The Experts below are selected from a list of 267 Experts worldwide ranked by ideXlab platform
Joseph G. Verbalis - One of the best experts on this subject based on the ideXlab platform.
-
disorders of water and salt metabolism associated with Pituitary Disease
Endocrinology and Metabolism Clinics of North America, 2008Co-Authors: Joseph G. VerbalisAbstract:Disorders of water and sodium homeostasis are very common problems encountered in clinical medicine. Disorders of water metabolism are divided into hyperosmolar and hypoosmolar states, with hyperosmolar disorders characterized by a deficit of body water in relation to body solute and hypoosmolar disorders characterized by an excess of body water in relation to total body solute. This article briefly reviews the physiology of hyperosmolar and hypoosmolar syndromes, then focuses on a discussion of the pathophysiology, evaluation, and treatment of specific pre- and postoperative disorders of water metabolism in patients with Pituitary lesions.
-
Disorders of Water and Salt Metabolism Associated with Pituitary Disease
Endocrinology and Metabolism Clinics of North America, 2008Co-Authors: Jennifer A. Loh, Joseph G. VerbalisAbstract:Disorders of water and sodium homeostasis are very common problems encountered in clinical medicine. Disorders of water metabolism are divided into hyperosmolar and hypoosmolar states, with hyperosmolar disorders characterized by a deficit of body water in relation to body solute and hypoosmolar disorders characterized by an excess of body water in relation to total body solute. This article briefly reviews the physiology of hyperosmolar and hypoosmolar syndromes, then focuses on a discussion of the pathophysiology, evaluation, and treatment of specific pre- and postoperative disorders of water metabolism in patients with Pituitary lesions. © 2008 Elsevier Inc. All rights reserved.
I A Macfarlane - One of the best experts on this subject based on the ideXlab platform.
-
cardiovascular Disease hypertension dyslipidaemia and obesity in patients with hypothalamic Pituitary Disease
Postgraduate Medical Journal, 2007Co-Authors: D Deepak, N J Furlong, John Wilding, I A MacfarlaneAbstract:Objective: Adults with hypothalamic-Pituitary Disease have increased morbidity and mortality from cardiovascular Disease (CVD). Therefore, the prevalence of CVD and adequacy of treatment of cardiovascular risk factors (according to current treatment guidelines) was studied in a large group of patients with hypothalamic-Pituitary Disease. Study design: In 2005, 152 consecutive adult patients with hypothalamic-Pituitary Disease attending our neuro-endocrine centre were clinically examined and blood pressure (BP), lipid profile, type 2 diabetes mellitus, body composition and smoking status were assessed. Results: Of the 152 patients, 36.8% had treated hypertension and 28.2% had treated dyslipidaemia. Many of these patients had inadequate BP control (BP >140/85 mm Hg, 44.6%) and undesirable lipid levels (total cholesterol >4.0 mmol/l, 69%). Also, many of the untreated patients had BP and lipid levels which should have been considered for treatment (26 patients (27%) and 83 patients (76%), respectively). Smoking was admitted in 18% of patients. Central adiposity was present in 86% and obesity (body mass index ⩾30) was present in 50%. Conclusions: Cardiovascular risk factors are highly prevalent and often inadequately treated in adult patients with hypothalamic-Pituitary Disease. Aggressive treatment of these factors is essential to reduce mortality and morbidity from CVD in these patients.
