Perioperative hypothalamic pituitary adrenal function in patients with silent corticotroph adenomas. 2017

Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
Division of Clinical and Molecular Endocrinology, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH, 44106, USA.

BACKGROUND Silent corticotroph adenomas (SCAs) are characterized by strong ACTH immunostaining without clinical manifestations of hypercortisolism. Patients with SCAs often present with mechanical symptoms related to tumor growth. This study investigates the hypothalamic pituitary adrenal axis (HPA) characteristics after adenomectomy in patients with SCAs. METHODS Biochemical parameters of HPA function were monitored frequently after surgical resection of non-functioning macroadenomas. Levels of ACTH, cortisol, DHEA and DHEA-S were measured frequently for 48 h after adenomectomy. HPA data of patients with SCAs (n = 38) were compared to others (Controls) with non-secreting, ACTH-negative immunostaining adenomas of similar age and gender distribution (n = 182) who had adenomectomy. RESULTS Plasma ACTH increased (P < 0.0001) equally in patients with SCA and controls reaching a peak at 3 h (238 ± 123 vs. 233 ± 96 ng/L, respectively) after extubation declining thereafter to baseline values 24-36 h. Similarly, serum cortisol levels increased (P < 0.0001) equally in both groups reaching a maximum at 7 h (36.8 ± 13.9 vs. 39.3 ± 13.3 ug/dL). Serum DHEA also increased (P < 0.001) equally in both groups in parallel to the rise in serum cortisol. Serum DHEA-S levels similarly increased (P < 0.001) from their respective baseline (105.9 ± 67.5 and 106.5 ± 58.7 ug/dL) reaching their peak (154.5 ± 69.5 and 153.5 ± 68.6 ug/dL; respectively) at 15 h after extubation. None of the patients acquired any hormone deficits. CONCLUSIONS Under the maximal stimulation of the peri-operative stress, HPA function in patients with SCA behaved in an identical manner to others with ACTH-negative macroadenomas. Thus, despite the strong ACTH-positive immunostaining of these tumors, SCAs are truly non- functional.

