Pituitary Disease

by Sheppard, Michael C.; Stewart, Paul M.

• ISBN13: 9781402071225
• ISBN10: 1402071221
• Format: Hardcover
• Copyright: 2002-08-01
• Publisher: Springer Nature

Summary

Pituitary Disease brings together an international panel of experts who summarize the most recent and exciting advances in the diagnosis and treatment of pituitary disease. Coverage includes pathogenesis and pathology of pituitary tumors; clinical scenarios underpinning each type of pituitary tumor as well as their diagnosis and treatment. It is a useful resource for clinicians, students or researchers with an interest in the pituitary and its disorders.

Table of Contents

List of Figures	xiii
List of Tables	xv
Preface	xvii
Contributing Authors	xix
Etiology of Pituitary Tumours	1	(32)
Anthony P. Heaney
Shlomo Melmed
Introduction	1	(1)
Pituitary Tumor Initiation	1	(3)
Tumor models	2	(2)
Oncogene Activation	4	(5)
Pituitary Tumor Transforming Gene (PTTG)	4	(3)
Activating gsp mutations	7	(1)
Activated cAMP-response element binding proteins (CREB)	8	(1)
Protein Kinase A and C	8	(1)
Ras oncogenes	9	(1)
Cyclin Dl	9	(1)
Tumor Suppressor Genes	9	(2)
Retinoblastoma (Rb)	9	(1)
Cyclin-Dependent Kinase Inhibitors	10	(1)
P16 / CDKN2A	10	(1)
P27	11	(1)
Growth Factors	11	(2)
Fibroblast Growth Factors (FGF's)	11	(1)
FGF-2 (Basic FGF)	11	(1)
FGF-4	12	(1)
Vascular Endothelial derived Growth Factor (VEGF)	12	(1)
Transforming Growth Factors (TGF's)	12	(1)
TGF-β	12	(1)
TGF-α	13	(1)
Angiogenesis	13	(1)
Hypothalamic Factors and Their Receptors	14	(1)
GHRH and Somatostatin	14	(1)
Corticotrophin releasing hormone (CRH)	14	(1)
Thyrotrophin Releasing Hormone (TRH)	15	(1)
Gonadotrophin Releasing Hormone (GnRH)	15	(1)
Hereditary Syndromes	15	(2)
Multiple endocrine neoplasia	15	(1)
Carney Complex	16	(1)
McCune-Albright syndrome	16	(1)
Familial acromegaly	16	(1)
Estrogen and Estrogen Receptor	17	(1)
Transcription Factors	17	(16)
Pathology of the Pituitary	33	(18)
Ann Marie McNichol
Introduction	33	(1)
Normal Anterior Pituitary	34	(3)
Anterior pituitary development and cytodifferentiation	35	(1)
Neuropeptides, growth factors and cytokines	36	(1)
Pituitary Adenomas	37	(14)
Classification	37	(2)
Growth hormone secreting tumours	39	(1)
Prolactin secreting adenomas	40	(1)
TSH secreting adenomas	41	(1)
Corticotroph adenomas	41	(1)
Gonadotroph adenomas	42	(1)
Plurihormonal adenomas	42	(1)
Non-functioning/silent adenomas	42	(1)
Other investigations	43	(1)
General immunohistochemistry	43	(1)
Pituitary hyperplasia	43	(1)
Other tumours	44	(7)
Imaging the Pituitary	51	(24)
Dr. Julie F.C. Olliff
Imaging Techniques and Normal Anatomy	51	(3)
Pathology	54	(21)
Congenital	54	(2)
Pituitary Tumours	56	(1)
Adenoma	56	(10)
Craniopharyngioma	66	(1)
Meningioma	66	(1)
Other Tumours	66	(9)
Non-Functioning Pituitary Tumours	75	(20)
R. N. Clayton
Introduction	75	(1)
Definition of Non-Functioning Tumours (NFA)	76	(2)
Histological classification of non-functioning tumour	76	(2)
Cytogenesis of NFA's	78	(1)
Incidence and prevalence of pituitary tumours	79	(2)
Presentation and Evaluation of NFA	81	(5)
Management of NFA's - Surgery and Radiotherapy	83	(3)
What Should be the Policy for Use of RT for NFA'S?	86	(9)
