Pituitary Disorders

MDNG EndocrinologyDecember 2010
Volume 12
Issue 8

//Medical Websites

Woman with Acromegaly Presenting as Unilateral Vision Loss

This article describes the experience of researchers affiliated with the University of South Florida College of Medicine and their treatment of a 36-year-old-woman with acromegaly presenting as unilateral vision loss. She “underwent resection of a macroadenoma,” but because “only part of the tumor could be removed,” was prescribed maintenance corticosteroid dosage, radiation therapy, octreotide, and pegvisomant. The case presentation is followed by a discussion of “current concepts in diagnosis and management” of acromegaly.


The Educated PatientTM

Pituitary Disorders Resources

This Hormone Foundation resource page provides patients with basic information on acromegaly, Cushing’s syndrome, hyperprolactinemia, and pituitary tumors (secretory and non-secretory tumors). The site also discusses lifestyle concerns, whether anything can be done to prevent tumor formation, and informs on the latest pituitary research.


Johns Hopkins Pituitary Center

Think of the Johns Hopkins Pituitary Center resource page as the Hormone Foundation resource page 2.0. Both sites cover the same topics, but Johns Hopkins does so in greater detail, while also featuring links to podcasts, and an introduction, complete with contact information, to every health care professional (23 in all) on their pituitary tumor care team.



This page serves as a very basic introduction to hyperprolactinemia, covering symptoms, causes, and treatment options. It is housed at FertilityJourney.com so might be used as part of a larger exploration of female infertility.


What is Cushing’s Syndrome

New York Hospital Queens does an excellent job of explaining how Cushing’s syndrome is diagnosed and treated. Whereas most information on any given disease simply lists the battery of tests and procedures used in disease management, New York Hospital Queens provides both definitions of each diagnostic test and an explanation for why they are used. Further, because “treatment for Cushing's syndrome depends on its cause,” the page explains everything (age, overall health, and medical history; extent of the disease; tolerance for specific medications, procedures, or therapies; expectations for the course of the disease; opinion or preference) that will will factor into a physician’s determination of he best course of treatment.


//Online CME

Unusual Changes in Physical Appearance in a Patient with AIDS

Credits: 0.50

Fee: None

Expiration Date: February 28, 2011

Multimedia: None

The third case in the University of Washington’s HIV Web Study attempts to uncover the different causes for body shape changes in HIV-infected patients. In the case of “a 44-year-old man on multiple medications who developed a multitude of body shape changes,” physicians will learn about “ritonavir-fluticasone interaction [which] can cause supraphysiologic concentrations of cortisol, leading to iatrogenic Cushing's syndrome.”


//Clinical Trials

Exploratory Study of Farletuzumab to Treat Resectable, Non-functioning Pituitary Adenomas

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Morphotek

Purpose: Researchers are looking into the safety, tolerability, and efficacy “of farletuzumab in subjects with resectable, non-functioning pituitary macroadenomas as measured by objective response in the tumor size” because “previous clinical work suggests there may be a role for a folate receptor in the treatment” of these tumors.



Efficacy and Complications of Neurosurgical Treatment of Acromegaly

Journal: Pituitary (November 25, 2010)

Authors: Krzentowska-Korek A, Go%u0142kowski F, Ba%u0142dys-Waligórska, Hubalewska-Dydejczyk A

Purpose: Researchers undertook this study in order “to evaluate the frequency of occurrence of pituitary failure following neurosurgery and the efficacy of transsphenoidal tumour resection in acromegalic patients.”

Results: The authors “retrospectively evaluated 85 patients (60 female and 25 male), of mean age 43.9 ± 13.2 years, treated by transsphenoidal neurosurgery,” and found that there was a “significant correlation between basal serum level of GH at diagnosis and size of pituitary tumour.” Efficacy was “affected by concentration of basal serum GH and IGF-1, GH at 120 min in OGTT, tumour size and invasiveness. Hypopituitarism after surgery is more frequent in patients with macroadenoma. Pituitary insufficiency, as a consequence of surgery, was found in 21% of patients with normal pituitary function prior to operation.”


Children with Cushing’s Syndrome: Primary Pigmented Nodular Adrenocortical Disease Should Always Be Suspected

Journal: Pituitary (October 6, 2010)

Authors: Gonçalves da Silva R, Pinto E, GoldmanS

Purpose: Here the authors “discuss the clinical and molecular findings of two Brazilian patients with ACTH-independent Cushing’s syndrome (CS) due to Primary Pigmented Nodular Adrenocortical Disease (PPNAD) and…show the diagnostic challenge CS represents in childhood.”

Results: “After several clinical and laboratory drawbacks that misled the diagnostic investigation in both patients, the diagnosis of PPNAD was finally established and confirmed through pathology and molecular studies.” The authors stress that “the etiologic diagnosis of endogenous CS in children is a challenge that requires expertise and a multidisciplinary collaboration for its prompt and correct management” and that “although rare, PPNAD should always be considered among the possible etiologies of CS, due to the high prevalence of this disease in this age group.”



What is Acromegaly?

William H. Ludlam, MD, PhD, an endocrinologist with the Seattle Pituitary Center at the Swedish Neuroscience Institute explains the causes of acromegaly, symptoms, incidence, chances of successful tumor resection, post-surgical treatment options, and the long-lasting physical manifestations of the disease.


Cushing’s Syndrome

Over five and a half minutes, MauiMaryRN discusses excess adrenal, glucocorticoid, and mineralcorticoid production and exposure, the physical characteristics of Cushing’s disease, and the various treatment strategies depending on etiology. MauiMary also delves into “nursing considerations” that may be useful for your nursing colleagues to consider if they are part of a health care team under your direction.


From the Network

Pharmacy Times

How Medications Impact Libido

Libido problems can be a serious adverse effect related to hypogonadism, hyperprolactinemia, depression, fear of sexual failure, certain medications, or systemic illness, impacting both men and women, and can lead to decreased quality of life or relationship dysfunction.


Pharma Focus

Vitamin D

Calcium and Vitamin D to Optimize Bone Mass in Boys With Risperidone-Induced Hyperprolactinemia

Study Type: Interventional

Age/Gender Requirements: 5-17 years (male)

Sponsor: University of Iowa

Purpose: Over the course of a nine-month period, study participants will be given a placebo or calcium carbonate 625mg and vitamin D 200IU, orally, twice per day in order to assess the experimental combination’s affect on “trabecular bone mineral density in the ultradistal radius” and “total body bone mineral content.”


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