Prevalence Of Pituitary Adenomas Research Articles

Clinical case of gonadotropinoma, which occurs for a long time under the guise of hyperprolactinemia

The prevalence of pituitary adenomas in the population among tumors of the central nervous system is about 17%. Pituitary adenomas are divided into non-functional (about 36–54%), characterized by the absence of secretory activity, and functional (about 46–64%), secreting hormones or their subunits. The most common are prolactinomas (32–51%), somatotropinomas (9– 11%), corticotropinomas (3–6%), the frequency of gonadotropins and thyrotropins is low and amounts to less than 1% of cases. This article presents a clinical observation of a patient with gonadotropinoma, which has been occurring for a long time under the guise of hyperprolactinemia.

Endocrinology: what's new in 2023

This overview provides a selection of studies published in 2023 with an impact on clinical practice. In reproductive endocrinology, important studies have addressed fertility preservation in men with Klinefelter's syndrome, the cardiovascular safety of testosterone replacement therapy, and a novel therapy, fezolinetant, for vasomotor symptoms of menopause. The updated European recommendations concerning adrenal incidentalomas will considerably modify current clinical practice. Based on a solid epidemiological work, the prevalence of pituitary adenomas has been confirmed to affect about 1 per 1000 individuals. Finally, a large British study allows to refine the benefit-risk profile of the three options available for the treatment of hyperthyroidism.

The global prevalence of primary central nervous system tumors: a systematic review and meta-analysis

BackgroundPrimary central nervous system (CNS) tumors are a heterogeneous group of neoplasms, including benign and malignant tumors. Since there are many heterogeneities in the prevalence reported in previous studies on this type of tumor, this study was performed to determine the overall prevalence of different primary CNS tumors.MethodThe study was conducted as a systematic review and meta-analysis by searching international databases, including PubMed, Scopus, Science Direct, Web of science, and the Google Scholar search engine until August 2020. After transferring the studies to information management software (EndNote) and eliminating duplicate studies, the remaining studies were reviewed based on inclusion and exclusion criteria according to three stages of primary and secondary evaluation and qualitative evaluation. Comprehensive Meta-Analysis software, Begg, Mazumdar, and I2 tests were used for data analysis, publication bias analysis, and heterogeneity analysis, respectively.ResultsAfter performing the systematic review steps, 80 studies were included for final analysis. Based on 8 studies, the prevalence of brain tumors was 70.9%. Also, studies on 7 other studies showed that the prevalence of spinal tumors was 12.2%. A review of 14 studies showed that the prevalence of neuroepithelial tumors was 34.7%. The analysis of 27 studies reported a prevalence of glioma tumors of 42.8%. Analyses performed on other studies showed that the prevalence of pituitary adenomas was 12.2%, embryonal tumors 3.1%, ependymal tumors 3.2%, meningiomas 24.1%, glial tumors 0.8%, astrocytic 20.3%, oligodendroglial 3.9%, glioblastoma 17.7%, schwannoma 6.7%, medulloblastoma 7.7% and Polycystic astrocytomas 3.8%.ConclusionAs a result, it can be stated that brain tumors are the most common type of primary CNS tumors. It was also observed that tumors involving neuroepithelial cells are more common in patients than other types of tumors.

