Median neuropathy (carpal-tunnel syndrome) in acromegaly. A sign of endocrine overactivity.
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Apart from partial or complete insufficiency, further diseases of the pituitary with clinical impact are those associated with hormone overproduction such as acromegaly, Cushing's disease and prolactinoma. The cardinal symptom of pituitary insufficiency or disruption of the female cycle, loss of libido or sexual potency reflecting a lesion of the gonadotrophic axis. Hyperprolactinemia also results in a loss of gonadotrophic function. Macroadenomas of the pituitary gland often give rise to visual field defects, so that an ophthalmological work-up is a must. With the exception of hyperprolactinemia, measurement of basic hormone levels is not always sufficient to detect pituitary diseases. For the establishment of hormone deficiency, therefore, stimulation tests, and for detection of hypersecretion suppression tests, are carried out. Owing to the increasing utilization of cranial MRI, incidental detection of intrasellar tumors, the so-called incidentalomas, is becoming ever more common, and these lesions require at least an endocrinological investigation.
The study covered 119 women with systemic undifferentiated dysplasia of the connective tissue (DCT) aged 14-39 years. All the examinees had vegetative disorders, 26.1% had a neuroendocrine-metabolic form of hypothalamic syndrome (HS), 51.3%--premenopausal syndrome, 65.5%--dysmenorrhea. It was found that women with DCT and HS develop symptoms of neuroendocrine disorders at earlier age than those with HS but free of DCT. Arterial hypertension was registered in 96.8% of patients with DCT and HS, 80.3% of DCT patients with premenopausal syndrome. Central hemodynamics was different in DCT patients without neuroendocrine disorders and with neuroendocrine dysfunction evidencing the role of the latter in development of arterial hypertension in DCT.
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A case is presented of Cushing's syndrome due to macronodular bilateral adrenal hyperplasia which is ACTH-independent as was demonstrated by the undetectable basal and after stimulation with metoprolol ACTH plasma levels. High cortisol levels is associated in this patient with empty sella turcica and anterior panhypopituitarism with confirm the exclusive adrenal origin of the hormone hypersecretion and the lack of treatment success with hypophysis ablation in this process.
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Increasing diagnostic sophistication among endocrinologists has continually expanded the horizon of surgical treatment of adenohypophyseal problems. This advancement in endocrinology has been paralleled by improvement in the technical sophistication of neurosurgeons which has resulted in an increasingly aggressive approach to these serious disorders. Neurosurgical treatment is clearly able to provide resolution of significant physical disorders with minimal sequelae. The apparent potential for transsphenoidal approaches to the sella turcica as described within this paper has intrigued a number of neurosurgeons throughout this century. Their continuing interest has carried this procedure to a secure position in the management of many of these complex problems. This paper describes the author's experience with 132 consecutive transsphenoidal hypophysectomies.
The pituitary gland is really a confederation of several relatively independent endocrine glands gathered together in close relationship to the hypothalamus which exerts considerable governing control. Each of these sub-glands of the pituitary should be considered separately in every case of pituitary disease. While such an approach is mandatory in dealing with laboratory investigation, it also is profitable in considering clinical and therapeutic aspects of each case to ensure that nothing is overlooked.