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Pituitary and COVID-19 vaccination: a systematic review. 脑垂体与 COVID-19 疫苗接种:系统综述。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-05-18 DOI: 10.1007/s11102-024-01402-2
Martina Verrienti, Valentino Marino Picciola, Maria Rosaria Ambrosio, Maria Chiara Zatelli

Purpose: This systematic review aims to examine the latest research findings and assess the impact of COVID-19 vaccination on the pituitary gland.

Method: PubMed and Tripdatabase were searched from January 1st, 2020 to February 12th, 2024. Case reports, case series and reviews related to post COVID-19 vaccination pituitary disease were included. Eligible articles were tabulated and analysed in the attempt to provide an overview on the epidemiology, clinical presentation, imaging, treatment, outcomes and pathophysiological background of post COVID-19 vaccination pituitary disease.

Results: Among the 23 case reports included in this review, post COVID-19 vaccination hypophysitis was reported in 9 patients, pituitary apoplexy (PA) in 6 cases, SIADH in 5 cases and Isolated ACTH deficiency in 2 cases. Additionally, precipitating adrenal crisis was registered in 7 patients and pituitary tumor enlargement in 1 patient after receiving COVID-19 vaccination.

Conclusion: Despite the rarity of these events, our research findings suggest an association between COVID-19 vaccination and the subsequent development of pituitary diseases. The most common manifestations include hypophysitis with ADH deficiency, PA and SIADH, with symptoms typically emerging shortly after vaccine administration. Potential pathogenetic mechanisms include molecular mimicry, vaccine adjuvants and vaccine-induced thrombotic thrombocytopenia (VITT), with the presence of ACE2 receptors in the hypothalamus-pituitary system contributing to the process. These findings can aid in diagnostic and treatment decisions for patients presenting with these syndromes. Nevertheless, given the rarity of these events, safety and efficacy of the currently available COVID-19 vaccines remain robust and we strongly advocate continuing pursuing vaccination efforts.

目的:本系统综述旨在研究最新的研究成果,评估接种 COVID-19 疫苗对垂体的影响:方法:检索 2020 年 1 月 1 日至 2024 年 2 月 12 日期间的 PubMed 和 Tripdatabase。纳入了与接种 COVID-19 疫苗后垂体疾病相关的病例报告、系列病例和综述。对符合条件的文章进行了制表和分析,试图概述 COVID-19 疫苗接种后垂体疾病的流行病学、临床表现、影像学、治疗、结果和病理生理背景:结果:在本综述收录的 23 例病例报告中,9 例为 COVID-19 疫苗接种后垂体功能减退症,6 例为垂体性脑瘫(PA),5 例为 SIADH,2 例为孤立性促肾上腺皮质激素(ACTH)缺乏症。此外,7 例患者在接种 COVID-19 疫苗后出现肾上腺危象,1 例患者出现垂体瘤增大:结论:尽管这些事件很少发生,但我们的研究结果表明,接种 COVID-19 疫苗与随后发生垂体疾病之间存在关联。最常见的表现包括伴有 ADH 缺乏的垂体功能减退症、PA 和 SIADH,症状通常在接种疫苗后不久出现。潜在的致病机制包括分子模拟、疫苗佐剂和疫苗诱导的血栓性血小板减少症(VITT),而下丘脑-垂体系统中 ACE2 受体的存在有助于这一过程。这些发现有助于对出现这些综合征的患者做出诊断和治疗决定。尽管如此,鉴于这些事件的罕见性,目前可用的 COVID-19 疫苗的安全性和有效性仍然很高,我们强烈建议继续开展疫苗接种工作。
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引用次数: 0
Approach to the patient with controlled acromegaly and acromegalic arthropathy: clinical diagnosis and management. 控制性肢端肥大症和肢端肥大性关节病患者的治疗方法:临床诊断和管理。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-11-01 DOI: 10.1007/s11102-024-01465-1
Iris C M Pelsma, Herman M Kroon, Cornelie D Andela, Enrike M J van der Linden, Margreet Kloppenburg, Nienke R Biermasz, Kim M J A Claessen

Following the description of an illustrative case of a 70-year-old female patient with longstanding active acromegaly and invalidating, progressive joint complaints, current insights regarding diagnosis, treatment, and long-term management of acromegalic arthropathy are summarized. Since clinical trials on this topic are lacking, the reported recommendations are based on extensive clinical and research experience with this clinical entity, and on established diagnostics and interventions in patients with other rheumatic diseases. The cornerstones of the management of acromegalic arthropathy remains normalization of growth hormone and insulin growth factor-1 levels. However, patients with severe or progressive acromegalic arthropathy require a multidisciplinary approach to determine adequate diagnostics and treatment options. Because of the high prevalence and invalidating character of acromegalic arthropathy, developing evidence-based effective prevention and treatment strategies, preferably by international collaboration within rare disease networks, e.g., Endo-ERN, is a clear unmet need.

