Hormone Deficient Patients Research Articles

Management of childhood-onset growth hormone deficiency in patients transitioning from pediatric to adult care: A review of the literature and consensus report from a panel of experts in Saudi Arabia

Despite increased recognition of the importance of optimizing care for patients with childhood-onset growth hormone deficiency (CO-GHD) during the transition period from pediatric to adult services, its implementation in clinical practice in Saudi Arabia remains challenging. By an initiative from the Saudi Society of Endocrinology and Metabolism, a panel comprising 11 experts, including both pediatric and adult endocrinologists with practical experience in the clinical management of patients with CO-GHD, was convened to discuss issues relating to transition care in this patient population. The primary objective of this consensus document was to develop the first clinician-led consensus statement that establishes best practices when transitioning adolescents with persistent CO-GHD to adult care in Saudi Arabia. A modified Delphi method was applied to develop consensus statements. A literature review was performed, and 20 statements were subsequently formulated. After two rounds of Delphi, consensus was achieved for 18 of the 20 statements.

Positive association between nonalcoholic fatty liver disease and growth hormone deficiency in patients with nonfunctioning pituitary adenoma.

Non-alcoholic fatty liver disease (NAFLD) is characterized by growth hormone deficiency (GHd). We investigated the association between NAFLD and GHd in patients with nonfunctioning pituitary adenomas (NFPA). We recruited patients with NFPA who underwent transsphenoidal adenectomy between January 2005 and December 2018. Pituitary function was determined by the insulin tolerance test, thyroid hormone assay, and gonadal hormone levels. NAFLD was defined as a hepatic steatosis index greater than 36. Among 278 patients (mean age, 44.2 years; 58.6% [n=163] female), 103 (37.0%) had GHd, 139 (50.0%) had hypogonadism, and 75 (27.0%) had NAFLD. The prevalence of NAFLD was significantly higher in patients with GHd than in those without (36.9% vs. 21.1%, p=0.01). Even after adjusting for age, total cholesterol level, gonadal function, and prolactin level, patients with GHd had approximately two-fold higher prevalence of NALFD than those without GHd (adjusted odds ratio [OR]=1.85, 95% confidence interval [CI]=1.05-3.28, p=0.03). Among female patients, the prevalence of NALFD was significantly higher in those with GHd than in those without (adjusted OR=2.39, 95% CI=1.03-5.55, p=0.04); whereas, among male patients, the prevalence of NAFLD was statistically similar between those with and without GHd (p>0.05). In addition, gonadal function did not affect the prevalence of NAFLD in patients with NFPA (29.3% with eugonadism vs. 47.8% with hypogonadism, p=0.14). Among patients with NFPA, the prevalence of NAFLD was two-fold higher in patients with GHd than that in those without GHd. Thus, screening for NAFLD might be required in NFPA patients with GHd.

Risk Factor and Replacement Therapy Analysis of Pre- and Postoperative Endocrine Deficiencies for Craniopharyngioma.

Pituitary hormone deficiency (PHD) is one of the most common symptoms and postoperative complications of craniopharyngiomas (CPs). However, the risk factors for PHD in CPs are little known. The purpose of this study was to analyze the risk factors of pre- and postoperative PHD and to investigate replacement therapy for CP patients. A retrospective study of 126 patients diagnosed with CP was performed. Univariate analysis was performed using Pearson's chi-squared test or Fisher's exact test, and a multiple logistic binary regression model was used to identify the influencing factors of pre- and postoperative PHD in craniopharyngioma. Children and patients with hypothalamic involvement were more likely to have preoperative PHD. Patients with suprasellar lesions had a high risk of postoperative PHD, and preoperative PHD was a risk factor for postoperative PHD. Children have a high incidence of preoperative PHD. Preoperative PHD can serve as an independent risk factor for postoperative PHD. Preoperative panhypopituitarism can serve as an indication of pituitary stalk sacrifice during surgery. The management of replacement therapy for long-term postoperative endocrine hormone deficiency in patients with craniopharyngioma should be enhanced.

Testosterone recovery therapy targeting dysfunctional Leydig cells.

