Clinical evaluation of pituitary insufficiency in adult population

Clinical evaluation of pituitary insufficiency in adult population

Background/aim: This retrospective study aimed to investigate the clinical profile of pituitary insufficiency (PI) in adult population.Materials and methods: One hundred and fifty patients who were diagnosed as having PI between 2012 and 2018 (53.3% female, meanage 48.13 ± 15.83 years) were retrospectively analyzed.Results: Age at diagnosis was higher in females as compared with males (51.13 ± 15.95 vs. 44.70 ± 15.08 years, P = 0.012). The mostfrequent presenting signs were headache (29.4%) and visual disturbance (19.6%) in general. Females frequently presented with headache(33.3%), whereas males presented with sexual dysfunction (34.4%). The most frequent cause of PI was nonfunctional pituitary adenoma(28.8%) in general population. A frequent cause of PI was Sheehan’s syndrome (33.8%) among females and nonfunctional pituitaryadenoma (38.6%) among males. Pituitary macroadenoma (75.8%) was frequent in pituitary tumors with PI. 55.3 % of the patients had 4pituitary hormones deficiencies and 26.0% of patients had 3 pituitary hormones deficiencies. Gonadotropin deficiency was the leadingpituitary hormone deficiency. The frequency of posttraumatic PI was 4.7% in the general population.Conclusion: Nonfunctional pituitary adenoma was the most common cause of PI among males and Sheehan’s syndrome was a majoretiologic factor in females. Sheehan’s syndrome remains an important health problem in Turkey although obstetric care has improved.Posttraumatic PI should be considered in the differential diagnosis of idiopathic PI.