本报告描述了一例 70 岁女性患者的病例,该患者患有长期活动性肢端肥大症,并伴有无效的进行性关节不适,报告总结了目前有关肢端肥大症关节病的诊断、治疗和长期管理的见解。由于缺乏相关的临床试验,报告中的建议是基于对这一临床实体的广泛临床和研究经验,以及对其他风湿性疾病患者的既定诊断和干预措施。治疗渐冻人关节病的基石仍然是使生长激素和胰岛素生长因子-1 水平恢复正常。然而,严重或进行性肢端肥大症关节病患者需要采用多学科方法来确定适当的诊断和治疗方案。由于肢端肥大性关节病的高发病率和无效性特点,制定以证据为基础的有效预防和治疗策略,最好是通过罕见病网络(如 Endo-ERN)内的国际合作来实现,这显然是一个尚未满足的需求。
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引用次数: 0
Hypopituitarism and COVID-19. 垂体功能减退症和 COVID-19。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-11-19 DOI: 10.1007/s11102-024-01463-3
Giulia Carosi, Arianna Cremaschi, Claudia Giavoli, Emanuele Ferrante, Giovanna Mantovani

Purpose: This review aims to collect and examine recent research findings regarding hypopituitarism and COVID-19, focusing on the virus's impact on the pituitary gland and the outcomes for infected patients with hormonal deficiencies.

Methods: Literature review using PubMed (pubmed.ncbi.nlm.nih.gov). The search included the following terms: "COVID19" in combination with "Pituitary" and "Hypopituitarism".

Results: Many studies have aimed to evaluate the function of the pituitary gland in infected patients, revealing variable degrees of deficiencies. The results are very heterogenous mostly because many different tests and hormonal cut-off have been adopted. It is unclear whether primary virus damage or the inflammatory response is responsible for these hormonal alterations. Interestingly, pituitary defects may persist long after the initial infection, possibly contributing to the "Long COVID syndrome". However, data on the recovery of pituitary function and long-term follow-up are not yet available. On the other hand, although findings are not consistent, patients with hypopituitarism may be at a higher risk for COVID-19 infection rate, complications, and mortality.

Conclusion: The COVID-19 pandemic presented challenges for endocrinologists. The endocrine system appears to be involved in both the acute phase of infection and the recovery period. Hypopituitarism can be a consequence of SARS-COV-2 infection, and patients with existing hypopituitarism may face higher risks of complications. It is advisable to educate these patients on how to adjust their replacement therapies. Long-term follow-up data on pituitary function after recovery from COVID-19 are needed.

目的:本综述旨在收集和研究有关垂体功能减退症和 COVID-19 的最新研究成果,重点关注病毒对垂体的影响以及受感染的荷尔蒙缺乏症患者的治疗效果:使用 PubMed (pubmed.ncbi.nlm.nih.gov)进行文献综述。搜索包括以下术语:"COVID19 "结合 "垂体 "和 "垂体功能减退症":结果:许多研究都旨在评估感染者的垂体功能,发现了不同程度的缺陷。研究结果差异很大,主要是因为采用了许多不同的检测方法和激素截止值。目前还不清楚是原发性病毒损伤还是炎症反应导致了这些激素变化。有趣的是,垂体缺陷在初次感染后可能会持续很长时间,这可能是 "长 COVID 综合征 "的原因。然而,有关垂体功能恢复和长期随访的数据尚未获得。另一方面,尽管研究结果并不一致,但垂体功能减退症患者感染 COVID-19 的风险、并发症和死亡率可能更高:COVID-19大流行给内分泌专家带来了挑战。内分泌系统似乎与感染的急性期和恢复期都有关系。垂体功能减退症可能是 SARS-COV-2 感染的一个后果,已有垂体功能减退症的患者可能面临更高的并发症风险。建议教育这些患者如何调整替代疗法。需要对 COVID-19 康复后的垂体功能进行长期随访。
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引用次数: 0
Growth hormone and bone: a basic perspective. 生长激素与骨骼:基本观点。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-10-30 DOI: 10.1007/s11102-024-01464-2
Simona Bolamperti, Isabella Villa, Luigi di Filippo

