scholarly journals Management of incidental pituitary tumors

2011 ◽  
Vol 5 (4) ◽  
pp. 232
Author(s):  
Nicholas F. Marko ◽  
Robert J. Weil
Keyword(s):  
Clinical Symptoms ◽  
Visual Fields ◽  
Pituitary Tumors ◽  
Field Testing ◽  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Mri Imaging ◽  
Asymptomatic Patients ◽  
Stimulating Hormone

Pituitary incidentalomas are common lesions for which neurosurgical referrals may become progressively more frequent, given the increasing application of neuroimaging. The initial evaluation of a patient with radiographic evidence of an incidentaloma should focus on addressing two questions: (1) is the lesion causing neurological symptoms, and (2) is the lesion hormonally active? The answers to these two questions provide a framework for subsequent clinical management. The initial patient assessment should include a detailed history and physical examination, including the bedside assessment of visual fields. High-quality MRI imaging is essential, and formal visual field testing should be obtained in patients where the lesion abuts or compresses the optic apparatus. The initial biochemical workup is intended to assess potential pituitary hypo- or hyperfunction and should include measurement of serum levels of prolactin, insulin-like growth factor type-1, free thyroxine, testosterone, and an assessment of axis hypothalamic–pituitary–adrenal axis function. Additional testing may include serum thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone levels. Neurologically-asymptomatic patients without endocrine dysfunction can be managed with observation at regular intervals, including MRI imaging at 6 months and 1 year and then annually for a period of 3 years. Follow-up biochemical assessment is not necessary in the absence of clinical symptoms or radiographic enlargement of the lesion. After 3 years the follow-up interval may be prolonged, although closer follow-up may be indicated for patients with lesions C1 cm. Most patients who either present with or who subsequently develop neurologic or endocrinologic symptoms should be considered for surgery as the first-line therapy.

scholarly journals Management of incidental pituitary tumors

2011 ◽  
pp. 232-239
Author(s):  
Nicholas F. Marko ◽  
Robert J. Weil
Keyword(s):  
Clinical Symptoms ◽  
Visual Fields ◽  
Pituitary Tumors ◽  
Field Testing ◽  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Mri Imaging ◽  
Asymptomatic Patients ◽  
Stimulating Hormone

Pituitary incidentalomas are common lesions for which neurosurgical referrals may become progressively more frequent, given the increasing application of neuroimaging. The initial evaluation of a patient with radiographic evidence of an incidentaloma should focus on addressing two questions: (1) is the lesion causing neurological symptoms, and (2) is the lesion hormonally active? The answers to these two questions provide a framework for subsequent clinical management. The initial patient assessment should include a detailed history and physical examination, including the bedside assessment of visual fields. High-quality MRI imaging is essential, and formal visual field testing should be obtained in patients where the lesion abuts or compresses the optic apparatus. The initial biochemical workup is intended to assess potential pituitary hypo- or hyperfunction and should include measurement of serum levels of prolactin, insulin-like growth factor type-1, free thyroxine, testosterone, and an assessment of axis hypothalamic–pituitary–adrenal axis function. Additional testing may include serum thyroid-stimulating hormone, follicle-stimulating hormone, and luteinizing hormone levels. Neurologically-asymptomatic patients without endocrine dysfunction can be managed with observation at regular intervals, including MRI imaging at 6 months and 1 year and then annually for a period of 3 years. Follow-up biochemical assessment is not necessary in the absence of clinical symptoms or radiographic enlargement of the lesion. After 3 years the follow-up interval may be prolonged, although closer follow-up may be indicated for patients with lesions C1 cm. Most patients who either present with or who subsequently develop neurologic or endocrinologic symptoms should be considered for surgery as the first-line therapy.

Effect of 3,5-diiodo-L-thyronine on thyroid stimulating hormone and growth hormone serum levels in hypothyroid rats

Life Sciences ◽  
1998 ◽  
Vol 62 (26) ◽  
pp. 2369-2377 ◽  
Author(s):  
Maria Moreno ◽  
Assunta Lombardi ◽  
Pietro Lombardi ◽  
Fernando Goglia ◽  
Antonia Lanni
Keyword(s):  
Growth Hormone ◽  
Serum Levels ◽  
Thyroid Stimulating Hormone ◽  
Stimulating Hormone

scholarly journals Approach to Subclinical Thyroid Diseas

1970 ◽  
Vol 26 (2) ◽  
pp. 91-96
Author(s):  
Satya Ranjan Sutradhar
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Hormone Level ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Good Evidence ◽  
Reference Ranges ◽  
Mineral Density ◽  
Asymptomatic Patients ◽  
Stimulating Hormone

Subclinical thyroid dysfunction is defined as an abnormal serum thyroid-stimulating hormone level and free thyroxine and triiodothyronine levels within their reference ranges. The prevalence of subclinical hyperthyroidism is about 2 percent. Subclinical hypothyroidism is found in approximately 4 to 8.5 percent of the population. Most national organizations recommend against routine screening of asymptomatic patients, but screening is recommended for high risk populations. The management of subclinical thyroid dysfunction is controversial. There is good evidence that subclinical hypothyroidism is associated with progression to overt disease. Patients with a serum thyroid-stimulating hormone level greater than 10 mIU/L have a higher incidence of elevated serum low density lipoprotein cholesterol concentrations; however, evidence is lacking for other associations. There is insufficient evidence that treatment of subclinical hypothyroidism is beneficial. A serum thyroid stimulating hormone level of less than 0.1 mIU/L is associated with progression to overt hyperthyroidism, atrial fibrillation, reduced bone mineral density, and cardiac dysfunction. There is little evidence that early treatment alters the clinical course. DOI: 10.3329/jbcps.v26i2.4187 J Bangladesh Coll Phys Surg 2008; 26: 91-96

