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Clinical spectrum of hypopituitarism in India: A single center experience.

Gundgurthi A, Garg MK, Bhardwaj R, Brar KS, Kharb S, Pandit A - Indian J Endocrinol Metab (2012)

Bottom Line: Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%).Panhypopituitarism was seen in 104 (92%) patients.Panhypopituitarism is present in 92% cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Pathology, Army Hospital (Research and Referral), Delhi Cantonment, India.

ABSTRACT

Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India.

Materials and methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations.

Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years). There were 78 (69%) males and 35 females (31%). There were 22 subjects aged ≤18 years (childhood and adolescence) and 91 adults (>18 years). Visual disturbances were the most common presenting complaint (33%), though headache was the most common symptom (81%). Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%). Panhypopituitarism was seen in 104 (92%) patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors.

Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

No MeSH data available.


Related in: MedlinePlus

The immunohistochemistry confirming the diagnosis of intrasellar germinoma, (a) positive for CD68, (b) positive for cytokeratin, (c) positive for epithelial membrane antigen
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Figure 2: The immunohistochemistry confirming the diagnosis of intrasellar germinoma, (a) positive for CD68, (b) positive for cytokeratin, (c) positive for epithelial membrane antigen

Mentions: The etiology of hypopituitarism is shown in Table 2. Tumors comprised 84% of the cases. Pituitary macroadenoma was the cause of hypopituitarism in 75 patients (66.4%). Of these, 47 patients had non-functioning adenoma (62.6%), 24 had acromegaly (32%), three had macroprolactinoma [Figure 1] (4%), and one had Cushing's disease. Other pituitary tumors were craniopharyngiomas (18 cases), one case each of intrasellar germ cell tumor [Figure 2] and granular cell tumor of neurohypophysis [Figure 3]. The latter two tumors were diagnosed by their immunohistochemistry characteristics. Non-tumor causes were seen in 16% of the patients. Sheehan's syndrome was documented in six patients (5.3%). There were few rare cases of hypopituitarism which we came across. Recurrent pituitary abscess was seen in one patient who had panhypopituitarism.[13] Snake bite (hemotoxic) was seen in one patient, she had presented with multiorgan failure and panhypopituitarism was diagnosed when she was evaluated for secondary hypothyroidism about two years after snake bite. Panhypopituitarism due to isolated lymphocytic hypothalamitis in a 16-year-old girl was also observed and reported by us.[14] There were two siblings with deficiency of GH, TSH, LH, FSH, and ACTH with a novel PROP-1 mutation (unpublished data). We detected adrenal insufficiency and GHD in a six-year-old boy with sacral agenesis.[15]


Clinical spectrum of hypopituitarism in India: A single center experience.

Gundgurthi A, Garg MK, Bhardwaj R, Brar KS, Kharb S, Pandit A - Indian J Endocrinol Metab (2012)

The immunohistochemistry confirming the diagnosis of intrasellar germinoma, (a) positive for CD68, (b) positive for cytokeratin, (c) positive for epithelial membrane antigen
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475908&req=5

Figure 2: The immunohistochemistry confirming the diagnosis of intrasellar germinoma, (a) positive for CD68, (b) positive for cytokeratin, (c) positive for epithelial membrane antigen
Mentions: The etiology of hypopituitarism is shown in Table 2. Tumors comprised 84% of the cases. Pituitary macroadenoma was the cause of hypopituitarism in 75 patients (66.4%). Of these, 47 patients had non-functioning adenoma (62.6%), 24 had acromegaly (32%), three had macroprolactinoma [Figure 1] (4%), and one had Cushing's disease. Other pituitary tumors were craniopharyngiomas (18 cases), one case each of intrasellar germ cell tumor [Figure 2] and granular cell tumor of neurohypophysis [Figure 3]. The latter two tumors were diagnosed by their immunohistochemistry characteristics. Non-tumor causes were seen in 16% of the patients. Sheehan's syndrome was documented in six patients (5.3%). There were few rare cases of hypopituitarism which we came across. Recurrent pituitary abscess was seen in one patient who had panhypopituitarism.[13] Snake bite (hemotoxic) was seen in one patient, she had presented with multiorgan failure and panhypopituitarism was diagnosed when she was evaluated for secondary hypothyroidism about two years after snake bite. Panhypopituitarism due to isolated lymphocytic hypothalamitis in a 16-year-old girl was also observed and reported by us.[14] There were two siblings with deficiency of GH, TSH, LH, FSH, and ACTH with a novel PROP-1 mutation (unpublished data). We detected adrenal insufficiency and GHD in a six-year-old boy with sacral agenesis.[15]

Bottom Line: Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%).Panhypopituitarism was seen in 104 (92%) patients.Panhypopituitarism is present in 92% cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology and Pathology, Army Hospital (Research and Referral), Delhi Cantonment, India.

ABSTRACT

Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India.

Materials and methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations.

Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years). There were 78 (69%) males and 35 females (31%). There were 22 subjects aged ≤18 years (childhood and adolescence) and 91 adults (>18 years). Visual disturbances were the most common presenting complaint (33%), though headache was the most common symptom (81%). Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%). Panhypopituitarism was seen in 104 (92%) patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors.

Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

No MeSH data available.


Related in: MedlinePlus