Effect of Surgery on Gonadal Function of Premenopausal Women with Pituitary Adenomas Other Than Prolactinomas.

Arita, Kazunori; Uozumi, Tohru; Yano, Takashi; Kurisu, Kaoru; Hirohata, Taizo; Eguchi, Kuniki; Tominaga, Atushi; Pant, Basant; Iida, Koji; Kawamoto, Hitoshi

doi:10.1507/endocrj.43.131

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…In one study, 55.6% of women with adenomas other than prolactinomas and preoperative gonadal dysfunction had return of menses after TS [33]. In premenopausal women gonadal function can be assessed based on menstrual history and gonadotropin and estradiol levels if necessary (Table 2).…”

Section: Pituitary-gonadal Axesmentioning

confidence: 99%

Postoperative assessment of the patient after transsphenoidal pituitary surgery

2008

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While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later postoperative periods. In the early period, which spans the first few weeks after surgery, both monitoring of anterior and posterior pituitary function and managing neurosurgical issues are the focus of care. Potential disruption of pituitary-adrenal function is covered with perioperative glucocorticoids. Various strategies exist for ensuring the integrity of this axis, but typically this is done by measuring a morning cortisol on the 2nd or 3rd postoperative days. Patients with levels <10 microg/l should continue therapy with reassessment in the later postoperative period. Monitoring for water imbalances, which are due to deficiency or excess of ADH (DI or SIADH, respectively), is accomplished by continuous accounting of fluid intake, urine output and specific gravities coupled with daily serum electrolyte measurements. DI is characterized by excess volumes of inappropriately dilute urine, which can lead to hypernatremia. Most patients maintain adequate fluid intake and euvolemia, but desmopressin therapy is required for some. SIADH, which peaks in incidence on 7th postoperative day, presents with hyponatremia that can be severe and symptomatic. Management consists of fluid restriction. Neurosurgical monitoring is primarily for disturbances in vision or neurological function, and although uncommon, for CSF leak and infections such as meningitis. In the later postoperative period, the adrenal, thyroid and gonadal axes are assessed. New persistent hypopituitarism is rare when transsphenoidal surgery is performed by an experienced surgeon. Various strategies are available for assessing each axis and for providing replacement therapy in patients with deficiencies. Long term monitoring with assessments of visual, neurological and pituitary function coupled with pituitary imaging is necessary for all patients who have undergone surgery, irrespective of the hormone status of their tumors.

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Section: Pituitary-gonadal Axesmentioning

confidence: 99%

Postoperative assessment of the patient after transsphenoidal pituitary surgery

2008

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“…For instance, growth hormone-secreting tumors are associated with irregular menses in 80% of patients [6] but hypogonadism in only 41.8% of patients [2]. Growth hormone hyper-secretion leads to increases in hepatic insulin growth factor-1 production, which may increase ovarian androgen production and disrupt follicular development.…”

Section: Gonadal Dysfunction With Pituitary Tumorsmentioning

confidence: 99%

“…Growth hormone hyper-secretion leads to increases in hepatic insulin growth factor-1 production, which may increase ovarian androgen production and disrupt follicular development. Adrenocorticotropic hormone (ACTH)-secreting tumors are associated with irregular menses in 71.4% of patients [6] and hypogonadism in 41.1% [2]. ACTH-secreting adenomas lead to an increase in cortisol, which suppresses gonadotropin secretion, and elevated androgen levels, which disrupt ovarian follicular development.…”

Section: Gonadal Dysfunction With Pituitary Tumorsmentioning

confidence: 99%

“…At times, new deficits arise postoperatively. In one study of pre-menopausal women undergoing surgery for non-prolactinoma pituitary tumors, menstrual irregularity was found in 78.2% of patients pre-operatively and in 37.0% (no recovery: 34.8%; new-onset: 2.2%) postoperatively [6]. Another group evaluated hypogonadism following surgical management of nonfunctioning pituitary adenomas.…”

Section: Gonadal Function After Pituitary Surgerymentioning

confidence: 99%

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Treatment of infertility in women with pituitary tumors

Hirshfeld-Cytron¹,

Kim²

2006

Expert Review of Anticancer Therapy

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Due to the pituitary's critical position, a pituitary tumor may disrupt gonadal function, either by its expanding size or the inappropriate secretion of hormones. Menstrual cycles may be disrupted even without frank hypogonadism, particularly in the case of hormone-secreting adenomas. Despite optimal medical and surgical management of pituitary tumors, ovulation-induction therapy with gonadotropins is often required to restore fertility in these women. This article will provide an overview of the therapeutic options available for women with infertility resulting from pituitary tumors. Treatment strategies including dopamine agonists, gonadotropins and the role of assisted reproductive technologies will be discussed. Unique pregnancy considerations in the female patient with hypopituitarism will also be addressed.

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