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