The pituitary gland is often referred to as the master gland, coordinating hormonal signals from the hypothalamus and peripheral circulation to maintain homeostasis in the body. Patients with pituitary dysfunction are faced with challenges unique to each stage of their life cycle. For example, the goals of management for a hypopituitary adolescent transitioning to adulthood would be to optimize growth and sexual development. In early adulthood, approaches that optimize of fertility in men and women can be a priority, and the management approach will be very different from that of older adults requiring sex hormone replacement.
This case-based guide will provide practical clinical guidance on approaches to the management of pituitary disorders organized by time of life, from childhood and fertile years through to older age. Sensibly divided into sections, various pituitary disorders and conditions are described and relevant treatment strategies are outlined. Sections included discussions of the unique considerations for the pituitary gland in childhood and adolescents, patients desiring fertility and pregnant patients, health optimization and non-tumoral diagnoses in adults, and management of disorders of the hypothalamic-pituitary axis in the elderly. Each chapter presents a clinical case vignette as an introduction to the concepts and a framework for the discussion of the diagnosis, management and unique consideration of each pituitary pathology.
Practical and user-friendly, Pituitary Disorders throughout the Life Cycle is an excellent resource for practicing clinical endocrinologists (pediatric, transitional care, adult) and reproductive endocrinologists as well as specialty residents and trainees.
Author(s): Susan L. Samson, Adriana G. Ioachimescu
Publisher: Springer
Year: 2022
Language: English
Pages: 398
City: Cham
Preface
Contents
Contributors
Part I: The Pituitary Gland in Childhood and Adolescence
Chapter 1: Pituitary Disorders Affecting Linear Growth: Short Stature
Overview of Assessment and Evaluation of Short Stature
Growth Hormone Deficiency
Case Presentation 1
Case Presentation 2
Case Presentation 3
Diagnosis and Evaluation
Treatment
Other Pituitary Causes of Short Stature
Case Presentation 4
Central Hypothyroidism
Case Presentation 5
Cushing Disease
Non-endocrine Causes of Short Stature
Conclusion
References
Chapter 2: Pituitary Disorders Affecting Linear Growth: Tall Stature
Case Presentation
Pathophysiology
Pituitary Gigantism in Familial Isolated Pituitary Adenoma (FIPA)
Aryl Hydrocarbon Receptor–Interacting Protein (AIP) Gene
G Protein–Coupled Receptor 101 (GPR101) Gene and X-Linked Acrogigantism (X-LAG)
Other Genetic Mutations in FIPA
Pituitary Gigantism in Syndromic Diseases
Carney Complex (CNC)
McCune–Albright Syndrome (MAS)
Multiple Endocrine Neoplasia Syndrome Types 1 and 4 (MEN1, MEN4)
Syndromes Involving Paragangliomas
Neurofibromatosis Type 1 (NF1)
Diagnostic Testing and Monitoring
Differential Diagnosis
Management
Conclusion
References
Chapter 3: Childhood Neoplasms and Impact on Hormones
Case Presentation
Introduction
Pathophysiology
Direct Effects of the Neoplasm
Effects of Radiation Therapy
External Beam Radiotherapy
Effects of Radiopharmaceuticals
Effects of Medications
Chemotherapy
Effects of Kinase Inhibitors
Effects of Immunotherapy
Considerations After Hematopoietic Stem Cell Transplant
