Case report: Pituitary enlargement associated with Addison's disease

Mineura, Katsuyoshi; Goto, T.; Yoneya, Motohiro; Kowada, Masayoshi; Tamakawa, Yoshihara; Kagaya, Hajime

doi:10.1016/s0009-9260(87)80258-1

Cited by 22 publications

(12 citation statements)

References 7 publications

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“…This is in line with previous reports which indicated that in some cases Addison's disease caused reactive pituitary hyperplasia, finally forming an ACTH-producing tumor [9,10].…”

Section: Discussionsupporting

confidence: 93%

Two Cases of Asymptomatic Adrenocortical Insufficiency with Autoimmune Thyroid Disease.

Koshiyama

Yoshinami

et al. 1994

Endocr J

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Abstract.Two cases of asymptomatic adrenocortical insufficiency are reported. Both patients had a normal cortisol and increased ACTH.The cortisol response to ACTH was impaired, although not absent, in both cases. One case was associated with autoimmune polyglandular syndrome type II (Graves' disease and vitiligo), and the other was possibly associated with an early stage of Hashimoto's thyroiditis, suggesting autoimmune pathogenesis of their adrenocortical insufficiency.CT of the abdomen revealed unilateral enlargement of the adrenal glands in one case, but no enlargement of the adrenal glands in another case. Adrenal hypofunction seemed to be compensated for by increased trophic hormone (ACTH), as in subclinical hypothyroidism. However, prolonged ACTH stimulation increased urinary 17-OHCS in both cases, and normalized cortisol response to ACTH in one case. In both cases, the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were normal, and adrenal autoantibodies were negative, suggesting that neither negative adrenal autoantibodies nor normal PRA can exclude asymptomatic adrenocortical insufficiency.The results suggest that a rapid ACTH test should be performed in cases with increased ACTH, especially those associated with other autoimmune endocrine disorders.

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“…This is in line with previous reports which indicated that in some cases Addison's disease caused reactive pituitary hyperplasia, finally forming an ACTH-producing tumor [9,10].…”

Section: Discussionsupporting

confidence: 93%

Two Cases of Asymptomatic Adrenocortical Insufficiency with Autoimmune Thyroid Disease.

Koshiyama

Yoshinami

et al. 1994

Endocr J

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“…Pituitary volume in antipsychotic-free and -treated patients CM Pariante et al shown on brain imaging (Kubota et al, 1992;Mineura et al, 1987). Moreover, patients with major depression, where HPA axis hyperactivity has been consistently demonstrated, also have increased pituitary volumes (Axelson et al, 1992;Krishnan et al, 1991;MacMaster and Kusumakar, 2004).…”

Section: Discussionmentioning

confidence: 96%

“…Indeed, increased size and number of corticotropes and increased volume of the pituitary are present also in subjects with a lack of negative inhibitory feedback by circulating glucocorticoid hormones because of Addison's disease (Mineura et al, 1987). In turn, glucocorticoid resistance is a common correlate of stress-induced HPA axis activation in animals and humans (Raison and Miller, 2003).…”

Section: Discussionmentioning

confidence: 99%

Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Pariante

Dazzan

Danese

et al. 2005

Neuropsychopharmacol

142

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Subjects at their first psychotic episode show an enlarged volume of the pituitary gland, but whether this is due to hypothalamicpituitary-adrenal (HPA) axis hyperactivity, or to stimulation of the prolactin-secreting cells by antipsychotic treatment, is unclear. We measured pituitary volume, using 1.5-mm, coronal, 1.5 T, high-resolution MRI images, in 78 patients at the first psychotic episode and 78 age-and gender-matched healthy controls. In all, 18 patients were antipsychotic-free (12 of these were antipsychotic-naïve), 26 were receiving atypical antipsychotics, and 33 were receiving typical antipsychotics. As hypothesized, patients had a larger pituitary volume than controls ( þ 22%, po0.001). When divided by antipsychotic treatment, and compared to controls, the pituitary volume was 15% larger in antipsychotic-free patients (p ¼ 0.028), 17% larger in patients receiving atypicals (p ¼ 0.01), and 30% larger in patients receiving typicals (po0.001). Patients receiving typicals not only had the largest pituitary volume compared to controls but also showed a trend for a larger pituitary volume compared to the other patients grouped together ( þ 11%, p ¼ 0.08). When divided by diagnosis, and compared to controls, the pituitary volume was 24% larger in patients with schizophrenia/schizophreniform disorder (n ¼ 40, po0.001), 19% larger in depressed patients (n ¼ 13, p ¼ 0.022), 16% larger in bipolar patients (n ¼ 16, p ¼ 0.037), and 12% larger in those with other psychoses (n ¼ 9, p ¼ 0.2). In conclusion, the first-episode of a psychotic disorder is associated with a larger pituitary independently of the presence of antipsychotic treatment, and this could be due to activation of the HPA axis. Typical antipsychotics exert an additional enlarging effect on pituitary volume, likely to be related to activation of prolactin-secreting cells. This activation of the hormonal stress response could participate to the important metabolic abnormalities observed in patients with psychosis.

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“…Clinically, the pituitary gland volume increases in patient with severe major depression, Addison's disease [36,37]. The decreased pituitary gland volume was seen in schizophrenia, eating disorder and in euthymic and depressed patients with bipolar disorder [2,38].…”

Section: Discussionmentioning

confidence: 99%

Comparison of three methods for the estimation of the pituitary gland volume using magnetic resonance imaging: a stereological study

et al. 2010

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Stereological techniques using point counting and planimetry have been used to estimate pituitary gland volume. However, many studies have estimated pituitary gland volume by the mathematical approach the elliptic formula. The objective of the current study was to determine pituitary gland volume using stereological methods and elliptic formula on magnetic resonance imaging (MRI). In this study, pituitary gland volumes were estimated in a total of 28 subjects (22 females, 6 males,) who were free of any pituitary or neurological symptoms and signs. The mean ± SD pituitary gland volumes for the point counting, planimetry and elliptic formulae groups were 582.14 ± 140.16 mm³, 610.08 ± 133.17 mm³, and 432.82 ± 147.38 mm³, respectively. The mean CE for the pituitary gland volume estimates derived from the point counting technique was 8.07%. No significant difference was found between point counting and planimetric methods for the pituitary gland volume (P > 0.05). In addition, there was a 26.14 and 29.71% underestimation of pituitary volume as measured by the elliptic formula compared to the point counting and planimetric techniques, respectively. From these results, it can be concluded that stereological techniques are unbiased, efficient and reliable methods and are ideally suitable for in vivo examination of MRI data for pituitary gland volume estimation. Hence, we suggest that estimating pituitary gland volume using MRI study and stereology may be clinically relevant for pituitary surgeons for the investigation of the structure and function of the pituitary gland.

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Case report: Pituitary enlargement associated with Addison's disease

Cited by 22 publications

References 7 publications

Two Cases of Asymptomatic Adrenocortical Insufficiency with Autoimmune Thyroid Disease.

Two Cases of Asymptomatic Adrenocortical Insufficiency with Autoimmune Thyroid Disease.

Increased Pituitary Volume in Antipsychotic-Free and Antipsychotic-Treated Patients of the Æsop First-Onset Psychosis Study

Comparison of three methods for the estimation of the pituitary gland volume using magnetic resonance imaging: a stereological study

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