Archive for the ‘Hypopituitarism’ Category

INTRODUCTION

Treatment of patients with hypopituitarism is the sum of the treatments of each of the individual pituitary hormonal deficiencies detected when a patient with a pituitary or hypothalamic disease is tested. The treatments of corticotropin (ACTH), thyroid-stimulating hormone (TSH), and luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiencies are in many ways the same as the treatments of primary deficiencies of the respective target glands, but in other ways they differ. Both the similarities and differences will be highlighted below. Treatment of growth hormone (GH) deficiency is unique to hypopituitarism.

The specifics of therapy for hypopituitarism will be reviewed here. The causes, clinical manifestations, and diagnosis of hypopituitarism, as well as GH deficiency in adults and the management of individual hormone deficiencies, are reviewed in more detail elsewhere. (See "Causes of hypopituitarism" and "Clinical manifestations of hypopituitarism" and "Diagnostic testing for hypopituitarism" and "Growth hormone deficiency in adults".)

IMPORTANCE OF TREATMENT

One reason to optimize treatment is that in a retrospective study of 344 patients who had hypopituitarism after pituitary surgery, the long-term mortality was about double that of the general population [1]. Most of the excess mortality was due to cerebrovascular disease. The relationship between the hypopituitarism and the excess mortality remains unknown, and we do not know if even optimal treatment will improve mortality.

ACTH DEFICIENCY

The primary consequence of lack of corticotropin (ACTH) is cortisol deficiency. As a result, treatment consists of the administration of hydrocortisone or other glucocorticoid in an amount and timing to mimic the normal pattern of cortisol secretion. Because there is no test to assess the adequacy of the replacement, the optimal replacement glucocorticoid and the optimal doses are not known. Most authorities recommend replacement with hydrocortisone because that is the hormone the adrenal glands make normally, but others prefer prednisone or dexamethasone for their longer durations of action.

Preparation and doseMost authorities recommend hydrocortisone doses of 15 to 25 mg/day [2,3] because those doses are similar to daily production rates [4]. Patients who are more severely deficient or weigh more tend to need doses at the upper end of this range and vice versa. Some patients, however, need even larger doses to avoid severely symptomatic adrenal insufficiency, and others can get by on smaller amounts.

Literature review current through: Apr 2017. | This topic last updated: Nov 03, 2015.

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Treatment of hypopituitarism - uptodate.com

Amy Neff Roth

Dominic Tebo has gotten a lot of love and a lot of medical care in his young life.

The Clinton 2-year old was born with an array of medical problems and has undergone many treatments. His parents put the other parts of their lives on hold for six months so they could stay in Syracuse while he remained in the neonatal intensive care unit.

Now Dominic needs one thing his parents cant afford to give him an accessible home.

My child has love. He has toys. He has everything that a 2-year-old needs, a normal two-year old. But unfortunately, I cannot give him the room to keep progressing, said Dominics mother, Monica Moffo.

So the Lake Delta Kiwanis are stepping in, hosting a fundraiser Sunday in Lee Center to raise money for the family. It will take place from noon to 5 p.m. at the Lee Center Fire Hall at 5510 School St. It will feature a chicken barbecue, live music and 50/50 and gift basket raffles. The cost is $10 per person.

Moffo and her fianc, Eric Tebo, Dominics father, lived in Lee Center before they temporarily stopped working to be with Dominic. Now they live in Clinton with Moffos mother.

Dominic has a rare gene mutation known as MAG-2. His doctor told the family that hes one of only five people in the world and the only one in the United States known to have the condition, Moffo said. Its rarity is apparent in the lack of information available through a Google search.

He has all his chromosomes and out of one of his chromosomes theres thousands of letters in a chromosome out of all of his chromosomes, hes missing one letter, Moffo explained.

Moffo said theyve been told that all the people with the mutation have respiratory problems like Dominic. But Dominic was born with a laundry list of medical conditions, many of which the others do not have, Moffo said.

Dominic was born with hypopituitarism (malfunctioning of the pituitary gland), tracheomalachia (in which the cartilage is so soft that the trachea partially collapses), clench hands, club feet, bell-shaped lungs and an enlarged tongue. He has a tracheotomy to help his breathing and had surgery on his tongue a year and a half ago. He used to be on a feeding tube, but hes able to eat on his own now.

Hes had multiple surgeries, some life threatening, and has been in and out of the hospital. Hes about to scooch around the house now and is learning to use a walker, his mother said. He also has a weakened immune system so his family tried to keep him somewhat isolated.

Its not clear if all his problems are linked to his genetic defect or if he has another medical condition as well.

They literally consider him an open book mystery, Moffo said.

Despite the challenges, Dominic has come a long way, she said.

Hes a very happy boy, she said, and always a smile, no matter what.

Follow @OD_Roth on Twitter or call her at 315-691-2961

Read this article:
Clinton child battles rare genetic disorder - Utica Observer Dispatch

ROCKLAND, Mass. and NEW YORK, May 9, 2017 /PRNewswire/ -- EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany, in the US and Canada, and Pfizer Inc. (NYSE: PFE) today announced that the US Food and Drug Administration (FDA) has approved BAVENCIO (avelumab) Injection for the treatment of patients with locally advanced or metastatic urothelial carcinoma (UC) who have disease progression during or following platinum-containing chemotherapy, or who have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy. BAVENCIO was previously granted accelerated approval from the FDA for the treatment of adults and pediatric patients 12 years and older with metastatic Merkel cell carcinoma (MCC). These indications are approved under accelerated approval based on tumor response and duration of response. Continued approval for these indications may be contingent upon verification and description of clinical benefit in confirmatory trials.1

"This approval for BAVENCIO in patients with locally advanced or metastatic urothelial carcinoma exemplifies our unwavering commitment to finding new treatments for the most challenging cancers," said Luciano Rossetti, M.D., Executive Vice President, Global Head of Research & Development at the biopharma business of Merck KGaA, Darmstadt, Germany. "Coming just a few weeks after the approval for metastatic Merkel cell carcinoma, we continue to demonstrate our ability to accelerate access to innovative medicines for patients in need."

"This approval builds on the ongoing clinical development program for BAVENCIO in urothelial carcinoma and reinforces our commitment to providing new medicines to patients with difficult-to-treat cancers," said Liz Barrett, Global President, Pfizer Oncology. "By drawing on the strength of the alliance, as well as Pfizer's deep experience in genitourinary cancers, we believe BAVENCIO will be an important treatment option, and we hope it will help to improve outcomes for these patients."

Bladder cancer makes up approximately 90% of urothelial carcinomas and is the sixth most common cancer in the US.2,3 When the disease has metastasized, the five-year survival rate is approximately 5%.4 Despite advances in the treatment of locally advanced or metastatic urothelial carcinoma, the prognosis for patients remains poor and more treatment options are needed.2

"Once urothelial carcinoma progresses after treatment with chemotherapy, the five-year survival rate is alarmingly low," said Dr. Andrea Apolo, National Cancer Institute, Bethesda, MD, US. "Until recently, there had been limited innovation in urothelial carcinoma, and this approval gives us another treatment to help battle this aggressive disease."

The efficacy and safety of BAVENCIO was demonstrated in the urothelial carcinoma cohorts (N=242) of the JAVELIN Solid Tumor trial, a Phase I, open-label, single-arm, multicenter study of BAVENCIO in the treatment of various solid tumors. The urothelial carcinoma cohorts enrolled patients with locally advanced or metastatic urothelial carcinoma with disease progression on or after platinum-containing chemotherapy or who had disease progression within 12 months of treatment with a platinum-containing neoadjuvant or adjuvant chemotherapy regimen. These data will be presented at an upcoming medical congress.

The warnings and precautions for BAVENCIO include immune-mediated adverse reactions (such as pneumonitis, hepatitis, colitis, endocrinopathies, nephritis and renal dysfunction and other adverse reactions), infusion-related reactions and embryo-fetal toxicity. The most common adverse reactions (reported in at least 20% of patients) in patients with locally advanced or metastatic urothelial carcinoma were fatigue (41%), infusion-related reaction (30%), musculoskeletal pain (25%), nausea (24%), decreased appetite/hypophagia (21%) and urinary tract infection (21%).1 For more information, please see Important Safety Information for BAVENCIO below.

BAVENCIO is designed to potentially engage both the adaptive and innate immune systems. By binding to PD-L1, BAVENCIO is thought to prevent tumor cells from using PD-L1 for protection against white blood cells, such as T cells, exposing them to anti-tumor responses.1 BAVENCIO has also been shown to induce antibody-dependent cell-mediated cytotoxicity (ADCC) in vitro.1

The alliance is committed to providing industry-leading patient access and reimbursement support through its CoverOne program. This program provides a spectrum of patient access and reimbursement support services intended to help patients receive appropriate access to BAVENCIO in the United States. CoverOne may be reached by phone at 844-8COVER1 (844-826-8371) or online at http://www.CoverOne.com.

About Urothelial Carcinoma Cohorts in JAVELIN Solid Tumor Trial The efficacy and safety of BAVENCIO was demonstrated in the urothelial carcinoma cohorts of the JAVELIN Solid Tumor trial, a Phase I, open-label, single-arm, multicenter study that included 242 patients with locally advanced or metastatic urothelial carcinoma with disease progression on or after platinum- containing chemotherapy or who had disease progression within 12 months of treatment with a platinum-containing neoadjuvant or adjuvant chemotherapy regimen who were treated with BAVENCIO.

Patients with active or a history of central nervous system metastasis; other malignancies within the last five years; an organ transplant; conditions requiring therapeutic immune suppression; or active infection with HIV, hepatitis B or C were excluded. Patients with autoimmune disease, other than type 1 diabetes, vitiligo, psoriasis, or thyroid disease that did not require immunosuppressive treatment, were excluded. Patients were included regardless of their PD-L1 status. Patients received BAVENCIO at a dose of 10 mg/kg intravenously over 60 minutes every two weeks until disease progression or unacceptable toxicity. Tumor response assessments were performed every six weeks, as assessed by an Independent Endpoint Review Committee (IERC) using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Efficacy outcome measures included confirmed overall response rate, (ORR) and duration of response (DOR). Efficacy measures were evaluated in patients who were followed for a minimum of both 13 weeks and 6 months at the time of data cut-off.

Out of the total 226 patients evaluable for efficacy, 44% had non-bladder urothelial carcinoma, including 23% of patients with upper tract disease; 83% of patients had visceral metastases; 34% of patients had liver metastases. Nine patients (4%) had disease progression following prior platinum-containing neoadjuvant or adjuvant therapy only. Forty-seven percent of patients only received prior cisplatin-based regimens, 32% received only prior carboplatin-based regimens, and 20% received both cisplatin and carboplatin-based regimens.

The international clinical development program for avelumab, known as JAVELIN, involves more than 30 clinical programs, including nine Phase III trials, and more than 5,200 patients across more than 15 tumor types.

In December 2015, Merck KGaA, Darmstadt, Germany and Pfizer announced the initiation of a Phase III multicenter, multinational, randomized, open-label, parallel-arm study (JAVELIN Bladder 100) of BAVENCIO plus best supportive care versus best supportive care alone as a maintenance treatment in patients with locally advanced or metastatic urothelial carcinoma whose disease did not progress after completion of first-line platinum-containing chemotherapy. This trial is currently enrolling patients.

For more information about JAVELIN trials, please visit http://www.clinicaltrials.gov.

For full prescribing information and medication guide for BAVENCIO, please see http://www.BAVENCIO.com.

