Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF‐1 levels

Yuen, Kevin C.J.; Cook, David M.; Sahasranam, P.; Patel, Pragnesh; Ghods, D. E.; Shahinian, Hrayr K.; Friedman, Theodore C.

doi:10.1111/j.1365-2265.2008.03201.x

Cited by 46 publications

(26 citation statements)

References 45 publications

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“…As expected, hypopituitarism was more frequent in macrodenomas (66% in the present series, 62% in Ferrante et al [13] and 85% in Nomikos et al [7]) but it was also found in 33% of microadenomas. In accordance with our data, a previous and smaller series on microNFPA showed that 50% of patients had one or more pituitary deficiencies at diagnosis [30]. We also observed that the prevalence of the different pituitary deficiencies was different in macro- and microadenomas: while the most frequent deficit in macroadenomas was hypogonadism, hypoadrenalism was most frequently observed in microadenomas, although the limited number of patients evaluated for GHD by dynamic tests in the present series might indeed underestimate the prevalence of this defect.…”

Section: Discussionsupporting

confidence: 93%

Hypothalamic-Pituitary Axis in Non-Functioning Pituitary Adenomas: Focus on the Prevalence of Isolated Central Hypoadrenalism

et al. 2015

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Introduction: Non-functioning pituitary adenomas (NFPA) account for about 40% of pituitary tumors. Pituitary deficiencies are present at diagnosis in 60-80% of NFPA, and, classically, growth hormone (GH) secretion is lost first, while adrenocorticotropic hormone is expected to disappear last. The aim of this study was to evaluate the incidence of multiple or isolated pituitary deficiencies in a large series of NFPA. Materials and Methods: We retrospectively analyzed data on 218 NFPA cases (59% females, 59% with macroadenomas, average age: 50.2 ± 17 years) followed up at our center from 1990 to 2013. At diagnosis all patients had a complete evaluation of pituitary function in basal conditions and provocative tests for the hypothalamic-pituitary-adrenal axis, while tests for GH deficiency (GHD) were carried out in 38%. Results: 52.3% of patients (65.6% of macroadenomas, 33.3% of microadenomas) presented at least 1 pituitary deficiency: isolated deficiency in 29.8%, multiple deficiencies in 30% and panhypopituitarism in 9%. Isolated deficiencies were hypogonadism in 11.5% of patients (8% in micro-, 14% in macroadenomas), hypoadrenalism in 10.1% (14% in micro-, 7% in macroadenomas) and GHD in 8.3% (8.9% in micro-, 7.8% in macroadenomas). About 30% of microadenomas had at least 1 pituitary deficiency at diagnosis, independently of tumor localization within the sellar region. Conclusions: The presence of isolated hypoadrenalism suggests that the order of appearance of hypopituitarism does not always follow the one expected. Given the relatively high prevalence of isolated hypoadrenalism even in microadenomas, we suggest a full assessment of basal and dynamic pituitary function in all NFPA regardless of tumor size.

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Section: Discussionsupporting

confidence: 93%

Hypothalamic-Pituitary Axis in Non-Functioning Pituitary Adenomas: Focus on the Prevalence of Isolated Central Hypoadrenalism

et al. 2015

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“…To explain this difference some hypothalamic-pituitary alterations reflecting previous neurosurgery and/or radiotherapy can be hypothesized. Moreover, this picture has also been reported by other authors (8,29) even in patients with non-functioning microadenomas never exposed to either previous neurosurgery and/or radiotherapy (29). It is a matter of debate whether this group of patients can be classified as having 'partial' GHD.…”

Section: Discussionsupporting

confidence: 73%

Acylated ghrelin as a provocative test for the diagnosis of GH deficiency in adults

Gasco¹,

Beccuti²,

Baldini³

et al. 2013

European Journal of Endocrinology

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Objective: Insulin tolerance test (ITT) is the test of reference for the diagnosis of adult GH deficiency (GHD), although GHRH in combination with arginine (ARG) or GH secretagogues are considered equally reliable tests. Testing with GH secretagogue alone is, anyway, a potent stimulus exploring the integrity of hypothalamic pathways controlling somatotropic function. We therefore aimed to determine the diagnostic reliability of testing with ghrelin, the natural GH secretagogue. Methods: We studied the GH response (every 15 min from K15 to C120 min) to acylated ghrelin (1 mg/kg i.v. at 0 min) in 78 patients with a history of pituitary disease (49 male, 29 female; age (meanGS.D.): 52.1G18.7 years; BMI: 26.7G5.3 kg/m 2 ). The lack of GH response to GHRHCARG and/or ITT was considered the gold standard for the diagnosis of GHD. The best GH cut-off to ghrelin test, defined as the one with the best sensitivity (SE) and specificity (SP), was identified using the receiver-operating characteristic curve analysis. Results: The best GH cut-off to ghrelin test was 7.3 mg/l in lean subjects (SE 88.2%, SP 90.9%), 2.9 mg/l in overweight subjects (SE 92.6%, SP 100%) and 0.6 mg/l in obese subjects (SE 50%, SP 100%). The diagnostic accuracy was 89.3, 94.1 and 62.5% respectively. Conclusions: Our data show that testing with acylated ghrelin represents a reliable diagnostic tool for the diagnosis of adult GHD, in lean and overweight subjects, if appropriate cut-off limits are assumed. Obesity strongly reduces GH response to ghrelin, GH weight-related cut-off limit and diagnostic reliability of the test.

