“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

Stalla, G. K.; Ciato, Denis; Dimopoulou, Christina

doi:10.1055/a-0664-7632

Cited by 6 publications

(5 citation statements)

References 97 publications

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“…Seine Sekretion wird geregelt durch das adrenokortikotrope Hormon der Hypophyse (ACTH) und das hypothalamische Corticotropin-releasing Hormone (CRH) [4]. Es morgendlichen ACTH-Basalwertes deutlich überlegen [9]. Die Kombination beider Testverfahren ermöglicht in den meisten Fällen die korrekte Di erenzialdiagnose des Cushing-Syndroms.…”

Section: Steroidinduzierter Diabetes Mellitus: Wie Erkennen -Wie Behaunclassified

Steroidinduzierter Diabetes mellitus: Wie erkennen – wie behandeln?

Jungmann¹

2019

Diabetes aktuell

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ZusammenfassungGeschätzt werden in Deutschland etwa 1 Million Patienten mit Glukokortikoiden behandelt. Etwa jeder Zehnte entwickelt einen Steroiddiabetes, dessen Entstehung durch verschiedene Risikofaktoren begünstigt werden kann. Außerdem hängt das Risiko einer Diabetesentwicklung von der Glukokortikoiddosierung ab, bei systemischer Therapie ist das Risiko höher als bei lokaler. Auch die topische Glukokortikoidanwendung schließt eine Diabetesentwicklung als unerwünschte Arzneimittelwirkung jedoch nicht aus. Die Entwicklung eines Steroiddiabetes ist auch Symptom des seltenen Cushing-Syndroms. Besteht ein klinischer Verdacht auf das Vorliegen dieses endogenen Hyperkortisolismus, sollte die Diagnostik und Differenzialdiagnostik des Cushing-Syndroms durch laborchemische Screeningtests begonnen werden, unerkannt hat das Cushing-Syndrom eine hohe Morbidität und Mortalität. Bei der Glukokortikoidtherapie mit unphysiologischen Glukokortikoiddosierungen von über 5 mg Prednisolonäquivalent täglich resultiert daraus eine zunehmende Insulinresistenz mit der Folge der hyperglykämischen Entgleisung. Aktuelle Studien erlauben genauere Einblicke in die intrazellulären Kortisoleffekte. Die Diabetesdiagnose wird nach den üblichen Kriterien gestellt. Bei Patienten mit nachgewiesener Glukosetoleranzstörung ist ebenso wie bei Patienten ohne vorbestehenden Diabetes zunächst eine Schulung erforderlich, eine orale Diabetestherapie mit Metformin oder auch Dipeptidylpeptidase (DPP)-4-Hemmern kann hilfreich sein, unter Umständen wird eine Insulinbehandlung notwendig. Bei Patienten mit bekanntem und bereits behandeltem Diabetes ist die Therapie zu eskalieren. Eine zusätzliche Insulintherapie ist zumeist erforderlich, vorherige Insulinmengen müssen um bis zu 100 % gesteigert werden. Wegen der vordergründig postprandialen Hyperglykämie wird die Zugabe von prandialem Humaninsulin gegenüber einem Basalinsulin bevorzugt. Risikofaktoren für die Entwicklung einer Hypoglykämie sind ebenfalls zu berücksichtigen. Es kann nicht durchgängig davon ausgegangen werden, dass die Entwicklung eines steroidinduzierten Diabetes reversibel ist, eine entsprechende Aufklärung der Patienten ist erforderlich.

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Section: Steroidinduzierter Diabetes Mellitus: Wie Erkennen -Wie Behaunclassified

Steroidinduzierter Diabetes mellitus: Wie erkennen – wie behandeln?

Jungmann¹

2019

Diabetes aktuell

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“…Additionally, the incidence of clinically significant PitNETs is 80–100 cases per 100,000 people 2,5 . PitNETs are generally classified as benign (~65%), invasive (~35%) or malignant (only ~0.2%), or as macroadenomas (≥10 mm) and microadenomas (<10 mm) according to their size 1,6,7 . Although most PitNETs are stable benign tumors with a good clinical prognosis after surgical excision, a minority of PitNETs are still difficult to control, even with advanced drugs and radiotherapy, so‐called aggressive tumors 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…2 , 5 PitNETs are generally classified as benign (~65%), invasive (~35%) or malignant (only ~0.2%), or as macroadenomas (≥10 mm) and microadenomas (<10 mm) according to their size. 1 , 6 , 7 Although most PitNETs are stable benign tumors with a good clinical prognosis after surgical excision, a minority of PitNETs are still difficult to control, even with advanced drugs and radiotherapy, so‐called aggressive tumors. 8 , 9 Therefore, the underlying mechanisms and microenvironments involved in the development of PitNETs require further investigation.…”