Reduced serum testosterone affects millions of men across the world and has been linked to several comorbidities, metabolic dysfunctions, and quality of life changes. The standard treatment for testosterone deficiency remains testosterone replacement therapy. However, limitations on its use and the risk of significant adverse effects make alternative therapeutics desirable. Studies on the mechanisms regulating and synthesizing testosterone formation in testicular Leydig cells demonstrate numerous endogenous targets that could increase testosterone biosynthesis, which could alleviate reduced testosterone effects. Testosterone biosynthesis is facilitated by a conglomerate of cytosolic and mitochondrial proteins that facilitate cholesterol translocation into the mitochondria, the rate-limiting step in steroidogenesis. An effective therapeutic approach would be required to increase endogenous testosterone formation by enhancing steroidogenesis in Leydig cells. Numerous ligands for steroidogenic proteins have been developed, which increase steroid hormone formation. However, off-target effects on neurosteroid and adrenal steroid formation may limit their clinical use. First-in-class biologics, such as voltage-dependent anion channel peptides and transplantation of induced human Leydig-like cells offer advances in the development of specific strategies that could be used to enhance endogenous steroid formation in hormone deficient patients.

MRI intensity and pituitary volume predict adult-onset growth hormone deficiency in patients with obesity and overweight: a new potential tool guiding subsequent diagnostic testing

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

A case of subclinical hypothyroidism with cerebellar ataxia

Hypothyroidism is a common condition, the symptoms and signs of which vary with the duration and magnitude of thyroid hormone deficiency. Hypothyroidism can have rare neurologic problems such as reversible cerebellar ataxia. Subclinical hypothyroidism refers to biochemical evidence of thyroid hormone deficiency in patients who have few or no apparent clinical features of hypothyroidism. Here, we present a case of a 70-year-old woman with complaints of giddiness and unsteadiness of 6 months’ duration. Subsequent evaluation revealed titubation, broad-based reeling gait, and dysarthria. A MRI of the brain showed diffuse moderate cerebral atrophy with periventricular ischemic white matter changes and normal cerebellum. Further investigations revealed evidence of subclinical hypothyroidism. The patient was started on oral thyroxine supplements with a relief of symptoms following 3 weeks after the initiation of treatment and a complete recovery from symptoms after about 3 months of the initiation of treatment. The association of cerebellar involvement at the stage of subclinical hypothyroidism is a rare finding, making the case academically interesting.

Value of Early Post-Operative Growth Hormone Testing in Predicting Long-Term Remission and Residual Disease after Transsphenoidal Surgery for Acromegaly

Introduction: Surgical remission for acromegaly is dependent on a number of factors including tumour size, invasiveness, and surgical expertise. We studied the value of early post-operative growth hormone (GH) level as a predictor of outcome and to guide early surgical re-exploration for residual disease in patients with acromegaly. Methods: Patients with acromegaly undergoing first-time endoscopic transsphenoidal surgery between 2005 and 2015, in 2 regional neurosurgical centres, were studied. Insulin-like growth factor-1 (IGF-1), basal GH (i.e., sample before oral glucose), and GH nadir on oral glucose tolerance test (OGTT) were tested at various time points, including 2–5 days post-operatively. Definition of disease remission was according to the 2010 consensus statement (i.e., GH nadir <0.4 μg/L during an OGTT and normalized population-matched IGF-1). Forward stepwise logistic regression was used to determine factors associated with remission. Results: We investigated 81 consecutive patients with acromegaly, 67 (83%) of which had macroadenomas and 22 (27%) were noted to be invasive at surgery. Mean follow-up was 44 ± 25 months. Overall, surgical remission was achieved in 55 (68%) patients at final follow-up. On univariate analysis, the remission rates at the end of the study period for patients with early post-operative GH nadir on OGTT of <0.4 (N = 43), between 0.4 and 1 (N = 28), and >1 μg/L (N = 8) were 88, 54, and 20%, respectively. Similar results were seen with basal GH on early post-operative OGTT. On multivariate regression analysis, pre-operative IGF-1 (odds ratio of 13.1) and early post-operative basal GH (odds ratio of 5.0) and GH nadir on OGTT (odds ratio of 6.8) were significant predictors of residual disease. Based on a raised early GH nadir and post-operative MR findings, 10 patients underwent early surgical re-exploration. There was reduction in post-operative GH levels in 9 cases, of which 5 (50%) achieved long-term remission. There was an increased risk of new pituitary hormone deficiencies in patients having surgical re-exploration compared to those having a single operation (60 vs. 14%). Conclusions: An early post-operative basal GH and GH nadir on OGTT are reliable predictors of long-term disease remission. It can be used to guide patients for early surgical re-exploration for residual disease, although there is increased risk of hypopituitarism.