A Follicular Stimulating Hormone Secreting Adenoma

A gonadotroph secreting pituitary adenoma, a rare endocrinopathy, is often overlooked due to ambiguous symptoms leading to other diagnoses, such as ovarian hyperstimulation syndrome (OHSS).A 53 year old African American woman presented for evaluation of a 4 month history of right hemianopsia. Her past medical history included a total hysterectomy and bilateral oophorosalpingectomy for recurrent ovarian cysts 11 years prior. Initial MRI:4.1x3.6x3.9 cm pituitary macroadenoma with prechiasmtic optic nerve compression. Initial laboratory studies: follicular stimulating hormone (FSH) level 186.83 mIU/mL (RR:23.0-116.3 mIU/mL) and luteinizing hormone (LH) 14.44 mIU/mL (RR:15.9-54.0 mIU/mL). Other pituitary labs were unremarkable. Debulking surgery was performed to relieve mass effect; pathology showed an FSH immunoreactive adenoma. Postoperatively, FSH was 2.55 mIU/mL and LH was 0.75 mIU/mL.The prevalence of pituitary adenomas is 80-100 per 100,000 persons; 15-30% are non-functional. The majority of gonadotroph adenomas are difficult to identify because they may not produce biologically active hormones. Clinically functioning gonadotroph adenomas are very rare, often macroadenomas when found, most often found in reproductive age women, and preferentially secrete FSH. In reproductive age women, a FSH secreting adenomas may present clinically with OHSS, with multiple large ovarian cysts found on ultrasound for menstrual or pelvic complaints as seen in our patient. While OHSS is a known complication of assisted reproductive procedures, spontaneous OHSS is atypical and suggests need for evaluation of a FSH-secreting adenoma. Men may present with macroorchidism. Children may present with precocious puberty.The treatment of choice is surgical removal of the adenoma, normalizing FSH to an age appropriate level. When OHSS is present, this results in a rapid decline in estradiol level and regression of ovarian cysts. Medical treatment, if surgery is contraindicated, is limited to cabergoline, which can initially decrease FSH and estradiol levels. In patients with normal pituitary function, gonadotropin-releasing hormone agonists acutely stimulate LH and FSH, thereby desensitizing GnRH receptors and decreasing gonadotropin secretion. In patients with FSH-secreting adenomas, they may have a persistent stimulatory effect, and in rare cases, result in pituitary apoplexy. Tumors that cannot be completely surgically removed may be treated by adjuvant radiotherapy or radiosurgery.

Pituitary Microadenoma Presenting with Panhypopituitarism and Hyponatremia: A Case Report

The prevalence of pituitary adenomas is rising as more are incidentally reported on Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) imaging studies. While most exist without causing clinical symptoms or laboratory abnormalities, a non-functional sellar mass can initially present with panhypopituitarism. We present a case of pituitary microadenoma that presented with severe hyponatremia and panhypopituitarism. This patient had a non-functional pituitary microadenoma and was hospitalized many times for hyponatremia before finally being diagnosed with panhypopituitarism.

Prevalence of pituitary adenomas in macroprolactinemic patients may be higher than it is presumed

One form of prolactin (PRL) is macroprolactin with high molecular mass. Many macroprolactinemic patients have no pituitary adenomas and no clinical symptoms of hyperprolactinemia, it is controversial whether macroprolactinemia is a benign condition that does not need further investigation and treatment. In this study, we aimed to compare macroprolactinemic patients (group I) with the true hyperprolactinemic patients (group II) for the presence of pituitary adenoma. We investigated 161 patients with hyperprolactinemia, whose magnetic resonance imaging records of the pituitary were taken. All patients were questioned for irregular menses, infertility and examined for galactorrhea. Patients were screened for macroprolactinemia by polyethylene glycol precipitation, and a recovery of ≤40% and normal monomeric PRL level was taken as an indication of significant macroprolactinemia. Of 161 patients with hyperprolactinemia, 60 (37.26%) had macroprolactinemia. PRL levels of group II were lower than those of group I (P = 0.011), although monomeric PRL levels of group II were higher than those of group I (P = 0.0005). Of 60 macroprolactinemic patients, 16 (26.7%) had pituitary adenomas. The prevalence of pituitary adenomas was lower in group I, compared with group II (P = 0.0005). No significant differences were found between the prevalences of irregular menses and infertility of group I and II (P = 0.084, P = 0.361). Prevalence of galactorrhea in group I was lower than that in group II (P = 0.048). Prevalence of pituitary adenomas in macroprolactinemic patients is lower compared with the true hyperprolactinemic patients, but may be higher than that found in other recent studies and in the general population.