IMPORTANT SAFETY INFORMATION and INDICATIONS

BAVENCIO can cause immune-mediated pneumonitis, including fatal cases. Monitor patients for signs and symptoms of pneumonitis and evaluate suspected cases with radiographic imaging. Administer corticosteroids for Grade 2 or greater pneumonitis. Withhold BAVENCIO for moderate (Grade 2) and permanently discontinue for severe (Grade 3), life-threatening (Grade 4), or recurrent moderate (Grade 2) pneumonitis. Pneumonitis occurred in 1.2% (21/1738) of patients, including one (0.1%) patient with Grade 5, one (0.1%) with Grade 4, and five (0.3%) with Grade 3.

BAVENCIO can cause immune-mediated hepatitis, including fatal cases. Monitor patients for abnormal liver tests prior to and periodically during treatment. Administer corticosteroids for Grade 2 or greater hepatitis. Withhold BAVENCIO for moderate (Grade 2) immune-mediated hepatitis until resolution and permanently discontinue for severe (Grade 3) or life-threatening (Grade 4) immune-mediated hepatitis. Immune-mediated hepatitis was reported in 0.9% (16/1738) of patients, including two (0.1%) patients with Grade 5 and 11 (0.6%) with Grade 3.

BAVENCIO can cause immune-mediated colitis. Monitor patients for signs and symptoms of colitis. Administer corticosteroids for Grade 2 or greater colitis. Withhold BAVENCIO until resolution for moderate or severe (Grade 2 or 3) colitis and permanently discontinue for life-threatening (Grade 4) or recurrent (Grade 3) colitis upon re-initiation of BAVENCIO. Immune-mediated colitis occurred in 1.5% (26/1738) of patients, including seven (0.4%) with Grade 3.

BAVENCIO can cause immune-mediated endocrinopathies, including adrenal insufficiency, thyroid disorders, and type 1 diabetes mellitus.

Monitor patients for signs and symptoms of adrenal insufficiency during and after treatment, and administer corticosteroids as appropriate. Withhold BAVENCIO for severe (Grade 3) or life-threatening (Grade 4) adrenal insufficiency. Adrenal insufficiency was reported in 0.5% (8/1738) of patients, including one (0.1%) with Grade 3.

Thyroid disorders can occur at any time during treatment. Monitor patients for changes in thyroid function at the start of treatment, periodically during treatment, and as indicated based on clinical evaluation. Manage hypothyroidism with hormone replacement therapy and hyperthyroidism with medical management. Withhold BAVENCIO for severe (Grade 3) or life- threatening (Grade 4) thyroid disorders. Thyroid disorders including hypothyroidism, hyperthyroidism, and thyroiditis were reported in 6% (98/1738) of patients, including three (0.2%) with Grade 3.

Type 1 diabetes mellitus including diabetic ketoacidosis: Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Withhold BAVENCIO and administer anti-hyperglycemics or insulin in patients with severe or life-threatening (Grade 3) hyperglycemia, and resume treatment when metabolic control is achieved. Type 1 diabetes mellitus without an alternative etiology occurred in 0.1% (2/1738) of patients, including two cases of Grade 3 hyperglycemia.

BAVENCIO can cause immune-mediated nephritis and renal dysfunction. Monitor patients for elevated serum creatinine prior to and periodically during treatment. Administer corticosteroids for Grade 2 or greater nephritis. Withhold BAVENCIO for moderate (Grade 2) or severe (Grade 3) nephritis until resolution to Grade 1 or lower. Permanently discontinue BAVENCIO for life-threatening (Grade 4) nephritis. Immune-mediated nephritis occurred in 0.1% (1/1738) of patients.

BAVENCIO can result in other severe and fatal immune-mediated adverse reactions involving any organ system during treatment or after treatment discontinuation. For suspected immune-mediated adverse reactions, evaluate to confirm or rule out an immune-mediated adverse reaction and to exclude other causes. Depending on the severity of the adverse reaction, withhold or permanently discontinue BAVENCIO, administer high-dose corticosteroids, and initiate hormone replacement therapy if appropriate. Resume BAVENCIO when the immune-mediated adverse reaction remains at Grade 1 or lower following a corticosteroid taper. Permanently discontinue BAVENCIO for any severe (Grade 3) immune-mediated adverse reaction that recurs and for any life-threatening (Grade 4) immune-mediated adverse reaction. The following clinically significant immune-mediated adverse reactions occurred in less than 1% of 1738 patients treated with BAVENCIO: myocarditis with fatal cases, myositis, psoriasis, arthritis, exfoliative dermatitis, erythema multiforme, pemphigoid, hypopituitarism, uveitis, Guillain-Barr syndrome, and systemic inflammatory response.

BAVENCIO can cause severe (Grade 3) or life-threatening (Grade 4) infusion-related reactions. Patients should be premedicated with an antihistamine and acetaminophen prior to the first 4 infusions and for subsequent doses based upon clinical judgment and presence/severity of prior infusion reactions. Monitor patients for signs and symptoms of infusion-related reactions, including pyrexia, chills, flushing, hypotension, dyspnea, wheezing, back pain, abdominal pain, and urticaria. Interrupt or slow the rate of infusion for mild (Grade 1) or moderate (Grade 2) infusion-related reactions. Permanently discontinue BAVENCIO for severe (Grade 3) or life-threatening (Grade 4) infusion-related reactions. Infusion-related reactions occurred in 25% (439/1738) of patients, including three (0.2%) patients with Grade 4 and nine (0.5%) with Grade 3.

BAVENCIO can cause fetal harm when administered to a pregnant woman. Advise patients of the potential risk to a fetus including the risk of fetal death. Advise females of childbearing potential to use effective contraception during treatment with BAVENCIO and for at least 1 month after the last dose of BAVENCIO. It is not known whether BAVENCIO is excreted in human milk. Advise a lactating woman not to breastfeed during treatment and for at least 1 month after the last dose of BAVENCIO due to the potential for serious adverse reactions in breastfed infants.

The most common adverse reactions (all grades, 20%) in patients with metastatic Merkel cell carcinoma (MCC) were fatigue (50%), musculoskeletal pain (32%), diarrhea (23%), nausea (22%), infusion-related reaction (22%), rash (22%), decreased appetite (20%), and peripheral edema (20%).

Selected treatment-emergent laboratory abnormalities (all grades, 20%) in patients with metastatic MCC were lymphopenia (49%), anemia (35%), increased aspartate aminotransferase (34%), thrombocytopenia (27%), and increased alanine aminotransferase (20%).

The most common adverse reactions (all grades, 20%) in patients with locally advanced or metastatic urothelial cancer (UC) were fatigue (41%), infusion-related reaction (30%), musculoskeletal pain (25%), nausea (24%), decreased appetite/hypophagia (21%) and urinary tract infection (21%).

Selected laboratory abnormalities (grades 3-4, 3%) in patients with locally advanced or metastatic UC were hyponatremia (16%), gamma-glutamyltransferase increased (12%), lymphopenia (11%), hyperglycemia (9%), increased alkaline phosphatase (7%), anemia (6%), increased lipase (6%), hyperkalemia (3%), and increased aspartate aminotransferase (3%).

INDICATIONS

BAVENCIO is indicated for the treatment of adults and pediatric patients 12 years and older with metastatic Merkel cell carcinoma (MCC).

BAVENCIO is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma (UC) who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.

These indications are approved under accelerated approval based on tumor response and duration of response. Continued approval for these indications may be contingent upon verification and description of clinical benefit in confirmatory trials.

Please see full Prescribing Information and Medication Guide.

Avelumab has not yet been approved for any indication in any market outside of the US. As announced on October 31, 2016, the European Medicines Agency (EMA) has validated for review Merck KGaA, Darmstadt, Germany's Marketing Authorization Application for avelumab, for the proposed indication of metastatic Merkel cell carcinoma.

About BAVENCIO (avelumab) BAVENCIO is a human programmed death ligand-1 (PD-L1) blocking antibody indicated in the US for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or who have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy, as well as for the treatment of adults and pediatric patients 12 years and older with metastatic Merkel cell carcinoma.1 These indications are approved under accelerated approval based on tumor response and duration of response. Continued approval for these indications is contingent upon verification and description of clinical benefit in confirmatory trials.

BAVENCIO is not approved for any indication in any market outside the US.

Alliance between Merck KGaA, Darmstadt, Germany, and Pfizer Inc., New York, US Immuno-oncology is a top priority for Merck KGaA, Darmstadt, Germany and Pfizer Inc. The global strategic alliance between Merck KGaA, Darmstadt, Germany, and Pfizer Inc., New York, US, enables the companies to benefit from each other's strengths and capabilities and further explore the therapeutic potential of avelumab, an anti-PD-L1 antibody initially discovered and developed by Merck KGaA, Darmstadt, Germany. The immuno-oncology alliance will jointly develop and commercialize avelumab and advance Pfizer's PD-1 antibody. The alliance is focused on developing high-priority international clinical programs to investigate avelumab as a monotherapy, as well as in combination regimens, and is striving to find new ways to treat cancer.

About EMD Serono, Inc. EMD Serono is the biopharmaceutical business of Merck KGaA, Darmstadt, Germany a leading science and technology company in the US and Canada focused exclusively on specialty care. For more than 40 years, the business has integrated cutting-edge science, innovative products and industry-leading patient support and access programs. EMD Serono has deep expertise in neurology, fertility and endocrinology, as well as a robust pipeline of potential therapies in oncology, immuno-oncology and immunology as R&D focus areas. Today, the business has 1,200 employees around the country with commercial, clinical and research operations based in the company's home state of Massachusetts. http://www.emdserono.com

About Merck KGaA, Darmstadt, Germany All Merck KGaA, Darmstadt, Germany Press Releases are distributed by e-mail at the same time they become available on the Merck KGaA, Darmstadt, Germany Website. Please go to http://www.emdgroup.com/subscribe to register online, change your selection or discontinue this service.

Merck KGaA, Darmstadt, Germany, is a leading science and technology company in healthcare, life science and performance materials. Around 50,000 employees work to further develop technologies that improve and enhance life from biopharmaceutical therapies to treat cancer or multiple sclerosis, cutting-edge systems for scientific research and production, to liquid crystals for smartphones and LCD televisions. In 2016, Merck KGaA, Darmstadt, Germany, generated sales of 15.0 billion in 66 countries.

Founded in 1668, Merck KGaA, Darmstadt, Germany, is the world's oldest pharmaceutical and chemical company. The founding family remains the majority owner of the publicly listed corporate group. Merck KGaA, Darmstadt, Germany, holds the global rights to the "Merck" name and brand except in the United States and Canada, where the company operates as EMD Serono, MilliporeSigma and EMD Performance Materials.

Pfizer Inc.: Working together for a healthier world At Pfizer, we apply science and our global resources to bring therapies to people that extend and significantly improve their lives. We strive to set the standard for quality, safety and value in the discovery, development and manufacture of health care products. Our global portfolio includes medicines and vaccines as well as many of the world's best-known consumer health care products. Every day, Pfizer colleagues work across developed and emerging markets to advance wellness, prevention, treatments and cures that challenge the most feared diseases of our time. Consistent with our responsibility as one of the world's premier innovative biopharmaceutical companies, we collaborate with health care providers, governments and local communities to support and expand access to reliable, affordable health care around the world. For more than 150 years, we have worked to make a difference for all who rely on us. We routinely post information that may be important to investors on our website at http://www.pfizer.com. In addition, to learn more, please visit us on http://www.pfizer.com and follow us on Twitter at @Pfizer and @PfizerNews, LinkedIn, YouTube and like us on Facebook at Facebook.com/Pfizer.

Pfizer Disclosure Notice The information contained in this release is as of May 9, 2017. Pfizer assumes no obligation to update forward-looking statements contained in this release as the result of new information or future events or developments.

