Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus

Abstract

Background: The micturition reflex is under the tonic influence of suprapontine structures including the anteromedial frontal cortex, basal ganglia, and hypothalamus. However, there have been few reports about the role of the hypothalamus on the lower urinary tract (LUT) function in humans. Objective: To investigate LUT function in patients with pituitary adenomas. Methods: Urodynamic studies were carried out in three patients with LUT symptoms who had pituitary adenomas extending upwards to the hypothalamus. Results: All three male patients (age 28 to 62 years) developed LUT symptoms (urinary urgency and frequency (3); urinary incontinence (3); voiding difficulty and retention (2)) along with weight loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One had the syndrome of inappropriate secretion of antidiuretic hormone, but none had diabetes insipidus. Two had resection of the tumour and subsequent radiation therapy, but LUT dysfunction persisted. The third patient had partial resection of the tumour to ameliorate hydrocephalus. Urodynamic studies showed detrusor overactivity during the storage phase in all patients; during the voiding phase there was underactive detrusor in two and non-relaxing sphincter in one. Conclusions: Hypothalamic lesions can cause severe LUT dysfunction in both the storage and voiding phases of micturition. This may reflect the crucial role of the hypothalamus in regulating micturition in humans.

Distinctive clinicopathological features of 2 large families with amyotrophic lateral sclerosis having L106V mutation in SOD1 gene

“…Lower urinary tract function is controlled by the spino-bulbo-spinal reflex arc including autonomic neurons in the spinal cord and pons [32]. The micturition reflex is under the tonic (mainly inhibitory) influence of several suprapontaine structures, such as the frontal cortex, basal nuclei, and hypothalamus [32,33]. Based on the neuropathological findings, the lesions considered to be possibly responsible for the neurogenic bladder (overactive bladder) observed in half of our patients were in the degenerated spinal cord and hypothalamus.…”

The micturition switch and its forebrain influences

“…More recently, Yamamoto et al . () reported three cases of pituitary adenoma that extended to the hypothalamus.…”

The dysfunction of affective picture processing in pituitary patients: an ERPs study

“…Pituitary adenomas patients were were recruited in the Department of Neurosurgery, Wuhan School of Clinical Medicine, Southern Medical University (China) during diagnostic hospitalization. The inclusion criteria for patients were as follows: (1) the tumors were pathologically and immunohistochemically diagnosed as pituitary adenoma; (2) No history of craniotomy and radiation therapy; (3) they did not have any severe heart, liver and kidney failure; (4) Participants could cooperate to complete ERPs tests. Exclusion criteria for patients were as follows: (1) A history of neurologic or psychiatric disorders; (2) No drug or alcohol abuse [subjects who drink alcohol over 2.0 standard drinks (10 g of pure alcohol) on days and meet any 2 of the 11 criteria under the DSM-V in the past year] [21], and medication intake (including oral contraceptives).…”

“…Pituitary adenomas are the most common intracranial tumors following meningiomas, accounting for about 16.5% of central nervous system tumors [1]. The mechanical pressure from tumor mass on adjacent neuroanatomical regions such as inferior frontal lobe, diencephalon, optic chiasma, and pituitary stalk could disrupt the tissue structures [2]- [4], which might decrease the endocrine functions of hypothalamus or pituitary stalk. On the other hand, the pituitary may secrete abnormally high hormones than usual.…”