Endocrinology and Metabolism

Review Articles

Adrenal Gland
Recent Updates on the Management of Adrenal Incidentalomas: Seung Shin Park, Jung Hee Kim; Endocrinol Metab. 2023;38(4):373-380. Published online August 16, 2023; DOI: https://doi.org/10.3803/EnM.2023.1779

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Abstract PDF PubReader ePub: Adrenal incidentalomas represent an increasingly common clinical conundrum with significant implications for patients. The revised 2023 European Society of Endocrinology (ESE) guideline incorporates cutting-edge evidence for managing adrenal incidentalomas. This paper provides a concise review of the updated contents of the revised guideline. In the 2023 guideline, in patients without signs and symptoms of overt Cushing’s syndrome, a post-dexamethasone cortisol level above 50 nmol/L (>1.8 μg/dL) should be considered as mild autonomous cortisol secretion. Regarding the criteria of benign adrenal adenomas, a homogeneous adrenal mass with ≤10 Hounsfield units on non-contrast computed tomography requires no further follow-up, irrespective of its size. The updated guideline also discusses steroid metabolomics using tandem mass spectrometry to discriminate malignancy. It underscores the importance of high-volume surgeons performing adrenalectomy and emphasizes the pivotal role of a multidisciplinary team approach in deciding the treatment plan for indeterminate adrenal masses. The guideline advocates for more proactive surgical treatment for indeterminate adrenal masses in young patients (<40 years) and pregnant women. This review of the 2023 ESE guideline underscores the ongoing evolution of the adrenal incidentaloma management landscape, emphasizing the need for further research and adaptation of diagnostic and therapeutic strategies.

Hypothalamus and Pituitary gland
Best Achievements in Pituitary and Adrenal Diseases in 2020: Chang Ho Ahn, Jung Hee Kim; Endocrinol Metab. 2021;36(1):51-56. Published online February 24, 2021; DOI: https://doi.org/10.3803/EnM.2021.108

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Significant progress in pituitary and adrenal diseases was made in 2020. This review presents major translational and clinical advances in research on pituitary and adrenal diseases, encompassing their epidemiology, pathogenesis, diagnosis, and clinical management. We address the controversy regarding the nomenclature of pituitary neuroendocrine tumors, omics-based molecular classification of pituitary adenomas, and novel drugs for Cushing’s disease in the field of pituitary diseases. In the field of adrenal diseases, we cover big data-driven epidemiology of adrenal tumors, steroid profiling as a new diagnostic tool, and the utility of scoring systems in the decision-making process of managing primary aldosteronism. This brief article will broaden readers’ understanding of pituitary and adrenal diseases.

Citations

Citations to this article as recorded by

Surgical management and outcomes of spinal metastasis of malignant adrenal tumor: A retrospective study of six cases and literature review
Xiangzhi Ni, Jing Wang, Jiashi Cao, Kun Zhang, Shuming Hou, Xing Huang, Yuanjin Song, Xin Gao, Jianru Xiao, Tielong Liu
Frontiers in Oncology.2023;[Epub] CrossRef
2023 Korean Endocrine Society Consensus Guidelines for the Diagnosis and Management of Primary Aldosteronism
Jeonghoon Ha, Jung Hwan Park, Kyoung Jin Kim, Jung Hee Kim, Kyong Yeun Jung, Jeongmin Lee, Jong Han Choi, Seung Hun Lee, Namki Hong, Jung Soo Lim, Byung Kwan Park, Jung-Han Kim, Kyeong Cheon Jung, Jooyoung Cho, Mi-kyung Kim, Choon Hee Chung
Endocrinology and Metabolism.2023; 38(6): 597. CrossRef

Original Article

Adrenal gland
Clinical Characteristics, Management, and Outcome of 22 Cases of Primary Hypophysitis: Sun Mi Park, Ji Cheol Bae, Ji Young Joung, Yoon Young Cho, Tae Hun Kim, Sang-Man Jin, Sunghwan Suh, Kyu Yeon Hur, Kwang-Won Kim; Endocrinol Metab. 2014;29(4):470-478. Published online December 29, 2014; DOI: https://doi.org/10.3803/EnM.2014.29.4.470

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Abstract PDF PubReader

Background

Primary hypophysitis causes varying degrees of endocrine dysfunction and mass effect. The natural course and best treatment have not been well established.

Methods

Medical records of 22 patients who had been diagnosed with primary hypophysitis between January 2001 and March 2013 were retrospectively reviewed. Based on the anatomical location, we classified the cases as adenohypophysitis (AH), infundibuloneurohypophysitis (INH), and panhypophysitis (PH). Clinical presentation, endocrine function, pathologic findings, magnetic resonance imaging findings, and treatment courses were reviewed.

Results

Among 22 patients with primary hypophysitis, 81.8% (18/22) had involvement of the posterior pituitary lobe. Two patients of the AH (2/3, 66.6%) and three patients of the PH (3/10, 30%) groups initially underwent surgical mass reduction. Five patients, including three of the PH (3/10, 33.3%) group and one from each of the AH (1/3, 33.3%) and INH (1/9, 11.1%) groups, initially received high-dose glucocorticoid treatment. Nearly all of the patients treated with surgery or high-dose steroid treatment (9/11, 82%) required continuous hormone replacement during the follow-up period. Twelve patients received no treatment for mass reduction due to the absence of acute symptoms and signs related to a compressive mass effect. Most of them (11/12, 92%) did not show disease progression, and three patients recovered partially from hormone deficiency.