This release contains forward-looking information about BAVENCIO (avelumab), the alliance between Merck KGaA, Darmstadt, Germany and Pfizer involving anti-PD-L1 and anti-PD-1 therapies, and clinical development plans, including their potential benefits, that involves substantial risks and uncertainties that could cause actual results to differ materially from those expressed or implied by such statements. Risks and uncertainties include, among other things, uncertainties regarding the commercial success of BAVENCIO; the uncertainties inherent in research and development, including the ability to meet anticipated clinical study commencement and completion dates and regulatory submission dates, as well as the possibility of unfavorable study results, including unfavorable new clinical data and additional analyses of existing clinical data; risks associated with interim data; the risk that clinical trial data are subject to differing interpretations, and, even when we view data as sufficient to support the safety and/or effectiveness of a product candidate, regulatory authorities may not share our views and may require additional data or may deny approval altogether; whether and when drug applications may be filed in any other jurisdictions for the Indication or in any jurisdictions for any other potential indications for BAVENCIO, combination therapies or other product candidates; whether and when any such applications (including the pending application for BAVENCIO for metastatic Merkel cell carcinoma in the EU) may be approved by regulatory authorities, which will depend on the assessment by such regulatory authorities of the benefit-risk profile suggested by the totality of the efficacy and safety information submitted; decisions by regulatory authorities regarding labeling and other matters that could affect the availability or commercial potential of BAVENCIO, combination therapies or other product candidates; and competitive developments.

A further description of risks and uncertainties can be found in Pfizer's Annual Report on Form 10-K for the fiscal year ended December 31, 2016, and in its subsequent reports on Form 10-Q, including in the sections thereof captioned "Risk Factors" and "Forward-Looking Information and Factors That May Affect Future Results", as well as in its subsequent reports on Form 8-K, all of which are filed with the U.S. Securities and Exchange Commission and available at http://www.sec.gov and http://www.pfizer.com.

References

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EMD Serono Inc.

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Melissa Lauer

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Pfizer Inc., New York, USA

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SOURCE EMD Serono; Pfizer

Excerpt from:
FDA Grants BAVENCIO (avelumab) Approval for a Common Type of Advanced Bladder Cancer - PR Newswire (press release)

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

See also: Prolactinoma written for patients

Hypopituitarism is the inability of the pituitary gland to provide sufficient hormones, due to an inability of the pituitary gland to produce hormones or due to an insufficient supply of hypothalamic-releasing hormones.

Symptoms depend on the degree of hormone depletion and the rapidity of onset. Hypopituitarism is usually a mixture of several hormonal deficiencies but rarely involves all the pituitary hormones. Hypopituitarism is usually chronic and lifelong, unless successful surgery or medical treatment of the underlying disorder can restore pituitary function.[1]

Taken from the results of one study:[1]

The most common cause of hypopituitarism is anterior pituitary tumours. The causes of hypopituitarism include:

See also the separate article on Pituitary Function Tests.

Hypopituitarism is sometimes associated with diabetes mellitus, dyslipidaemia, cardiovascular disease and osteoporosis.[1]

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Hypopituitarism. Medical information about Hypopituitarism ...

As a practising specialist in internal medicine with 34 years of professional experience at the San Fernando General Hospital, and as a past president of the Council of the Medical Board of Trinidad and Tobago (2004-2010), I am calling on the Medical Association of this country, through its president, to set the record straight with regard to the utterances of the Minister of Health, Terrence Deyalsingh, who continues to insist that the hereditary haemoglobinopathy called beta thalassaemia major, which is what has been reported in the media that the child Shannen Luke suffers from, is not a life-threatening illness in this country.

His statement is patently untrue. The minister has stated in the Parliament that he has obtained five independent professional opinions from doctors in this country and Barbados in support of his position. Further, he has insisted that he has formed his opinion based on the recommendation of the board that advises the Children's Life Fund. I am also, therefore, calling on this board to publicly outline their position regarding the advice given to the minister as it pertains to this specific issue.

Having not been a party to the details of this child's diagnosis, I am guided solely by media reports. All of the reports that I have read concerning the issue of this unfortunate child's illness consistently attest to the fact that she has been diagnosed with beta thalassaemia major.

Beta thalassaemia major is a hereditary haemoglobinopathy that results in variable phenotypes depending on the extent of the patient's inability to synthesise non-alpha globin chains. Based on media reports, including an excerpt of a referring letter from the child's attending haematologist taken together with what the Minister of Health has said in the Parliament, one can reasonably conclude that this child suffers from beta (0) thalassaemia which refers to mutations of the beta-globin locus that result in the absence of production of beta globin. This is to be distinguished from beta thalassaemia intermedia and beta thalassaemia minor.

Only the last of these mutations can truly be considered to be non-life-threatening in the context of the present state of development of the health services in this country.

Beta (0) thalassaemia is a rare illness with a reported annual global incidence of just one in 100,000. Such children usually present with severe anaemia during the first two years of life. These children require repeated and regular transfusions of red cells which, in turn, if not managed properly with commensurate parenteral iron chelating therapy, e.g., deferoxamine (Desferal), administered through a continuous infusion pump device, will lead inevitably to a systemic iron overload with resultant organ failure.

Are infusion pumps routinely and reliably provided by Mr Deyalsingh's ministry today?

Can he say that these patients reliably receive a supply of deferoxamine?

How often are they transfused and how safe are these red cell transfusions? Inadequacy in any one of these aspects of treatment poses a threat to life!

Furthermore, poorly transfused individuals with this disease suffer from obligatory resultant conditions that reduce their life expectancy considerably. On the other hand, regular transfusions in the absence of addressing iron overload similarly lead to a range of pathologic entities, e.g., diabetes, hypothyroidism, hypopituitarism, adrenal insufficiency and most frequently cardiomyopathy.

How on earth then, can the Minister of Health insist that this illness, such as it is reported to be, is not life-threatening?

See the article here:
Shannen's illnesslife-threatening or not? - Trinidad & Tobago Express

Traumatic brain injury (TBI) is considered the main cause of hypopituitarism in adults and growth hormone (GH) deficiency is the most common pituitary deficit associated with TBI.

According to Cedars-Sinai, even after we stop growing, adults need growth hormone. Growth hormone plays a role in healthy muscle, how our bodies collect fat (especially around the stomach area), the ratio of high density to low density lipoproteins in cholesterol levels, and bone density. In addition, growth hormone is needed for normal brain function.

A recent study aimed to assess pituitary function and GH deficiency in adult patients at different time durations following complicated mild TBI, according to the Glasgow Coma Scale (GCS). The study also aimed to evaluate whether mild TBI patients with GH deficiency had developed alterations in the glycolipid profile.

Forty-eight patients (34 men and 14 women) with complicated mild TBI were included in the study. Twenty-three patients were evaluated at 1 year (Group A), and 25 patients at 5 years or longer after the injury (Group B). All patients underwent basal hormonal evaluation for pituitary function. GH deficiency was investigated by the combined test (GH releasing hormone + arginine). The glycolipid profile was also evaluated.

Researchers report that GH deficiency occurred in 8/23 patients (34.7 percent) of Group A and in 12/25 patients (48 percent) of Group B. In addition, two patients, one in each group, showed evidence of central hypothyroidism. Patients examined one-year or several years after complicated mild TBI had a similarly high occurrence of isolated GH deficiency, which was associated with visceral adiposity and metabolic alterations.

These findings suggest that patients with complicated mild TBI should be evaluated for GH deficiency even if several years have passed since the underlying trauma.

Link:
Growth Hormone Deficiency Following Complicated Mild Traumatic Brain Injury - Lexology (registration)

The loss of pituitary gland hormone production also known as hypopituitarism can be a serious, life-long condition. The pituitary gland is our master gland. Ithelps to produce many hormones that are necessary for our bodies to function properly. Symptoms for this rare condition can be severe. However, with appropriate treatment, individuals with hypopituitarism should be able to live normal, productive lives. For some people, hormone replacement therapy may be necessary. There are also ways to balance your hormones naturallythat can beuseful as well.

Hypopituitarism refers to under-functioning of the pituitary gland. The pituitary gland is a tiny organ about the size of a pea. Its locatedat the base of the brain. Known as the master gland of the body, it produces many hormones that travel throughout the body. It directs certain processes andstimulates other glands to produce hormones.

A person with hypopituitarism has a pituitary gland that doesntproduce one or more of its hormones, or doesnt produce enough of them. This disorder can affect any number of the bodys routine functions, including growth, blood pressure and reproduction.

According to research published in Postgraduate Medical Journal, the prevalence of hypopituitarism is 45 cases per 100,000 people and the incidence rate is about 4 cases per 100,000 people, per year. Nearly 50 percent of patients have 3 to 5 pituitary hormone deficits. (1)

Hypopituitarism symptoms are sometimes not obviousand may be overlooked. The severity of symptoms typically depends on which pituitary hormones are lowand the extent of hormone deficiency. Some common signs and symptoms of hypopituitarism include:

Hypopituitarism symptoms depend on which hormone or hormones are missing. Symptoms associated with specific hormone deficiencies are listed below:

Adrenocorticotropic hormone (ACTH) deficiency.Fatigue, low sodium in blood, weight loss and skin paleness.

Thyroid-stimulating hormone (TSH) deficiency. Fatigue, weight gain, dry skin, constipation, sensitivity to cold

Luteinizing hormone (LH), Follicle-stimulating hormone (FSH) deficiency.Loss of periods for women, erectile dysfunction and impotence for men, loss of sex drive and infertility.

Growth hormone (GH) deficiency.Lack of growth (height) for children and adolescents, increased body fat, failure to achieve normal peak bone mass or decreased muscle and bone mass.

Prolactin (PRL) deficiency.Inability to breast feed

Oxytocin deficiency.Couldmake breastfeeding more difficult.

Antidiuretic hormone (vasopressin) deficiency.Frequent urination during the day and night, dilute urine and excessive thirst (3)

The progressive loss of pituitary hormone secretion is usually a slow process. Itcan occur over a period of months or years. However, occasionally hypopituitarism does start suddenly with a rapid onset of symptoms.

Generally, growth hormone is lost first. Then luteinizing hormone deficiency occurs. The loss of follicle-stimulating hormone, thyroid stimulating hormone, and adrenocorticotropin hormones and prolactin typically follow much later. (4)

Anumber of factors or health conditions can cause hypopituitarism. These include diseases of the pituitary gland or diseases of the hypothalamus that cause diminished secretion of hypothalamic releasing hormones. These hypothalamus diseases reduce the secretion of corresponding pituitary hormones.

Certain tumors can also affect pituitary gland function; this includes brain tumors, pituitary gland tumors and hypothalamus tumors. As a tumor gets bigger, it can compress and damage pituitary tissue, thereby interfering with hormone production. The most common cause of hypopituitarism is a pituitary tumor, also known as a pituitary adenoma. A pituitary tumor isalmost always benign. However,it puts pressure on the restof the pituitary gland. It also limits or even destroys the pituitary glandsability to produce hormones appropriately.

Your pituitary gland may also stop producing one or more of its hormones because of a traumatic injury. This can include brain surgery, a brain infection or a head injury.

Diseases caused by inflammation, impaired immune function or abnormal growth of tissue can causethe pituitary gland not to work properly. (5) This includes infections of the brain, such as meningitis, infections such as tuberculosis, syphilis and mycoses, and the following inflammatory diseases:

Other health issues that may lead to hypopituitarism include: a severe loss of blood during childbirth, which may cause damage to the front part of the pituitary gland (this is known Sheehans syndrome or postpartum pituitary necrosis), genetic mutations resulting in impaired pituitary hormone production, radiation damage and diseases of the hypothalamus.

