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Fahrettin Kelestimur - One of the best experts on this subject based on the ideXlab platform.
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a comparison of low dose acth glucagon stimulation and insulin tolerance test in patients with Pituitary Disorders
Clinical Endocrinology, 2015Co-Authors: Yasin Simsek, Zuleyha Karaca, Fatih Tanriverdi, Kursad Unluhizarci, Ahmet Selcuklu, Fahrettin KelestimurAbstract:SummaryContext Diagnosis of secondary adrenal insufficiency and GH deficiency requires evaluation by dynamic stimulation tests in most cases. Although insulin tolerance test (ITT) is accepted as the gold-standard test for the evaluation of both hypothalamo-Pituitary-adrenal (HPA) and (GH)-IGF-1 axes, the test is cumbersome. In clinical practice, low-dose adrenocorticotrophic hormone (ACTH) stimulation test is a sensitive, safe and easily applicable alternative to ITT. Although it takes more time, glucagon stimulation test (GST) is also a good alternative to ITT and can evaluate both axes. Objective The primary aim of this study was to compare the ITT, low-dose ACTH and GSTs in the evaluation of HPA and GH-IGF-1 axes in patients with Pituitary Disorders and to evaluate the repeatability of all three tests. Design ITT, low-dose ACTH and GSTs were performed in all 129 patients, and the tests were repeated in 66 of these patients. Setting Erciyes University Medical School, Department of Endocrinology. Patients or Other Participants One hundred and twenty-nine adult patients (76 women, 53 men) with Pituitary disorder were included in the study. Main Outcome Measure(s) The cortisol and GH responses of patients to dynamic tests. Results Peak cortisol levels obtained during ITT were significantly lower than the values obtained during both low-dose ACTH and GSTs. Peak cortisol levels obtained during the GST were lower than those found during the low dose ACTH stimulation test. Peak GH responses were found to be higher in GST than in ITT. All three tests had good reproducibility. Conclusions Any of 3 tests can be used in the evaluation of the HPA axis and either GST or the ITT can be used in the evaluation of the GH-IGF-1 axis but cut-off levels for the insufficiency of HPA or GH-IGF-1 axis should be individualized for each test.
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pregnancy and other Pituitary Disorders including gh deficiency
Best Practice & Research Clinical Endocrinology & Metabolism, 2011Co-Authors: Zuleyha Karaca, Fahrettin KelestimurAbstract:The Pituitary gland is one of the most affected organs with altered anatomy and physiology during pregnancy. Acromegaly is the second most common Pituitary adenoma seen in relation to gestation after prolactinomas. Acromegaly should be treated before conception to prevent potential tumor growth in patients who desire fertility. Medical therapy can be ceased safely after confirmation of pregnancy in acromegalic patients, but octreotide may be used in selected cases with compressive signs. Other hormonal and non-functional tumors are rarer and have been presented as case reports. Sheehan's syndrome, which is one of the most common causes of hypopituitarism in developing countries, and lymphocytic hypophysitis are known to be associated with pregnancy. They usually result in hypopituitarism, sometimes with delays in diagnosis and difficulties in differential diagnosis. Pregnancy is not common among patients with hypopituitarism or Pituitary adenomas due to altered gonadotroph functions. Ovulation induction is essential for fertility achievement, but the replacement of other deficient Pituitary hormones, including GH, seems to play an important role in the preparation of the uterus for implantation of the embryo.
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Pregnancy and Pituitary Disorders
European journal of endocrinology, 2009Co-Authors: Zuleyha Karaca, Fatih Tanriverdi, Kursad Unluhizarci, Fahrettin KelestimurAbstract:Major hormonal changes emerge during pregnancy. The Pituitary gland is one of the most affected organs with altered anatomy and physiology. The Pituitary gland is enlarged as a result of lactotroph hyperplasia. Due to physiological changes in the Pituitary and target hormone levels, binding globulins, and placental hormones, hormonal evaluation becomes more complex in pregnant women. As a consequence of physiological hormonal changes, the evaluation of Pituitary functions in pregnant women is quite different from that done in the prepregnant state. Pituitary adenomas may cause problems by their hormone secretion that affects the mother and the fetus besides causing an increased risk of tumor growth. Furthermore, diagnosis, course, and treatment of Pituitary diseases point out differences. The changes in anatomy and physiology of the Pituitary gland during pregnancy are reviewed. Pituitary Disorders namely Cushing's disease; acromegaly; prolactinoma; TSH-secreting, gonadotropin-producing, and clinically nonfunctioning adenomas; craniopharyngioma; and Sheehan's syndrome, which is one of the most common causes of hypopituitarism, lymphocytic hypophysitis, and hypopituitarism, in relation to pregnancy are discussed. Being aware of all this information will prevent any serious problems which mother and child will be exposed to.