Abstract #1000170: Growth Hormone Deficiency in Patients With Mild Traumatic Brain Injury: Insights From a US Advisory Board

Abstract #1000170: Growth Hormone Deficiency in Patients With Mild Traumatic Brain Injury: Insights From a US Advisory Board

Prevalence of growth hormone deficiency in patients with unexplained chronic fatigue after undergoing bone marrow transplantation in adulthood.

Many patients who undergo bone marrow transplantation (BMT) in adulthood experience unexplained chronic fatigue which can have a major impact on their health-related quality of life (QoL). Pre-BMT treatment regimens increase the risk of developing acquired growth hormone deficiency (GHD), which results in a clinical syndrome with decreased energy and has additionally been linked to metabolic syndrome. Using the gold-standard insulin hypoglycemic test (IHT), we evaluated the prevalence of GHD in 18 post-BMT adult patients with unexplained chronic fatigue, as well as the correlation between peak serum GH response and QoL scores, the metabolic syndrome, and insulin resistance. Peak serum GH cut-point less than 3.0 ug/L was used for the diagnosis of severe GHD. The Fatigue Severity Scale and Quality of Life in Adult GHD Assessment questionnaires were used to quantify fatigue symptoms. The prevalence of severe GHD within this sample of 18 patients was 50%. A trend between lower peak serum GH response and higher fatigue and QoL-AGHDA scores was observed. GHD may represent a remediable contributor to post-BMT chronic fatigue in adults, further studies are needed to evaluate the potential role of screening and GH replacement therapy in this vulnerable patient population. GHD may be a treatable explanation for disabling post-BMT fatigue pending results of intervention studies.

Secondary Adrenal Insufficiency and Growth Hormone Deficiency in Patients with Fibromyalgia.

PurposePatients with fibromyalgia (FM) may demonstrate low cortisol concentrations during diagnostic evaluation. However, it remains unclear whether low cortisol reflects underlying pituitary dysfunction. We aimed to determine if a subset of patients with FM have concomitant secondary adrenal insufficiency (SAI) and growth hormone deficiency (GH).Patients and MethodsThis is a retrospective study of all patients with FM diagnosed with SAI based on abnormal insulin tolerance test (ITT) between June 2002 and August 2019. Patients were excluded if they had other reasons for SAI. Measurements include cortisol and GH during ITT in all patients, and peak cortisol during cosyntropin stimulation test in a subset of patients.ResultsWe identified 22 patients (median age of 38 years (range 19–65), 18 (82%) women) diagnosed with secondary AI based on abnormal ITT (peak median cortisol level of 11 mcg/dL (range 5.4–17)). Concomitant GH deficiency was diagnosed in 19 (86%) patients. Cosyntropin stimulation test was performed in 14 (64%) patients and was normal in 11 (79%) (peak cortisol ≥18 mcg/dL). MRI pituitary imaging was performed in 20 patients and showed no significant pituitary pathology. All patients were started on physiologic glucocorticoid replacement, and 5 patients were started on GH replacement. Of the 13 patients with follow-up, 8 (62%) reported symptom improvement after starting treatment.ConclusionPatients with FM can have concurrent SAI and GH deficiency. Cosyntropin stimulation test should not be used to exclude SAI in patients with FM. Appropriate glucocorticoid and/or GH replacement may improve symptoms in some patients.

Evaluation of Calcium Regulating Hormones and Some Biochemical Parameters in Growth Hormone Deficient Patients