___

  • 1. Fernandez-Rodriguez E, Lopez-Raton M, Andujar P, MartinezSilva IM, Cadarso-Suarez C et al. Epidemiology, mortality rate and survival in a homogeneous population of hypopituitary patients. Clinical Endocrinology 2013; 78 (2): 278-284. doi: 10.1111/j.1365-2265.2012.04516.x
  • 2. Regal M, Páramo C, Sierra SM, Garcia-Mayor RV. Prevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain. Clinical Endocrinology 2001; 55 (6): 735-740.
  • 3. Tanriverdi F, Dokmetas HS, Kebapcı N, Kilicli F, Atmaca H et al. Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database. Endocrine 2014; 47 (1): 198-205. doi: 10.1007/s12020-013-0127-4
  • 4. Colao A, Cotta OR, Ferone D, Torre ML, Ferraù F et al. Role of pituitary dysfunction on cardiovascular risk in primary empty sella patients. Clinical Endocrinology 2013; 79 (2): 211-216. doi: 10.1111/cen.12122
  • 5. Giustina A, Aimaretti G, Bondanelli M, Buzi F, Cannavò S et al. Primary empty sella: why and when to investigate hypothalamic-pituitary function. Journal of Endocrinological Investigation 2010; 33 (5): 343-346. doi: 10.1007/BF03346597
  • 6. Guitelman M, Garcia Basavilbaso N, Vitale M, Chervin A, Katz D et al. Primary empty sella (PES): a review of 175 cases. Pituitary 2013; 16 (2): 270-274. doi: 10.1007/s11102-012-0416- 6
  • 7. Tanriverdi F, De Bellis A, Ulutabanca H, Bizzarro A, Sinisi AA et al. A five year prospective investigation of anterior pituitary function after traumatic brain injury: is hypopituitarism longterm after head trauma associated with autoimmunity? Journal of Neurotrauma 2013; 30 (16): 1426-1433. doi: 10.1089/ neu.2012.2752
  • 8. Tanriverdi F, De Bellis A, Teksahin H, Alp E, Bizzarro A et al. Prospective investigation of pituitary functions in patients with acute infectious meningitis: is acute meningitis induced pituitary dysfunction associated with autoimmunity? Pituitary 2012; 15 (4): 579-588. doi: 10.1007/s11102-011-0371-7
  • 9. Karaca Z, Tanriverdi F, Dagli AT, Selcuklu A, Casanueva FF et al. Three years prospective investigation of pituitary functions following subarachnoid haemorrhage. Pituitary 2013; 16 (1): 76-82. doi: 10.1007/s11102-012-0377-9
  • 10. Zuhur SS, Kuzu I, Ozturk FY, Uysal E, Altuntas, Y. Anterior pituitary hormone deficiency in subjects with total and partial primary empty sella: do all cases need endocrinological evaluation? Turkish Neurosurgery 2014; 24: 374-379. doi: 10.5137/1019-5149.JTN.8671-13.0
  • 11. Keleştimur F, Jonsson P, Molvalilar S, Gomez JM, Auernhammer CJ et al. Sheehan’s syndrome: baseline characteristics and effect of 2 years of growth hormone replacement therapy in 91 patients in KIMS - Pfizer International Metabolic Database. European Journal of Endocrinology 2005; 152 (4): 581-587. doi: 10.1530/eje.1.01881
  • 12. Diri H, Tanriverdi F, Karaca Z, Senol S, Unluhizarci K et al. Extensive investigation of 114 patients with Sheehan’s syndrome: a continuing disorder. European Journal of Endocrinology 2014; 171 (3): 311-318. doi:10.1530/EJE-14-0244
  • 13. Schneider HJ, Kreitschmann-Andermahr I, Ghigo E, Stalla GK, Agha, A. Hypothalamopituitary dysfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. Journal of the American Medical Association 2007; 298 (12): 1429-1438. doi: 10.1001/ jama.298.12.1429
  • 14. Wilson V, Mallipedhi A, Stephens JW, Redfern RM, Price DE. The causes of hypopituitarism in the absence of abnormal pituitary imaging. An International Journal of Medicine 2014; 107 (1): 21-24. doi: 10.1093/qjmed/hct193
  • 15. Bates AS, Van’t Hoff W, Jones PJ, Clayton RN. The effect of hypopituitarism on life expectancy. The Journal of Clinical Endocrinology and Metabolism 1996; 81 (3): 1169-1172. doi: 10.1210/jcem.81.3.8772595
  • 16. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Vance ML. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism 2011; 96 (6): 1587-1609. doi: 10.1210/jc.2011-0179
  • 17. Stewart PM, Sherlock M. Mortality and pituitary disease. Annales d’Endocrinologie 2012; 73 (2): 81-82. doi: 10.1016/j. ando.2012.03.026
  • 18. De Marinis L, Bonadonna S, Bianchi A, Maira G, Giustina A. Primary empty sella. The Journal of Clinical Endocrinology and Metabolism 2005; 90 (9): 5471-5477. doi: 10.1210/jc.2005- 0288
  • 19. Abs R, Bengtsson BA, Hernberg-Stâhl E, Monson JP, Tauber JP et al. GH replacement in 1034 growth hormone deficient hypopituitary adults: demographic and clinical characteristics, dosing and safety. Clinical Endocrinology 1999; 50 (6): 703- 713.
  • 20. Gokalp D, Alpagat G, Tuzcu A, Bahceci M, Tuzcu S et al. Four decades without diagnosis: Sheehan’s syndrome, a retrospective analysis. Gynecological Endocrinology 2016; 32 (11): 904-907. doi: 10.1080/09513590.2016.1190331
  • 21. Tanriverdi F, Unluhizarci K, Kula M, Guven M, Bayram F et al. Effects of 18-month of growth hormone (GH) replacement therapy in patients with Sheehan’s syndrome. Growth Hormone & IGF Research 2005; 15 (3): 231-237. doi: 10.1016/j. ghir.2005.03.005
  • 22. De Graaff LCG, De Bellis A, Bellastella A, Hokken-Koelega ACS. Antipituitary antibodies in dutch patients with idiopathic hypopituitarism. Hormone Research in Paediatrics 2009; 71 (1): 22-27. doi: 10.1159/000173738
  • 23. Baş F, Uyguner ZO, Darendeliler F, Aycan Z, Çetinkaya E et al. Molecular analysis of PROP1, POU1F1, LHX3, and HESX1 in Turkish patients with combined pituitary hormone deficiency: a multicenter study. Endocrine 2015; 49 (2): 49-91. doi: 10.1007/ s12020-014-0498-1
  • 24. Kandemir N, Vurallı D, Taşkıran E, Gönç N, Özön A et al. Frequency of mutations in PROP-1 gene in Turkish children with combined pituitary hormone deficiency. The Turkish Journal of Pediatrics 2012; 54 (6): 570-575.
  • 25. Doknić M, Pekić S, Miljić D, Soldatović I, Popović V et al. Etiology of hypopituitarism in adult patients: the experience of a single center database in the Serbian population. International Journal of Endocrinology 2017; 1-8. doi: 10.1155/2017/6969286
  • 26. Askitis D, Tsitlakidis D, Müller N, Waschke A, Wolf G et al. Complete evaluation of pituitary tumours in a single tertiary care institution. Endocrine 2018; 60 (2): 255-262. doi: 10.1007/ s12020-018-1570-z
  • 27. Gundgurthi A, Garg MK, Bhardwaj R, Brar KS, Kharb S et al. Clinical spectrum of hypopituitarism in India: a single center experience. Indian Journal of Endocrinology Metabolism 2012; 16 (5): 803-808. doi: 10.4103/2230-8210.100681
  • 28. Verhelst J, Mattsson AF, Luger A, Thunander M, Góth MI et al. Prevalence and characteristics of the metabolic syndrome in 2479 hypopituitary patients with adult-onset GH deficiency before GH replacement: a KIMS analysis. European Journal of Endocrinology 2011; 165 (6): 881-889. doi: 10.1530/EJE-11- 0599
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Neurotrophic factors in bipolar disorders patients with manic episode