Hypopituitarism is associated with increased mortality	86	(9)
Prolactinoma	95	(18)
A J Norris
J R E Davis
Introduction	95	(1)
Production and Effects of Prolactin	95	(2)
Presentation	97	(1)
Endocrine Effects	97	(1)
Mass Effects of Pituitary Lesion	97	(1)
Diagnosis	98	(2)
Biochemical Evaluation	98	(1)
Radiological Evaluation	99	(1)
Treatment	100	(13)
Why Treat?	100	(1)
Dopamine Agonists	101	(1)
Bromocriptine	101	(1)
Cabergoline	101	(1)
Quinagolide	102	(1)
Pituitary Surgery	103	(1)
Radiotherapy	104	(1)
Monitoring Treatment	104	(1)
Macroprolactinomas	105	(1)
Macroadenomas with Moderate Prolactin Excess	105	(1)
Microadenomas with Minimal Hyperprolactinaemia: No treatment?	105	(1)
Pregnancy	105	(1)
Hormone Replacement and Menopause	106	(1)
Resolution of Disease and Cessation of Treatment	107	(6)
Acromegaly	113	(14)
James Gibney
Ken KY Ho
Introduction	113	(1)
Clinical Features of Acromegaly	113	(3)
Effects on the cardiorespiratory system	114	(1)
Acromegaly and cancer risk	115	(1)
Diagnosis of Acromegaly	116	(3)
Approach to diagnosis	119	(1)
Treatment of Acromegaly	119	(5)
Cure and remission of disease in acromegaly	119	(1)
Mortality and disease control	120	(1)
Treatment goals for acromegaly	121	(1)
Approach to treatment	121	(1)
Surgery	121	(1)
Radiotherapy	121	(1)
Medical Treatment	122	(1)
Dopamine (D2) receptor agonists	122	(1)
Somatostatin analogues	122	(1)
GH receptor antagonists	123	(1)
Summary	124	(3)
Cushing's Disease	127	(40)
Professor A. Brew Atkinson
Clinical History	127	(5)
Minnie G	127	(1)
Clinical Features	128	(3)
Infections in Cushing's syndrome	131	(1)
Vascular complications	132	(1)
Sexual Dysfunction	132	(1)
Psychiatric Manifestations	132	(1)
Childhood Cushing's Syndrome	132	(1)
Intermittent, Periodic and Cyclical Cushing's Syndrome	133	(1)
Alternative Diagnoses to Cushing's Syndrome	134	(1)
Biochemical Diagnosis of Cushing's Syndrome	135	(2)
Serum cortisol	136	(1)
Salivary cortisol	136	(1)
Urinary cortisol	136	(1)
Low dose dexamethasone suppression test	136	(1)
Single-dose dexamethasone suppression test	137	(1)
Other methods	137	(1)
Differential Diagnosis of Cushing's Syndrome	137	(8)
Therapeutic Intervention and Follow-Up of Cushing's Disease	145	(1)
Pituitary surgery	145	(1)
Methods to Determine Whether Pituitary Surgery Has Been Curative	146	(6)
Clinical assessment	146	(1)
Unmeasurable early serum cortisol	146	(1)
Serum or urinary cortisol	147	(1)
Pituitary irradiation	148	(1)
Bilateral adrenalectomy	149	(1)
Choice of Therapy	150	(1)
Drug therapy	150	(1)
Nelson's Syndrome	151	(1)
Conclusions on therapy and follow-up	152	(1)
Summary	152	(15)
Thyrotropin-Secreting Pituitary Adenomas	167	(18)
Paolo Beck-Peccoz
Luca Persani
Introduction	167	(1)
Occurrence	168	(1)
Pathology and Molecular Aspects	168	(3)
Clinical Manifestations	171	(1)
Laboratory and Biochemical Findings	172	(3)
Serum thyroid hormone and TSH levels	172	(1)
Pitfalls in thyroid hormone and TSH determinations	173	(1)
Other useful biochemical parameters	174	(1)
Dynamic Testing	175	(1)
Imaging Studies and Localization of the Tumor	175	(1)
Differential Diagnosis	176	(1)
Treatment and Outcome	177	(2)
Criteria of Cure and Follow-Up	179	(6)
Craniopharyngioma	185	(22)
Professor P.H. Baylis