Sheehans syndrome is a condition that affects women who lose a life-threatening amount of blood in childbirthand/or dont have enoughoxygen after childbirth. It is one of the most common causes of hypopituitarism in both underdeveloped and developing countries. (6)

Various studies have also looked into the effects of radiation damage and its link to hypopituitarism. Data shows that with low radiation doses, growth hormone deficiency usually occurs in isolation in about 30 percent of patients. With higher radiation doses (30 to 50 Gy), the incidence of growth hormone deficiency can reach 50 to 100 percent of patients. Researchers have also found that with higher dose cranial irradiation or following conventional irradiation for pituitary tumors, multiple hormonal deficiencies happenin 30 to 60 precent of patients after ten years of follow-up. (7)

Research shows that hypopituitarism is treatable. A patient with this condition should be able to perform normal activities as long as the appropriate hormonal therapy is used consistently and properly.

Hormone replacement therapyregulates circulating hormones, restores normal physiology as closely as possible and eliminates symptoms of hormone problems. To treat hypopituitarism, the replacement of deficient hormones is required for life. Thiscan be discouraging for patients who resist long-term therapy because of the fear of adverse effects. One rule of hormone replacement therapy is that no one dose will suit every patient. Because of this, when hormone replacement therapy is prescribed, the patient must be seen regularly to check see how they are responding to the treatment,and to change the dose if needed. (8)

Hormone replacement medications may include:

According to research published in Expert Opinion on Pharmacotherapy, lifelong therapeutic replacement of target hormonal deficiencies is necessary to avoid potentially life-threatening complications of hypopituitarism. But, there may be problems associated with administration and routine monitoring of this treatment. An ongoing challenge is to create and manage a helpfulplanof tailoring hormonal replacement regimens for individuals in order to avoid morbidity and mortality associated with hypopituitarism. (9)

Although the goal of hormone replacement therapy is to enable the patient to live a normal life, there are some risks involved in this type of therapy. Hormone replacement at doses that are higher than needed, especially in the case of cortisol, may harm the heart, bones and other organs. On the other hand, too low a dose of cortisol increases the risk of adrenal insufficiency, which is why patients must take additional cortisol when they are in stressful situations. (10)

Some medications, like human growth hormone replacement, may have side effects. These side effects include ankle swelling, joint aches and an increase in blood sugar levels.

People who havehypopituitarism a long time have a slight shorterlife span due to vascular causes, such as heart attacks and stroke, and infections. Although the reasons for this are not clear, patients with hypopituitarism should be screened for additional cardiovascular risk factors. They should also take steps to control their risk of developing cardiovascular issues. (11)

1. L-arginine

L-arginine is a type of amino acid that stimulates the production of certain hormones. These include especially beneficial growth hormones and insulin. L-arginine can help to reduce the symptoms of hypopituitarism, such as hair loss. It can also help to balance the bodys fluids, heal wounds, boost sperm production and allow for blood vessel relaxation.

A 2005 studypublished in Growth Hormone and IGF Research found that 5 to 9 grams of oral arginine caused a significant growth hormone response, which started approximately 30 minutes after ingestion and peaked approximately 60 minutes after ingestion. (12)

To naturally help your body make and use more L-arginine, eat clean sources of protein. These include cage-free eggs, cultured yogurt, grass-fed beef, pasture-raised poultry, liver and organ meats, wild-caught fish, walnuts and almonds.

2. Probiotics

The gut microflora has metabolic effects. This is why they are sometimes given to preterm infants. Research shows that young children who receive probiotic supplementation may achieve faster growth. (13) Research also suggests that probiotics cause significant elevations in growth hormone and testosterone levels in animals. (14)

Aside from taking a daily supplement, use probiotic foods to boost your intake of these healthy bacteria. This includes kefir, cultured vegetables, cultured yogurt, raw cheese, kombucha, apple side vinegar and miso. At the same time, its important that you steer clear of foods that can cause damage to your gut. These includeprocessed foods, hydrogenated oils and added sugar.

3. Copper

A severe copper deficiency may harm the body in multiple ways, including slowing growth. Research shows that adequate intake of copper and other micronutrients isneeded for childhood growth promotion. Copper plays an important role in bodily growth and repair. (15) The body uses copper frequently and it cannot store the mineral in sufficient amounts. Eating copper-rich foods like nuts, seeds, wild seafood, beans, liver and oysters can help you to prevent a copper deficiency and maintain hormone balance.

4. Glycine

Glycine is an amino acid that plays a role in the production of human growth hormone. Studies show that glycine increases growth hormone levels. Evidence is mixedabout its effectivenessfor people with an existing growth hormone deficiency. A 2003 study published in Nutritional Neuroscienceinvolved 42 healthy participants who received either five grams of a nutritional supplement containing glycine, glutamine and niacin, or placebo, twice daily for three weeks. The nutritional supplement containing glycine increased serum growth hormone levels by 70 percent relative to placebo. (16)

5. Adaptogen Herbs

Adaptogen herbs help to balance, restore and protect the body. They respond to any influence or stressor, normalizing your physiological functions. Research shows that adaptogen herbs have positive benefits on the reproductive health of both men and women. They can improve fertility and sexual desire. Adaptogens may also have beneficial effects on the cardiovascular system, helping to protect the heart and regulate blood pressure. This is important because people with hypopituitarism are at a greater risk of deathdue to cardiovascular issues. (17)

Some of the most powerful adaptogen herbs include ginseng, holy basil, rhodiola, ashwagandha and astragalus root. Because these herbs affectstress hormones, you should only use them under the care of your healthcare provider. This is especially important if you are already onhormone replacement therapy.

6. Healthy Fats

Eating healthy fats, such as coconut oil, avocados, grass-fed butter and wild-caught salmon, help to balance your hormones naturally. The body needs short, medium and long-chain fatty acids to create hormones. These essential fats are not only fundamental building blocks for hormone production. They also reduce inflammation and improve heart health. (18)

7. Exercise

One of the many benefits of exercise is its ability to increase growth hormone prevalence. Research conducted at Syracuse University suggests that exercise is a very potent stimulator of growth hormone release. There is considerable research documenting the dramatic rise of growth hormone. Studies suggest that exercise can increase growth hormone levels by 300 to 500 percent. (19)

8. Sleep

Adequate sleep, which means 7 to 8 hours every night, is essential for hormone balance. Your hormones work on a schedule. The body regulatescortisol levelsin the middle of the night. This helpsto give your bodya break from your flight or fight stress response. Sleep helps to keep stress hormones balanced. It also helps to build energy and allow the body to recover from stress properly. (20)

Hypopituitarism can be a life-threatening condition if its not regulated properly. Natural remedies should always be used under the care of your doctor. For some people, hormone replacement therapy may be a neededtreatment.

Leaky gut syndrome is a rapidly growing condition that millions of people are struggling with and dont even know it. From the sound of it, you might think leaky gut syndrome only affects the digestive system, but in reality it can lead to many other health conditions. Because Leaky Gut is so common, and such an enigma, Im offering a free webinar on all things leaky gut. Click here to learn more about the webinar.

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Hypopituitarism Symptoms, Causes & 8 Natural Remedies

Newswise Scott Halpern, MD, PhD, MBE, an associate professor of Medicine, Epidemiology, and Medical Ethics and Health Policy, and director of the Palliative and Advanced Illness Research (PAIR) Center, and Peter J. Snyder, MD, a professor of Medicine in the division of Endocrinology, Diabetes and Metabolism, will be presented with the 2017 Association for Clinical and Translational Science (ACTS) Distinguished Investigator Award for Career Achievement and Contribution to Clinical and Translational Science at Translational Science 2017, the organizations annual meeting, in Washington, D.C. Halpern will also receive the American Federation for Medical Researchs (AFMR) Outstanding Investigator Award at the meeting next month.

The ACTS Distinguished Investigator Award recognizes senior investigators whose innovative research or education leadership has significantly impacted clinical and translational science. The AFMR Outstanding Investigator Award is presented annually to an investigator age 45 or younger in recognition of excellence in biomedical research.

The ACTS Distinguished Investigator Award for Translation from Clinical Use into Public Benefit and Policy & AFMR Outstanding Investigator Award

Dr. Halpern is also the founding director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) program, and deputy director of the Center for Health Incentives and Behavioral Economic (CHIBE). By blending ethical analyses and empirical research, Dr. Halpern's work promotes the ideals of fairness and value in how scarce healthcare resources, including transplantable organs, ICU beds and services, and clinicians time are allocated to seriously ill patients. The PAIR Center conducts large, pragmatic randomized trials of interventions that seek to improve the lives of all people affected by serious illness. The FIELDS program includes scholars from multiple health-related disciplines who use principles of behavioral economics in an effort to understand and improve upon the healthcare decisions made by seriously ill patients and their family members and clinicians. Finally, his work through the CHIBE develops behavioral economic interventions that motivate smoking cessation, research participation, and reductions in the use of low-value healthcare services, without unduly constraining autonomous choice.

Dr. Halperns research is supported by the National Institutes of Health (NIH) and by a number of foundations. He is an elected member of the American Society of Clinical Investigation, and a member of the editorial boards of the Annals of Internal Medicine and the American Journal of Bioethics. From 2013 2015 he was an anniversary fellow at the Institute of Medicine. He holds a bachelors degree from Duke University, and an MD, PhD, MSCE and MBE from the University of Pennsylvania.

The ACTS Distinguished Investigator Award for Translation from Early Clinical Use to Applicability for Widespread Clinical Practice

Snyders clinical expertise is focused on neuroendocrinology, or the diagnosis and treatment of pituitary adenomas and other pituitary and hypothalamic abnormalities, including excessive and deficient pituitary hormone secretion. These conditions include acromegaly, Cushings disease, hyperprolactinemia, gonadotroph and other clinically nonfunctioning adenomas, other pituitary and hypothalamic tumors, hypopituitarism, and diabetes insipidus. In clinical practice, he also specializes in male reproductive endocrinology, the diagnosis and treatment of hypogonadism and infertility in men.

Over his nearly five-decade career, Snyder has examined the effects of hormones on bone and pituitary adenomas. Most notably, Snyder was the principle investigator of The Testosterone Trials, a multicenter study of seven coordinated trials of the effects of testosterone in elderly men with low testosterone on physical function, vitality, sexual function, cognitive function, anemia, bone and cardiovascular risk.

Snyder is also involved in several professional societies including the American Society for Bone and Mineral Research, the American Society for Clinical Investigation, the Association of American Physicians, and the Endocrine Society. He holds a bachelors degree from Williams College and a medical degree from Harvard University.

### Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

Newswise The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community. Contacts

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Penn Medicine Researchers Receive Distinguished Investigator Awards - Newswise (press release)

Dr. John Hanson has a colorful, stylish office in the Cudahy Tower, converted from an old apartment, reducing his morning commute to a short stroll from a condominium in the building. A retired oncologist, Hanson now spends his time spearheading his 5-year-old John P. Hanson Foundation for Cancer and Cellular Research, which supports research into cell therapy and other forms of cancer immunotherapy, advanced treatments that direct the power of the bodys immune system (including T-cells) against unwanted cancer cells. Hanson is currently gathering funding to support up to three young researchers at the cutting-edge Robert H. Lurie Comprehensive Cancer Center at Northwestern University, with hopes of one day endowing a professorship.

Should cancer patients challenge their doctors?I think thats fine. Theres no cure. There might be two or three different options. And the next thing is, is there a clinical trial or an attempt to improve on standard practices available? Its all about the patient getting better.

Must the immune system miss something for a tumor to form? No. Its not missing something. What happens is the cancer outfoxes everyone. Instead of supporting the body, it begins to support itself and becomes self-aggrandizing.