-
elderly people with hypothalamic Pituitary Disease and untreated gh deficiency clinical outcome body composition lipid profiles and quality of life after 2 years compared to controls
Clinical Endocrinology, 2002Co-Authors: J Li Voon S W Chong, M Wallymahmed, T Groves, I A MacfarlaneAbstract:Summary objective Elderly patients with GH deficiency (GHD) have significant impairments in multiple aspects of quality of life (QOL) but similar lipid profiles compared to age-matched control subjects. There are, however, no data on changes in these parameters with time. This study assessed the impact of untreated GHD over a period of 2 years in a group of elderly patients with hypothalamic-Pituitary Disease in relation to new illnesses and differences in body composition, circulating lipid profile levels and QOL. Control subjects were also followed for 2 years. subjects Twenty-seven elderly patients (> 65 years) with hypothalamic-Pituitary disorders and GHD (mean peak stimulated GH response 1·6 mIU/l, range 0·6–5·0) were studied initially. Two years later 21 (13 males) agreed to attend for reassessment. Mean age was then 72·7 ± 5·04 years (range 67–85). Eighteen patients had Pituitary tumours, three had craniopharyngiomas. Twenty-seven control subjects were studied at baseline and 17 (7 males) agreed to attend for reassessment. Mean age was then 75·9 ± 6·97 years (range 67–88). methods Weight, body mass index (BMI), total fat mass (FM) (bioelectrical impedance), serum IGF-1 and fasting lipid profile (total cholesterol, triglyceride, HDL cholesterol, LDL cholesterol) were measured. QOL was assessed in both groups using five interviewer-administered self-rating questionnaires: the Nottingham Health Profile, Short Form-36, Hospital Anxiety and Depression Scale, Mental Fatigue Questionnaire and Life Fulfilment Scale. The GHD group also completed the Disease Impact Scale. results Two of the 27 patients with GHD died during the 2-year follow-up (myocardial infarction and probable cerebrovascular accident). Four controls could not be traced but there were no deaths in the other 23. In the 21 GHD patients after 2 years, mean serum IGF-1 and BMI were unchanged (12·6 ± 5·8 vs. 13·3 ± 5·1 nmol/l, P = 0·5 and 28·3 ± 4·3 vs. 29·1 ± 4·2, P = 0·5, respectively) at the 2-year follow-up and there were no significant changes in the lipid profiles. However, there was a significant reduction in fat mass (31·7 ± 11·2 vs. 28·5 ± 10·9%, P = 0·04). In the 17 control subjects after 2 years, serum IGF-1 levels (17·2 ± 4·0 vs. 15·7 ± 5·6 nmol/l, P = 0·4), BMI and fat mass were unchanged. However, there was a significant fall in total cholesterol levels over the 2-year follow-up (6·3 ± 0·9 vs. 5·7 ± 0·9 mmol/l, P < 0·0001), although LDL cholesterol, triglycerides and HDL cholesterol were unchanged. Analysing the QOL data, the GHD patients had less energy (P < 0·05), more depression (P < 0·05), more pain (P < 0·05) and lower life fulfilment scores (P < 0·01) after 2 years. However, the control subjects also had less energy (P < 0·05), less vitality (P < 0·05) and lower self-esteem (P < 0·05), more depression (P < 0·05), worse mental health (P < 0·05), life fulfilment personal (P < 0·01), life fulfilment material (P < 0·02), physical functioning and role physical functioning (P < 0·05) after 2 years. Comparing the patients and controls at baseline, there were significant differences in IGF-1, BMI, FM, LDL cholesterol, personal life fulfilment, mental fatigue, general health and mental health. However, after 2 years, only BMI and depression scores were significantly different. conclusion These patients with untreated GHD did not have deterioration of body composition or lipid profiles when reassessed after a period of 2 years. In fact, fat mass fell. The control subjects did have a significant decrease in total cholesterol but no change in other lipids or body composition. Some quality of life domains did deteriorate in the patients with GHD. However, the control subjects also had worse quality of life scores after 2 years which were then little different from the GHD patients. These results raise doubts about the benefits of GH replacement in elderly people with GHD.
