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Book: Pituitary disorders

Karavitaki, Niki

(Endocrinology and metabolism clinics of North America ; volume 49, number 3 (September 2020))

2020

Author's details	editor Niki Karavitaki
Series title	Endocrinology and metabolism clinics of North America ; volume 49, number 3 (September 2020)
Collection
Language	English
Size	xviii Seiten, Seite 347-564, Illustrationen
Publisher	Elsevier
Publishing place	Philadelphia, Pennsylvania
Publishing country	United States
Document type	Book
HBZ-ID	HT020608516
ISBN	978-0-323-75502-3 ; 0-323-75502-X
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: Pituitary Disorders: Striving for Excellence.

Karavitaki, Niki

Endocrinology and metabolism clinics of North America

2020 Volume 49, Issue 3, Page(s) xvii–xviii

MeSH term(s)	Delivery of Health Care/methods ; Delivery of Health Care/trends ; Endocrinology/methods ; Endocrinology/trends ; Humans ; Pituitary Diseases/diagnosis ; Pituitary Diseases/etiology ; Pituitary Diseases/therapy ; Practice Patterns, Physicians'/trends ; Treatment Outcome
Language	English
Publishing date	2020-07-15
Publishing country	United States
Document type	Editorial ; Introductory Journal Article
ZDB-ID	92116-6
ISSN	1558-4410 ; 0889-8529
ISSN (online)	1558-4410
ISSN	0889-8529
DOI	10.1016/j.ecl.2020.06.001
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Article ; Online: Refractory lactotroph adenomas.

Urwyler, Sandrine A / Karavitaki, Niki

Pituitary

2023 Volume 26, Issue 3, Page(s) 273–277

Abstract: A small subset of lactotroph adenomas is resistant to dopamine agonists (DA) and can also demonstrate aggressive or even malignant behavior. The implicated mechanisms are not clearly defined. Management can be challenging and requires a multidisciplinary ...

Abstract	A small subset of lactotroph adenomas is resistant to dopamine agonists (DA) and can also demonstrate aggressive or even malignant behavior. The implicated mechanisms are not clearly defined. Management can be challenging and requires a multidisciplinary approach. In DA resistant prolactinomas, switching to another DA could be the first option to consider. Further strategies include surgery and radiotherapy used alone or in combination. In cases of aggressive or malignant prolactinomas, temozolomide could be offered. Immune checkpoint inhibitors have been also recently proposed as an alternative approach. The place of other treatments (e.g., metformin, selective estrogen modulators, somatostatin analogues, tyrosine kinase inhibitors, inhibitors of mammalian target of rapamycin and peptide radio-receptor therapy) remains to be carefully assessed.
MeSH term(s)	Humans ; Prolactinoma/drug therapy ; Prolactinoma/pathology ; Pituitary Neoplasms/drug therapy ; Pituitary Neoplasms/pathology ; Dopamine Agonists ; Temozolomide/therapeutic use ; Somatostatin
Chemical Substances	Dopamine Agonists ; Temozolomide (YF1K15M17Y) ; Somatostatin (51110-01-1)
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-023-01305-8
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Article ; Online: Impulse Control Disorders in Patients with Pituitary Tumors Treated with Dopamine Agonists: A Systematic Review.

Hamblin, Ross / Karavitaki, Niki

Archives of medical research

2023 Volume 54, Issue 8, Page(s) 102910

Abstract: Background: The increased prevalence of Impulse Control Disorders (ICDs) in dopamine agonist (DA) treated patients with Parkinson's disease is well described. Despite the frequent use of DAs in the management of pituitary tumors, the relationship ... ...