Cell therapy sounds great. Does it have limitations?It works extremely well with melanoma because there are large genetic differences. Breast cancer has been treated successfully. A few colon cases have been treated successfully. A pancreatic cancer has been treated successfully, one or two [times]. The imperative is you must develop this [approach] for common cancers because theyre what kill people. It works extremely well with melanoma because there are large genetic differences. Breast cancer has been treated successfully. A few colon cases have been treated successfully. A pancreatic cancer has been treated successfully, one or two [times]. The imperative is you must develop this [approach] for common cancers because theyre what kill people.

During immunotherapy, can the immune system target things other than cancer? That does happen. Diabetes can occur. Hypothyroidism can occur. Hypopituitarism can occur, and bowel diseases can happen. Its a reaction to the immune system being turned on too much.

What was it like to work with cancer patients? Did you find it rewarding? Oh sure. You can help the sick. The art is to listen to what the patient wants. If you listened enough early on, you could say, This is what you want, and this is what I can do. If they wanted to do something high risk, we would talk about it for a week or two to make sure they got it and understood what the risks were. The goal was, I am going to get you through this. You can do this, and you will do this. We have to get to the end of a course [of treatment] to see if it works. Theres a sorrow at death, but we tried as best we could. Can we learn something to help the other families, the other patients? Almost always we do. Was it worth it? Absolutely. Every human being who has cancer wants to live.

Why hasnt immunotherapy taken over the field?Doctors are committed to the life and well-being of patients, and theyre not convinced it works. But youre dealing with people who are dying and sick. I think theres an imperative. You cant keep putting up with the same old shit. Its not in human nature to accept that what is [is beyond improvement]. You have to try.

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Fighting Cancer With Fundraising: Meet Milwaukee's Dr. John Hanson - Milwaukee Magazine

Oncology Nurse Advisor

Thymomas Trigger Newly Described Autoimmune Endocrine Disease Oncology Nurse Advisor Thymomas, a rare type of cancer in the thymus gland, can result in a newly described autoimmune disease, potentially leading to hypopituitarism, according to a recent study in Scientific Reports. Understanding the underlying mechanisms could improve ...

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Thymomas Trigger Newly Described Autoimmune Endocrine Disease - Oncology Nurse Advisor

Cold Springs FCCLA students took home an array of honors at state conference, with one student advancing to compete nationally.

On March 9-10, 2017, Cold Springs FCCLA students attended the FCCLA State Meeting in Montgomery. Members throughout Alabama gathered to increase their leadership skills, explore career options, compete in the state FCCLA STAR Events and elect a new team of state officers. With FCCLA there are unlimited opportunities for our youth.

This year Cold Springs had a student, Matthew Blair, to run for the FCCLA Executive Council Officer position. Matthew ran for this office with 10 other young adults from all over Alabama. Only six are chosen for the Executive Council. Matthew gave his speech and answered an on stage question to over 800 members, advisors, and guests. Matthew was voted in by his peers. He will be required to represent the state of Alabama at state and national meetings.

Cold Springs FCCLA had five students to complete the Power of One projects and be recognized at the state meeting: Rachel Haynes, Jessica Roden, Andrew Blair, Matthew Blair, and Stormy Schmidt received a certificate of completion.

Power of One helps students find and use their personal power. Each youth created a Power of One project that relates to one of the following five units:

A better you: Improve personal traits.

Family ties: Get along better with family members.

Working on working: Explore work options, prepare for a career, or sharpen skills useful in business.

Take the lead: Develop leadership qualities.

Speak out for FCCLA: Tell others about positive experiences in FCCLA.

Cold Springs students also competed in the FCCLA STAR Events Competition. These are competitive events in which members are recognized for proficiency and achievement in chapter and individual projects, leadership skills, and career preparation.

Rachel Haynes competed in the Career Investigation category and won gold. Her project title was Labor Lawyer. She will be representing the state of Alabama in this category at Nationals this summer in Nashville.

Matthew Blair, Raegan Lindsey, and Stormy Schmidt won gold in the Illustrated Talk category. They presented about teen depression and suicide.

Jessica Roden placed silver in the Life Event Planning category. Her topic was, Dedication to a Preacher. She planned, organized, and presented her project.

Kylie Gann and Samantha Willcutt won bronze in the Focus on Children category. They discussed and presented the topic of Living with Hypopituitarism. The girls wanted other students to understand what it is like to live with this. One of the girls cousins was born with this.

FCCLA has provided unlimited possibilities for our young adults at Cold Springs and other area schools. Its helps prepare todays teens for tomorrows workforce. It provides personal growth, leadership development, and career preparation opportunities for students in Family and Consumer Sciences. Advisor is Stephanie Blair.

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Cold Springs FCCLA brings home state awards - Cullman Times Online

Our understanding as to how the brain works has developed over the years with medical research. It is an extremely complex organ and when trauma happens it can be very unpredictable as to how the injured person will be affected and what treatment they will require. The problems that can occur are generally split into three areas:

Another area which can be affected following a brain injury which is less commonly understood is hormonal. The pituitary gland is found at the base of the brain. It is approximately the size of a pea and is attached to the brain by a thin stalk. This gland is often referred to as the master gland and is very important in that as well as producing hormones it regulates and controls the other glands in the body which produce hormones.

The pituitary gland is vulnerable to damage if someone suffers trauma to their brain given its location at the base of the brain. Damage to the pituitary gland can result in the gland failing to produce sufficient amount of hormones and this is known as hypopituitarism.

Symptoms of hypopituitarism

It is often not immediately apparent that someone has suffered damage to the pituitary gland and developed hypopituitarism. This is because the symptoms may not develop for a number of weeks, months or even years.

When the symptoms become apparent it is often the case that these can overlap with those suffered as a result of the actual brain injury and be overlooked and therefore misdiagnosed. The symptoms are often subtle and difficult to distinguish meaning treatment can therefore be delayed.

The most common symptoms of hypopituitarism are:

If you display some of these symptoms and your doctor suspects you may be suffering from hypopituitarism they can carry out blood tests to identify any abnormalities. A CT scan may also be carried out to rule out the possibility of a growth or tumour on the pituitary gland. You may then be referred to an endocrinologist a specialist doctor who diagnoses and treats hormone imbalances. Dependant on the particular imbalance you are suffering from, the treatment should aim to return the balance to your hormone levels.

You may be prescribed hormone replacement medication. The endocrinologist will then have to monitor your hormone levels regularly to ensure the levels are kept at a normal level and hopefully ensuring normal hormonal function can resume. Medication may require adjustment to ensure the correct dosage is found and the prescribed treatment acts in conjunction with any other medication which the person may be prescribed to deal with the other symptoms of their brain injury. Hormone replacement treatment will likely be life-long if the damage to the pituitary gland is significant.

Our understanding as to the frequency at which hypopituatarism develops following traumatic brain injury is still in its early stages. We do not yet have accurate statistics to illustrate the likelihood of developing hypopituitarism following brain injury however it is beginning to become clear that it may be more common than previously thought. It is important that patients are warned prior to discharge from hospital following a brain injury to be vigilant as to the symptoms of hypopituitarism. The danger of misdiagnosis or delayed diagnosis could lead to serious consequences however, if identified, hormone replacement treatment is often very successful.

If you have any concerns that you are experiencing symptoms of hypopituitarism following a brain injury it is important that you speak to your GP or other treating doctors. The blood test is quick and easy to undertake to diagnose the condition.

If you have been diagnosed with this condition as a result of an accident, and have suffered a traumatic brain injury, then this condition ought to be taken into account when bringing your personal injury claim. If your medical team have delayed in diagnosing or misdiagnosed your hypopituitarism then you may have a claim for medical negligence.

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Hypopituatarism - a lesser-known effect of traumatic brain injury - Lexology (registration)

Dear Editor: I am writing this after reading Karl Curtis' column on brain injuries in the hope that it may be helpful to some of your readers.

Our son Chris committed suicide eight years ago at the age of 31. He'd had a head injury long ago, in childhood, which he'd seemed to recover from fine. But we discovered after his death that he'd never been able to have full sex with his girlfriend, and also that his depression had been far worse than we knew, going back 10 years at least.

We looked it up and found that head injury, even mild (which Chris' wasn't; he fractured his skull) can cause damage to the pituitary gland, and the effects can be depression, lost sex drive, lost fertility, obesity and chronic fatigue, plus less serious symptoms like intolerance of heat or cold. The pituitary disorder (post-traumatic hypopituitarism or PTHP) may show immediately, or not until many years later. It is treatable by replacing the hormones which the pituitary can no long make.

Cranial irradiation can cause hypopituitarism also.

Growth hormone replacement can restore clear thought and energy levels, and may reduce weight. It can also help fatigue and depression. The other pituitary hormones that may need replacing are ACTH, LH/FSH, and TSH. LH/FSH replacement can restore sex drive and fertility.

For more detail plus the research see my book "Mother of a Suicide" available from Amazon.

Joanna Lane

London, UK

Send your letter to the editor to tctvoice@madison.com. Include your full name, hometown and phone number. Your name and town will be published. The phone number is for verification purposes only. Please keep your letter to 250 words or less.

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Joanna Lane:: Brain injury can cause treatable pituitary disorder - Madison.com

How is hypopituitarism treated?

Your doctor will treat the condition that is the cause of your hypopituitarism first. This can help restore your pituitary glands ability to produce hormones.

If a tumor on your pituitary gland is causing your hypopituitarim, your doctor may recommend surgery to remove it or radiation therapy to shrink it.

If your body does not produce enough of one or more pituitary hormones after treating the underlying condition, your doctor may prescribe a hormone replacement medicine to add to your bodys hormone production.

Hormone replacement medicines include:

If you are taking hormone replacement medicine, your doctor may want to monitor the levels of hormones in your blood to make sure youre getting the right amount of replacement hormones.

If you become very sick (such as with the flu) or go through a stressful time, your doctor may adjust the dose of replacement hormone you take to act the way a normally functioning pituitary gland would act in response to these situations. You might also need a dose adjustment if you become pregnant or have a significant change in weight.

You should carry a medical alert card and bracelet at all times so that emergency medical workers know what kind of care you need in case of emergency.

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Hypopituitarism - familydoctor.org

Science Daily

New autoimmune disease triggered by thymomas Science Daily A Japanese research group has discovered that a newly-identified autoimmune endocrine disease that leads to hypopituitarism is caused by thymomas (a type of tumor originating from the thymic gland). These underlying mechanisms could help to ...

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New autoimmune disease triggered by thymomas - Science Daily

YEOVIL Hospital has apologised to the mother of disabled girl who keeps getting fined by a faulty car parking system as she takes her daughter for treatment.

Nicky Fordon regularly drives daughter Rebecca to the hospital as she has learning disabilities and suffers from the rare condition diabetes insipidus and hypopituitarism.

Nicky visits Yeovil Hospital more than once a week to make sure Rebeccas sodium levels are sufficient because she cant retain liquids.

Nicky, 52, has a blue badge and her car registration is registered with the hospital yet she has racked up fines of 400 in the last two months.

On each occasion she has protested and the ticket has been cancelled but only after she has had to make yet another journey to the hospital to deal with it in person. The hospitals cameras monitoring the car parking entrance keep registering her as parking there and not in a disabled parking bay.

Mum-of-three Nicky said: Its stressful, time-consuming and completely unnecessary.

When I had the first one I was really worried I couldnt work out what Id done. It showed my car and registration and it said Id stopped there for an hour and a half but it could only have been for a few seconds while I waited for a parking bay to be free or to let someone out. I was in the car and the brake lights were on.

I feel like I spend my life at the hospital so its a real pain to have to go back with the tickets. Theres no number you can phone to talk to anyone, Ive got to go in person.

I think there must be loads of elderly people who just pay without questioning it.

A Yeovil Hospital spokeswoman said: We would like to apologise for the inconvenience caused to this lady who has received these fines in error.