Prevalence of pituitary adenomas: a community‐based, cross‐sectional study in Banbury (Oxfordshire, UK)

Pituitary adenomas (PAs) are associated with increased morbidity and mortality. The optimal delivery of services and the provision of care for patients with PAs require distribution of the resources proportionate to the impact of these conditions on the community. Currently, the resource allocation for PAs in the health care system is lacking a reliable and an up-to-date epidemiological background that would reflect the recent advances in the diagnostic technologies, leading to the earlier recognition of these tumours. To determine the prevalence, the diagnostic delay and the characteristics of patients with PA in a well-defined geographical area of the UK (Banbury, Oxfordshire). Sixteen general practitioner (GP) surgeries covering the area of Banbury and a total population of 89 334 inhabitants were asked to participate in the study (data confirmed on 31 July 2006). Fourteen surgeries with a total of 81,449 inhabitants (91% of the study population) agreed to take part. All cases of PAs were found following an exhaustive computer database search of agreed terms by the staff of each Practice and data on age, gender, presenting manifestations and their duration, imaging features at diagnosis, history of multiple endocrine neoplasia type 1 and family history of PA were collected. A total of 63 patients with PA were identified amongst the study population of 81,149, with a prevalence of 77.6 PA cases/100,000 inhabitants (prolactinomas; PRLoma: 44.4, nonfunctioning PAs: 22.2, acromegaly; ACRO: 8.6, corticotroph adenoma: 1.2 and unknown functional status; UFS: 1.2/100,000 inhabitants). The distribution of each PA subtype was for PRLoma 57%, nonfunctioning PAs 28%, ACRO 11%, corticotroph adenoma 2% and UFS 2%. The median age at diagnosis and the duration of symptoms until diagnosis (in years) were for PRLoma 32.0 and 1.5, nonfunctioning PAs 51.5 and 0.8, ACRO 47 and 4.5 and corticotroph adenoma 57 and 7, respectively. PRLoma was the most frequent PA diagnosed up to the age of 60 years (0-20 years: 75% and 20-60 years: 61% of PAs) and nonfunctioning PA after the age of 60 years (60% of PAs). Nonfunctioning PAs dominated in men (57% of all men with PA) and PRLoma in women (76% of all women with PA). Five patients (7.9%) presented with classical pituitary apoplexy, with a prevalence of 6.2 cases/100,000 inhabitants. Based on a well-defined population in Banbury (Oxfordshire, UK), we have shown that PAs have a fourfold increased prevalence than previously thought; our data confirm that PAs have a higher burden on the Health Care System and optimal resource distribution for both clinical care and research activities aiming to improve the outcome of these patients are needed.

Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)

Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)

Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)

Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK)

Prevalence of pituitary adenomas in a geographically well-defined population

Prevalence of pituitary adenomas in a geographically well-defined population

The epidemiology and genetics of pituitary adenomas

According to data derived from autopsy and radiological imaging series, pituitary tumours occur very commonly in the general population; however, most of these tumours are incidental findings with no obvious clinical impact. The historical data on the prevalence of pituitary adenomas in the clinical setting are scant and point to such tumours being relatively rare. Recent studies have shown that the prevalence of clinically relevant pituitary adenomas is 3-5 times higher than previously reported, which adds impetus to research into the aetiology of these tumours. Although the majority of pituitary adenomas are sporadic, approximately 5% of all cases occur in a familial setting and over half of these are due to Multiple Endocrine Neoplasia Type 1 (MEN-1) and Carney's Complex (CNC) disorders. Since the late 1990 s, we have described non-MEN1/CNC familial pituitary tumours that include all tumour phenotypes as a condition termed Familial Isolated Pituitary Adenomas (FIPAs). The clinical characteristics of the FIPAs vary from those sporadic pituitary adenomas, as patients with FIPAs have a younger age at diagnosis and larger tumours. About 15% of the FIPA patients have mutations in the aryl hydrocarbon receptor-interacting protein gene (AIP), which indicates that the FIPA may have a diverse genetic pathophysiology.