Diagnostic Testing and Monitoring
Management
Conclusion
References
Chapter 4: Central Precocious Puberty
Case Presentation
Pathophysiology
Diagnostic Testing and Monitoring
Management
Conclusion of the Case Presentation
References
Untitled
Chapter 5: Transitions in Care of the Adolescent with Pituitary Dysfunction
Case Presentation
Introduction
Monitoring Considerations Among Adolescents and Young Adults with Hypopituitarism
Management Considerations Among Adolescents and Young Adults
Unexplained Pituitary Dysfunction: Clinical Conundrums
Psychosocial Barriers Among Adolescents and Young Adults with Hypopituitarism
Managing Transition to Adult Care in Adolescents and Young Adults with Hypopituitarism
Summary
References
Part II: Fertility and Optimization of Reproductive Potential
Chapter 6: Maintenance of Fertility in the Male Patient with Hypogonadism
Case Presentation
Pathophysiology
Diagnostic Testing and Monitoring
Medical Management of Hypergonadotropic Hypogonadism/Primary Testicular Failure
Medical Management of Hypogonadotropic Hypogonadism
Nonpharmacologic Approaches to Improving Endogenous Testosterone
Conclusion
References
Chapter 7: Preconception Management of Female Patients with Hypopituitarism
Case Presentation 1
Pathophysiology
Hypopituitarism
Fertility Outcomes
Hormonal Replacement
Tumor Size
Diagnostic Testing and Monitoring
Management
Case Presentation 2
Pathophysiology
Diagnostic Testing and Monitoring
Management
References
Chapter 8: Acromegaly: Preconception Management
Case Presentation
Introduction
Case Discussion
General Aspects
Reproductive Life Planning
Hypopituitarism
Hyperprolactinemia
Acromegaly Complications
Treatment of GH Excess During Prenatal Care
Conclusion
References
Chapter 9: Hyperprolactinemia and Preconception Management
Case Presentation
Pathophysiology
Causes of Hyperprolactinemia
Pituitary Tumors
Other Cause of Hyperprolactinemia
Diagnosis
History and Physical Examination
Laboratory and Imaging Evaluation
Treatment
Microadenoma
Macroadenoma
Treatment of the Consequences of Hyperprolactinemia
Treatment of Other Common Causes of Hyperprolactinemia
Withdrawal of DA Agonists
Case Follow-Up
Preconception Counseling
Effects of DA Agonists on the Developing Fetus
Effect of Pregnancy on Prolactinoma Size
Our Case
References
Chapter 10: Cushing’s Disease: Preconception Management
Case Presentation
Pathophysiology
Diagnostic Considerations
Management in the Context of Future Pregnancy
Repeat Transsphenoidal Surgery
Bilateral Adrenalectomy
Radiation Therapy
Medical Therapy
Elements Leading to Our Patient’s Management Decisions
Final Synthesis and Outcome
Conclusion
References
Chapter 11: Functional Gonadotroph Pituitary Adenomas: Clinical Presentation and Management
Case Presentation
Introduction
Pathophysiology
Clinical Presentation
Clinical and Laboratory Presentation: Females (Tables 11.1 and 11.2)
Clinical and Laboratory Presentation: Males (Table 11.3)
Management
Conclusion
References
Chapter 12: Optimization of Care for Women with Complex Pituitary Tumors Who Seek Fertility
Case Presentation
Pathophysiology of Infertility in Patients with Pituitary Tumors
Hypothalamic-Pituitary-Gonadal (HPG) Axis
Hypothalamic-Pituitary-Growth Hormone (HPGH) Axis
Hypothalamic-Pituitary-Adrenal (HPA) Axis
Hypothalamic-Pituitary-Thyroid Axis
Posterior Pituitary/Diabetes Insipidus (DI)