The spaces out of the front of the hospital are controlled by ParkingEye, which uses number-plate recognition cameras.

We have assisted with dealing with each ticket on an individual basis but this issue will now be escalated to Parking Eye for them to investigate.

This is an unusual case and we would encourage this lady to get back into contact with us so we can address her concerns.

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Hopsital apologises to mother for parking fines caused by faulty system - View News

JOHNSON CREEK That Jackson Piskula is alive today already is a miracle. But keeping him here and healthy is going to take a lot of work and support.

Jackson, 8 months old, of Johnson Creek, has been diagnosed with a rare genetic disorder called Oral Facial Digital Syndrome, which kills almost all of the boys who are born with it.

In fact, Jackson initially was a twin, but his sibling, likely a brother, died in the womb at just 16 weeks gestation, probably because of this disorder.

Nicole Piskula said that when Jackson was born, he seemed like a perfectly healthy baby. She and husband Randy were ecstatic and so happy to add this little guy to their growing family, which includes Jacksons 5-year-old brother Noah, who lives with them, and stepbrother Robert, 9, who joins the family on weekends.

However, it soon became apparent that something wasnt right with little Jackson.

His parents noticed that Jacksons eyes were misaligned most of the time, which was different from what theyd experienced with their older children.

Jackson initially was diagnosed with Sixth Nerve Palsy and required surgery.

When doctors did a brain scan, they found he had a defective pituitary gland, leading to a condition called Hypopituitarism. Right now, the gland is functioning fine, but as he grows, it will have trouble, and even with lifelong hormone therapies, it is not expected to be able to function normally.

Jackson also has a hole in his heart. A lot of people have this condition and are able to function just fine, but with all of Jacksons other challenges, its just another troubling factor.

Were just taking it one day at a time, Nicole said.

In addition, doctors found Jackson had a couple of tumors, which are common with his main diagnosis. Ones on his tongue and is not causing much trouble, but the other, in his brain, could be life-threatening.

The tumor, located on the hypothalamus, is connected to the pituitary stem and is inoperable. Jackson is expected to undergo laser treatments his whole life to shrink it. The treatment is harsh and causes multiple and other undesirable effects, but is necessary to save his life.

This little guy has had one successful operation, with many more in his future, Nicole said.

Meanwhile, Jackson is experiencing seizures and is under heavy medication to try to get those under control.

When the Daily Union talked with Nicole on Wednesday, the family had just returned from a several-day stay at Childrens Hospital of Wisconsin in the Milwaukee area.

We thought we had the seizures under control, but I had to take him into the ER a couple of times in the last week. There was one time he stopped breathing and was unresponsive, Nicole said.

On Friday, Jackson was admitted to Childrens Hospital of Wisconsin, where a team of specialists has been overseeing his case.

This disorder is usually lethal to males, Nicole said. Our doctors are searching worldwide to see if there is any case we can base his treatment on for a better outcome.

With intensive treatment and high doses of medication, doctors were able to stabilize Jackson and bring him back to normal.

As of Wednesday, he had not suffered a seizure since Sunday, Nicole said.

Hes on two medications, pretty high doses, but he is back to himself, she said. Hes tired, but hes back home and doing pretty well.

The Piskula family has lived in Johnson Creek for the past year-and-a-half and Nicole said they have found the little Crossroads community to be very warm and welcoming.

Due to Jacksons medical problems, Nicole is focusing all her energy on being a stay-at-home mom right now, while her husband, Randy, works long hours at the Tools Inc. machining business in Sussex.

Nicole also is expecting their daughter, Charlotte, is due to be born in two months and she is doing everything she can to stay healthy for the entire family.

As one can imagine, the Piskulas medical bills are pretty high.

Insane, is what Nicole calls them. Family and friends have started a Go Fund Me page to raise money for Jacksons care. Recently, her cousin, Jenny Meinders, joined with Kades Klassic President Jill Donnelly to set up a fundraiser that will take place this Sunday afternoon at the Johnson Creek Community Center, located at 417 Union St. in Johnson Creek.

Donnelly, who runs the Kades Klassic nonprofit based in Elkhorn, said that her organization usually puts on a golf outing once a year for a deserving family.

When she heard about Jackson, his situation didnt quite fit the bill for what Kades Klassic usually does, but it was urgent and she wanted to help on an individual basis.

So she worked with Meinders to help coordinate Sundays fundraiser.

Donnelly is coordinating the silent auction and raffle, while Meinders is pulling together a spaghetti dinner.

The event will run from noon to 4 p.m. Sunday, with all-you-can eat dinners going for $10 for adults or $5 for children age 12 and under.

We (Kades Klassic) have all the stuff to put on a raffle and silent auction, so there was no need for anyone to go out and buy something, Donnelly said.

In the meantime, supporters have donated tons of food and other materials for the spaghetti dinner, meaning the costs of putting on the event will be less, and there will be more proceeds.

All proceeds will go directly to the Piskula family to offset Jacksons medical costs, Donnelly said.

Meinders said that all of the community support coordinators already have seen has been great. Nicole said their neighbors and community members have been really wonderful, as well.

People around town know us, and I get a lot of comments on the little helmet that Jackson wears, Nicole said.

The best thing about this whole thing is all of the people who have reached out to us to express their support or to help in whatever way they can, the mom said. Whether its locally or online, Ive heard from a lot of people. They share their own stories. Theyre praying for Jackson in church ...

Nicole had special praise for the local emergency medical technicians, who have gotten to know Jackson through his trials, coming out to assist a couple of times just in the past week.

The Johnson Creek EMT team is awesome, Nicole said. They brought equipment just his size. They knew just what to do, and they worked with me and accommodated our familys needs.

Meanwhile, coordinators said they hope to see a lot of people come out to the Johnson Creek Community Center Sunday to support the Piskula family and raise money for Jacksons care.

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Fundraiser Sunday to benefit Creek infant - Daily Union

Raised prolactin levels and their management, including clinical presentations, recent research on dopamine agonists and when surgery may be indicated.

Coloured CR scan showing a side view of a tumour (orange) of the pituitary gland (Picture: Science Photo Library)

Hyperprolactinaemia is a raised level of prolactin in the blood. This hormone stimulates breast epithelial cell proliferation and induces milk production. However, excessive production of prolactin can lead to infertility and gonadal dysfunction.1

Prolactin suppresses gonadotrophin-releasing hormone (GnRH), resulting in suppression of ovulation in females and reduced testosterone levels and hypogonadism in males.

Prolactin levels are normally high during pregnancy and lactation. Levels also increase after meals, after exercise and during stress, as well as during sleep.

Abnormally high levels of prolactin may be caused by a prolactin-secreting pituitary tumour (prolactinoma), or by a non-secreting pituitary tumour that prevents dopamine (a prolactin release-inhibiting hormone) from reaching normal prolactin-producing cells.

Common and rarer causes

Prolactinomas are the most common cause of hyperprolactinaemia, although it has many different causes. They are benign tumours that account for 40% of pituitary tumours and are the most common type of pituitary adenomas. More than 90% are intrasellar microprolactinomas (<10mm) that seldom increase in size.

Primary hypothyroidism may lead to hyperprolactinaemia as a consequence of increased synthesis of thyrotropin-releasing hormone, which stimulates prolactin production.

Severe liver disease and chronic renal failure can also be causes. Head injuries, brain surgery and cranial radiotherapy can also cause hyperprolactinaemia.

Drugs

The commonest medications to cause hyperprolactinaemia are antipsychotic drugs. Antidepressants, opiates, verapamil and oestrogens can also lead to hyperprolactinaemia.

Mildly increased prolactin levels (400-600mu/L) may be physiological and asymptomatic but higher levels are usually pathological. Very elevated levels (above 5,000mu/L) usually imply a prolactin-secreting pituitary tumour. Most patients with a prolactinoma are women.

The clinical presentation in women is more obvious and so occurs earlier than in men. Women present most commonly with galactorrhoea (up to 90% of cases), menstrual disturbance, reduced fertility and libido. Men present with galactorrhoea (10-20% of men), loss of libido, erectile dysfunction and occasionally, reduced fertility and gynaecomastia.

In both sexes, a macroadenoma (>10 mm in diameter) can cause mass effects, which may result in visual-field defects or headache.

In both sexes, long-standing hyperprolactinaemia can lead to low bone mineral density with an increased risk of developing osteoporosis.

A single measurement of prolactin level is usually adequate to diagnose hyperprolactinaemia. However, when the result is borderline, the test should be repeated. The pain/stress of venepuncture can actually elevate prolactin levels. Obviously, pregnancy must be excluded, if relevant. Renal and thyroid function tests should also be performed.

When other causes of hyperprolactinaemia have been excluded, the diagnosis of a prolactinoma is usually confirmed by a pituitary MRI scan.

Patients with macroadenomas that extend beyond the sella should undergo testing to exclude visual field defects, and also dynamic testing of the anterior pituitary function to exclude hypopituitarism.

Treatment of hyperprolactinaemia will vary according to the cause - for example, a drug review may be required where it is drug-related. The aim of treatment is to improve symptoms and avoid the long-term effects of oestrogen deficiency in women or testosterone deficiency in men.

Dopamine agonists suppress prolactin in most patients, normalise gonadal function and stop galactorrhoea. In patients with prolactinomas, they reduce the size of the tumour.2

Cabergoline and bromocriptine are both ergot-based dopamine receptor agonists. Cabergoline is the first-line treatment for prolactinomas as it has greater efficacy in suppressing prolactin secretion. It is better tolerated and has a more convenient dosing regimen when compared with bromocriptine.

The MHRA issued a warning in the past about the safety of dopamine agonists for treating hyperprolactinaemia, due to concerns about an association with chronic pleuropulmonary, pericardial and retroperitoneal fibrosis, and particularly fibrotic valvular heart disease.3

However, recent studies have not shown a clinically significant association between the use of ergot-derived dopamine agonist drugs for the treatment of hyperprolactinaemia and valvulopathy.4,5

In some patients with microprolactinomas, withdrawal of treatment can be tried after three years, as microprolactinomas can spontaneously resolve, especially after the menopause or pregnancy. Transsphenoidal surgery is an option in infertile patients who cannot tolerate or are resistant to dopamine agonists. It may also be performed if a macroadenoma does not shrink with drug treatment.

Definitive treatment depends on the size of the tumour and the patient's wishes (including future fertility).

Over 90% of microadenomas remain stable or gradually reduce their secretion of prolactin. One third of patients with idiopathic hyperprolactinaemia improve without treatment. This is more common in women around their menopause.

However, recurrence rates of hyperprolactinaemia are as high as 80 per cent, and therefore the majority of patients require long-term medical treatment.

This is an updated version of an article that was first published in September 2009.

Useful website: Pituitary Foundation -www.pituitary.org.uk

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Hyperprolactinaemia: diagnosis and management - GP online

Comments(0)

Imagine you're a busy mother-of-three with a daughter who has profound disabilities.

You have to visit Yeovil Hospital quite often on more than one occasion every week - you have a blue badge, your car registration is registered with the hospital.

And yet you keep getting issued with parking charges.

That's what's happened to Nicky Fordon from Ash six times in the last couple of months - the charges she has faced total more than 400.

On each occasion the ticket has been cancelled - but after she's had to make yet another journey there to deal with it in person.

"It's stressful, time-consuming and completely unnecessary," said Mrs Fordon, 52.

"When I had the first one I was really worried - I couldn't work out what I'd done."

The hospital has admitted there is a problem with the system and apologised, but Mrs Fordon says she's worried about vulnerable and elderly people who may be shelling out unnecessarily.

MORE: Yeovil Hospital's new multi-storey car park opening is delayed for another two months

She was shocked to get the first ticket and studying it closely she realised that somehow the camera monitoring the entrance to the hospital had registered her as parking there and not in a disabled parking bay.