The present study aims to evaluate levels of calcium regulating hormones and some biochemical parameters in a sample of growth hormone (GH) deficient patients. Seventy five GH deficient patients and twenty healthy subjects used as a control group have been involved in this study during their attendance at the National Diabetic Centerfor Treatment and Research /Al-Mustansiriya University. The studied subjects were in an age range of 3-15 years. Blood samples were collected from the studied subjects to determine levels of basal GH,GH2. and GH3 after 60 mins. and 90mins. of provocation with clonidine. The study also included the measurement of the levels of insulin like growth factor (IGF-1); calcium regulating hormones [parathyroid hormone (PTH) and vitamin D],and some biochemical parameters [calcium (Ca), phosphorus (P), urea, and creatinine].Distribution of the studied groups according to gender revealed that most of the GH deficientpatients (60 %) were males while 40 % were females,with the difference being statistically significant (P&lt;0.05), while the control included two equal subgroups (50 % males and 50 % females). Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups Distribution of the studied groups according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed according to BMI values showed that the percentage of underweight was significantly (P&lt;0.01) higher in the patients (48%) compared to the control (10%), while the percentage of normal weight was significantly (P&lt;0.01) higher in the control (85%) as compared to the patients (40%).The results showed highly significant decreases (P&lt;0.01) in the levels of basal GH, GH2 and GH3 in the patients as compared to the control group. Also, IGF-1 levels showed a high significant (P&lt;0.01) decrease in the patients as compared to the control group.The findings of calcium regulating hormones revealed non-significant differences in the levels of PTH and vitamin D between the patients and the control group. Also, the results of the biochemical parameters (Ca, P, urea, and creatinine) showed non-significant differences in their values between the patients and the control group.It can be concluded from the present study that GH deficiency (GHD) seems to be dominating in the males under weighted patients. The diagnosis of GHD cannot be achieved at the basal GH level.IGF-1 is a reliable marker of GH functions. Finally, levels of calcium regulating hormones are not affected by GHD.

Suprasellar extension independently predicts preoperative pituitary hormone deficiencies in patients with nonfunctioning pituitary macroadenomas: a single-center experience.

Nonfunctioning pituitary adenomas (NFPAs) are among the commonest benign tumors of the pituitary. Hypopituitarism is frequently present at the time of diagnosis, and this has been attributed to stalk portal vessel compression and/or destruction of normal anterior pituitary cells. The aim of our study was to examine possible factors at diagnosis associated with the presence of hypopituitarism. We retrospectively evaluated the records of patients with nonfunctioning pituitary macroadenomas from the database of our department. The inclusion criterion was the availability of imaging data regarding the extension of the lesion. A total of 148 patients (89 men, 60.1%) with nonfunctioning macroadenomas and available imaging data were identified. Mean age at diagnosis was 56.0 ± 14.5years, and hypopituitarism was found in 66.2%. The maximum diameter of the adenoma, the patient's age at diagnosis, and compression of the optic chiasm were significant factors predicting the presence of hypopituitarism (OR 1.077, p = 0.006; OR 1.025, p = 0.045; and OR 2.893, p = 0.042, respectively). Suprasellar adenomas with extension to adjacent sinuses, although larger than those with only suprasellar extension, did not differ as to the degree of hypopituitarism. Moreover, in suprasellar adenomas, prolactin levels, albeit not independently, were also related to hypopituitarism (OR 1.035, p = 0.045). In patients with NFPAs, prognostic factors related to increased risk of hypopituitarism are age at diagnosis, size of the adenoma, and most importantly the presence of suprasellar extension. These data accentuate the necessity for surgical decompression in case of suprasellar extension, in order, apart from saving visual acuity, to possibly avoid or reverse hypopituitarism.

Distinct pituitary hormone levels of 184 Chinese children and adolescents with multiple pituitary hormone deficiency: a single-centre study