Abstract	Background: The increased prevalence of Impulse Control Disorders (ICDs) in dopamine agonist (DA) treated patients with Parkinson's disease is well described. Despite the frequent use of DAs in the management of pituitary tumors, the relationship between DAs and prevalence of ICDs in patients with pituitary tumours is unclear. Aims: To establish the prevalence of ICDs in patients with prolactinoma or acromegaly and determine whether prevalence differs in those on DAs to those treated without. Methods: Systematic review of the literature (registered a priori) reporting prevalence of ICDs in patients with prolactinoma or acromegaly (conducted June 2023). A narrative synthesis describing prevalence of ICDs according to assessment method was performed. Prevalence comparisons between patients with prolactinoma or acromegaly treated with DAs, to patients treated without, were summarised. Results: Studies were largely retrospective, observational and heterogenous, with few patients with prolactinoma and acromegaly treated without DA. Prevalence of ICDs varied between 0-60% in patients with prolactinoma, and from 5-23% in studies with at least five patients with acromegaly. In most studies comparing DA exposed to non-DA exposed cases, DA use was not associated with ICDs. Conclusions: Reported prevalence of ICDs in patients with prolactinoma and acromegaly varies considerably. Given ICDs were reported to be highly prevalent in some studies, clinicians should be mindful of these potentially serious disorders. ICD screening tools validated for use in patients with pituitary tumors combined with prospective studies including appropriate controls, are necessary to accurately establish prevalence of ICDs and true impact of DAs in their development.
MeSH term(s)	Humans ; Dopamine Agonists/adverse effects ; Pituitary Neoplasms/complications ; Pituitary Neoplasms/drug therapy ; Pituitary Neoplasms/epidemiology ; Prolactinoma/complications ; Prolactinoma/drug therapy ; Prolactinoma/chemically induced ; Acromegaly/complications ; Acromegaly/drug therapy ; Acromegaly/chemically induced ; Retrospective Studies ; Prospective Studies ; Disruptive, Impulse Control, and Conduct Disorders/chemically induced ; Disruptive, Impulse Control, and Conduct Disorders/epidemiology
Chemical Substances	Dopamine Agonists
Language	English
Publishing date	2023-11-19
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	1156844-6
ISSN	1873-5487 ; 0188-4409 ; 0188-0128
ISSN (online)	1873-5487
ISSN	0188-4409 ; 0188-0128
DOI	10.1016/j.arcmed.2023.102910
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Article ; Online: Management of Nelson's Syndrome.

Fountas, Athanasios / Karavitaki, Niki

Medicina (Kaunas, Lithuania)

2022 Volume 58, Issue 11

Abstract: Nelson's syndrome is a potentially severe condition that may develop in patients with Cushing's disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal ... ...

Abstract	Nelson's syndrome is a potentially severe condition that may develop in patients with Cushing's disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal tumour control, whilst pituitary irradiation alone needs to be considered in cases requiring intervention and are poor surgical candidates. Observation is an option for patients with small lesions, not causing mass effects to vital adjacent structures but close follow-up is required for a timely detection of corticotroph tumour progression and for further treatment if required. To date, no medical therapy has been consistently proven to be effective in Nelson's syndrome. Pharmacotherapy, however, should be considered when other management approaches have failed. A subset of patients with Nelson's syndrome may develop further tumour growth after primary treatment, and, in some cases, a truly aggressive tumour behaviour can be demonstrated. In the absence of evidence-based guidance, the management of these cases is individualized and tailored to previously offered treatments. Temozolomide has been used in patients with aggressive Nelson's with no consistent results. Development of tumour-targeted therapeutic agents are an unmet need for the management of aggressive cases of Nelson's syndrome.
MeSH term(s)	Humans ; Adrenocorticotropic Hormone ; Nelson Syndrome/diagnosis ; Nelson Syndrome/etiology ; Nelson Syndrome/therapy ; Adrenalectomy/adverse effects ; Temozolomide
Chemical Substances	Adrenocorticotropic Hormone (9002-60-2) ; Temozolomide (YF1K15M17Y)
Language	English
Publishing date	2022-11-02
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina58111580
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Article ; Online: Cushing's syndrome update: 100 years after Minnie G.

Millar, Robert P / Karavitaki, Niki / Kastelan, Darko

Journal of neuroendocrinology

2022 Volume 34, Issue 8, Page(s) e13167

MeSH term(s)	Cushing Syndrome ; Humans ; Hydrocortisone
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2022-08-18
Publishing country	United States
Document type	Editorial
ZDB-ID	1007517-3
ISSN	1365-2826 ; 0953-8194
ISSN (online)	1365-2826
ISSN	0953-8194
DOI	10.1111/jne.13167
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Article ; Online: Management of Nelson’s Syndrome

Athanasios Fountas / Niki Karavitaki

Medicina, Vol 58, Iss 1580, p

2022 Volume 1580

Abstract: Nelson’s syndrome is a potentially severe condition that may develop in patients with Cushing’s disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal ... ...

