Hypothalamic Pituitary Diseases

This book presents the state of the art in the pathophysiology, diagnosis, and therapy of hypothalamic and pituitary disorders. After an introduction devoted to the physiology of the neuroendocrine control of the hypothalamic-pituitary unit, the diverse disorders involving hormonal excess or deficiency are systematically addressed axis by axis. For each disorder, pathophysiology, clinical presentation, and management are discussed in detail. In addition, individual chapters focus on the neuroendocrinology of energy homeostasis and of bone metabolism, metabolic derangement secondary to pituitary dysfunction, and pituitary control of the endocrine pancreas. While the focus of the book is predominantly on pathophysiological and clinical aspects, due attention is also devoted to potential diagnostic and therapeutic innovations. The book is intended as a major reference for endocrinologists and basic and clinical scientists.

This book presents the state of the art in the pathophysiology, diagnosis, and therapy of hypothalamic and pituitary disorders. After an introduction devoted to the physiology of the neuroendocrine control of the hypothalamic-pituitary unit, the diverse disorders involving hormonal excess or deficiency are systematically addressed axis by axis. For each disorder, pathophysiology, clinical presentation, and management are discussed in detail. In addition, individual chapters focus on the neuroendocrinology of energy homeostasis and of bone metabolism, metabolic derangement secondary to pituitary dysfunction, and pituitary control of the endocrine pancreas. While the focus of the book is predominantly on pathophysiological and clinical aspects, due attention is also devoted to potential diagnostic and therapeutic innovations. The book is intended as a major reference for endocrinologists and basic and clinical scientists..

The pituitary, albeit a small gland, is known as the "master gland" of the endocrine system and contributes to a wide spectrum of disorders, diseases, and syndromes. Since the publication of the second edition of The Pituitary, in 2002, there have been major advances in the molecular biology research of pituitary hormone production and action and there is now a better understanding of the pathogenesis of pituitary tumors and clinical syndromes resulting in perturbation of pituitary function. There have also been major advances in the clinical management of pituitary disorders. Medical researchers and practitioners now better understand the morbidity and mortality associated with pituitary hormone hyposecretion and hypersecretion. Newly developed drugs, and improved methods of delivering established drugs, are allowing better medical management of acromegaly and prolactinoma. These developments have improved the worldwide consensus around the definition of a "cure" for pituitary disease, especially hormone hypersecretion, and hence will improve the success or lack of success of various forms of therapy. It is therefore time for a new edition of The Pituitary. The third edition will continue to be divided into sections that summarize normal hypothalamic-pituitary development and function, hypothalamic-pituitary failure, and pituitary tumors; additional sections will describe pituitary disease in systemic disorders and diagnostic procedures, including imaging, assessment of the eyes, and biochemical testing. The first chapter will be completely new – placing a much greater emphasis on physiology and pathogenesis. Two new chapters will be added on the Radiation and Non-surgical Management of the Pituitary and Other Pituitary Lesions. Other chapters will be completely updated and many new author teams will be invited. The second edition published in 2002 and there have been incredible changes in both the research and clinical aspects of the pituitary over the past 8 years – from new advances in growth hormones to pituitary tumor therapy. Presents a comprehensive, translational source of information about the pituitary in one reference work Pituitary experts (from all areas of research and practice) take readers from the bench research (cellular and molecular mechanism), through genomic and proteomic analysis, all the way to clinical analysis (histopathology and imaging) and new therapeutic approaches Clear presentation by endocrine researchers of the cellular and molecular mechanisms underlying pituitary hormones and growth factors as well as new techniques used in detecting lesions (within the organ) and other systemic disorders Clear presentation by endocrinologists and neuroendocrine surgeons of how imaging, assessment of the eyes, and biochemical testing can lead to new therapeutic approaches