BackgroundPituitary tumors and/or their treatment are associated with multiple pituitary hormone deficiency (MPHD) in adults, but the distinct pituitary hormone profile of MPHD in Chinese children and adolescents remains unclear.MethodsPatients with MPHD were divided into four groups according to their MRI results: 1) pituitary stalk interruption syndrome (PSIS); 2) hypoplasia; 3) normal; and 4) tumor survivor.ResultsAmong the 184 patients, 93 patients (50.5%) were with PSIS, 24 (13.0%) had hypoplastic pituitary gland, 10 (5.4%) patients were normal, and 57 (31.0%) were tumor survivors. There was an association between abnormal fetal position and PSIS (P ≤ 0.001). The CA/BA in PSIS, hypoplasia, normal, tumor survivor groups were 2.27 ± 1.05, 1.48 ± 0.39, 1.38 ± 0.57, 1.49 ± 0.33, and HtSDS were − 3.94 ± 1.39, − 2.89 ± 1.09, − 2.50 ± 1.05, − 1.38 ± 1.63. Patients in PSIS group had the largest CA/BA (P ≤ 0.001 vs. hypoplasia group, P = 0.009 vs. normal group, P ≤ 0.001 vs. tumor survivors) and lowest HtSDS (P ≤ 0.001 vs. hypoplasia group, P = 0.003 vs. normal group, P ≤ 0.001 vs. tumor survivors). The levels of TSH in the PSIS, hypoplasia, normal, and tumor survivor groups were 1.03 ± 1.08 (P = 0.149 vs. tumor survivors), 1.38 ± 1.47 (P = 0.045 vs. tumor survivors), 2.49 ± 1.53 (P < 0.001 vs. tumor survivors), and 0.76 ± 1.15 μIU/ml. The levels of GH peak in PSIS, hypoplasia, normal, tumor survivor groups were 1.37 ± 1.78, 1.27 ± 1.52, 3.36 ± 1.79, 0.53 ± 0.52 ng/ml and ACTH were 27.50 ± 20.72, 25.05 ± 14.64, 34.61 ± 59.35, 7.19 ± 8.63 ng/ml. Tumor survivors had the lowest levels of GH peak (P ≤ 0.001 vs. PSIS group, P = 0.002 vs. hypoplasia group, P ≤ 0.001 vs. normal group) and ACTH (all the P ≤ 0.001 vs. the other three groups).ConclusionThe frequency of PSIS is high among children and adolescents with MPHD. The severity of hormone deficiencies in patients with MPHD was more important in the tumor survivor group compared with the other groups.

ALTERED IRON METABOLISM IN SUBCLINICAL HYPOTHYROIDISM: MYTH OR REALITY

Introduction: Subclinical hypothyroidism refers to thyroid hormone deficiency in patients who have no apparent clinical features. Both iron deficiency anemia and subclinical hypothyroidism, due to their high prevalence and close interrelation, are significant clinical problems.&#x0D; Aims and Objectives: Association of subclinical hypothyroidism and disordered iron metabolism was studied so that better management of iron deficiency could be advised in these patients.&#x0D; Materials and Methods: 150 newly diagnosed subclinical hypothyroid patients and 150 healthy euthyroid controls were included. Total T3, total T4, TSH, iron, TIBC, transferrin and ferritin were measured. Data was analysed by student‘t’ test and Person’s formula.&#x0D; Results: Mean total T3, total T4, iron, TIBC, transferrin and ferritin values of study group were lower than that of control group (p &lt; 0.05). Mean TSH values of study group was higher than that of control group (p &lt; 0.05). Total T4 and T3 were positively correlated with transferrin (p &lt; 0.05). The patients of subclinical hypothyroidism had altered iron metabolism.&#x0D; Conclusion: Decreased iron profile in subclinical hypothyroidism was significantly high. It was suggestive to regularly investigate iron profile for early detection and its early management in case of subclinical hypothyroidism.&#x0D; Keywords: Subclinical Hypothyroidism, Serum Iron, TIBC, Ferritin, Transferrin

Contribution of functionally assessed GHRHR mutations to idiopathic isolated growth hormone deficiency in patients without GH1 mutations.

Isolated growth hormone deficiency (IGHD) is a rare condition mainly caused by mutations in GH1. The aim of this study was to assess the contribution of GHRHR mutations to IGHD in an unusually large group of patients. All GHRHR coding exons and flanking intronic regions were sequenced in 312 unrelated patients with nonsyndromic IGHD. Functional consequences of all newly identified missense variants were assessed in vitro (i.e., study of the expression of recombinant GHRHRs and their ability to activate the cyclic adenosine monophosphate (cAMP) signaling pathway). Genotype-phenotype correlation analyses were performed according to the nature of the identified mutation. We identified 20 different disease-causing GHRHR mutations (truncating and missense loss-of-function mutations), among which 15 are novel, in 24 unrelated patients. Of note, about half (13/24) of those patients represent sporadic cases. The clinical phenotype of patients with at least one missense GHRHR mutation was found to be indistinguishable from that of patients with bi-allelic truncating mutations. This study, which unveils disease-causing GHRHR mutations in 8% (24/312) of IGHD cases, identifies GHRHR as the second IGHD gene most frequently involved after GH1. The finding that 8% of IGHD cases without GH1 mutations are explained by GHRHR molecular defects (including missense mutations), together with the high proportion of sporadic cases among those patients, has important implications for genetic counseling.