Özgür Korhan TUNÇEL, Arzu KARAUSTAOĞLU, Gökhan SARISOY, Eda ÇETİN, Birşen BİLGİCİ, Ebru Kaynar TUNÇEL

Fatma BİLGEN, Alper URAL, Mehmet BEKERECİOĞLU

The effect of sacrospinous ligament fixation during vaginal hysterectomy on postoperative de novo stress incontinence occurrence: a prospective study with 2-year follow-up

Eralp BAŞER, Kerem Doğa SEÇKİN, Hüseyin KIYAK, Pınar KADİROĞULLARI

DTI-MRI findings in synthetic cannabinoid users

Dilek GÖKHARMAN, Pınar Nercis KOŞAR, Sonay AYDIN, Salih PALTUN, Şafak ŞAHİNER, Erdem FATİHOĞLU

The effect of iatrogenic subclinical hyperthyroidism on anxiety, depression and quality of life in differentiated thyroid carcinoma

Cüneyd ANIL, Nazlı GÜLSOY KIRNAP, Özlem TURHAN İYİDİR, Yusuf BOZKUŞ, Şerife Mehlika IŞILDAK, Sevde Nur FIRAT, Canan DEMİR, Aslı NAR, Neslihan BAŞÇIL TÜTÜNCÜ

Eralp BAŞER, Kerem Doğa SEÇKİN, Pınar KADİROĞULLARI, Hüseyin KIYAK

Comment on: “Which nostril should be used for nasotracheal intubation with Airtraq NT® : the right or left?”

Raghuraman M SETHURAMAN

Preoperative estimation of breast resection weight in patients undergoing inferior pedicle reduction mammoplasty: the Bilgen formula

Fatma BİLGEN, Alper URAL, Mehmet BEKERECİOĞLU

Seher ŞİRİN, Mehmet Fatih ÖĞÜT, Cem BİLGEN

Melis KESKİN YILDIZ, Yusuf Kemal KEMALOĞLU, Yetkin TUAÇ, Güven MENGÜ, Recep KARAMERT, Çağıl GÖKDOĞAN