Growth hormone is fundamental for growth during childhood and for maintaining bone mass and homeostasis in the adults. GH deficiency causes decreased bone growth and osteopenia, whereas GH excess causes increased bone fragility and decreased bone quality. In the past, it was common knowledge that GH effects on the skeletal system were due to the production of IGF1 from the liver, which has a huge bone anabolic effect per se. However, with the progress of basic research techniques new light has been shed on the mechanisms underlying GH effect in bone, and it is now clear that GH has effects that go beyond the downstream activation of liver IGFs. Therefore, the purpose of this review is to summarize the milestones in basic research that led to the discovery of GH local activity on bone.

生长激素对儿童时期的生长以及成年人维持骨量和平衡至关重要。生长激素缺乏会导致骨骼生长减少和骨质疏松,而生长激素过量则会导致骨脆性增加和骨质量下降。过去,人们普遍认为 GH 对骨骼系统的影响是由于肝脏产生 IGF1,而 IGF1 本身具有巨大的骨骼同化效应。然而,随着基础研究技术的进步,人们对 GH 在骨骼中的作用机制有了新的认识,现在可以清楚地看到,GH 的作用超出了激活肝脏 IGFs 的下游作用。因此,本综述旨在总结导致发现 GH 在骨骼中的局部活性的基础研究的里程碑。
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引用次数: 0
Syndrome of inappropriate antidiuresis/hyponatremia in COVID-19. COVID-19 中的不当抗利尿/高钠血症综合征。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-08-28 DOI: 10.1007/s11102-024-01446-4
Alessandro Peri, Laura Naldi, Dario Norello, Benedetta Fibbi

Hyponatremia is the most frequent electrolyte alteration among hospitalized patients and it has been reported in 20-40% of patients with SARS-CoV-2 (COVID-19) infection. Multiple causes of hyponatremia have been hypothesized in these patients. The syndrome of inappropriate antidiuresis (SIAD) has been considered one of the main reasons leading to hyponatremia in this condition. SIAD can be secondary to cytokines release, in particular IL-6. Positive pressure ventilation can be another cause of hyponatremia due to SIAD. Other possible etiologies of hyponatremia in COVID-19 patients can be related to secondary hypocortisolism, nausea, vomiting, heart and kidney damage. Similar to many other clinical conditions, there is strong evidence that hyponatremia is associated with a worse prognosis also in patients with COVID-19 infection. In particular, hyponatremia has been identified as an independent risk of ICU transfer, need of non-invasive ventilation and death. Hyponatremia in COVID-19 patients is in principle acute and symptomatic and should be treated as such, according to the published guidelines. Therefore, patients should be initially treated with i.v. hypertonic saline (3% NaCl) infusion and serum [Na+] should be frequently monitored, in order to remain within a safe rate of correction. There is evidence showing that serum [Na+] correction is associated with a better outcome in different pathologies, including COVID-19 infection.

低钠血症是住院患者中最常见的电解质变化,据报道,20%-40% 的 SARS-CoV-2 (COVID-19) 感染患者都会出现低钠血症。据推测,这些患者出现低钠血症的原因有多种。不适当抗利尿综合征(SIAD)被认为是导致这种情况下低钠血症的主要原因之一。SIAD 可继发于细胞因子的释放,尤其是 IL-6。正压通气可能是 SIAD 导致低钠血症的另一个原因。COVID-19 患者低钠血症的其他可能病因与继发性皮质醇分泌过少、恶心、呕吐、心脏和肾脏损伤有关。与许多其他临床症状相似,有确凿证据表明低钠血症也与 COVID-19 感染患者的预后恶化有关。特别是,低钠血症已被确定为转入重症监护病房、需要无创通气和死亡的独立风险。COVID-19 患者的低钠血症原则上是急性和无症状的,应根据已发布的指南进行治疗。因此,患者最初应静脉输注高渗盐水(3% NaCl),并经常监测血清[Na+],以保持在安全的纠正率范围内。有证据表明,血清[Na+]纠正与不同病理情况下的较佳预后有关,包括 COVID-19 感染。
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引用次数: 0
Novel approach to bone comorbidity in resistant acromegaly. 抗药性肢端肥大症骨合并症的新方法。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-11-21 DOI: 10.1007/s11102-024-01468-y
Stefano Frara, Matteo Acanfora, Vincenzo Franzese, Maria Luisa Brandi, Marco Losa, Andrea Giustina