-
an audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and acth secretion in patients with hypothalamic Pituitary Disease
Clinical Endocrinology, 2001Co-Authors: K Leong, John Wilding, A B Walker, I Martin, D Wile, I A MacfarlaneAbstract:OBJECTIVE: The insulin tolerance test (ITT) is usually regarded as the 'gold standard' for the assessment of the hypothalamic-Pituitary axis (growth hormone (GH) and ACTH) but must be used with caution and is contra-indicated in certain groups of patients. The glucagon stimulation test (GST) has previously been shown to be a good alternative when the ITT is contra-indicated and like the ITT stimulates both GH and ACTH secretion. There is however limited data on the use of the GST in patients with hypothalamic-Pituitary Disease. DESIGN AND PATIENTS: An audit of 500 GST was performed in 374 patients with hypothalamic-Pituitary Disease. Glucagon was administered via the subcutaneous route and bloods were taken at times 0 90 120 150 180 210 and 240 minutes. RESULTS: In the vast majority peak GH (84.4%) and cortisol (93%) responses occurred between 120 and 180 minutes Little information was obtained from the 240 minute sample. The medical supervision required was minimal and the side-effects encountered during this test were mild; 20% of the tests were associated with nausea occasionally with vomiting sweating or headaches. Four patients fainted but recovered quickly. CONCLUSIONS: This large audit has shown that the glucose stimulation test is well tolerated and can easily be performed in an out-patient setting with minimal medical supervision. The 240 minute sample added little additional information and could be omitted.
-
elderly people with hypothalamic Pituitary Disease and growth hormone deficiency lipid profiles body composition and quality of life compared with control subjects
Clinical Endocrinology, 2000Co-Authors: J Li Voon S W Chong, D Wile, Susan J Benbow, M Wallymahmed, I A MacfarlaneAbstract:OBJECTIVE In healthy adults the secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) declines with ageing and body composition alters, particularly with an increase in total body fat. In elderly people, hypothalamic–Pituitary Disease can cause GH deficiency (GHD), compared with age matched controls. This study aimed to clarify whether GHD in the elderly is associated with differences in body composition, circulating lipid levels and quality of life (QOL) compared with control subjects. SUBJECTS Twenty-seven elderly patients (14 males, mean age 71 years, range 65–83) with hypothalamic–Pituitary disorders (23 Pituitary tumours) and GHD (mean (SD) peak stimulated GH response 1.6 mIU/l (1.03) range 0.6–5) were studied. Twenty-five patients had been treated surgically (six cranial surgery, 19 transsphenoidal) and eight patients had received external cranial irradiation. Twenty-seven control subjects (14 males, mean age 72 years, range 65–86) were also studied. METHODS Weight, body mass index (BMI), total fat mass (FM, bioelectrical impedance), waist to hip ratio (WHR), serum IGF-1, fasting blood glucose and lipid profile were measured. QOL was assessed in both groups using five interviewer administered self-rating questionnaires: The Nottingham Health Profile, Short-Form 36, Hospital Anxiety and Depression Scale, Mental Fatigue Questionnaire and Life Fulfilment Scale. The GHD group also completed the Disease Impact Scale. RESULTS The data (mean (SD)) from males and females were analyzed separately. The male patients had a higher BMI than controls, 28.9(4.5) vs. 25.2(2.3) kg/m2 (P = 0.01) but the BMI in the female patients and controls was similar. In the female patients compared with the controls, FM was higher 39.4(6) vs. 33.1(8.3) % (P = 0.02), WHR was also higher 0.9(0.08) vs. 0.83(0.09) (P = 0.03) and serum IGF-1 levels were lower 10.8(6.4) vs. 18.2(6.5) nmol/l (P = 0.01). However, in the male patients, FM, WHR and IGF-1 levels were similar to the controls. Fasting blood glucose was similar in both male and female patients and the controls. Two female patients and one male control subject were taking lipid-lowering agents and were therefore excluded from the analysis of lipid profiles. Total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol and total cholesterol/HDL cholesterol ratio were not significantly different for both male and female patients compared with the controls. The 27 patients with GHD reported significantly less energy (P < 0.05), mobility (P < 0.05) and personal life fulfilment (P < 0.01) than the 27 controls. There were significantly more problems with emotional reaction (P < 0.01), social isolation (P < 0.05) and mental fatigue (P < 0.05). Additionally the GHD group reported more impairment in areas of social functioning (P < 0.05), general health (P < 0.05) and mental health (P < 0.05). The GHD group reported a modest degree of Disease impact (mean score of 14.1). There were no significant differences in the domains of material life fulfilment, pain, sleep, physical functioning, vitality, anxiety, depression, self-esteem or role physical functioning compared with the controls. CONCLUSION Compared with control subjects, the elderly female patients with hypothalamic–Pituitary Disease and GHD had a significantly higher total fat mass, with the WHR indicating a more central fat distribution and lower female serum IGF-1 levels. In contrast, elderly male patients had similar total fat mass, WHR and IGF-1 levels compared to the controls. There were no significant differences in the lipid profiles between male or female patients compared to controls. However, many of the male patients were receiving androgen replacement which might have influenced these results. Low HDL cholesterol concentrations are probably a better predictor of future cardiovascular Disease than raised LDL cholesterol levels in the elderly population and these were similar in patients and controls for both males and females. Therefore, these elderly patients with hypothalamic–Pituitary Disease and GHD, in contrast to younger adults, do not have an adverse lipid profile compared with controls. Both male and female patients did, however, report significant impairments in multiple aspects of QOL compared to the control subjects and similar QOL problems compared to younger adults with GHD but of lesser severity.
-
Elderly people with hypothalamic-Pituitary Disease and growth hormone deficiency: lipid profiles, body composition and quality of life compared with control subjects.
Clinical Endocrinology, 2000Co-Authors: J. S. W. Li Voon Chong, Susan J Benbow, D Wile, M Wallymahmed, I A MacfarlaneAbstract:OBJECTIVE In healthy adults the secretion of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) declines with ageing and body composition alters, particularly with an increase in total body fat. In elderly people, hypothalamic–Pituitary Disease can cause GH deficiency (GHD), compared with age matched controls. This study aimed to clarify whether GHD in the elderly is associated with differences in body composition, circulating lipid levels and quality of life (QOL) compared with control subjects. SUBJECTS Twenty-seven elderly patients (14 males, mean age 71 years, range 65–83) with hypothalamic–Pituitary disorders (23 Pituitary tumours) and GHD (mean (SD) peak stimulated GH response 1.6 mIU/l (1.03) range 0.6–5) were studied. Twenty-five patients had been treated surgically (six cranial surgery, 19 transsphenoidal) and eight patients had received external cranial irradiation. Twenty-seven control subjects (14 males, mean age 72 years, range 65–86) were also studied. METHODS Weight, body mass index (BMI), total fat mass (FM, bioelectrical impedance), waist to hip ratio (WHR), serum IGF-1, fasting blood glucose and lipid profile were measured. QOL was assessed in both groups using five interviewer administered self-rating questionnaires: The Nottingham Health Profile, Short-Form 36, Hospital Anxiety and Depression Scale, Mental Fatigue Questionnaire and Life Fulfilment Scale. The GHD group also completed the Disease Impact Scale. RESULTS The data (mean (SD)) from males and females were analyzed separately. The male patients had a higher BMI than controls, 28.9(4.5) vs. 25.2(2.3) kg/m2 (P = 0.01) but the BMI in the female patients and controls was similar. In the female patients compared with the controls, FM was higher 39.4(6) vs. 33.1(8.3) % (P = 0.02), WHR was also higher 0.9(0.08) vs. 0.83(0.09) (P = 0.03) and serum IGF-1 levels were lower 10.8(6.4) vs. 18.2(6.5) nmol/l (P = 0.01). However, in the male patients, FM, WHR and IGF-1 levels were similar to the controls. Fasting blood glucose was similar in both male and female patients and the controls. Two female patients and one male control subject were taking lipid-lowering agents and were therefore excluded from the analysis of lipid profiles. Total cholesterol, triglyceride, LDL cholesterol, HDL cholesterol and total cholesterol/HDL cholesterol ratio were not significantly different for both male and female patients compared with the controls. The 27 patients with GHD reported significantly less energy (P
Showkat Mirza - One of the best experts on this subject based on the ideXlab platform.