Abstract	Nelson’s syndrome is a potentially severe condition that may develop in patients with Cushing’s disease treated with bilateral adrenalectomy. Its management can be challenging. Pituitary surgery followed or not by radiotherapy offers the most optimal tumour control, whilst pituitary irradiation alone needs to be considered in cases requiring intervention and are poor surgical candidates. Observation is an option for patients with small lesions, not causing mass effects to vital adjacent structures but close follow-up is required for a timely detection of corticotroph tumour progression and for further treatment if required. To date, no medical therapy has been consistently proven to be effective in Nelson’s syndrome. Pharmacotherapy, however, should be considered when other management approaches have failed. A subset of patients with Nelson’s syndrome may develop further tumour growth after primary treatment, and, in some cases, a truly aggressive tumour behaviour can be demonstrated. In the absence of evidence-based guidance, the management of these cases is individualized and tailored to previously offered treatments. Temozolomide has been used in patients with aggressive Nelson’s with no consistent results. Development of tumour-targeted therapeutic agents are an unmet need for the management of aggressive cases of Nelson’s syndrome.
Keywords	Nelson’s syndrome ; Cushing’s ; corticotroph tumour progression ; bilateral adrenalectomy ; tumour growth ; pituitary surgery ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article: Discontinuation of long-term growth hormone treatment in adults with growth hormone deficiency: a survey of UK practice.

Criseno, Sherwin / Gleeson, Helena / Toogood, Andrew A / Gittoes, Neil / Topping, Anne / Karavitaki, Niki

Endocrine connections

2024 Volume 13, Issue 5

Abstract: Objective: We conducted a survey of UK endocrine clinicians between June 2022 and August 2022 to understand current practices regarding GH treatment discontinuation in adults with growth hormone deficiency.: Design and methods: Using Survey Monkey®, ... ...

Abstract	Objective: We conducted a survey of UK endocrine clinicians between June 2022 and August 2022 to understand current practices regarding GH treatment discontinuation in adults with growth hormone deficiency. Design and methods: Using Survey Monkey®, a web-based multiple-choice questionnaire was disseminated to the UK Society for Endocrinology membership. It consisted of 15 questions on demographics, number of patients receiving GH and current practice on GH treatment discontinuation. Results: In total, 102 endocrine clinicians completed the survey. Of these, 65 respondents (33 endocrinologists and 32 specialist nurses) indicated active involvement in managing patients with growth hormone deficiency. In total, 27.7% of clinicians were routinely offering a trial of GH discontinuation to adults receiving long-term GH therapy. Only 6% had a clinical guideline to direct such practice. In total, 29.2% stated that GH discontinuation should be routinely offered as an option to patients on long-term treatment, whilst 60% were not clearly in favour or against this approach but stated that it should probably be considered, and 9.2% were against. During the GH withdrawal period, most clinicians monitor signs and symptoms (75.4%), measure IGF-1 (84.6%), and complete a quality-of-life assessment (89.2%). Conclusion: The practice of offering a trial of GH discontinuation in growth hormone deficiency adults on long-term GH therapy is highly variable, reflecting the lack of high-quality evidence. Around a quarter of clinicians offer GH withdrawal for a number of reasons, but only a few have a local clinical guidance. A further 60% of clinicians stated they would probably consider such an approach. Methodologically sound studies underpinning the development of safe and cost-effective guidance are needed. Significance statement: In this UK survey of endocrine clinicians managing adults with growth hormone deficiency on long-term GH therapy, we explored for the first-time current practice and views on offering GH treatment discontinuation. In total, 27.7% of clinicians were routinely offering this option for a variety of reasons. Only 6% have local clinical guideline available to direct their practice on this. The majority of clinicians (60%), were not clearly in favour or against this approach but indicated it should probably be considered. In the absence of robust evidence on consequences of GH withdrawal, clinicians proposed monitoring of various clinical, biochemical and quality-of-life parameters during the period of discontinuation. Methodologically sound studies that will underpin the development of a safe, cost-effective guidance are needed.
Language	English
Publishing date	2024-04-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2668428-7
ISSN	2049-3614
ISSN	2049-3614
DOI	10.1530/EC-23-0533
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Article ; Online: Cardiovascular health and mortality in Cushing's disease.

