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• W2018048915 endingPage "534" @default.
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• W2018048915 abstract "It can be readily appreciated from the preceding discussion that many endocrine and non-endocrine tests are available for the evaluation of patients with suspected hypothalamic-pituitary disease. The endocrine evaluation of these subjects should be tailored according to the type and extent of pathology suspected (see Tables 2 and 3). For patients with pituitary adenomas and clinical features of hyperpituitarism, such as hyperprolactinaemia, Cushing's disease or acromegaly, the initial tests should be directed at the hormone whose excess is suspected. For example, a glucose suppression test for acromegaly or dexamethasone suppression test for Cushing's disease should be performed early in the evaluation. The possibility of deficiencies of the other pituitary hormones should then be addressed in patients with secretory tumours, but initially in those with apparent non-functioning adenomas. In patients with large macroadenomas pituitary hormone deficiencies are almost invariable with GH and FSH/LH being the most commonly affected, followed by TSH and ACTH in that order (Snyder et al, 1979a; Valenta et al, 1982). Basal thyroid function tests, serum oestradiol or testosterone, and basal gonodotrophins should be routinely obtained in patients with macroadenomas. Additionally, the integrity of the pituitary-adrenal axis should be determined and an overnight water deprivation test for assessment of neurohypophyseal function is also recommended. GH stimulation testing is valuable as a test of pituitary function in patients with suspected pituitary tumours since GH reserve is lost very early in the development of hypopituitarism. Evaluation of the pituitary-thyroid axis with TRH or the pituitary gonadal axis with LHRH generally provides limited additional information of diagnostic value in individual patients with macroadenomas. However, the ‘paradoxical’ responses to TRH and LHRH may be useful as a biological marker following therapy in patients with GH- or ACTH-secreting tumours. In patients with microadenomas, pituitary hormone deficiencies are uncommon (Valenta et al, 1982). Despite this observation, it may be beneficial to determine basal thyroid levels, gonadotrophin levels, serum testosterone or oestradiol levels, and the reponse to an overnight metyrapone test in such patients to provide a baseline for future care. While it has been suggested that hypothalamic-pituitary endocrine testing can be performed using protocols with combined stimulation tests (Mortimer et al, 1973b), in some patients the simultaneous administration of insulin, TRH and LHRH, for example, may not allow the physician to determine which substance resulted in the observed responses (e.g., GH rise in acromegaly). Finally, the recent discoveries of CRF and GHRF promise to provide new information on hypothalamic-pituitary function in health and disease." @default.
• W2018048915 created "2016-06-24" @default.
• W2018048915 creator A5075246057 @default.
• W2018048915 creator A5077251291 @default.
• W2018048915 date "1983-11-01" @default.
• W2018048915 modified "2023-10-14" @default.
• W2018048915 title "Investigation of hypothalamic-pituitary disease" @default.
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