P.040 New-onset secondary hormone deficiency in patients with incidental versus clinically manifesting sellar masses

Background: Secondary hormonal deficiency (SHD) in patients with sellar masses (SM) is associated with significant morbidity. Purpose: to compare long-term risk of new-onset SHD in SM found incidentally (ISM) versus those clinically manifesting (CMSM). Methods: From the Halifax Neuropituitary Program’s database, we identified all patients having non-functioning and non-pituitary SM from January 1, 2006, with ≥ 12 months follow-up. Results: There were 214 CMSM (108 with baseline SHD) and 148 ISM (37 with baseline SHD) patients (mean follow-up: 5.7 and 5.0 years, respectively). In patients who underwent early surgery (&lt;90 days from diagnosis), 3-month post-op hormonal function was considered baseline. Despite unchanged tumour size in over 95%, 129 (35.6%) developed new-onset SHD at up to 120 months. The risk of developing new-onset SHD was similar in CMSM and ISM groups (HR = 1.10; CI= 0.69-1.75; p= 0.7), and in surgical and nonsurgical patients (HR=1.24; CI= 0.59-2.61; p = 0.58). Conclusions: More than one third of patients with non-functioning or non-pituitary SM, presenting either with clinical manifestations or as incidental lesions, will develop new-onset SHD. Furthermore, SHD may develop several years later and despite stability of tumors, highlighting the need for ongoing, long-term hormonal assessment.

The Incidence of Anterior Pituitary Hormone Deficiencies in Patients with Pituitary Microadenoma and Idiopathic Hyperprolactinaemia. A Retrospective Single Centre Study

Introduction: Patients with microprolactinoma and idiopathic hyperprolactinaemia are not generally considered to be at risk of hypopituitarism and are therefore not routinely screened for this abnormality. Aims: We aimed to establish the frequency and clinical significance of anterior pituitary hormone deficiencies, comparing patients with radiologically proven microprolactinomas and idiopathic hyperprolactinaemia. Study Design: We retrospectively examined the case notes of 242 patients with hyperprolactinaemia from our centre. Patients who did not fit the profile of surgically naïve microprolactinoma or idiopathic hyperprolactinaemia or who had incomplete data were excluded, resulting in a study group of 185 patients. Results: Out of 242 patients, 185 patients were identified with microprolactinoma and idiopathic hyperprolactinaemia. 47 (20 %) were male and 148 (80 % ) were female with mean age 35.4 ± 13.7. 87(47%). Four types of hypofunctioning pituitary gland were seen such as panhypopituitarism, secondray hypogonadism, growth hormone deficiency and central hypothroidism and were associated with more frequent normal MRI. Patients with MRI evidence of microprolactinoma were identified, three (3.4%) of whom had one or more anterior pituitary hormone deficiencies. A total of 98 (53%) patients with MRI-negative idiopathic hyperprolactinaemia were identified, twelve (12.2%) of whom had one or more anterior pituitary hormone deficiencies. Patients in the MRI-positive and MRI-negative groups had panhypopituitarism, hypogonadotrophic hypogonadism and growth hormone deficiency that required hormone. Conclusion: The current study shows an increased frequency anterior pituitary hormone deficiency in patients with idiopathic hyperprolactinaemia, not with pitutary microadenoma. A prospective study would be required to assess the underlying cause for these abnormalities, as they suggest a nontumour pan-pituitary process. Limitations: Question of clustering of cases within the study region and limited study sample size.

Limited Adherence to Growth Hormone Replacement in Patients with Traumatic Brain Injury.

BackgroundGrowth hormone deficiency is a recognized consequence of traumatic brain injury. The aim of this study was to determine adherence to human growth hormone therapy among patients with traumatic brain injury compared with patients with hypothalamic or pituitary disease.MethodsA retrospective chart review of patients with traumatic brain injury referred for growth hormone stimulation testing since December 2013. Within the same electronic medical record, patients who were started on human growth hormone for aetiologies other than traumatic brain injury were reviewed. Adherence to therapy at 1-year followup was compared.ResultsOf the patients with traumatic brain injury, 12/23 (52%) returned for follow-up at 1 year to continue human growth hormone treatment, whereas 11/23 (48%) did not return at 1 year. Amongst the patients with non-traumatic brain injury: 25/29 (86%) continued human growth hormone treatment, vs 4/29 (14%) who did not return. A higher proportion of patients with non-traumatic brain injury continued human growth hormone treatment; x2 (1, n = 52)p = 7.238, p = 0.007.ConclusionThere may be differences in the patient-perceived benefits of human growth hormone between these patient populations. However, it is important to consider the potential influences of cognitive and psychosocial dysfunction that can occur in patients with brain injuries.LAY ABSTRACTTraumatic brain injuries can damage the pituitary gland and cause hormone deficiencies. Growth hormone deficiency is the most common hormone deficiency in patients with head injuries. These patients have adverse symptoms and poor quality of life, but it is not known whether these issues can be reversed or improved by growth hormone replacement therapy. This study investigated how many patients who started on growth hormone therapy after brain injury continued the treatment long-term. This allowed us to estimate whether the patients perceived such treatment to be beneficial. More than half (52%) of the patients with traumatic brain injury chose to continue growth hormone therapy for one year or longer. However, while some patients with brain injury may experience benefit from growth hormone replacement, it is possible that not all patients find growth hormone therapy helpful.