UI MeSH Term Description Entries
D007030 Hypothalamo-Hypophyseal System A collection of NEURONS, tracts of NERVE FIBERS, endocrine tissue, and blood vessels in the HYPOTHALAMUS and the PITUITARY GLAND. This hypothalamo-hypophyseal portal circulation provides the mechanism for hypothalamic neuroendocrine (HYPOTHALAMIC HORMONES) regulation of pituitary function and the release of various PITUITARY HORMONES into the systemic circulation to maintain HOMEOSTASIS. Hypothalamic Hypophyseal System,Hypothalamo-Pituitary-Adrenal Axis,Hypophyseal Portal System,Hypothalamic-Pituitary Unit,Hypothalamic Hypophyseal Systems,Hypothalamic Pituitary Unit,Hypothalamo Hypophyseal System,Hypothalamo Pituitary Adrenal Axis,Portal System, Hypophyseal
D007031 Hypothalamus Ventral part of the DIENCEPHALON extending from the region of the OPTIC CHIASM to the caudal border of the MAMMILLARY BODIES and forming the inferior and lateral walls of the THIRD VENTRICLE. Lamina Terminalis,Preoptico-Hypothalamic Area,Area, Preoptico-Hypothalamic,Areas, Preoptico-Hypothalamic,Preoptico Hypothalamic Area,Preoptico-Hypothalamic Areas
D008297 Male Males
D010900 Pituitary Diseases Disorders involving either the ADENOHYPOPHYSIS or the NEUROHYPOPHYSIS. These diseases usually manifest as hypersecretion or hyposecretion of PITUITARY HORMONES. Neoplastic pituitary masses can also cause compression of the OPTIC CHIASM and other adjacent structures. Adenohypophyseal Diseases,Hypophyseal Disorders,Neurohypophyseal Diseases,Anterior Pituitary Diseases,Pituitary Disorders,Pituitary Gland Diseases,Posterior Pituitary Diseases,Adenohypophyseal Disease,Anterior Pituitary Disease,Disease, Adenohypophyseal,Disease, Anterior Pituitary,Disease, Neurohypophyseal,Disease, Pituitary,Disease, Pituitary Gland,Disease, Posterior Pituitary,Diseases, Adenohypophyseal,Diseases, Anterior Pituitary,Diseases, Neurohypophyseal,Diseases, Pituitary,Diseases, Pituitary Gland,Diseases, Posterior Pituitary,Disorder, Hypophyseal,Disorder, Pituitary,Disorders, Hypophyseal,Disorders, Pituitary,Hypophyseal Disorder,Neurohypophyseal Disease,Pituitary Disease,Pituitary Disease, Anterior,Pituitary Disease, Posterior,Pituitary Diseases, Anterior,Pituitary Diseases, Posterior,Pituitary Disorder,Pituitary Gland Disease,Posterior Pituitary Disease
D010902 Pituitary Gland A small, unpaired gland situated in the SELLA TURCICA. It is connected to the HYPOTHALAMUS by a short stalk which is called the INFUNDIBULUM. Hypophysis,Hypothalamus, Infundibular,Infundibular Stalk,Infundibular Stem,Infundibulum (Hypophysis),Infundibulum, Hypophyseal,Pituitary Stalk,Hypophyseal Infundibulum,Hypophyseal Stalk,Hypophysis Cerebri,Infundibulum,Cerebri, Hypophysis,Cerebrus, Hypophysis,Gland, Pituitary,Glands, Pituitary,Hypophyseal Stalks,Hypophyses,Hypophysis Cerebrus,Infundibular Hypothalamus,Infundibular Stalks,Infundibulums,Pituitary Glands,Pituitary Stalks,Stalk, Hypophyseal,Stalk, Infundibular,Stalks, Hypophyseal,Stalks, Infundibular
D010913 Pituitary-Adrenal System The interactions between the anterior pituitary and adrenal glands, in which corticotropin (ACTH) stimulates the adrenal cortex and adrenal cortical hormones suppress the production of corticotropin by the anterior pituitary. Pituitary Adrenal System,Pituitary-Adrenal Systems,System, Pituitary-Adrenal,Systems, Pituitary-Adrenal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000324 Adrenocorticotropic Hormone An anterior pituitary hormone that stimulates the ADRENAL CORTEX and its production of CORTICOSTEROIDS. ACTH is a 39-amino acid polypeptide of which the N-terminal 24-amino acid segment is identical in all species and contains the adrenocorticotrophic activity. Upon further tissue-specific processing, ACTH can yield ALPHA-MSH and corticotrophin-like intermediate lobe peptide (CLIP). ACTH,Adrenocorticotropin,Corticotropin,1-39 ACTH,ACTH (1-39),Adrenocorticotrophic Hormone,Corticotrophin,Corticotrophin (1-39),Corticotropin (1-39),Hormone, Adrenocorticotrophic,Hormone, Adrenocorticotropic
D049913 ACTH-Secreting Pituitary Adenoma A pituitary adenoma which secretes ADRENOCORTICOTROPIN, leading to CUSHING DISEASE. Corticotroph Adenoma,Pituitary Adenoma, ACTH-Secreting,Pituitary Corticotropin-Secreting Adenoma,ACTH-Producing Pituitary Adenoma,ACTH Producing Pituitary Adenoma,ACTH Secreting Pituitary Adenoma,ACTH-Producing Pituitary Adenomas,ACTH-Secreting Pituitary Adenomas,Adenoma, Corticotroph,Adenomas, Corticotroph,Corticotroph Adenomas,Corticotropin-Secreting Adenoma, Pituitary,Corticotropin-Secreting Adenomas, Pituitary,Pituitary Adenoma, ACTH Secreting,Pituitary Adenoma, ACTH-Producing,Pituitary Adenomas, ACTH-Producing,Pituitary Adenomas, ACTH-Secreting,Pituitary Corticotropin Secreting Adenoma,Pituitary Corticotropin-Secreting Adenomas

Related Publications

Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
April 2018, Pituitary,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
April 2015, Pituitary,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
November 2007, Arquivos brasileiros de endocrinologia e metabologia,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
October 2012, Internal medicine journal,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
February 2005, British journal of neurosurgery,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
May 2010, Clinical endocrinology,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
July 2018, World neurosurgery,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
August 2012, Neurosurgery,
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
April 2004, Neurocirugia (Asturias, Spain),
Abdelle F Cheres, and Nadine ElAsmar, and Aman Rajpal, and Warren R Selman, and Baha M Arafah
June 1973, Acta endocrinologica,
Copied contents to your clipboard!