Section: Introductionmentioning

confidence: 99%

Oxidative stress in pituitary neuroendocrine tumors: Affecting the tumor microenvironment and becoming a new target for pituitary neuroendocrine tumor therapy

et al. 2023

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Pituitary adenomas (PAs), or pituitary neuroendocrine tumors (PitNETs), are commonly found in the anterior pituitary gland. Although the majority of PitNETs are benign and stable, several tumors have malignant characteristics. The tumor microenvironment (TME) plays an important role in the process of tumorigenesis and is composed of several types of cells. Various cells in the TME are significantly affected by oxidative stress. It has been reported that immunotherapeutic strategies have good effects in several cancers. However, the clinical potential of immunotherapies in PitNETs has not yet been fully discussed. Oxidative stress can regulate PitNET cells and immune cells in the TME, thus affecting the immune status of the TME of PitNETs. Therefore, modulation of oxidative stress‐regulated immune cells using a combination of several agents and the immune system to suppress PitNETs is a promising therapeutic direction. In this review, we systematically analyzed the oxidative stress process within PitNET cells and various immune cells to elucidate the potential value of immunotherapy.

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“…Pituitary adenoma (PA) is a common intracranial neoplasm that occurs in the central regulatory organ pituitary gland in the hypothalamic-pituitary-target organ axis system, which seriously affects human endocrine system and health. PAs account for 10-25% of all intracranial tumors, and are classified into benign (∼65%), invasive (∼35%), and malignant (carcinoma; only 0.1-0.2%) PAs according to the malignancy level (Stalla et al, 2019). PAs are divided into macroadenomas (≥10 mm) and microadenomas (<10 mm) according to tumor size (Lopes, 2017).…”

Section: Introductionmentioning

confidence: 99%

Targeting Nrf2-Mediated Oxidative Stress Response Signaling Pathways as New Therapeutic Strategy for Pituitary Adenomas

Zhan

Zhou

2021

Front. Pharmacol.

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Oxidative stress and oxidative damage are the common pathophysiological characteristics in pituitary adenomas (PAs), which have been confirmed with many omics studies in PA tissues and cell/animal experimental studies. Nuclear factor erythroid 2 p45-related factor 2 (Nrf2), the core of oxidative stress response, is an oxidative stress sensor. Nrf2 is synthesized and regulated by multiple factors, including Keap1, ERK1/2, ERK5, JNK1/2, p38 MAPK, PKC, PI3K/AKT, and ER stress, in the cytoplasm. Under the oxidative stress status, Nrf2 quickly translocates from cytoplasm into the nucleus and binds to antioxidant response element /electrophile responsive element to initiate the expressions of antioxidant genes, phases I and II metabolizing enzymes, phase III detoxifying genes, chaperone/stress response genes, and ubiquitination/proteasomal degradation proteins. Many Nrf2 or Keap1 inhibitors have been reported as potential anticancer agents for different cancers. However, Nrf2 inhibitors have not been studied as potential anticancer agents for PAs. We recommend the emphasis on in-depth studies of Nrf2 signaling and potential therapeutic agents targeting Nrf2 signaling pathways as new therapeutic strategies for PAs. Also, the use of Nrf2 inhibitors targeting Nrf2 signaling in combination with ERK inhibitors plus p38 activators or JNK activators targeting MAPK signaling pathways, or drugs targeting mitochondrial dysfunction pathway might produce better anti-tumor effects on PAs. This perspective article reviews the advances in oxidative stress and Nrf2-mediated oxidative stress response signaling pathways in pituitary tumorigenesis, and the potential of targeting Nrf2 signaling pathways as a new therapeutic strategy for PAs.

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“The Adrenal Gland: Central Relay in Health and Disease - Current Challenges and Perspectives 2018” – Cushing’s Disease

Cited by 6 publications

References 97 publications

Steroidinduzierter Diabetes mellitus: Wie erkennen – wie behandeln?

Steroidinduzierter Diabetes mellitus: Wie erkennen – wie behandeln?

Oxidative stress in pituitary neuroendocrine tumors: Affecting the tumor microenvironment and becoming a new target for pituitary neuroendocrine tumor therapy

Targeting Nrf2-Mediated Oxidative Stress Response Signaling Pathways as New Therapeutic Strategy for Pituitary Adenomas

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