"It showed my car and registration and it said I'd stopped there for an hour and a half - but it could only have been for a few seconds while I waited for a parking bay to be free or to let someone out.

"I mean I was in the car and the brake lights were on!"

Mrs Fordon has to regularly visit the hospital with her daughter Rebecca who has learning disablities and suffers from a rare condition called diabetes insipidus and hypopituitarism.

It means she has to have regular appointments at Yeovil hospital to make sure her sodium levels are sufficient because she can't retain liquids.

If they're too low this can be dangerous and mean a trip to the Bristol Royal Infirmary.

MORE: New Boots branch to open in Yeovil Hospital later this month

"I feel like I spend my life at the hospital so it's a real pain to have to go back with the tickets - there's no number you can phone to talk to anyone, I've got to go in person.

"I think there must be loads of elderly people who just pay without questioning it.

"What's going to happen when they open the new car park? Is it going to get any better?"

A Yeovil Hospital spokeswoman said: "We would like to apologise for the inconvenience caused to this lady who has received these fines in error.

"The spaces out of the front of the hospital are controlled by ParkingEye who use number-plate recognition cameras. We have assisted with dealing with each ticket on an individual basis but this issue will now be escalated to ParkingEye for them to investigate.

"This is an unusual case and we would encourage this lady to get back into contact with us so we can address her concerns."

READ NEXT: Tributes to 'an amazing' Yeovil Town supporter, 103, who had soft spot for Terry Skiverton's legs

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Yeovil Hospital sorry for charges of over 400 wrongly sent to stressed mum of disabled girl - Somerset Live

Agnethe Berglund,1 Morten Olsen,2 Marianne Andersen,3 Eigil Husted Nielsen,4 Ulla Feldt-Rasmussen,5 Caroline Kistorp,6 Claus Hjbjerg Gravholt,1,7 Kirstine Stochhholm1,8

1Department of Endocrinology and Internal Medicine, 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, 3Department of Endocrinology, Odense University Hospital, Odense, 4Department of Endocrinology, Aalborg University Hospital, Aalborg, 5Department of Endocrinology, Rigshospitalet, Copenhagen University,Copenhagen, 6Department of Endocrinology, Herlev Hospital, Herlev, 7Department of Molecular Medicine, 8Department of Pediatrics, Center of Rare Diseases, Aarhus University Hospital, Aarhus, Denmark

Objective: Routinely collected health data may be valuable sources for conducting research. This study aimed to evaluate the validity of algorithms detecting hypopituitary patients in the Danish National Patient Registry (DNPR) using medical records as reference standard. Study design and setting: Patients with International Classification of Diseases (10th edition [ICD-10]) diagnoses of hypopituitarism, or other diagnoses of pituitary disorders assumed to be associated with an increased risk of hypopituitarism, recorded in the DNPR during 20002012 were identified. Medical records were reviewed to confirm or disprove hypopituitarism. Results: Hypopituitarism was confirmed in 911 patients. In a candidate population of 1,661, this yielded an overall positive predictive value (PPV) of 54.8% (95% confidence interval [CI]: 52.457.3). Using algorithms searching for patients recorded at least one, three or five times with a diagnosis of hypopituitarism (E23.0x) and/or at least once with a diagnosis of postprocedural hypopituitarism (E89.3x), PPVs gradually increased from 73.3% (95% CI: 70.675.8) to 83.3% (95% CI: 80.785.7). Completeness for the same algorithms, however, decreased from 90.8% (95% CI: 88.792.6) to 82.9% (95% CI: 80.385.3) respectively. Including data of hormone replacement in the same algorithms PPVs increased from 73.2% (95% CI: 70.675.7) to 82.6% (95% CI: 80.184.9) and completeness decreased from 94.3% (95% CI: 92.695.7) to 89.7% (95% CI: 87.591.6) with increasing records of E23.0x. Conclusion: The DNPR is a valuable data source to identify hypopituitary patients using a search criteria of at least five records of E23.0x and/or at least one record of E89.3x. Completeness is increased when including hormone replacement data in the algorithm. The consequences of misclassification must, however, always be considered.

Keywords: ICD-10 algorithms, registry health data, hypopituitarism

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

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Evaluation of ICD-10 algorithms to identify hypopituitary patients in the Danish National Patient Registry - Dove Medical Press

Hypopituitarism in Children (cont.) Hypopituitarism Treatment

Treatment primarily involves hormone replacement therapy.

Drugs used to treat hypopituitarism replace the deficient hormone.

Surgery may be performed if a tumor is present within or near the pituitary gland, depending on the type and location of the tumor, and depending on the symptoms being experienced.

The doctor or health care practitioner may schedule routine checkups every three months to monitor growth and development.

Frequent checkups for children on growth hormone replacement therapy may be scheduled to monitor progress and side effects.

A doctor who specializes in studying hormones (a pediatric endocrinologist) should supervise the treatment of children with hypopituitarism.

With appropriate treatment, the prognosis is very good.

The Magic Foundation

The Hormone Foundation

John A. Seibel, MD; Board Certified Internal Medicine with a subspecialty in Endocrinology & Metabolism

REFERENCE:

"Causes and clinical manifestations of central adrenal insufficiency in children" UpToDate.com

Medically Reviewed by a Doctor on 12/24/2015

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Hypopituitarism in Children Causes, Symptoms, Treatment ...

What Is Hypopituitarism?

The pituitary gland is one of the smallest parts of the endocrine system, yet it is also one of the most important. Without this tiny gland functioning as it should, your body is not going to function well either. Hypopituitarism, also known as pituitary insufficiency, is one condition that affects this important gland and can impact the health and well-being of your entire body.

The pituitary gland is a small gland that sits at the base of the brain, right behind the nose and between the ears. This gland may be small, but its powerful hormones affect almost every area of the body. In fact, the gland is so important to the overall function of the body that it is sometimes called the "master gland." The pituitary gland signals other glands in the body to produce their own hormones, and as such has a role to play in almost every bodily function. A deficiency in these hormones can affect many different functions, including reproduction, sexual health, growth and blood pressure.

Hypopituitarism is a condition that occurs when the pituitary gland does not produce enough of its important hormones. Because the hormones are lacking, the condition is sometimes called pituitary insufficiency. It can occur for a variety of reasons and cause a wide range of symptoms because of the far-reaching effects of the pituitary gland.

Hypopituitarism has a wide range of causes. Sometimes, tumors, also known as adenomas, in the pituitary gland can interfere with the production of pituitary hormones. While these tumors are rarely cancerous, they can have far-reaching effects.

Some patients who have undergone radiation treatment to remove pituitary gland tumors may notice a poor function of the gland. This occurs because the pituitary gland tissue is destroyed during the radiation treatment. Similarly, chemotherapy can destroy the tissue and leave the pituitary gland without proper function.

Patients who have had brain surgery or a traumatic brain injury may have a pituitary insufficiency. Severe bleeding on the brain or loss of blood, especially if it occurs during childbirth, can also have this impact. Patients who have had meningitis or tuberculosis may have damaged pituitary glands. In a small portion of patients, the cause is never found.

Pituitary insufficiency is a rare condition, but for those who have it, this disease can be life changing. While it can be controlled with medication, it must be dealt with consistently to ensure that the patient suffers no ill effects from the hormonal insufficiencies.

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What is Hypopituitarism, Pituitary Insufficiency | Hormone.org

The pituitary gland produces a number of hormones, which are released into the blood to control other glands in the body (thyroid, adrenal, ovary or testicles). If the pituitary is not producing one or more of these hormones, the condition is called hypopituitarism. If all the hormones produced by the anterior pituitary are decreased, the condition is called panhypopituitarism. Hypopituitarism is most often caused by large benign tumors of the pituitary gland, or of the brain in the region of the hypothalamus. Pituitary underactivity may be caused by the direct pressure of the tumor mass on the normal pituitary or by the effects of surgery or radiotherapy used to treat the pituitary tumors.

Less frequently, hypopituitarism can be caused by infections in or around the brain (such as meningitis) or by severe blood loss, by head injury, or by other rare diseases. Some of the clinical features that may be associated with hypopituitarism include excessive tiredness and decreased energy, irregular periods (oligomenorrhea) or loss of normal menstrual function (amenorrhea), impotence (in men), infertility, increased sensitivity to cold, constipation, dry skin, low blood pressure and lightheadedness upon standing (postural hypotension). Treatment of hypopituitarism consists of long-term hormone replacement therapy, since pituitary hormone deficits are rarely reversed after tumor removal.

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Hypopituitarism-Panhypopituitarism

Causes of pituitary insufficiency include pituitary adenomas or other intrasellar and parasellar tumors, inflammatory and infectious destruction, surgical removal, radiation-induced destruction of pituitary tissue, traumatic brain injury (TBI), subarachnoid hemorrhage, and postpartum pituitary necrosis (Sheehan syndrome). Similar diseases originating in the hypothalamus or pituitary stalk may also result in pituitary insufficiency.

Pituitary tumors, or adenomas, are the most common cause of hypopituitarism in adults, although traumatic brain injury as a cause is being more frequently recognized.

Hypopituitarism resulting from pituitary adenomas is due to impaired blood flow to the normal tissue, compression of normal tissue, or interference with the delivery of hypothalamic hormones via the hypothalamus-hypophysial portal system.

In primary pituitary destruction, the anterior pituitary is destroyed, causing a deficiency in some or all pituitary hormones, including prolactin. Disease involving the hypothalamus or pituitary stalk may cause pituitary hormone deficiency with an elevated serum prolactin. Pituitary tumors, or adenomas, can be secretory or nonsecretory. Approximately 30% of all macroadenomas larger than 10 mm produce at least 1 hormone.

Hypothalamic disease involves destruction of the hypothalamus. This causes a deficiency or loss of hypothalamic regulatory hormone input to the pituitary, which leads to the loss of anterior pituitary hormone secretion, with an elevated serum prolactin level. Loss of antidiuretic hormone (ADH) may have concomitant diabetes insipidus.

Hypersecretion of the secretory pituitary tumor hormone is suggestive of an adenoma. Another indication of a pituitary adenoma is a deficiency in some pituitary hormones with concomitant hyperprolactinemia. Normally, dopamine, produced in the hypothalamus, inhibits prolactin secretion by the anterior pituitary. Compressing the pituitary stalk decreases the inhibitory effect of dopamine and increases prolactin levels.

Longstanding target gland disease may result in hyperplasia of the relevant pituitary cell secreting the tropic hormone, the level of which would be elevated, with an enlarged pituitary gland simulating a mass. Although uncommon, this may appear to be a pituitary adenoma, but the target gland is not hyperfunctioning.

Another common intracranial tumor is craniopharyngioma, a squamous cell tumor that arises from remnants of the Rathke pouch. One third of these tumors extend into the sella, while approximately two thirds remain suprasellar.

Sheehan syndrome occurs with a large volume of postpartum hemorrhage. During pregnancy, the pituitary gland enlarges due to hyperplasia and hypertrophy of the lactotroph cells, which produce prolactin. The hypophyseal vessels, which supply the pituitary, constrict in response to decreasing blood volume, and subsequent vasospasm occurs, causing necrosis of the pituitary gland. The degree of necrosis correlates with the severity of the hemorrhage.

As many as 30% of women experiencing postpartum hemorrhage with hemodynamic instability may develop some degree of hypopituitarism. These patients can develop adrenal insufficiency, hypothyroidism, amenorrhea, diabetes insipidus, and an inability to breastfeed (an early symptom). Lymphocytic hypophysitis occurs most commonly in the postpartum state and may appear as Sheehan syndrome with postpartum hypopituitarism.