Gigantism and Acromegaly brings together pituitary experts, taking readers from bench research, to genetic analysis, clinical analysis, and new therapeutic approaches. This book serves as a reference for growth hormone over-secretion and its diagnosis and treatment for endocrinologists, pediatricians, internists, and neurosurgeons, and for geneticists. Pharmaceutical companies may use it as a reference for drug development and research. Students, residents and fellows in medicine and endocrinology and genetics will also find it valuable as it provides a single up-to-date review of the molecular biology of gigantism and acromegaly as well as recommended approaches to evaluation and management. Acromegaly is a rare pituitary disorder that slowly changes its adult victim’s appearance over time: larger hands and feet, bigger jaw, forehead, nose, and lips. Generally, a benign pituitary tumor is the cause and symptoms of acromegaly can vary from patient to patient, making a diagnosis difficult and prolonging suffering for years. Early detection is key in the management of acromegaly as the pathologic effects of increased growth hormone (GH) production are progressive and can be life-threatening as the result of associated cardiovascular, cerebrovascular, and respiratory disorders and malignancies. Accessible, up-to-date overview of the characteristics, state-of-the-art diagnostic procedures, and management of acromegaly and gigantism Provides a unique compendium of endocrinology, genetics, clinical diagnosis and therapeutics Contains contributions from internationally known experts who have treated patients with acromegaly and gigantism

The hypothalamic-pituitary-adrenal axis controls reactions to stress and regulates various body processes such as digestion, the immune system, mood and sexuality, and energy usage. This volume focuses on the role it plays in the immune system and provides substantive experimental and clinical data to support current understanding in the field, and potential applications of this knowledge in the treatment of disease. * Evidence presented in this book suggests that the nervous, endocrine, and immune systems form the Neuroendoimmune Supersystem, which integrates all the biological functions of higher organisms both in health and disease for their entire life cycle. * Contributors include both the scientists who initiated the work on the HPA axis and on the autonomic nervous system, and those who joined the field later.

Currently, surgical management provides the definitive treatment of choice for most pituitary adenomas, craniopharyngiomas and meningiomas of the sellar region. The elegant minimally invasive transnasal endoscopic approach to the sella turcica and the anterior skull base has added a new dimension of versatility to pituitary surgery and can be adapted to many lesions in the region. In this multi-author book with numerous color illustrations the main aspects of the endonasal endoscopic approach to the skull base are presented, starting with a clear description of the endoscopic anatomy, the panoramic view afforded by the endoscope and the development of effective instruments and adjuncts. After the diagnostic studies, the strictly surgical features are considered in detail. The standard technique is described and particular aspects are treated, including the new extended approaches to the cavernous sinus, spheno-ethmoid planum and clival regions.

Nineteen cutting-edge review articles by leading authorities provide a comprehensive overview of the normal function of the pituitary and of the diagnosis and treatment of pituitary disorders. Topics range from normal hypothalamic-pituitary interactions and the processes that disrupt them to new advances in pituitary imaging and appropriate surgical intervention in various pituitary disorders. Among the diseases discussed are congenital hypopituitarism, deficiency states, strategies for evaluating patients with hyperprolactinemia, Cushing's syndrome, acromegaly, and glycoprotein pituitary tumors.

In recent years dramatic progress has been made in understanding the pathophysiology of pituitary diseases by a combination of experimental studies, molecular genetics and clinical research. This book presents an updated overview of normal and pathological hypothalamic-pituitary development. Several chapters include experimental data and describe brain and facial defects associated with various conditions of pituitary insufficiency. A major part is devoted to the still increasing number of molecular and genetic defects which are responsible for various clinical presentations of pituitary insufficiency: diseases due to genetic defects of growth hormone, TSH, gonadotropins and corticotropin secretion are extensively described. These diseases present as metabolic (diabetes insipidus and adrenal insufficiency), growth and reproductive (including puberty) disorders. A distinct chapter emphasizes the contribution of a multidisciplinary comprehensive approach including the most recent molecular and genetic tools. Finally in most chapters an effort was made to address phenotypic and genotypic presentations in affected patients including valuable information provided by magnetic resonance imaging of the pituitary and brain. This book will help endocrinologists and paediatricians by providing unique models of genetic and developmental defects of the pituitary region which bear ultimate consequences on metabolic control, growth and reproduction.