Conclusion

Deficits of the posterior pituitary were the most common features in our cases of primary hypophysitis. Pituitary endocrine defects responded less favorably to glucocorticoid treatment and surgery. In the absence of symptoms related to mass effect and with the mild defect of endocrine function, it may not require treatment to reduce mass except hormone replacement.

Citations

Citations to this article as recorded by

Secondary xanthogranulomatous hypophysitis mimicking a pituitary macroadenoma: a case report
Salma Salhi, Ibtissem Oueslati, Yasmine Mouelhi, Alia Zehani, Nidhameddine Kchir, Elyes Kamoun, Meriem Yazidi, Melika Chihaoui
Journal of International Medical Research.2024;[Epub] CrossRef
Glucocorticoid therapy as first-line treatment in primary hypophysitis: a systematic review and individual patient data meta-analysis
Brijesh Krishnappa, Ravikumar Shah, Saba Samad Memon, Chakra Diwaker, Anurag R Lila, Virendra A Patil, Nalini S Shah, Tushar R Bandgar
Endocrine Connections.2023;[Epub] CrossRef
Hypophysitis, the Growing Spectrum of a Rare Pituitary Disease
Fabienne Langlois, Elena V Varlamov, Maria Fleseriu
The Journal of Clinical Endocrinology & Metabolism.2022; 107(1): 10. CrossRef
Outcomes of Initial Management Strategies in Patients With Autoimmune Lymphocytic Hypophysitis: A Systematic Review and Meta-analysis
Diane Donegan, Zeb Saeed, Danae A Delivanis, Mohammad Hassan Murad, Juergen Honegger, Felix Amereller, Seda Hanife Oguz, Dana Erickson, Irina Bancos
The Journal of Clinical Endocrinology & Metabolism.2022; 107(4): 1170. CrossRef
Early Pulse Glucocorticoid Therapy and Improved Hormonal Outcomes in Primary Hypophysitis
Brijesh Krishnappa, Ravikumar Shah, Vijaya Sarathi, Anurag Ranjan Lila, Manjeet Kaur Sehemby, Virendra A. Patil, Shilpa Sankhe, Nalini Shah, Tushar Bandgar
Neuroendocrinology.2022; 112(2): 186. CrossRef
Preoperative differentiation of hypophysitis and pituitary adenomas using a novel clinicoradiologic scoring system
Kyla Wright, Hyon Kim, Travis Hill, Matthew Lee, Cordelia Orillac, Nikita Mogar, Donato Pacione, Nidhi Agrawal
Pituitary.2022; 25(4): 602. CrossRef
Hypophysitis
Diane Donegan, Jürgen Honegger
Endocrine Practice.2022; 28(9): 901. CrossRef
Rare Case of a Disappearing Pituitary Adenoma During the Coronavirus Disease 2019 (COVID-19) Pandemic
David P. Bray, C. Arturo Solares, Nelson M. Oyesiku
World Neurosurgery.2021; 146: 148. CrossRef
Diabetes insipidus secondary to sellar/parasellar lesions
Anna Angelousi, Chrysoula Mytareli, Paraskevi Xekouki, Eva Kassi, Konstantinos Barkas, Ashley Grossman, Gregory Kaltsas
Journal of Neuroendocrinology.2021;[Epub] CrossRef
Clinical presentation and management of hypophysitis: An observational study of case series
Marouan Karrou, Salma Benyakhlef, Achwak Alla, Najoua Messaoudi, Asmae Oulad Amar, Siham Rouf, Imane Kamaoui, Noureddine Oulali, Faycal Moufid, Naima Abda, Hanane Latrech
Surgical Neurology International.2021; 12: 304. CrossRef
Clinical aspects of autoimmune hypothalamitis, a variant of autoimmune hypophysitis: Experience from one center
Qian Wei, Guoqing Yang, Zhaohui Lue, Jingtao Dou, Li Zang, Yijun Li, Jin Du, Weijun Gu, Yiming Mu
Journal of International Medical Research.2020; 48(3): 030006051988783. CrossRef
Primary and Ipilimumab-induced Hypophysitis: A Single-center Case Series
Paul Atkins, Ehud Ur
Endocrine Research.2020; 45(4): 246. CrossRef
Hypophysitis (Including IgG4 and Immunotherapy)
Anna Angelousi, Krystallenia Alexandraki, Marina Tsoli, Gregory Kaltsas, Eva Kassi
Neuroendocrinology.2020; 110(9-10): 822. CrossRef
Hypophysitis in the era of immune checkpoint inhibitors and immunoglobulin G4-related disease
Leen Wehbeh, Sama Alreddawi, Roberto Salvatori
Expert Review of Endocrinology & Metabolism.2019; 14(3): 167. CrossRef
Immune check point inhibitors-induced hypophysitis: a retrospective analysis of the French Pharmacovigilance database
Julie Garon-Czmil, Nadine Petitpain, Franck Rouby, Marion Sassier, Samy Babai, Mélissa Yéléhé-Okouma, Georges Weryha, Marc Klein, Pierre Gillet
Scientific Reports.2019;[Epub] CrossRef
Clinical Features, Magnetic Resonance Imaging, and Treatment Experience of 20 Patients with Lymphocytic Hypophysitis in a Single Center
Qiang Zhu, Ke Qian, Guijun Jia, Gang Lv, Jisheng Wang, Liyong Zhong, Shuqing Yu
World Neurosurgery.2019; 127: e22. CrossRef
Idiopathic granulomatous hypophysitis presenting with galactorrhea, headache, and nausea in a woman: a case report and review of the literature
Guive Sharifi, Mohammad Reza Mohajeri-Tehrani, Behrouz Navabakhsh, Bagher Larijani, Touraj Valeh
Journal of Medical Case Reports.2019;[Epub] CrossRef
Paciente de 31 años con polidipsia
A.R. Benavides Aramburu, M. Seguí Díaz
Medicina de Familia. SEMERGEN.2018; 44(2): e77. CrossRef
Primary hypophysitis and other autoimmune disorders of the sellar and suprasellar regions
Sriram Gubbi, Fady Hannah-Shmouni, Constantine A. Stratakis, Christian A. Koch
Reviews in Endocrine and Metabolic Disorders.2018; 19(4): 335. CrossRef
Primary lymphocytic hypophysitis: Clinical characteristics and treatment of 50 cases in a single centre in China over 18 years
Shuchang Wang, Linjie Wang, Yong Yao, Feng Feng, Hongbo Yang, Zhiyong Liang, Kan Deng, Hui You, Jian Sun, Bing Xing, Zimeng Jin, Renzhi Wang, Hui Pan, Huijuan Zhu
Clinical Endocrinology.2017; 87(2): 177. CrossRef
Clinical presentation and outcome of children with central diabetes insipidus associated with a self‐limited or transient pituitary stalk thickening, diagnosed as infundibuloneurohypophysitis
J. Schaefers, M. Cools, K. De Waele, I. Gies, V. Beauloye, P. Lysy, I. Francois, D. Beckers, J. De Schepper
Clinical Endocrinology.2017; 87(2): 171. CrossRef
Intrachiasmatic abscess caused by IgG4-related hypophysitis
Georgios F. Hadjigeorgiou, Eva Løbner Lund, Lars Poulsgaard, Ulla Feldt-Rasmussen, Åse Krogh Rasmussen, Marianne Wegener, Kåre Fugleholm
Acta Neurochirurgica.2017; 159(11): 2229. CrossRef
Granulomatous and lymphocytic hypophysitis – are they immunologically distinct?
Shilpa Rao, Anita Mahadevan, Tanmoy Maiti, Manish Ranjan, Shivayogi Durgad Shwetha, Arimappamagan Arivazhagan, Jitender Saini
APMIS.2016; 124(12): 1072. CrossRef
Articles in 'Endocrinology and Metabolism' in 2014
Won-Young Lee
Endocrinology and Metabolism.2015; 30(1): 47. CrossRef