Coulden, Amy / Hamblin, Ross / Wass, John / Karavitaki, Niki

Pituitary

2022 Volume 25, Issue 5, Page(s) 750–753

Abstract: Exposure to cortisol excess in Cushing's disease (CD) results in increased cardiovascular morbidity and reduces survival, with cardiovascular disease being a leading cause of death. At diagnosis, a significant number of patients have adverse ... ...

Abstract	Exposure to cortisol excess in Cushing's disease (CD) results in increased cardiovascular morbidity and reduces survival, with cardiovascular disease being a leading cause of death. At diagnosis, a significant number of patients have adverse cardiovascular profiles (e.g., obesity, diabetes or impaired glucose tolerance, dyslipidemia, hypertension, cardiac abnormalities and vascular disease). Remission of hypercortisolemia reduces but does not completely eliminate the cardiovascular complications; hazard ratios for myocardial infarction and stroke are high during long-term monitoring, highlighting the long-lasting effects of hypercortisolism and the importance of the timely diagnosis and successful management of this condition. Data on mortality of patients in remission are not consistent but in a multicenter study, an increased all-cause and circulatory mortality in patients with CD in remission for at least 10 years has been demonstrated. Cardiovascular morbidity requires particular focus and effective management during the care of patients with CD, from their presentation until long-term follow up.
MeSH term(s)	Humans ; Pituitary ACTH Hypersecretion/diagnosis ; Hydrocortisone ; Hypertension ; Cardiovascular Diseases/etiology ; Diabetes Mellitus ; Multicenter Studies as Topic
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2022-07-22
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1385151-2
ISSN	1573-7403 ; 1386-341X
ISSN (online)	1573-7403
ISSN	1386-341X
DOI	10.1007/s11102-022-01258-4
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Article ; Online: The diagnosis and management of Cushing's syndrome in pregnancy.

Hamblin, Ross / Coulden, Amy / Fountas, Athanasios / Karavitaki, Niki

Journal of neuroendocrinology

2022 Volume 34, Issue 8, Page(s) e13118

Abstract: Endogenous Cushing's syndrome (CS) is rarely encountered during pregnancy. Clinical and biochemical changes in healthy pregnancy overlap with those seen in pregnancy complicated by CS; the diagnosis is therefore challenging and can be delayed. During ... ...

Abstract	Endogenous Cushing's syndrome (CS) is rarely encountered during pregnancy. Clinical and biochemical changes in healthy pregnancy overlap with those seen in pregnancy complicated by CS; the diagnosis is therefore challenging and can be delayed. During normal gestation, adrenocorticotrophic hormone, corticotrophin-releasing hormone, cortisol, and urinary free cortisol levels rise. Dexamethasone administration fails to fully suppress cortisol in pregnant women without CS. Localisation may be hindered by non-suppressed adrenocorticotrophic hormone levels in a large proportion of those with adrenal CS; smaller corticotroph adenomas may go undetected as a result of a lack of contrast administration or the presence of pituitary hyperplasia; and inferior petrosal sinus sampling is not recommended given the risk of radiation and thrombosis. Yet, diagnosis is essential; active disease is associated with multiple insults to both maternal and foetal health, and those cured may normalise the risk of maternal-foetal complications. The published literature consists mostly of case reports or small case series affected by publication bias, heterogeneous definitions of maternal or foetal outcomes or lack of detail on severity of hypercortisolism. Consequently, conclusive recommendations, or a standardised management approach for all, cannot be made. Management is highly individualised: the decision for surgery, medical control of hypercortisolism or adoption of a conservative approach is dependent on the timing of diagnosis (respective to stage of gestation), the ability to localise the tumour, severity of CS, pre-existing maternal comorbidity, and, ultimately, patient choice. Close communication is a necessity with the patient placed at the centre of all decisions, with risks, benefits, and uncertainties around any investigation and management carefully discussed. Care should be delivered by an experienced, multidisciplinary team, with the resources and expertise available to manage such a rare and challenging condition during pregnancy.
MeSH term(s)	Adenoma ; Adrenocorticotropic Hormone ; Cushing Syndrome/complications ; Cushing Syndrome/diagnosis ; Cushing Syndrome/therapy ; Diagnosis, Differential ; Female ; Humans ; Hydrocortisone ; Pregnancy
Chemical Substances	Adrenocorticotropic Hormone (9002-60-2) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2022-05-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1007517-3
ISSN	1365-2826 ; 0953-8194
ISSN (online)	1365-2826
ISSN	0953-8194
DOI	10.1111/jne.13118
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