Diagnostic Testing and Biochemical Monitoring of the Pituitary Patient Desiring Fertility
Imaging Evaluation
Management
Treatment of Pituitary Hormone Excess
Treatment of Hypopituitarism
Hypothalamic-Pituitary-Adrenal Axis (HPA)
Hypothalamic-Pituitary-Thyroid Axis
Hypothalamic-Pituitary-Gonadal (HPG) Axis
Hypothalamic-Pituitary-Growth Hormone (HPGH) Axis
Conclusion
References
Part III: Management of the Pregnant Patient
Chapter 13: Ovulation, Pregnancy, and Delivery in the Female Patient with Hypopituitarism
Case Presentation
Ovulation Induction
Role of Gonadotropins
Role of Thyroid Hormone
Role of Growth Hormone
Impact of GH on Other Hormone Replacement Therapies
Pregnancy
Glucocorticoid Replacement During Pregnancy
Thyroid Hormone Replacement During Pregnancy
Replacement of GH During Pregnancy
Management of Central Diabetes Insipidus During Pregnancy
Labor and Delivery
Glucocorticoid Replacement During Labor and Delivery
Treatment of Diabetes Insipidus During Labor and Delivery
Postpartum
Conclusion
References
Chapter 14: Management of the Patient with Acromegaly During Pregnancy
Case Presentation
Pathophysiology
Diagnostic Testing and Monitoring
Management
References
Chapter 15: Management of the Patient with Prolactinoma During Pregnancy
Case Presentation
Pathophysiology
Diagnostic Testing, Monitoring, and Management
Conclusion
References
Chapter 16: Management of the Patient with Cushing’s Syndrome During Pregnancy
Case Presentation
Pathophysiology
Physiological Changes of the HPA Axis in Normal Pregnancy (Fig. 16.1)
Causes of CS in Pregnancy
Maternal and Fetal Morbidity and Mortality
Diagnostic Tests and Monitoring
Biochemical Testing (Table 16.1)
Imaging
Management (Fig. 16.2)
Conclusion
References
Chapter 17: Pregnancy-Associated Pituitary Disorders: Hypophysitis
Introduction
Case Presentation
Pathophysiology and Clinical Presentation
Diagnosis
Laboratory Investigations
Imaging
Visual Assessment
Histopathology
Management
Management of Hypopituitarism
Observation
Immunosuppressive Treatment
Conclusion
References
Chapter 18: Sheehan Syndrome
Case Presentation
Introduction
Pathogenesis
Clinical Manifestations
Diagnosis
Radiological Findings
Management
Conclusion
References
Part IV: Optimizing Health for Adults with Pituitary Disorders
Chapter 19: A Pragmatic Clinical and Pathophysiological Approach to Growth Hormone Replacement in the Adult Patient
Introduction
Pathophysiology
Case Presentations
Case 1
Diagnostic Testing and Monitoring
Management
Case 2
Diagnostic Testing and Monitoring
Management
Conclusions
References
Chapter 20: Minimising Cardiometabolic Risk Factors in Patients with Hypopituitarism
Case 1 Presentation
Case 2 Presentation
Pathophysiology
GH Deficiency and Cardiovascular Risk
Central Hypogonadism and Cardiovascular Risk
Central Hypothyroidism and Cardiovascular Risk
Central Adrenal Insufficiency (CAI) and Cardiovascular Risk
Clinical Studies on Cardiometabolic Risk
GH and Cardiometabolic Risk
TH and Cardiovascular Risk
Gonadal Hormone Replacement and Cardiovascular Risk
GC Replacement and Cardiovascular Risk
Management Issues Related with Cardiometabolic Risk
Summary of Patient Treatment
Conclusions
References
Chapter 21: Minimizing Cardiometabolic Risk Factors in Patients with Acromegaly
Case History
Introduction
Does Elevated IGF-1 Automatically Endow Increased Cardiometabolic Risk?