-
Radiological features for the approach in trans-sphenoidal Pituitary surgery
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, Ramkishan Balakumar, Saurabh Sinha, Showkat MirzaAbstract:Introduction In order to perform trans-sphenoidal endoscopic Pituitary surgery safely and efficiently it is important to identify anatomical and Pituitary Disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. Methods We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary surgery. Results Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. Conclusions There are significant variations in the anatomical and Pituitary Disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary surgery.
-
Radiological features for the approach in trans-sphenoidal Pituitary surgery.
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, Ramkishan Balakumar, Saurabh Sinha, Showkat MirzaAbstract:In order to perform trans-sphenoidal endoscopic Pituitary surgery safely and efficiently it is important to identify anatomical and Pituitary Disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary surgery. Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. There are significant variations in the anatomical and Pituitary Disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary surgery.
R N Clayton - One of the best experts on this subject based on the ideXlab platform.
-
comparison of the low dose short synacthen test 1 μg the conventional dose short synacthen test 250 μg and the insulin tolerance test for assessment of the hypothalamo Pituitary adrenal axis in patients with Pituitary Disease
The Journal of Clinical Endocrinology and Metabolism, 1999Co-Authors: Tarig A M Abdu, Tarik A Elhadd, R Neary, R N ClaytonAbstract:There is still uncertainty about what is the most appropriate test for assessment of the integrity of the hypothalamo-Pituitary-adrenal (HPA) axis. Many advocate the insulin tolerance test (ITT), but this is unpleasant and resource intensive, and may occasionally give misleading results. The conventional [250 μg tetracosactrin, ACTH-(1–24)] short synacthen test (SST) has been used as a simple alternative to the ITT, but it has produced some falsely reassuring results with potentially serious consequences. A low dose [1 μg tetracosactrin, ACTH-(1–24)] short synacthen test (LDSST) has recently been advocated as a more reliable and safer alternative to ITT. Some studies, however, have failed to demonstrate any difference between SST and LDSST. The purpose of this study was to assess the clinical usefulness of LDSST compared to SST and ITT in patients with Pituitary Disease. We studied 64 patients with suspected or proven Pituitary Disease. All patients underwent SST and LDSST. Forty-two patients underwent IT...
Victoria Twigg - One of the best experts on this subject based on the ideXlab platform.
-
Radiological features for the approach in trans-sphenoidal Pituitary surgery
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, Ramkishan Balakumar, Saurabh Sinha, Showkat MirzaAbstract:Introduction In order to perform trans-sphenoidal endoscopic Pituitary surgery safely and efficiently it is important to identify anatomical and Pituitary Disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. Methods We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary surgery. Results Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. Conclusions There are significant variations in the anatomical and Pituitary Disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary surgery.
-
Radiological features for the approach in trans-sphenoidal Pituitary surgery.
Pituitary, 2017Co-Authors: Victoria Twigg, Simon D. Carr, Ramkishan Balakumar, Saurabh Sinha, Showkat MirzaAbstract:In order to perform trans-sphenoidal endoscopic Pituitary surgery safely and efficiently it is important to identify anatomical and Pituitary Disease features on the pre-operative CT and MRI scans; thereby minimising the risk to surrounding structures and optimising outcomes. We aim to create a checklist to streamline pre-operative planning. We retrospectively reviewed pre-operative CT and MRI scans of 100 adults undergoing trans-sphenoidal endoscopic Pituitary surgery. Radiological findings and their incidence included deviated nasal septum (62%), concha bullosa (32%), bony dehiscence of the carotid arteries (18%), sphenoid septation overlying the internal carotid artery (24% at the sella) and low lying CSF (32%). The mean distance of the sphenoid ostium to the skull base was 10 mm (range 2.7–17.6 mm). We also describe the ‘teddy bear’ sign which when present on an axial CT indicates the carotid arteries will be identifiable intra-operatively. There are significant variations in the anatomical and Pituitary Disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal Pituitary surgery.