Active acromegaly may lead to irreversible complications. Among them, acromegaly osteopathy and fragility (vertebral and hip) fractures have emerged as frequent and precocious events in the natural history of the disease, being correlated with longer disease duration and higher growth hormone (GH) levels, accounting for patients' reported poor quality of life, physical performance and other life-impacting complications. Differently from primary osteoporosis, bone mineral density is not a reliable tool to predict fracture risk in this clinical setting, as patients with active disease frequently have normal or slightly reduced bone mass; whereas bone quality is particularly compromised, as determined by low trabecular bone score (TBS) in patients with active disease as compared to healthy controls or patients with cured/controlled disease. The evidence of impaired bone microstructure has been profoundly investigated with different computed tomography (CT) techniques, reporting low trabecular number and thickness as well as wide but more porous cortical bone, providing an explanation for such a high prevalence of vertebral fractures (up to 40-50% in selected cohorts). Since data on bone-active drugs are scanty, disease control remains a cornerstone to prevent fractures. Nonetheless, some potential protective effects may derive from vitamin D supplementation and pasireotide therapies, independently from disease status. Aim of this manuscript is to review the current and emerging evidence on skeletal fragility in patients with active and resistant acromegaly.

活动性肢端肥大症可能导致不可逆转的并发症。其中,肢端肥大症骨病和脆性(椎骨和髋骨)骨折是该病自然病史中频繁发生的早发症,与较长的病程和较高的生长激素(GH)水平相关,也是导致患者生活质量低下、体能下降和其他影响生活的并发症的原因。与原发性骨质疏松症不同的是,在这种临床环境下,骨矿物质密度并不是预测骨折风险的可靠工具,因为活动性疾病患者的骨量经常正常或略有减少;而与健康对照组或已治愈/控制的疾病患者相比,活动性疾病患者的骨小梁评分(TBS)较低,这表明骨质量尤其受到影响。不同的计算机断层扫描(CT)技术已对骨微观结构受损的证据进行了深入研究,结果显示骨小梁数量和厚度较低,皮质骨较宽但多孔,这为椎骨骨折发生率如此之高(在选定的队列中高达 40-50%)提供了解释。由于有关骨活性药物的数据很少,疾病控制仍是预防骨折的基石。然而,维生素 D 补充剂和帕西瑞肽疗法可能会产生一些潜在的保护作用,而与疾病状态无关。本手稿旨在回顾有关活动性和抵抗性肢端肥大症患者骨骼脆性的现有证据和新证据。
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引用次数: 0
Modern approach to bone comorbidity in prolactinoma. 泌乳素瘤骨合并症的现代治疗方法。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-11-14 DOI: 10.1007/s11102-024-01469-x
Meliha Melin Uygur, Sara Menotti, Simona Santoro, Andrea Giustina

Prolactinomas account for more than half of pituitary adenomas, and besides their clinical impact on fertility and gonadal function, they lead to detrimental effects on bone. Patients with prolactinoma are prone to deterioration of bone structure caused not only by prolactin (PRL) induced hypogonadism but also by its direct actions on bone cells and calcium metabolism. However, clinical studies have shown inconsistent evidence regarding whether PRL could have a deleterious effect independently from gonadal insufficiency on skeletal integrity. Seminal studies from our group reported an increased prevalence of vertebral fractures (VFs) in both female and male patients with prolactinoma. Treatment of prolactinoma with dopamine agonists can restore gonadal function and improve bone mineral density. Since the presence of VFs may be related to more aggressive disease, bone comorbidities in prolactinoma should be managed by a multidisciplinary team in line with the recent concept of 'pituitary tumors centers of excellence'. The review aims to evaluate the mechanism of PRL actions on bone, as well as to provide practical indications for a modern approach to the management of skeletal complications of patients with prolactin-secreting adenoma considering different clinical characteristics and outcomes.