Case Report

A Case of Pituitary Abscess that was Difficult to Diagnose due to Repeated Symptomatic Responses to Every Corticosteroid Administration.: Jin Sun Jang, Jae Seung Yun, Jung Ah Shin, Min Hee Kim, Dong Jun Lim, Jae Hyung Cho, Kun Ho Yoon, Moo Il Kang, Bong Yun Cha, Ho Young Son, Yong Kil Hong; Endocrinol Metab. 2011;26(1):72-77. Published online March 1, 2011; DOI: https://doi.org/10.3803/EnM.2011.26.1.72

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Abstract PDF: Pituitary abscess is a rare pathology, but it is a potentially life-threatening condition. Therefore, timely intervention, including antibiotics and an operation, can prevent the morbidity and mortality in such cases. A 31-year-old woman, who was 16 months after her second delivery, presented with intermittent headache for 3 months. Amenorrhea, polyuria and polydipsia were noticed and the endocrinological hormone studies were compatible with panhypopituitarism and diabetes insipidus. Pituitary MRI demonstrated a 2.3 cm sized cystic mass with an upper small nodular lesion. Her symptoms such as headache and fever were repeatedly improved whenever corticosteroid was administered, which led us to suspect the diagnosis of an inflammatory condition like lymphocytic hypophysitis. During the hormone replacement therapy, her cystic pituitary mass had grown and her symptoms progressively worsened for another two months. The patient underwent trans-sphenoidal exploration and she turned out to have a pituitary abscess. At the 3-month follow-up, amenorrhea was noticed and her residual function of the pituitary was tested by a combined pituitary stimulation test. The results were compatible with panhypopituitarism. She received levothyroxine 100 microg, prednisolone 5 mg and desmopressin spray and she is being observed at the out-patient clinic. The authors experienced a patient with primary pituitary abscess that was confirmed pathologically and we report on its clinical course with a literature review.

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