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Physiopathology, Diagnosis, and Treatment of Functional Pituitary Dysfunction

  • Dragana Miljic
  • Sandra Pekic
  • Marko Stojanovic
  • Vera Popovic
Reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

Neuroendocrine signals are integrated by the hypothalamus. Both hypothalamic and peripheral hormone signals are executed in the pituitary. Functional hypothalamic-pituitary changes may develop as a result of chronic stress, energy imbalance (both positive-obesity and negative-anorexia nervosa), and critical illness. Abnormalities of the endocrine system include increased activity of hypothalamic-pituitary-adrenal axis (HPA), impaired growth hormone axis, gonadal and thyroid dysfunction, and alteration in prolactin secretion. These hormonal alterations may also contribute to the development of underlying condition. A skillful use of dynamic tests together with careful clinical evaluation and follow-up are necessary to establish the correct diagnosis. Some of these changes are viewed as adaptive, and improvement in pituitary dysfunctions is expected with reversal of causation.

Keywords

Obesity Amenorrhea Eating disorders Thyroid Pseudo-Cushing’s 

List of Abbreviations

ACTH

Adrenocorticotropic hormone

AgRP

Agouti-related-peptide

aMSH

Alpha-melanocyte-stimulating hormone

AN

Anorexia nervosa

ATP

Adenosine tri-phosphate

AVP

Arginine vasopressin

BMD

Bone mineral density

BMI

Body mass index

CFS

Chronic fatigue syndrome

CRH

Corticotropin-releasing hormone

CS

Cushing’s syndrome

DM

Diabetes mellitus

E2

Estradiol

FFA

Free fatty acids

FGF-21

Fibroblast growth factor-21

FHA

Functional hypothalamic amenorrhea

FM

Fibromyalgia

FSH

Follicle-stimulating hormone

fT3

Free tri-iodothyronine

fT4

Free thyroxine

GC

Glucocorticoid

GH

Growth hormone

GHD

Growth hormone deficiency

GHRH

Growth hormone releasing hormone

GnRH

Gonadotropin-releasing hormone

GR

Glucocorticoid receptors

HPA

Hypothalamo-pituitary-adrenal axis

HPG

Hypothalamo-pituitary-gonadal axis

HPO

Hypothalamo-pituitary-ovary

HPT

Hypothalamo-pituitary-thyroid

ICU

Intensive care unit

IGF-1

Insulin-like growth factor 1

IGFBP

Insulin-like growth hormone binding protein

IHH

Idiopathic hypogonadotropic hypogonadism

IL

Interleukin

ITT

Insulin tolerance test

LH

Luteinizing hormone

MCH

Melanine-concentrating hormone

MR

Mineralocorticoid receptors

MRI

Magnetic resonance imaging

NEFA

Non-esterified fatty acids

NPY

Neuropeptide Y

NTIS

Non-thyroidal illness syndrome

OSAS

Obstructive sleep apnea syndrome

PCOS

Polycystic ovary syndrome

PCS

Pseudo- Cushing`s syndrome

PRL

Prolactin

PTSD

Posttraumatic stress disorder

RAI

Relative adrenal insufficiency

rT3

Reverse tri-iodothyronine

SHBG

Sex hormone binding globulin

T3

Tri-iodothyronine

T4

Thyroxine

TNFa

Tumor necrosis factor alpha

TRH

Thyrotropin-releasing hormone

TSH

Thyroid-stimulating hormone

UFC

Urinary free cortisol

Notes

Acknowledgments

This work was supported by the Serbian Ministry of Science (project number 17503).

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dragana Miljic
    • 1
    • 2
  • Sandra Pekic
    • 1
    • 2
  • Marko Stojanovic
    • 1
    • 2
  • Vera Popovic
    • 2
  1. 1.Clinic for Endocrinology, Diabetes and Metabolic Diseases, Neuroendocrine UnitClinical Centre of SerbiaBelgradeSerbia
  2. 2.University of Belgrade, School of MedicineBelgradeSerbia

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