Steven G. Ball
Introduction	185	(1)
Pathology	185	(3)
Adamantinous craniopharyngioma	186	(2)
Papillary craniopharyngioma	188	(1)
Epidemiology	188	(1)
Aetiology	189	(1)
Diagnosis	189	(2)
Radiology	191	(1)
Differential diagnosis	191	(1)
Treatment of Primary Craniopharyngioma	191	(3)
Surgery	192	(1)
Adjuvant radiotherapy	192	(1)
Radiosurgery	193	(1)
Intracystic brachytherapy	194	(1)
Intracystic bleomycin	194	(1)
Treatment Outcomes in Craniopharyngioma	194	(3)
Overall standard outcome data	195	(1)
Surgery: gross total excision or sub-total resection?	195	(1)
Adjuvant radiotherapy	196	(1)
Endocrine outcomes of craniopharyngioma	196	(1)
The Management of Recurrent Disease	197	(4)
Monitoring of recurrent disease	198	(1)
Surgery for recurrent disease	198	(1)
Adjuvant radiotherapy and radiosurgery in recurrent disease	198	(1)
Options for recurrent cystic disease: drainage or intracystic therapy	199	(1)
Systemic treatments for recurrent and resistant disease: cytotoxic and immunomodulatory therapy	199	(2)
An Integrated Approach to the Management of Craniopharyngioma	201	(6)
Pituitary Incidentaloma	207	(14)
Mark E. Molitch
Introduction	207	(1)
Types of Pituitary Mass Lesions	207	(1)
Autopsy Findings	208	(2)
CT and MRI Scans in Normal Individuals	210	(1)
Diagnostic Evaluation	211	(3)
Endocrinologic Evaluation	211	(2)
Radiologic Evaluation	213	(1)
Recommendations	214	(1)
Summary	215	(6)
Pituitary Surgery	221	(12)
Professor J.A.H. Wass
History of Pituitary Surgery	221	(1)
Aims	221	(1)
Techniques of Surgery	222	(1)
Preparation for Operation	222	(1)
Risks of Surgery	223	(1)
Technical Aspects of Surgery	223	(1)
Transcranial Surgery Technical Aspects	224	(1)
Results of Pituitary Surgery	225	(1)
Non Functioning Adenoma	225	(1)
Acromegaly	225	(1)
Cushing's Disease	225	(1)
Prolactinomas	226	(1)
Pituitary Apoplexy	226	(1)
Pituitary Re-Exploration	226	(1)
Complications of Transphenoidal Surgery	226	(2)
Nasal Complications	227	(1)
Impaired Pituitary Function	227	(1)
CSF Leakage	227	(1)
Visual Deterioration	227	(1)
Meningitis	227	(1)
Syndrome of Inappropriate Anti-diuretic Hormone Release (SIADH)	228	(1)
Complications of Transfrontal Surgery	228	(1)
Frontal Lobe Damage	228	(1)
Optic Nerve Damage	228	(1)
Vascular Damage	228	(1)
Hypothalamic Damage	228	(1)
Surgical Experience	229	(1)
Future	230	(3)
Radiotherapy for Pituitary Tumours	233	(14)
P.N. Plowman
Testing of Hypothalamo-Pituitary Axis	247	(13)
John J. Orrego
Ariel L. Barkan
Introduction	247	(1)
Prolactinoma	248	(1)
Acromegaly	248	(1)
Cushing's Syndrome	249	(1)
TSH-Secreting Pituitary Adenoma	250	(1)
Nonfunctioning Pituitary Adenoma	251	(1)
Diabetes Insipidus	251	(1)
GH Deficiency in Adults	252	(1)
ACTH Deficiency	253	(1)
Hypothyroidism	254	(1)
Hypogonadism	255	(1)
Hypothalamic-Pituitary Axis Testing	256	(4)
Oral glucose tolerance test (OGTT)	256	(1)
TRH stimulation test	256	(1)
GnRH stimulation test	257	(1)
GHRH stimulation test	257	(1)
Arginine stimulation test	257	(1)
Low dose DST	258	(1)
Standard high-dose DST	258	(1)
Metyrapone test	258	(1)
CRH stimulation test	259	(1)
ACTH stimulation test	259	(1)
Insulin tolerance test (ITT)	259	(1)
Clomiphene stimulation test	260	(1)
Fluid deprivation/DDAVP test	260