The Pituitary Mass: Diagnosis and Management

Sam, Susan; Molitch, Mark E.

doi:10.1007/s11154-005-5225-z

Cited by 25 publications

(14 citation statements)

References 59 publications

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“…The absence of immunohistochemical staining for S100 protein led to the rejection of this diagnosis [3]. The spectrum of disorders associated with inflammatory hypophysitis is broad and includes lymphocytic hypophysitis, granulomatous hypophysitis, xanthomatous hypophysitis [1,2]. Lymphocytic hypophysitis usually presents in young women and may present in late pregnancy or in the early post-partum period [2].…”

Section: Discussionmentioning

confidence: 99%

“…A heterogeneous group of diseases can present as an inflammatory mass in the pituitary fossa [1]. These diseases are either primary (intrinsic to the pituitary, aetiology unknown) or secondary (an etiologic agent or systemic disease is implicated).…”

Section: Introductionmentioning

confidence: 99%

“…These diseases are either primary (intrinsic to the pituitary, aetiology unknown) or secondary (an etiologic agent or systemic disease is implicated). The clinical presentation of such lesions is often similar to pituitary adenomas, although headache, nausea and vomiting and posterior pituitary involvement are more common presentations of hypophysitis than pituitary adenomas [1]. Infection is a rare cause of hypophysitis but should be considered in the differential diagnosis of hypophysitis [2].…”

Section: Introductionmentioning

confidence: 99%

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Fatal inflammatory hypophysitis

McIntyre

Perros

2007

Pituitary

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A young female patient presented as an acute medical emergency with hypoglycaemia. Investigations revealed panhypopituitarism and an inflammatory pituitary mass. An antibody screen was negative for anti-neutrophil cytoplasmic antibodies with cytoplasmic distribution (cANCA). Pituitary histology showed lymphocytic infiltration and a few Langerhan's cells. The pituitary mass rapidly expanded to involve the optic nerves and led to bilateral blindness. Later, the patient developed diarrhoea, a vasculitis rash, scleritis, and proteinuria. In subsequent investigations cANCA became positive. The patient responded to steroids and cyclophosphamide treatment and remained in partial remission for six months before dying of severe sepsis. This is the first description of Wegener's granulomatosis presenting with acute anterior pituitary failure in the absence of other organ involvement and negative serology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fatal inflammatory hypophysitis

McIntyre

Perros

2007

Pituitary

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“…These can be divided broadly into complete endocrine function testing, with or without stimula tion tests, 20,22,25,35,36 or selective endocrine testing, specifically testing of serum prolactin alone. 6, 27,37 Cost-effectiveness analyses can be performed when there is a measure of the outcome of interventions (either individual or treatment-based) in terms of their health impact, combining the quantity and quality of life.…”

Section: Hormonal Evaluationmentioning

confidence: 99%

Evaluation and management of pituitary incidentalomas—revisiting an acquaintance

Krikorian

Aron

2006

Nat Rev Endocrinol

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Incidentalomas of the pituitary gland have been described with increasing frequency, paralleling the advances in diagnostic imaging modalities. Several approaches have been proposed in order to appropriately evaluate their impact on patients, some recommending extensive investigations, while others advocate a more focused and potentially more cost-effective approach. The first part of this article will review current data about the prevalence, natural history and potential morbidity associated with these tumors. The second part will focus on imaging and hormonal evaluation of the incidental mass and suggest an updated management algorithm.

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“…It is generally considered that patients with idiopathic hyperprolactinemia are most likely to have a pituitary adenoma too small to be detected by the current screening procedures used [4,13,14]. Since the introduction of screening for macroprolactinaemia and retrospective review of sera from patients carrying this diagnosis, macroprolactin has been found to account for hyperprolactinemia in 16-50% of such patients [15,16].…”

mentioning

confidence: 99%

Diagnosis, misdiagnosis and management of hyperprolactinemia

Healy¹,

Smith²,

McKenna³

2006

Expert Review of Endocrinology & Metabolism

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Hyperprolactinemia is a commonly encountered disorder that suppresses both male and female gonadal function. The etiology includes pituitary tumors, hypothalamic or pituitary stalk lesions, drugs and hypothyroidism. In women, the hyperprolactinemic syndrome is characterized by menstrual disorders with or without galactorrhea, while men present with hypogonadism and related symptoms. Occasionally, a pituitary macroadenoma may be associated with pressure symptoms and/or hypopituitarism. Clinically, the most important cause of hyperprolactinemia is a prolactin-secreting pituitary adenoma. The majority of patients with prolactinomas are successfully managed medically with dopamine agonists such as cabergoline or bromocriptine. Misdiagnosis of hyperprolactinemia owing to immunoassay interference by a biologically minimally active form of prolactin termed macroprolactin is common in laboratory medicine. Alhough the etiology of macroprolactinemia is unclear, the condition is commonly associated with the presence of circulating antiprolactin antibodies. In the absence of specific testing, macroprolactin represents a diagnostic pitfall resulting in misdiagnosis and mismanagement of patients. This review examines the investigation and treatment of hyperprolactinemia in the broadened context of screening for macroprolactin and the consequences of failure to identify its presence.

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The Pituitary Mass: Diagnosis and Management

Cited by 25 publications

References 59 publications

Fatal inflammatory hypophysitis

Fatal inflammatory hypophysitis

Evaluation and management of pituitary incidentalomas—revisiting an acquaintance

Diagnosis, misdiagnosis and management of hyperprolactinemia

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