Cardiomyopathy in Patients with Acromegaly
Hypertension
Dysglycemia
Dyslipidemia
Sleep Apnea
Hypopituitarism
Conclusions
References
Chapter 22: Minimizing Cardiometabolic Risk Factors and Other Complications in Patients with Cushing’s Syndrome and Disease
Case Presentation
Introduction
Cardiometabolic Complications (Table 22.1)
Hypertension
Thromboembolism
Dyslipidemia
Impaired Glucose Tolerance
Cardiovascular
Obesity
Hepatic Steatosis
Other Complications
Immunologic
Musculoskeletal
Dermatologic
Neuropsychiatric
Reproductive
Conclusion
References
Chapter 23: Benefits and Risks of Sex Hormone Replacement in Women with Hypopituitarism and Hypogonadism Across the Lifespan
Case Presentation
Introduction: Incidence, Prevalence, and Implications
Physiology and Pathophysiology
Diagnostic Testing and Monitoring
Management of Sex Steroids in Women with Hypopituitarism
Prepubertal/Pubertal Patients
Adult Patients
Menopausal Patients
Conclusion
References
Part V: Non-tumoral Causes of Hypopituitarism in the Adult
Chapter 24: Impact of Repetitive and Traumatic Brain Injury on Pituitary Function
Case Presentation
Traumatic Brain Injury
Mechanism of Pituitary Function Alteration After Traumatic Brain Injury
Prevalence of Pituitary Dysfunction After a Single TBI
Hypopituitarism After Repetitive Head Injuries
Clinical Manifestations of Hypopituitarism After TBI
Diagnostic Considerations
Studies of GH Replacement in Patients with TBI
Endocrine Treatment of the TBI Patient
Conclusion
References
Chapter 25: Anti-neoplastic Immunomodulatory Treatments and the Pituitary
Patient Case
Epidemiology, Clinical Presentation, and Diagnosis
Management
Pathophysiology
References
Chapter 26: Infiltrative and Inflammatory Disorders of the Hypothalamus and Pituitary
Case Presentation
Introduction
Lymphocytic Hypophysitis (LH)
IgG4 Hypophysitis
Granulomatous Hypophysitis
Sarcoidosis
Langerhans Cell Histiocytosis (LCH)
Erdheim-Chester Disease (ECD)
Granulomatosis with Polyangiitis (GPA; Formerly Wegener’s Granulomatosis)
Idiopathic Granulomatous Hypophysitis (IGH)
Xanthomatous Hypophysitis (XH)
Necrotizing Hypophysitis (NH)
Infiltrative
Iron Overload
Amyloidosis
Infectious Hypophysitis
Abscess
Tuberculosis (TB)
Syphilis
Viral Infection
Parasitic Infection
References
Chapter 27: Opioid Interference with Hypothalamic-Pituitary Function
Case Presentation
Introduction
Pathophysiology
Hypothalamic-Pituitary-Gonadal Axis
Hypothalamic-Pituitary-Adrenal Axis
Prolactin
Growth Hormone
Hypothalamic-Pituitary-Thyroid Axis
Antidiuretic Hormone
Oxytocin
Diagnostic Testing and Monitoring
Management
Conclusions
References
Chapter 28: Impact of HIV on the Hypothalamic-Pituitary Hormonal Axis
Case Presentation
Introduction
Pathophysiology
Diagnosis and Monitoring
Management
Conclusion
References
Part VI: Hypothalamic-Pituitary Disorders in the Elderly
Chapter 29: Surgical Risk and Outcomes for Pituitary Masses in the Elderly
Case Presentation
Introduction
Clinical and Radiological Characteristics
Tumor Histology in the Elderly
Surgical Outcomes and Complications
Medical Outcomes
Endocrinological Outcomes
Outcomes in the Elderly Based on Preoperative Characteristics
Outcomes in Elderly with Hypersecreting Pituitary Adenomas
Conclusion
References
Chapter 30: Benefits and Risks of Testosterone Replacement in the Older Man with Hypogonadism
Case Presentation
Introduction
Pathophysiology
Diagnostic Testing
Management
Are There Contraindications to the Use of TRT?
What Testosterone Formulation Should Be Used?
Alternative Therapies
Monitoring
Conclusion
References
Chapter 31: Risks and Benefits of Growth Hormone Replacement in the Elderly
Introduction
Case #1
Presentation
Discussion
Case #2
Presentation
Discussion
Case #3
Presentation
Discussion
Summary
References
Index