Karen K Miller - One of the best experts on this subject based on the ideXlab platform.
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hormones and female sexual dysfunction beyond estrogens and androgens findings from the fourth international consultation on sexual medicine
The Journal of Sexual Medicine, 2016Co-Authors: Roisin Worsley, Karen K Miller, Nanette Santoro, Sharon J Parish, Susan R DavisAbstract:Abstract Introduction In recent years, multiple hormones have been investigated in relation to female sexual function. Because consumers can easily purchase products claiming to contain these hormones, a clear statement regarding the current state of knowledge is required. Aim To review the contribution of hormones, other than estrogens and androgens, to female sexual functioning and the evidence that specific endocrinopathies in women are associated with female sexual dysfunction (FSD) and to update the previously published International Society of Sexual Medicine Consensus on this topic. Methods The literature was searched using several online databases with an emphasis on studies examining the physiologic role of oxytocin, prolactin, and progesterone in female sexual function and any potential therapeutic effect of these hormones. The association between common endocrine Disorders, such as polycystic ovary syndrome, Pituitary Disorders, and obesity, and FSD also was examined. Main Outcome Measures Quality of data published in the literature and recommendations were based on the Grading of Recommendations Assessment, Development and Education system. Results There is no evidence to support the use of oxytocin or progesterone for FSD. Treating hyperprolactinemia might lessen FSD. Polycystic ovary syndrome, obesity, and metabolic syndrome could be associated with FSD, but data are limited. There is a strong association between diabetes mellitus and FSD. Conclusion Further research is required; in particular, high-quality, large-scale studies of women with common endocrinopathies are needed to determine the impact of these prevalent Disorders on female sexual function.
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overweight obese adults with Pituitary Disorders require lower peak growth hormone cutoff values on glucagon stimulation testing to avoid overdiagnosis of growth hormone deficiency
The Journal of Clinical Endocrinology and Metabolism, 2014Co-Authors: Laura E Dichtel, Beverly M K Biller, Kevin C J Yuen, Miriam A Bredella, Anu V Gerweck, Brian M Russell, Ariana Riccio, Michelle H Gurel, Patrick M Sluss, Karen K MillerAbstract:Context: Obesity is associated with diminished GH secretion, which may result in the overdiagnosis of adult GH deficiency (GHD) in overweight/obese Pituitary patients. However, there are no body mass index (BMI)-specific peak GH cutoffs for the glucagon stimulation test (GST), the favored dynamic test for assessing adult GHD in the United States. Objective: The objective of the study was to determine a peak GH cutoff level for the diagnosis of adult GHD in overweight/obese individuals using the GST. Design: This was a retrospective, cross-sectional study. Setting: The study was conducted at Massachusetts General Hospital and Oregon Health and Science University. Methods: A total of 108 subjects with a BMI ≥ 25 kg/m2 were studied: healthy controls (n = 47), subjects with total Pituitary deficiency (TPD) (n = 20, ≥ 3 non-GH Pituitary hormone deficiencies), and subjects with partial Pituitary deficiency (PPD) (n = 41, 1–2 non-GH Pituitary hormone deficiencies). Intervention: The intervention consisted of a s...
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effects of growth hormone deficiency on body composition and biomarkers of cardiovascular risk after definitive therapy for acromegaly
Clinical Endocrinology, 2012Co-Authors: Eleanor Lin, Nicholas A. Tritos, Brooke Swearingen, Beverly M K Biller, Tamara Wexler, Lisa B Nachtigall, Linda C Hemphill, Jay S Loeffler, Anne Klibanski, Karen K MillerAbstract:Background Both growth hormone (GH) excess and GH deficiency are associated with body composition and biomarkers of cardiovascular risk in patients with Pituitary Disorders. However, the effects of developing GH deficiency after definitive treatment of acromegaly are largely unknown.