The incidence of anterior pituitary hormone deficiencies in patients with microprolactinoma and idiopathic hyperprolactinaemia

Patients with microprolactinoma and idiopathic hyperprolactinaemia are not generally considered to be at risk of hypopituitarism and are therefore not routinely screened for this abnormality. In our clinical practice, we have observed a number of patients with nonmacroadenomatous hyperprolactinaemia to have anterior pituitary hormone deficits. We aimed to establish the frequency and clinical significance of anterior pituitary hormone deficiencies, comparing patients with radiologically proven microprolactinomas and patients with idiopathic hyperprolactinaemia. We retrospectively examined the casenotes of 206 patients with hyperprolactinaemia from our centre. Patients who did not fit the profile of surgically naïve microprolactinoma or idiopathic hyperprolactinaemia or who had incomplete data were excluded, resulting in a study group of 56 patients. A total of 35 patients with MRI evidence of microprolactinoma were identified, three (8.57%) of whom had one or more anterior pituitary hormone deficiencies. A total of 21 patients with MRI-negative idiopathic hyperprolactinaemia were identified, nine (42%) of whom had one or more anterior pituitary hormone deficiencies (P<.01). Only one patient in the MRI-positive group had deficiency that required hormone replacement, in contrast six patients in the MRI-negative group had deficiencies that were of clinical significance and which required hormone replacement. This study shows a clinically significant incidence of anterior pituitary hormone deficiency in patients with idiopathic hyperprolactinaemia. The authors recommend that dynamic pituitary assessment should be considered routinely in this patient group. A prospective study would be required to assess the underlying cause for these abnormalities, as they suggest a nontumour pan-pituitary process.

Hypoglycemia as a manifestation of congenital multiple pituitary hormone deficiency in patients without growth retardation: a clinical series

Congenital hypopituitarism is usually diagnosed in children with growth retardation. Severe life-threatening hypoglycemia and cholestasis can be early manifestations of hypopituitarism in neonates. The pituitary stalk interruption syndrome revealed by MRI confirms the diagnosis of congenital hypopituitarism.&#x0D; We report six cases of children admitted with recurrent ketotic hypoglycemia since early age. The median age of the first clinical presentation of hypoglycemia was 16 months. The median age at primary endocrinological examination was 45 months. At the first examination none of the patients had growth failure. Neonatal jaundice was noticed in four patients. Free T4 levels were decreased in all the patients (median level, 8.6 pmol/l; the lower limit of normal being 10 pmol/l), while the TSH level was normal or moderately increased, suggesting secondary hypothyroidism. Cortisol levels were low (median 92 nmol/L; range, 37—130 nmol/l). IGF-1 level was below the limit of detection (&lt;25 ng/ml) in all patients and reached the normal values in none of patients. All children had elevated prolactin levels: 540—1778 mU/l (normal level, 90—540 mU/l). MRI of the brain revealed similar abnormalities in the chiasmal sellar region in all the patients: anterior pituitary hypoplasia, thin or interrupted pituitary stalk, ectopic neurohypophysis into the chiasm and the hypothalamic structures.&#x0D; Ketotic hypoglycemia can be the first manifestation of congenital hypopituitarism before the growth failure. Hormonal results showing secondary hypothyroidism, secondary adrenal failure, low IGF-1 and pituitary stalk interruption syndrome detected by MRI are sufficient for making the diagnosis of congenital combined pituitary deficiency in children with hypoglycemia; GH-stimulation tests could be avoided in these cases.