The risks of overlooking the diagnosis of secreting pituitary adenomas

Abstract

Secreting pituitary adenomas that cause acromegaly and Cushing’s disease, as well as prolactinomas and thyrotroph adenomas, are uncommon, usually benign, slow-growing tumours. The rarity of these conditions means that their diagnosis is not familiar to most non-specialist physicians. Consequently, pituitary adenomas may be overlooked and remain untreated, and affected individuals may develop serious comorbidities that reduce their quality of life and life expectancy. Because many signs and symptoms of pituitary adenomas overlap with those of other, more common disorders, general practitioners and non-endocrinology specialists need to be aware of the “red flags” suggestive of these conditions. A long duration of active disease in patients with secreting pituitary adenomas is associated with an increased risk of comorbidities and reduced quality of life. Appropriate treatment can lead to disease remission, and, although some symptoms may persist in some patients, treatment usually reduces the incidence and severity of comorbidities and improves quality of life. Therefore, correct, early diagnosis and characterization of a pituitary adenoma is crucial for patients, to trigger timely, appropriate treatment and to optimize outcome. This article provides an overview of the epidemiology of hormonal syndromes associated with pituitary adenomas, discusses the difficulties of and considerations for their diagnosis, and reviews the comorbidities that may develop, but can be prevented, by accurate diagnosis and appropriate treatment. We hope this review will help general practitioners and non-endocrinology specialists to suspect secreting pituitary adenomas and refer patients to an endocrinologist for confirmation of the diagnosis and treatment.

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The Role of Non-Pharmacological Treatment for Osteoporosis at Patients with High Plasmatic Concentration of ACTH

“…Many cardiovascular risk factors, including hypertension, diabetes, obesity, and dyslipidaemia, are improved upon resolution of hypercortisolism, but an increased cardiovascular risk may persist and manifest in the long term [8]. Patients with Cushing's disease have severe atheroscleroses damage; persistence of metabolic syndrome, vascular damage, and atheroscleroses plaques after normalizationof cortisol levels contributes to a high cardiovascular risk despite treatment [9].…”

“…Factors contributing to the increased thrombosis risk include a long duration of uncontrolled hypercortisolism, glucocorticoid-induced hypercoagulability, and obesity [6]. This risk is thought to be already present 1-2 years before diagnosis of Cushing's disease and may remain for months after surgery [8].…”

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“…11,13 TSH-releasing tumors (thyrotroph adenomas) account for only 0.5 to 2% of all pituitary adenomas but typically present with symptoms of hyperthyroidism. 13,16 Gonadotroph adenomas typically are nonfunctioning, and do not secrete any hormones. In rare cases when they release FSH or LH, they can cause polycystic ovarian syndrome, menstrual irregularities, ovarian hyperstimulation syndrome, sexual dysfunction, and testicular hypertrophy in males.…”