Pituitary apoplexy denotes the sudden destruction of the pituitary tissue resulting from infarction or hemorrhage into the pituitary. The most likely cause of the apoplexy is brain trauma; however, it can occur in patients with diabetes mellitus, pregnancy, sickle cell anemia, blood dyscrasias or anticoagulation, or increased intracranial pressure. Apoplexy usually spares the posterior pituitary and solely affects the anterior pituitary. In patients with such underlying diseases, Sheehan syndrome can occur with lesser degrees of postpartum hemorrhage or hypotension.

Head trauma from a motor vehicle accident, a fall, or a projectile can cause hypopituitarism by direct damage to the pituitary or by injuring the pituitary stalk or the hypothalamus. Hypopituitarism may occur immediately, or it may develop months or years later. Recovery is uncommon. Many studies show an incidence of 15-40%, [2] but a study by Kokshoorn et al found the incidence of posttraumatic hypopituitarism to be low. [3]

Other causes of hypopituitarism include empty sella syndrome and infiltrative diseases. Empty sella syndrome occurs when the arachnoid herniates into the sella turcica through an incompetent sellar diaphragm and flattens the pituitary against bone, but resulting pituitary insufficiency is uncommon. Infiltrative diseases, such as Wegener granulomatosis and sarcoidosis, can cause destruction of the anterior pituitary. Lymphocytic hypophysitis is an autoimmune destructive disease that may be directed towards the pituitary or its stalk.

Physiologic or psychological states can influence the hypothalamus by impairing synthesis and secretion of regulating hormones. For example, poor nutrition may impair the hypothalamic secretion of gonadotropin-releasing hormone (GnRH), resulting in reversible pituitary gonadotropin deficiency. Medications may affect measured hormone levels, such as opioids decreasing serum LH and testosterone.

The degree of hormone deficiency varies greatly and depends on the extent of the process and its location. Some functional causes include emotional disorders, changes in body weight, habitual exercise, anorexia, bulimia, congestive heart failure (CHF), renal failure, and certain medications.

Hypopituitarism occurs in adult patients after cranial radiotherapy performed to treat nonpituitary tumors. Thus, patients who undergo cranial radiotherapy should be periodically assessed for pituitary functions. [4]

Additional causes of hypopituitarism include the following:

With regard to item 9 above, in a study of 435 patients, Fatemi et al found evidence that the likelihood of hypopituitarism development after transsphenoidal adenoma removal is higher when the tumor is larger than 20 mm. [6] In contrast, some with hypopituitarism prior to adenomectomy may have improved pituitary function following surgery, if the cause of the hypopituitarism was increased suprasellar pressure resulting from the mass itself.

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Hypopituitarism (Panhypopituitarism): Background ...

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When I was between five and six, I attended balletclasses. One day the ballet teacher was observing myarm positions and could not understand why my rightarm did not look the correct shape in certain positions.

The ballet teacher decided to ask my mum if I had anyproblems with it i.e. had I broken it at any time? My mumwas not aware of any problems and had not noticed it.

My mum and dad took me to our local GP, who afterlooking at my arm, decided to refer me to a bonespecialist at the Royal National Orthopaedic Hospital inLondon. I remember thinking it was fun, as I got to goon a train, a few x-rays were taken and afterwards Iwas diagnosed with Ollier disease (discondroplasia ofthe bone) this was managed by a yearly appointment tocheck things had not changed.

At around age of 11 to 12, they found that I also had itin my left ankle. We were told if they did not correct thetwisted ankle it would cause problems when I got olderwith walking.I went into hospital when I was 13 years old. This was ahard thing to deal with but luckily the hospital I went intoStanmore RNOH, Edgware was brilliant. My mum wasable to stay with me as there were parents housing onsite but it was hard on my sisters as my mum was awayfrom home a lot.

I was in hospital for nearly four months, as I caught amajor infection in the wound following surgery. It tookhold quickly. The plaster cast that they put on in theatresuddenly turned yellow; they took me into the treatmentroom, my dad came in and when they took the plaster offthey undone the stitches and the wound spilled infectioneverywhere; I remember my dad saying he could seethe bone beneath - it was bad!

I was put on IV antibiotics, but my veins kept collapsingwhich was very painful, and it would always happen lateat night. I had a fantastic friend; she sat with me everytime they needed to change the needle and she wassuch a wonderful person; she had gone through herown trauma by losing her leg due to cancer, but shewas such a strong person.

The nurses, doctors and domestic staff made my timein there enjoyable I made some good friends who I wishI had stayed in touch with but I was young and thoughtit did not matter.About a year or so after that surgery, I was back inhospital having my leg lengthened as the first surgeryhad left me with a 2 inch limp, so that I would notdevelop a back problem; they made the decision to lengthenit.

I went into surgery and had an external fixate attachedto my right tibia. I stayed in hospital for 3 months.Again, it was made fun but this time I was studying formy GCSEs so I had to do a lot more schooling, but itpassed the time as we had a giggle. We had some roughtimes too, but because most of the kids in there werenot poorly and as it was corrective surgery, we were allable bodied, so we would all take our wheelchairs downto the hospital shop; some would be on crutches, but wewere allowed our own space.

I saw a lot in my time in that hospital but it made methe person I am, because when you witness somebodyelses pain and it is greater than your own, you realisethat there is always someone worse off than yourself.I came home with the fixator still attached and went backto school; they were very supportive and my friendsthere were great, but I got a lot of attention as kids hadnot seen this device before, so they were curious butnever cruel.I lengthened it millimetre by millimetre, so it took alongtime, but once it was done I had no limp and things wereback to normal.

Once all that was finished with I then got on with myschooling; passed my GCSEs and left school. I thenmet my husband; I was age 16 and he lived in Harlow,Essex and I commuted to Harlow every weekend;during the week I worked in a bakery and went to nightcollege to learn cake decorating.

My consultant decided to lengthen my ulna bone as it wasshort. So once again I was in Stanmore hospital havinga fixator attached to my arm; once the lengthening wascomplete I had an op to take bone from my hip, as newbone had not grown between the gap; this was painfulas the removal of bone from the hip has to be chiselled.

Then, in early 1999 I was at work and my face suddenlystarted to tingle and went very red and numb in thespace of a couple of hours. I stayed at work and thoughtit was just an infection of some sort but as the daywent on I decided to go to my GP where by he gaveme antibiotics and said it could be the trigeminal nerve,I took them but the problem continued over the nextcouple of weeks and I was back and forward to my GP.When I was pregnant with my son (1997) I had to havea grommet fitted in my ear as it blocked up.

As the GP doc could not think what could be causingthe numbness, he sent me back to Dr OMalley at MiltonKeynes hospital; I went for the appointment and thedoctor decided to order an MRI scan. I had the scanand then went back to see Dr OMalley; I took my dadwith me and we were stunned by what we were beingshown - a tumour growing from the base of my skull thesize of an orange. It had grown up and into the opticnerve and damaged the nerves surrounding the rightside of my face; that is why I had numbness, rednessand a few painful headaches.

I was then referred from there to Oxford hospital where Isaw a Dr Kerr; they did not want to do a biopsy but theybrought in a specialist on tumours connected to Ollierdisease - a Dr Cadu Hudson. I was diagnosed witha chondrosarcoma, which is the rare form of maffuccisyndrome; these two diseases run side by side but itsrare to have both.

They talked us through the steps of how they weregoing to go about sorting the problem as the tumourwas very close to the carotid artery, so it was going tobe difficult to remove.The doctors thought it had been growing for about tenyears; as they are slow growing tumours they did not wantto rush in.

I had a Robbie Williams concert to go to in the September,Neil had brought me the tickets for Christmas; I loveRobbie and really wanted to go, so Dr Kerr said wewould hold off until after then as he knew the op wouldbe difficult - he implied I was to do and experience asmuch as I could. The only trouble was that the tumourwas not going to hold off, so in the May, I was rushed intoOxford hospital with a major headache. I was in over theweekend and Neil had gone home for the weekend asit was my mums 50th party and their 25th anniversary.It was hard for Neil and my family to celebrate it withoutme with them.

Over the weekend the headache got worse. ComeMonday morning, I had had a really bad night and theteam thought the tumour could have been bleeding!! Nopainkiller was working and I was given IV morphine. Iwas in so much pain in the morning, Dr Cadu Hudsonhad to come in as Dr Kerr was on holiday and theywanted to do surgery early that morning; Neil wascalled and he was on his way. They told me the risksthat were involved but I would not let them take medown to surgery until Neil arrived. My mum and dadwere not told how bad it was due to them being away,so I wanted him there to help me make some important decisions. I was so scared and confused; the consultantwas phoning Neil to find out how far away he was as itwas getting harder to hold off.

When Neil arrived, I then felt I could have the surgeryas I could relay things to him and say what I needed tosay to him and Ryan. I had the surgery; it went well butthe damage was already done to my eye, eye lid andface and I was in intensive care for three days - thesedays I dont remember. It took only ten days after that torecover and I went home to recover further.Once again, I had very good help and treatment atOxford from the nurses and doctors and I think theworld of Dr Cadu Hudson and Dr Kerr; they are veryclever people and special surgeons.I made it to the Robbie concert, three months aftersurgery and it was fantastic.I was kept a very close eye on at the clinic but theydecided a course of radiation would be needed to makesure that the tumour had stopped growing; but thething was, the radiation could not be done with normal radiation, I had to go to Paris for Proton and Photontherapy, at the IGR hospital Paris. The governmentwould pay for treatment but we had to fund the eightweek stay so family, friends, work friends and the localpaper helped find the money by fund raising, so I couldbe comfortable out there and that our son could belooked after while Neil was with me.

It was a hard time as we were away from our four yearold son, in a foreign country trying to communicate ourproblems when I did not speak French; Neil knew somebut only the kind of stuff for holiday visits, not hospitaltranslation. We had help from a lovely multilingual manin the hospital but it was very hard having radiation andnot being able to understand the instructions.Again the treatment and care we received was fantastic;we had two hospitals to visit- one that gave me theProton therapy at the IGR, and then we moved to thesecond hotel so I could have the second part of theradiation Photon therapy.

When I got back from Paris I was then referred to the endocrinology unit at the Churchill Radcliffe hospitalwhere I was kept a close eye on, as I was developingsymptoms of pituitary gland failure. They diagnosedhypopituitarism and I was gradually put on the relevanttablets for each part of pituitary shutdown.I am now on thyroxin, hydrocortisone, Premique HRTand growth hormone. I have a neck problem also due tothe radiation, so I am on pregabalin and ranitidine dueto the side effects of the pregabalin.Living with this pituitary problem is harder thandealing with the tumour itself and with my bonedisease put together, I am a different person. When Igot married to Neil six years ago, I was not well, butI weighed 10 stones 3lbs. Now I have no control overmy weight and I am 16 stones and 10lbs. You mightsay (and often I hear people say) But you are alive!!Yes I am, but its easy for them to say that as they are not inmy situation. It is a daily battle to remember to take mydrugs and to stay positive; deep depression, fatigue,keeping up with my son and not being able to get aboutdue to muscle fatigue. As I have low levels of growthhormone, this is being replaced slowly due to thepressure in my brain increasing the first time round.I am not a person to sit around and feel sorry for myself;I have continued to work with the help of my employerand friends, but have just been made redundant soam worried now if any employer will employ me. Mypositivity has come hugely from my husband Neil; hehas had to go through a lot of changes with me and stillhe is here supporting me.

I would like my story to be told as I feel I havebeen through a lot, but I still keep smiling, fundraising, working and generally staying positiveand as I said before There is always someonein more pain than you.If I can bring awareness and support, any research intoall of the diseases I have I will work to do that.

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Suzy's story - hypopituitarism | The Pituitary Foundation