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“…Erişkinlerdeki BH eksikliğinin en sık nedeni hipofiz adenomu veya bu nedenle yapılan operasyonlar veya radyoterapidir [6]. Makroadenomlar daha fazla oranda hipofizer yetmezliğe neden olurken (%30-60) nonfonksiyone mikroadenomların da (%42) BH eksikliğine neden olduğu gösterilmiştir [11]. Son dönemlerde yapılan çalışmalar sonucunda beyin hasarı (travmatik beyin hasarı, spora bağlı tekrarlaycı kafa travması ve subaraknoid kanaması) olan hastaların da hipofizer yetmezlik açısından değerlendirilmesi gerektiği ortaya çıkmıştır [12][13][14].…”

Section: Erişkin Dönemde Başlayan Bh Eksikliğiunclassified

Erişkinlerde büyüme hormonu tedavisi

Kilicli¹,

Dökmetaş²

2012

CMJ

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ÖzetBüyüme hormonu sentezi yaşam boyu devam eden, anabolizan etkisi olan, lipoliz ve karbonhidrat metabolizmasını etkileyen bir hormondur. Bin dokuz yüz seksenlerin 2. yarısına kadar çoğu endokrinolog erişkinlerde görülen büyüme hormonu eksikliğinin klinik bir sorun olmadığını düşünmekteydi. Erişkinlerde görülen büyüme hormonu eksikliği yaşam beklentisinde azalma, kardiyovasküler morbidite ve prematür aterosklerozda artış, vücut kompozisyonunda değişiklik, osteoporoz, egzersiz toleransında azalma ve yaşam kalitesinde düşme ile ilişkilidir. Büyüme hormonu replasman tedavisi, erişkin tip büyüme hormonu eksikliği olan hipofizer yetmezliği olanlarda faydalı etkiler gösterir. Büyüme hormonu eksikliği olanlarda büyüme hormonu tedavisi ile yaşam kalitesi, kemik mineral dansitesi, vücut kompozisyonu, egzersiz toleransı, lipid profili ve kan şekeri gibi vasküler risk faktörlerinde olumlu değişiklikler olduğu gösterilmiştir. Çocukluk döneminde başlayan büyüme hormonu eksikliklerinde, erişkin boya ulaştıktan sonra, büyüme hormonu durumu geçiş döneminde yeniden değerlendirilmelidir. Böylece maksimum kemik ve kas artışı gibi tam somatik gelişimi sağlamak için BH replasmanına devam edilip edilmeyeceğine karar verilebilir. Anahtar sözcükler: Büyüme hormonu eksikliği, tedavi Abstract Growth hormone secretion occurs throughout life and is known to have profound effects on anabolism, lipolysis, and carbohydrate metabolism. Until the second half of 1980's growth hormone deficiency in adult life was not considered as a clinical problem by most endocrinologists. Growth hormone deficiency in adults is associated with reduced life expectancy, increased cardiovascular morbidity and premature atherosclerosis, changes in body composition, osteoporosis, reduced exercise tolerance and reduced quality of life. Growth hormone replacement therapy has important beneficial effects in adult hypopituitary patients with growth hormone deficiency. It is shown that growth hormone therapy has a positive influence in growth hormone deficiency patients on quality of life, bone mineral density, body composition, exercise tolerance and vascular risk factors such as blood glucose levels and lipid profile. In patients with childhoodonset growth hormone deficiency, after cessation of linear growth, growth hormone status should be reevaluated in the transition age for continued growth hormone replacement to achieve full somatic development including the maintenance of maximal bone and muscle mass.

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Prevalence of GH and other anterior pituitary hormone deficiencies in adults with nonsecreting pituitary microadenomas and normal serum IGF‐1 levels

Cited by 46 publications

References 45 publications

Hypothalamic-Pituitary Axis in Non-Functioning Pituitary Adenomas: Focus on the Prevalence of Isolated Central Hypoadrenalism

Hypothalamic-Pituitary Axis in Non-Functioning Pituitary Adenomas: Focus on the Prevalence of Isolated Central Hypoadrenalism

Acylated ghrelin as a provocative test for the diagnosis of GH deficiency in adults

Erişkinlerde büyüme hormonu tedavisi

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