Treatment of pituitary adenomas

According to epidemiological studies, the prevalence of pituitary adenomas is 16.5% and the majority of them are "incidentalomas". The symptoms of pituitary disorders are often non-specific; disturbances of pituitary function, compression symptoms, hypophysis apoplexy or accidental findings may help the diagnosis. The hormonal evaluation of pituitary adenomas is different from the algorithm used in the disorders of peripheral endocrine organs. The first-line therapy of prolactinomas are the dopamine agonists, and the aims of the treatment are to normalize the prolactin level, restore fertility in child-bearing age, decrease tumor mass, save or improve the residual pituitary function and inhibit the relapse of the disease. The available dopamine agonists in Hungary are bromocriptine and quinagolide. In case of tumors with good therapeutic response, medical therapy can be withdrawn after 3-5 years; hyperprolactinemia will not recur in 2/3 of these patients. Neurosurgery is the primary therapy of GH-, ACTH-, TSH-producing and inactive adenomas. In the last decades, significant improvement has been reached in surgical procedures, resulting in low mortality rates. Acromegalic patients with unresectable tumors have a great benefit from somatostatin analog treatment. The growth hormone receptor antagonist pegvisomant is the newest modality for the treatment of acromegaly. The medical therapy of Cushing's disease is still based on the inhibition of steroid production. A new, promising somatostatin analog, pasireotide is evaluated in clinical trials. The rare TSH-producing tumor can respond to both dopamine agonist and somatostatin analog therapy. The application of conventional radiotherapy has decreased; radiotherapy is mainly used in the treatment of invasive, incurable or malignant tumors. Further studies are needed to elucidate the exact role of radiosurgery and fractionated stereotaxic irradiation in the treatment of pituitary tumors.

Physician Recommendations to Patients Taking Chronic Systemic Glucocorticoid Therapy.

Multiple endocrine neoplasia type 1 (MEN 1) is a rare autosomal dominant disorder with variable expressivity. A kindred of four Newfoundland families with this syndrome was identified in the 1970s and this has been called MEN1 Burin. A mutation R460X in the menin gene was identified in 1997. Affected individuals present with primary hyperparathyroidism, pituitary adenomas, pancreatic islet cell tumours, carcinoid tumors and other manifestations. Previous work has shown a higher than expected prevalence of pituitary adenomas and carcinoid tumors and a lower than expected prevalence of pancreatic islet cell tumors compared to the general MEN 1 literature. However, it was suspected from recent clinical experience that the incidence of pancreatic tumors in the MEN 1 Burin kindred may be higher than originally described. Members of the MEN1 Burin kindred were identified thorough previous work by Dr J. Green and the MEN/VHL clinic of the Endocrinology and Medical Genetics departments, and their medical records reviewed. The relative prevalence of the different clinical manifestations of MEN1 including pancreatic islet cell tumors were calculated to define the phenotype of MEN1 Burin kindred living in Newfoundland and any changes in the natural history of MEN1 Burin. To date 121 patients from the MEN 1 Burin kindred have been identified with the mutation R460X. Of the 116 patients with records available, 101 patients are clinically affected. There have been 97 individuals with primary hyperparathyroidism, 38 pituitary adenomas, 31 pancreatic tumors, and 11 carcinoid tumors. Members of the MEN 1 Burin kindred with the R460X mutation have a prevalence of primary hyperparathyroidism of 96%, pituitary adenoma of 38%, pancreatic islet cell tumors of 31%, and carcinoid tumors of 11%. There was a higher prevalence of pancreatic islet cell tumors in the MEN1 Burin kindred than previously reported but still not as high as the prevalence of pancreatic islet cell tumors in the general MEN 1 literature. ABSTRACT #182

Assessment and Management of Galactorrhea

Galactorrhea, inappropriate lactation, is a relatively common clinical sign encountered by primary health care providers. However, this physical sign is not synonymous with life-threatening breast or intracranial malignancy; rather, it may be physiologic, drug-induced or idiopathic. Given the 20 percent prevalence of pituitary adenomas in women with galactorrhea, the primary health care provider must rule out, in every case, intracranial causes for galactorrhea. This article reviews relevant physiopathology and develops an assessment and diagnostic protocol, which includes indications for urgent referral. It concludes with summaries of treatment modalities, outlining the role of the primary care provider throughout the diagnostic and treatment processes.