Pituitary

Late-night salivary cortisol measurements are not consistent in cushing disease

Late-night salivary cortisol measurements are not consistent in cushing disease

The study reveals that late-night salivary cortisol (LNSC) measures are variable in cushing disease, particularly in those with recurrent or persistent illness. Less variability was seen in new cases of the disease who had not undergone treatment. Hypercortisolemia is expected to be lower in treated vs. untreated patients, thus it is reasonable to suspect similar inconsistencies in LNSC values in those with subtle hypercortisolemia, frequently seen with adrenal adenomas.

GT

A rare source of cushing's syndrome: ovary

A rare source of cushing's syndrome: ovary

Cushing's syndrome (CS) is a rare illness that leads to visceral adiposity, muscle wasting, insulin resistance, osteoporosis, diabetes, blood clots, high blood pressure, dyslipidemia and frequent infections. Subsequently, affected individuals have increased mortality rates.

The most common cause of the syndrome is a pituitary tumor, otherwise called cushing disease. Although rare, other organs also have the potential of producing excessive cortisol. The article describes a unique case of CS where the source is a right ovarian mass. The selective ovarian and adrenal venous sampling was important in confirming the diagnosis, and eventually driving the therapy.

GT

New FDA approval: a more convenient test for adult growth hormone deficiency

New FDA approval: a more convenient test for adult growth hormone deficiency

FDA has approved the oral agent macrilen for evaluation of growth hormone deficiency in adults. Macrilen is a ghrelin agonist which leads to the provocative release of growth hormone by the anterior pituitary gland. The diagnostic procedure is safe, efficient and comparable with the gold standard isulin tolerance test (ITT). This is a meaningful advancement in the field of endocrinology.

GT

Pituitary disorders caused by cancer immunotherapy

Pituitary disorders caused by cancer immunotherapy

Cancer immunotherapy is becoming more common due to its specificity and efficacy. However endocrinopathy is an undesirable byproduct. Ipilimumab, approved for melanoma, has shown to cause pituitary anomalies in 10-15% of patients.

Current report reveals two cases of hypophysitis caused by a different immunotheraputic agent, atezolizumab. Unlike Ipilimumab, atezolizumab seems to have a higher inclination for corticotroph destruction leading to late-onset central adrenal insufficiency. 

It is important to be aware of endocrine disorders associated with cancer immunotherapy as early diagnosed and management could be life saving.

GT

More options for Cushing's disease

More options for Cushing's disease

Cushing's disease is a rare debilitating endocrine disorder for which few prospective interventional studies have been done. Long-acting pasireotide normalised mean urinary free cortisol concentration in about 40% of patients with Cushing's disease at month 7 and had a similar safety profile to that of twice-daily subcutaneous pasireotide.

Long-acting pasireotide is an efficacious treatment option for some patients with Cushing's disease who have persistent or recurrent disease after initial surgery or are not surgical candidates, and provides a convenient monthly administration schedule.

Lancet

Prolactinoma, pheochromocytoma and MAX gene

Prolactinoma, pheochromocytoma and MAX gene

Pheochromocytomas are rare neuroendocrine tumors. They could be adrenal vs. extra-adrenal, sporadic vs. familial, isolated vs. multifocal, or benign vs. malignant. MAX gene mutation has recently been recognized as an unusual cause of familial pheochromocytoma.

This article documents the first patient with simultaneous germline MAX mutation, pituitary prolactinoma, bilateral pheochromocytoma and mild primary hyperparathyroidism.

Could the germline MAX mutation be a direct cause of prolactinoma as well?

GT

Rare form of pituitary mass: epithelioid angiosarcoma

Rare form of pituitary mass: epithelioid angiosarcoma

This is an unusual and rare case of a large pituitary mass. Based on molecular and histological markers, authors identified the mass as primary epithelioid angiosarcoma. 

The patient presented with symptoms of subacute intracranial hypertension, confusion, and left third nerve palsy. Hypernatremia and panhypopituitarism were also noted.

GT

Ovarian Suppression by Elagolix

Ovarian Suppression by Elagolix

This study elucidates kinetic and dynamic properties of elagolix, an oral GnRH antagonist. Authors find that elagolix suppresses LH/FSH and Estradiol/Progestorone fully at respective doses of 300 mg and 200 mg BID. As expected the main side effects were hot flashes and headaches (induced menopausal symptoms). A group of 45 healthy premenopausal women were followed for 21 days.

Estrogen/ovarian suppression is needed in certain medical conditions such as hormone-dependent breast carcinomas.

GT

Would Growth Hormone Treatment Lead to Cancer?

Would Growth Hormone Treatment Lead to Cancer?

The study raises concern for possible new cancer development in patients treated with human growth hormone, while already having a history of treated malignancy. There was also a trend for Hodgkin lymphoma, bone and bladder cancer in individuals without prior history of carcinoma. About 25,000 patient data were analyzed, including initial hGH users from 1984. Further research is needed to confirm or identify the mechanism of causality.

GT

Long-acting Human Growth Hormone

Long-acting Human Growth Hormone

Long acting human growth hormone, now in a phase 2 trial, appears to be efficacious and tolerable. Its duration of action is about 5-10 times longer then the daily-dose counterpart. It is administered once weekly and so it could improve adherence to therapy in children.

GT

Endocrine Society Guidelines: Functional Hypothalamic Amenorrhea

Endocrine Society Guidelines: Functional Hypothalamic Amenorrhea

Functional hypothalamic amenorrhea stems from decreased action and release of GnRH, LH and FSH; in turn leading to lower estrogen production and inability to ovulate.

Long term consequences are low bone mass and infertility. Functional hypothalamic amenorrhea is a diagnosis of exclusion, and thus no specific cause can be found. Main culprits are excessive exercise, weight loss and stress.

GT

2016 Endocrine Society Guidelines: Central DI

2016 Endocrine Society Guidelines: Central DI

Low ADH production by the posterior pituitary can cause excessive urination, severe dehydration and high sodium measures. The natural response is increased thirst leading to additional water intake. Polyuria could be so advanced that drinking alone would not correct dehydration or sodium anomalies. Supplementation with ADH hormone is needed in these cases.

Please find below excerpts from Endocrine Society guidelines on central diabetes insipidus published in November 2016.

GT

2016 Endocrine Society Guidelines: Central Hypothyroidism

2016 Endocrine Society Guidelines: Central Hypothyroidism

Central Hypothyroidism is a very rare cause of reduced thyroid production, mainly secondary to pituitary anomaly. Infections, tumors, cysts, autoimmunity, surgery and radiation are usually responsible for the abnormal TSH secretion by the pituitary gland.

Endocrine Society released guidelines on diagnosis and management of central hypothyroidism in November 2016. Please find below excerpts with slightly modified wording for easier and succinct reading.

GT

2016 Endocrine Society Guidelines: CENTRAL Adrenal Insufficiency

2016 Endocrine Society Guidelines: CENTRAL Adrenal Insufficiency

Adrenal Insufficiency (AI) is defined by low cortisol production.  It could be due to failure, infection, injury, bleeding or inflammation of the adrenal glands, or from limited production of ACTH hormone by the pituitary.  

Adrenal Insufficiency as a result of low ACTH is called “central” or “secondary”. These guidelines were developed by Endocrine Society to address specifically Central AI. They were released in November 2016.

Please find below excerpts with slightly modified wording for easier and succinct reading.

GT