Clinical evaluations of pituitary apoplexy in incidental nonfunctional pituitary adenomas

Abstract

Pituitary apoplexy is an uncommon syndrome that often results in spontaneous hemorrhage or infarction of pituitary tumors or glands. We previously reported pituitary apoplexy occurred most frequently in nonfunctional pituitary adenomas among all types of pituitary incidentalomas. In the present study, we aimed to investigate the characteristics of pituitary apoplexy in patients with incidental nonfunctional pituitary adenomas. 65 patients with pituitary incidentaloma were enrolled. All patients underwent clinical/endocrinological/pathological investigations. As a result, 33 patients were diagnosed with nonfunctional pituitary adenomas. Of these, 12.1% of patients had pituitary apoplexy. There was no difference in tumor diameter, age, or sex between the apoplexy and the non-apoplexy groups. However, the liver enzymes aspartate transaminase and alanine aminotransferase were significantly higher, and plasma sodium and chloride levels were significantly lower in the apoplexy group than in the non-apoplexy group (each P < .05). In addition, low-density lipoprotein-cholesterol was significantly higher in the apoplexy group than in the non-apoplexy group (P < .05). Besides, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, and prolactin deficiencies were significantly more frequent in the apoplexy group than in the non-apoplexy group (each P < .05), and growth hormone and adrenocorticotropic hormone deficiencies were more frequent in the apoplexy group than in the non-apoplexy group (P = .09 and.08, respectively). Furthermore, tumor diameter was not associated with pituitary apoplexy, whereas thyroid-stimulating hormone, luteinizing hormone, and follicle-stimulating hormone deficiencies were significantly associated with the apoplexy group (each P < .05). Hence, the present study indicated that pituitary apoplexy could not be related to tumor diameter. Moreover, hormonal deficiencies, hepatic dysfunction, hyponatremia or hypochloremia, and dyslipidemia might be indicators of pituitary apoplexy. There could be the possibility the treatment for dyslipidemia prevents pituitary apoplexy.

Investigation of the metabolic and endocrinological differences between daily and weekly growth hormone replacement therapy, somapacitan, in patients with adult growth hormone deficiency: A real-world pilot study

“…We investigated 11 individuals with AGHD previously diagnosed with no or inadequate changes in GH levels after a GH-releasing peptide-2 test/insulin tolerance test/arginine test at Fukuoka University Chikushi Hospital and Nagasaki Prefecture Iki Hospital. [ 13 , 14 ] All patients had received daily GH replacement therapy for over 2 years and switched from daily GH replacement therapy to weekly GH replacement therapy with somapacitan between January 2022 and June 2022.…”

“…Central diabetes insipidus was diagnosed by a combination of increased urinary volume; low urinary osmolarity; low antidiuretic hormone (ADH) levels compared with serum osmolarity; no or inadequate changes in ADH levels after a water restriction test/5% NaCl loading test; and increased ADH levels and decreased urinary volume after 1-desamino-8-D-arginine vasopressin administration. [ 13 , 14 ]…”