Time to diagnosis in Cushing’s syndrome: A meta-analysis based on 5367 patients

The time from first symptom to diagnosis of Cushing's syndrome is considered relevant for the severity of phenotype at presentation and long-term outcome. We therefore performed a systematic literature search to investigate relevant factors associated with a short time to diagnosis. The meta-analysis of 45 studies with 5560 patients showed significant differences for adrenal Cushing’s syndrome, Cushing’s disease and the ectopic Cushing’s syndrome. We did not find difference for gender, age or time of publication

JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM

Context: Dopamine agonist (DA)-induced impulse control disorder (ICD) in patients with prolactinomas is not sufficiently known. Objective: To evaluate the prevalence of DA-induced ICDs and possible risk factors related to these disorders in patients with prolactinoma. Design, Setting, and Participants: This is a cross-sectional multicenter study involving 308 patients with prolactinoma followed up in tertiary referral centers who received at least three months of DA therapy. DA-induced ICDs (pathological gambling, hypersexuality, compulsive shopping, and compulsive eating) and impulsivity were assessed using the Questionnaire for ImpulsiveCompulsive Disorders in Parkinson Disease and the Barratt Impulsiveness Scale-11, respectively. Patients were evaluated in terms of parameters related to ICD development. Results: Any ICD prevalence was 17% (n = 51). Hypersexuality was most common (6.5%). Although any ICD and hypersexuality were more common in male patients (P = 0.009, P < 0.001, respectively), compulsive eating was more common in female patients (P = 0.046). Current smoking, alcohol use, and gambling history were more frequent (P = 0.033, P = 0.002, P = 0.008, respectively) in patients with any ICD. In Barratt Impulsiveness Scale-11 total, attentional, motor, and nonplanning scores were higher in patients with any ICD (P < 0.001). Current smoking and alcohol use were more frequent (P = 0.007, P = 0.003, respectively) and percentage increase of testosterone levels at last visit was higher (P = 0.021) in male patients with prolactinomas with hypersexuality. Conclusion: Any ICD may be seen in one of six patients with prolactinoma who are receiving DA therapy. Endocrinology specialists should be aware of this side effect, particularly in male patients with a history of gambling, smoking, or alcohol use

Assessment of macroprolactinemia inpatients with prolactinoma

Purpose: Macroprolactin, the high-molecular mass prolactin isoform, is considered to be an inactive product with extrapituitary origin. Although macroprolactinemia is considered a benign condition, there is evidence of overlapping clinical features among patients with hyperprolactinemia. Data on the prevalence of macroprolactinemia in prolactinomas is also quite limited. The aim of this study was to assess the prevalence of macroprolactinemia in our patients with prolactinoma

UNCOMPLICATED PREGNANCY IN A PATIENT WITH CUSHING'S DISEASE

The coexistence of Cushing's syndrome (CS) and pregnancy is uncommon due to the suppression of gonadotropin secretion in CS. Adrenocorticotropic hormone (ACTH) dependent CS in pregnancy is less frequent than adrenal causes. The diagnosis of CS during pregnancy is difficult since physiological changes in the hypothalamo-pituitary-adrenal axis may cause dynamic tests to be misinterpreted. Radiological imaging is limited

Review of Clinical Recommendations on Prolactinoma and Pregnancy

Prolactinomas are the most common hormone-secreting pituitary adenomas. Prolactinomas account for nearly 30-40 percent of all the pituitary adenomas. Although it affects individuals over a wide age range, it is more common in 20-40-year-old female patients, who are in their reproductive age. Prolactinomas may cause hypogonadism, menstrual cycle dysfunction (oligomenorrhea or amenorrhea) and infertility (luteal phase abnormalities or anovulation) in premenopausal women. When pregnancy is excluded, hyperprolactinemia in approximately 10 to 20 percent of the patients results in amenorrhea. Women with untreated pro-lactinomas are generally unable to achieve pregnancy, as the hyperprolactinemia affects the pulsatility of gonadotropin-releasing hormone (GnRH) and diminishes follicle-stimulating hormone (FSH) as well as luteinizing hormone (LH) secretion. The sum of these effects induces amenorrhea, infertility, and hypogonadism, thereby posing difficulties in fertility. Therefore, in most women prolactinoma is diagnosed prior to conception. However, ovulation and fertility usually improve after proper diagnosis and treatment of prolactinoma. Therefore, during the surveillance of these patients, the onset of pregnancy is a common phenomenon. Management of these pregnancies may sometimes be challenging and require a multidisciplinary approach involving an endocrinologist, a gynecologist, a radiologist and an experienced neurosurgeon in order to achieve the best outcomes both for the patient as well the infant. In this report, the authors aim to summarize the consensus statements and the current guidelines for clinical practice

Nodular Thyroid Disease and Papillary Thyroid Carcinoma in Functional Pituitary Adenomas

Objective: Increased frequency of nodular thyroid disease has been reported in acromegalic patients. Recent studies have also demonstrated an increased co-existence of nodular thyroid disease with Cushing's disease and prolactinoma. In this study, we evaluated the frequency and outcomes of nodular thyroid disease in each type of functional pituitary adenoma

The higher incidence of autoimmune thyroid disease in prolactinomas than in somatotrophinomas

Objective: Many studies have shown that prolactin (PRL) plays an important role in autoimmune diseases. The aim of this study was to compare the current frequency of autoimmune thyroid disease (ATD) in prolactinomas with another type of functional pituitary adenoma (FPA), somatotrophinoma. Another aim of the study was to evaluate possible factors related to thyroid autoimmunity and, the process of ATD in FPAs

Clinical Significance of Granulation Pattern in Corticotroph Pituitary Adenomas

Objective: The granulation pattern of pituitary tumors may be important to predict tumor behavior, treatment outcomes, and recurrences. Therefore, we compared densely granulated corticotroph tumor (DGCT) and sparsely granulated corticotroph tumor (SGCT) in terms of clinicopathologic findings