Remarkable Cystic Expansion of Microprolactinoma Causing Diabetes Insipidus during Pregnancy

Amano, Eri; Nishiyama, Mitsuru; Iwasaki, Yoshinobu; Matsushima, Sachio; Oguri, Hiroyoshi; Fukuhara, Noriaki; Nishioka, Hiroshi; Yamada, Shozo; Inoshita, Naoko; Fukaya, Takao; Terada, Yoshio

doi:10.1210/jc.2012-1535

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…Previous anecdotal reports in the literature have described cases of DI in approximately 2% of non‐functioning pituitary adenomas pre‐operatively 69 . Rare cases of macroprolactinomas developing DI during pregnancy have been also described, although their exact pathogenesis was not completely delineated 72 . In a recent study, only 0.6% of 160 patients (a single patient) with non‐functional pituitary adenomas presented with pre‐operative DI 73 …”

Section: Discussionmentioning

confidence: 99%

Diabetes insipidus secondary to sellar/parasellar lesions

Angelousi

Mytareli

Xekouki

et al. 2021

J Neuroendocrinology

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Diabetes insipidus (DI) is a well‐recognised transient or permanent complication following transsphenoidal surgery for pituitary adenomas or other sellar/parasellar lesions. However, data regarding the prevalence of pre‐operative DI in sellar/parasellar lesions other than pituitary adenomas are scarce. We systematically reviewed the existing data for defining the prevalence of DI before any treatment in adult patients with sellar/parasellar lesions, excluding pituitary adenomas and metastatic lesions. In total, 646 patients with sellar/parasellar lesions presenting with DI at diagnosis were identified. The most common pathologies of sellar/parasellar lesions presenting with DI at diagnosis were lymphocytic hypophysitis (26.5%), craniopharyngiomas (23.4%), Langerhans's cell histiocytosis (18.9%) and Rathke's cleft cyst (12.7%), accounting for the vast majority (more than 80%) of these lesions. Overall, DI at diagnosis was found in 23.4% of all patients with sellar/parasellar lesions, albeit with a wide range from 10.6% to 76.7%, depending on the nature of the pathology. The highest prevalence of DI was found in less commonly encountered lesions namely germ‐cell tumours (76.7%), abscesses (55.4%) and neurosarcoidosis (54.5%), each accounting for less than 3% of all sellar/parasellar lesions. Most DI cases (68.8%) were associated with anterior pituitary hormonal deficiencies, in contrast to pituitary adenomas that rarely present with DI. The enlargement and enhancement of the pituitary stalk were the most common findings on magnetic resonance imaging besides the loss of the high signal of the posterior pituitary on T1‐weighted images. Resolution of DI spontaneously or following systemic and surgical management occurred in 22.4% of cases. Post‐operative DI, not evident before surgery, was found in 27.8% of non‐adenomatous sellar/parasellar lesions, and was transient in 11.6% of them. Besides distinctive imaging features and symptoms, early recognition of DI in such lesions is important because it directs the diagnosis towards a non‐adenomatous sellar/parasellar tumour and the early initiation of appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Diabetes insipidus secondary to sellar/parasellar lesions

Angelousi

Mytareli

Xekouki

et al. 2021

J Neuroendocrinology

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“…Regarding the risk of tumor growth during pregnancy, a systematic review indicated 2.4% symptomatic tumor growth in microprolactinomas, 21% in macroprolactinomas, and 4.7% in macroprolactinomas with previous surgery or radiotherapy [ 63 ]. Since there have been a few cases of tumor growth during the interruption of DAs during pregnancy, the course of clinical symptoms (e.g., headache or visual field disturbances) should be carefully monitored [ 1 , 63 , 66 ]. In healthy women, the high estrogen levels in pregnancy cause lactotroph hypertrophy and hyperprolactinemia, and serum PRL levels gradually elevate during the course of gestation; thus, serum PRL is not an indicator of prolactinoma progression.…”

Section: Pregnancymentioning

confidence: 99%

Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

Fukuhara

Nishiyama

Iwasaki

2022

Cancers

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Prolactinomas comprise 30–50% of all pituitary neuroendocrine tumors, frequently occur in females aged 20 to 50, and cause hypogonadism and infertility. In typical cases, female patients exhibit galactorrhea and amenorrhea due to serum prolactin (PRL) elevation, and patients during pregnancy should be carefully treated. During diagnosis, other causes of hyperprolactinemia must be excluded, and an MRI is useful for detecting pituitary neuroendocrine tumors. For treating prolactinoma, dopamine agonists (DAs) are effective for decreasing PRL levels and shrinking tumor size in most patients. Some DA-resistant cases and the molecular mechanisms of resistance to a DA are partially clarified. The side effects of a DA include cardiac valve alterations and impulse control disorders. Although surgical therapies are invasive, recent analysis shows that long-term remission rates are higher than from medical therapies. The treatments for giant or malignant prolactinomas are challenging, and the combination of medication, surgery, and radiation therapy should be considered. Regarding pathogenesis, somatic SF3B1 mutations were recently identified even though molecular mechanisms in most cases of prolactinoma have not been elucidated. To understand the pathogenesis of prolactinomas, the development of new therapeutic approaches for treatment-resistant patients is expected. This review updates the recent advances in understanding the pathogenesis, diagnosis, and therapy of prolactinoma.

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Remarkable Cystic Expansion of Microprolactinoma Causing Diabetes Insipidus during Pregnancy

Cited by 2 publications

References 5 publications

Diabetes insipidus secondary to sellar/parasellar lesions

Diabetes insipidus secondary to sellar/parasellar lesions

Update in Pathogenesis, Diagnosis, and Therapy of Prolactinoma

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