Nicholas A. Tritos - One of the best experts on this subject based on the ideXlab platform.
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Pituitary society guidance: Pituitary disease management and patient care recommendations during the COVID-19 pandemic—an international perspective
Pituitary, 2020Co-Authors: Maria Fleseriu, Michael Buchfelder, Pouneh K. Fazeli, Susana M. Mallea-gil, Ann Mccormack, Maria M. Pineyro, Luis V. Syro, Justin S Cetas, Mark Gurnell, Nicholas A. TritosAbstract:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the viral strain that has caused the coronavirus disease 2019 (COVID-19) pandemic, has presented healthcare systems around the world with an unprecedented challenge. In locations with significant rates of viral transmission, social distancing measures and enforced ‘lockdowns’ are the new ‘norm’ as governments try to prevent healthcare services from being overwhelmed. However, with these measures have come important challenges for the delivery of existing services for other diseases and conditions. The clinical care of patients with Pituitary Disorders typically involves a multidisciplinary team, working in concert to deliver timely, often complex, disease investigation and management, including Pituitary surgery. COVID-19 has brought about major disruption to such services, limiting access to care and opportunities for testing (both laboratory and radiological), and dramatically reducing the ability to safely undertake transsphenoidal surgery. In the absence of clinical trials to guide management of patients with Pituitary disease during the COVID-19 pandemic, herein the Professional Education Committee of the Pituitary Society proposes guidance for continued safe management and care of this population.
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effects of growth hormone deficiency on body composition and biomarkers of cardiovascular risk after definitive therapy for acromegaly
Clinical Endocrinology, 2012Co-Authors: Eleanor Lin, Nicholas A. Tritos, Brooke Swearingen, Beverly M K Biller, Tamara Wexler, Lisa B Nachtigall, Linda C Hemphill, Jay S Loeffler, Anne Klibanski, Karen K MillerAbstract:Background Both growth hormone (GH) excess and GH deficiency are associated with body composition and biomarkers of cardiovascular risk in patients with Pituitary Disorders. However, the effects of developing GH deficiency after definitive treatment of acromegaly are largely unknown.
Erik Hagg - One of the best experts on this subject based on the ideXlab platform.
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a low dose acth test to assess the function of the hypothalamic Pituitary adrenal axis
Clinical Endocrinology, 1996Co-Authors: S Rasmuson, Tommy Olsson, Erik HaggAbstract:OBJECTIVE The insulin tolerance test (ITT) has long been used to assess the hypothalamic–Pituitary–adrenal axis, but may be hazardous. The standard synthetic ACTH (Synacthen) test has been advocated as a substitute but is sometimes insensitive. In this study the ITT has been compared to a low dose ACTH stimulation test (1 μg) and the standard ACTH stimulation test (250 μg). SUBJECTS Twenty-seven subjects were studied, 24 with verified or suspected hypothalamic–Pituitary Disorders and three on long-term glucocorticoid therapy. DESIGN Insulin tolerance, low dose ACTH and standard ACTH tests were performed in all patients. The ITT was performed less than 48 hours after the ACTH tests. Synacthen was administered as an intravenous bolus. MEASUREMENTS Serum cortisol values were determined by radioimmunoassay. The peak cortisol value during ITT was compared to the cortisol levels during the ACTH tests. RESULTS There was a highly significant correlation between peak cortisol values during ITT and cortisol levels after 20–60 minutes in the low dose ACTH test (rs = 0.91–0.93; P< 0.0001) and after 30 and 60 minutes in the standard ACTH test (rs= 0.85 and 0.89 respectively; P< 0.0001). Four patients showed discrepancies between the three tests. CONCLUSIONS The 1-μg ACTH test follows the ITT more closely and may be more sensitive than the standard ACTH test in detecting more subtle insufficiency of the hypothalamic–Pituitary–adrenal axis. The standard ACTH test and the insulin tolerance test may thus be replaced by the 1-μg ACTH test in screening for secondary cortisol insufficiency. We recommend that serum cortisol is measured before and 30 and 40 minutes after the ACTH injection.
I A Macfarlane - One of the best experts on this subject based on the ideXlab platform.
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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.
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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, David 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.