly through dopamine released from tuberoinfundibular dopaminergic neurons. This review provides a reference for further study and describes the regulation of lactation and prolactin secretion by melatonin, primarily via the protection and stimulation of tuberoinfundibular dopaminergic neurons.

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Preoperative preparation of alcohol and psychoactive substances-addicted patients

Acta chirurgica iugoslavica ◽

10.2298/aci1102151d ◽

2011 ◽

Vol 58 (2) ◽

pp. 151-155

Author(s):

Ivan Dimitrijevic ◽

Zoran Zoricic ◽

Miodrag Milenovic ◽

Ivan Palibrk ◽

Draga Dimitrijevic ◽

...

Keyword(s):

Substance Abuse ◽

Postoperative Care ◽

Surgical Intervention ◽

Elective Surgery ◽

Perioperative Period ◽

Psychoactive Substance ◽

Preoperative Preparation ◽

Psychoactive Substances ◽

Key Issues ◽

Proper Diagnosis

Proper diagnosis of psychoactive substance abuse and addiction, as well as acute intoxication, withdrawal syndrome and overdosing are of great importance in patients who are preparing for surgical intervention. There are some specific details in their preoperative preparation whether they underwent emergency or elective surgery. Good knowledge of the characteristics of psychoactive substance abuse and addiction, interaction of psychoactive substances and anesthetics and any other drugs that could be used in the perioperative period is important especially for anastesiologist. In this work we present key issues for recognizing theese patients as well as some guidelines for adequate preoperative preparation and postoperative care.

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Evaluation of Adrenal Cortical Function in Neonatal and Weanling Laboratory Beagle Dogs

Toxicologic Pathology ◽

10.1177/01926233211009492 ◽

2021 ◽

pp. 019262332110094

Author(s):

Janet M. Petruska ◽

Maria Adamo ◽

Jeffrey McCartney ◽

Ahamat Aboulmali ◽

Thomas J. Rosol

Keyword(s):

Adrenal Gland ◽

Pituitary Gland ◽

Endocrine System ◽

Beagle Dogs ◽

Cortical Function ◽

Test Species ◽

Toxicity Studies ◽

Gland Function ◽

Common Target ◽

Adrenal Cortical Function

The most common target organ for toxicity in the endocrine system is the adrenal gland, and its function is dependent upon the hypothalamus and pituitary gland. Histopathologic examination of the adrenal glands and pituitary gland is routinely performed in toxicity studies. However, the function of the adrenal gland is not routinely assessed in toxicity studies. Assessment of adrenal cortical function may be necessary to determine whether a histopathologic finding in the adrenal cortex results in a functional effect in the test species. As juvenile toxicity studies are more commonly performed in support of pediatric indications for pharmaceuticals, it is important to establish historical control data for adrenal gland function. In this study, adrenal cortical function was assessed in control neonatal and weanling beagle dogs as part of an ongoing juvenile toxicology program. Measurements of serum adrenocorticotropic hormone (ACTH), cortisol prior to and following administration of exogenous ACTH, and aldosterone were conducted beginning at 2 weeks of age continuing through 26 weeks of age. Serum electrolyte concentrations were determined at 4, 13, and 26 weeks of age. Dogs as young as 2 weeks of age synthesize and secrete adrenal cortical hormones and exhibit a functional hypothalamic pituitary adrenal axis.

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The effects of human leptin fragment(126-140) on pituitary functions in man

Acta Endocrinologica ◽

10.1530/eje.0.1490407 ◽

2003 ◽

pp. 407-412 ◽

Cited By ~ 4

Author(s):

K Hanew

Keyword(s):

Dose Response ◽

Area Under The Curve ◽

Inhibitory Effect ◽

Pituitary Hormones ◽

Pituitary Function ◽

Gh Secretion ◽

Combined Administration ◽

The Mean ◽

Spontaneous Secretion ◽

Control Study

OBJECTIVE: The effects of human leptin fragment(126-140) on pituitary function in eight healthy, non-obese men were studied. METHODS AND DESIGN: The effects of the fragment on spontaneous secretion of pituitary hormones and endogenous leptin, as well as on GHRH-induced GH secretion were examined. RESULTS: After the administration of the fragment (50 microg i.v. for 150 min), the mean nadir value and 45 min value were significantly lower than that of the control study. Endogenous leptin levels did not decrease significantly following the administration of the leptin fragment. Other pituitary hormones were not affected by the fragment. The area under the curve of the GH response to GHRH(1-44)NH(2) (10 microg, i.v. from 0 to 75 min) was also significantly inhibited by the combined administration of the leptin fragment (100 microg i.v. from -30 to 75 min) (P<0.001). Three subjects were re-examined with larger doses of the leptin fragment (200-400 microg), and even greater GH suppression was observed. CONCLUSIONS: These results indicate that human leptin fragment(126-140) has an inhibitory role in GH secretion, since when administered exogenously this fragment significantly suppressed spontaneous and, in a dose-response manner, GHRH-induced GH secretion. Clear effects of the fragment on other pituitary hormones and an inhibitory effect on endogenous leptin secretion were not observed in this study.

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