A STUDY OF CLINICAL PRESENTATION AND MANAGEMENT OF PITUITARY TUMORS

2021 ◽  
pp. 58-60
Author(s):  
Manthan Patel ◽  
Naimish Patel
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Pituitary Tumors ◽  
Csf Leak ◽  
Total Removal ◽  
Diagnostic Investigation ◽  
Subtotal Removal ◽  
Visual Disturbances ◽  
Bitemporal Hemianopia

The study includes 25 cases of pituitary adenomas. Most common age group by pituitary tumors falls between 41-50 years of age. Male: Female incidence of these tumors is 1: 2.12. Most common clinical symptoms in our series are visual disturbances followed by headache. Optic nerve involvement is other common clinical nding presenting in form of decreased vision or loss of vision, eld defect or fundus changes. Commonest eld defect is bitemporal hemianopia. MRI is the diagnostic investigation of choice in pituitary tumors to dene extent, invasion and relationship to major vessels and nerves. Approximately half (44%) of the patients exhibited normal preoperative pituitary function in form of baseline hormone prole. Increased GH level (32%) followed by hyperprolactinemia (20%) are the most common endocrinologic abnormalities. Total/near total removal was done in 21 patients (84%) and subtotal removal done in 4 patients (16%). Adjuvant therapies were given in 5 patients. Two patients were given radiotherapy and 3 were given pharmacotherapy. Post operative complications were CSF leak, diabetes insipidus and meningitis. 20 patients (80%) had improvement in their symptoms including relief from headache, improvement in vision and endocrinal dysfunction. Post operatively visual functions improved in 13 patients (52%) and it remained stationary in 11 (44%) patients. Only one patient (4%) complained of worsening of his visual function and it was improved in follow up period

scholarly journals A raised thyroid stimulating hormone result - a 12-month follow-up study in general practice

2010 ◽  
Vol 2 (1) ◽  
pp. 29 ◽  
Author(s):  
Veronique Gibbons ◽  
John Conaglen ◽  
Ross Lawrenson
Keyword(s):  
General Practice ◽  
Quantitative Research ◽  
Best Practice ◽  
Adult Population ◽  
Laboratory Data ◽  
Reference Interval ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Stimulating Hormone

INTRODUCTION: Subclinical hypothyroidism (SCH) is common in older patients. AIM: To review the management of patients identified with a raised thyroid stimulating hormone (TSH) result in a 12-month period and compare this to current guidelines from the New Zealand Best Practice Advocacy Centre (BPAC). METHODS: We collected laboratory data on thyroid function tests (TFTs) that were reported between December 2005 and November 2006 from two general practices with an adult population of approximately 21 000. Data were collected on symptoms, investigations, thyroid medication, family history and comorbidities. We used chi-squared tests to compare findings by age, gender and ethnicity. RESULTS: Older women of European descent were more likely to be to have initial results suggesting SCH. The number of follow-up tests ranged from 0 to 5 tests in a 12-month period. Forty-eight percent of individuals did not have any follow-up investigations. Seventy-three percent of FT4 tests taken are requested concurrently with TSH. Of those who had a repeat TSH test, just over 40% had a result within the reference interval. Twenty-eight percent had two TSH results consistent with SCH. Thirty-five percent of patients with antibody results were positive. The most commonly-recorded symptoms were tiredness and weight gain. DISCUSSION: We found inconsistencies in the management of SCH which were not related to patient characteristics such as age, gender or ethnicity. Further research is needed to determine if SCH is associated with increased morbidity and to provide a clear rationale for management of patients with SCH. KEYWORDS: Hypothyroidism; family practice; quantitative research; general practice

Screening for New Markers to Assess Thyroid Hormone Action by OMICs Analysis of Human Samples

2020 ◽  
Vol 128 (06/07) ◽  
pp. 479-487 ◽  
Author(s):  
Nele Friedrich ◽  
Maik Pietzner ◽  
Beatrice Engelmann ◽  
Georg Homuth ◽  
Dagmar Führer ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Function ◽  
Clinical Symptoms ◽  
Pituitary Tumors ◽  
Population Based ◽  
Thyroid Stimulating Hormone ◽  
Central Hypothyroidism ◽  
Free Thyroid Hormones ◽  
Molecular Alterations ◽  
Novel Biomarkers

ABSTRACTDetermination of the levels of thyroid-stimulating hormone (TSH) and free thyroid hormones (fTHs) is crucial for assessing thyroid function. However, as a result of inter-individual genetic variability and different environmental factors individual set points exist for TSH and fTHs and display considerable variation. Furthermore, under specific pathophysiological conditions like central hypothyroidism, TSH secreting pituitary tumors, or thyroid hormone resistance the established markers TSH and fTH fail to reliably predict thyroid function and adequate supply of TH to peripheral organs. Even in case of overt hyper- and hypothyroidism circulating fTH concentrations do not correlate with clinical symptoms. Therefore, there is a clear need for novel, more specific biomarkers to diagnose and monitor thyroid function. OMICs screening approaches allow parallel profiling of hundreds to thousands of molecules and thus comprehensive monitoring of molecular alterations in tissues and body fluids that might be associated with changes in thyroid function. These techniques thus constitute promising tools for the identification of urgently needed novel biomarkers. This mini review summarizes the findings of OMICs studies in thyroid research with a particular focus on population-based and patient studies as well as interventional approaches investigating the effects of thyroid hormone administration.

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