泌乳素瘤占垂体腺瘤的一半以上,除了对生育和性腺功能产生临床影响外,还会对骨骼产生有害影响。泌乳素瘤患者容易出现骨结构退化,这不仅是由于泌乳素(PRL)引起的性腺功能减退,还由于它对骨细胞和钙代谢的直接作用。然而,关于 PRL 是否会独立于性腺功能不足而对骨骼完整性产生有害影响,临床研究显示的证据并不一致。我们小组的重要研究报告显示,女性和男性泌乳素瘤患者的脊椎骨折(VFs)发生率均有所增加。使用多巴胺激动剂治疗泌乳素瘤可恢复性腺功能,改善骨质密度。由于VFs的出现可能与疾病更具侵袭性有关,因此催乳素瘤患者的骨合并症应由多学科团队根据最近提出的 "垂体瘤卓越中心 "概念进行管理。本综述旨在评估PRL对骨骼的作用机制,并根据不同的临床特征和结果,为治疗分泌催乳素腺瘤患者骨骼并发症的现代方法提供实用指标。
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引用次数: 0
SARS-CoV-2 infection and vaccination in patients with pituitary diseases: the experience of a Brazilian reference center. 脑垂体疾病患者的 SARS-CoV-2 感染和疫苗接种:巴西一家参考中心的经验。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-09-09 DOI: 10.1007/s11102-024-01456-2
Marcela Cunha da Silva, Solena Ziemer Kusma Fidalski, Cesar Luiz Boguszewski

Purpose: To evaluate the prevalence and characteristics of SARS-CoV-2 infection, and the prevalence, efficacy, and safety of anti-SARS-CoV-2 vaccination in patients with pituitary diseases.

Methods: Observational, cross-sectional study of adult patients with pituitary diseases followed in a reference center. Clinical data were collected and a questionnaire about SARS-CoV-2 infection, vaccination and its possible adverse effects was applied. COVID-19 disease severity was defined as mild, moderate, and severe according to the WHO classification.

Results: 145 patients were studied (79 women; age 50 ± 15.8 years; duration of pituitary disease 16.8 ± 11.5 years), the cause of pituitary disease was tumoral in 74.5%, and 45.9% were on glucocorticoid replacement due to ACTH deficiency. SARS-CoV-2 infection was confirmed in 51 patients (35.2%; 32 women; age 53.8 ± 14.8 years, 22 before vaccination), with 28 (54.9%), 17 (33.3%) and 6 (11.8%) cases of mild, moderate, and severe disease, respectively, and hospitalization was indicated in 7 (14%) cases. One mild case presented pituitary apoplexy after SARS-CoV-2 infection. Advanced age was a risk factor for COVID-19. Patients with moderate and severe forms of COVID-19 had higher prevalence of dyslipidemia and duration of pituitary disease. All but one of the participants were vaccinated against COVID-19, and 60.4% had adverse events, the most common local pain (54.0%), fever (33.3%), and headache (18.4%), with one case of alopecia and two of persistent fatigue.

Conclusion: The prevalence of SARS-CoV-2 infection in our cohort was 35.2%, including 14% of moderate and severe cases requiring hospitalization. The vaccination was universal and safe.

目的:评估脑垂体疾病患者中 SARS-CoV-2 感染的流行率和特征,以及接种抗 SARS-CoV-2 疫苗的流行率、有效性和安全性:方法:对一家参考中心随访的成年垂体疾病患者进行横断面观察研究。研究收集了临床数据,并就 SARS-CoV-2 感染、疫苗接种及其可能的不良反应进行了问卷调查。根据世界卫生组织的分类,COVID-19 疾病的严重程度被定义为轻度、中度和重度:研究了 145 名患者(79 名女性;年龄(50±15.8)岁;垂体病程(16.8±11.5)年),74.5% 的垂体疾病的病因是肿瘤,45.9% 的患者因缺乏促肾上腺皮质激素(ACTH)而使用糖皮质激素替代治疗。51 名患者(35.2%;32 名女性;年龄(53.8 ± 14.8)岁,22 名接种疫苗前)确诊感染了 SARS-CoV-2,其中轻度、中度和重度病例分别为 28 例(54.9%)、17 例(33.3%)和 6 例(11.8%),7 例(14%)需要住院治疗。其中一例轻症患者在感染 SARS-CoV-2 后出现脑垂体骤停。高龄是 COVID-19 的一个危险因素。中度和重度 COVID-19 患者的血脂异常发生率较高,垂体疾病的病程也较长。除一人外,所有参与者都接种了COVID-19疫苗,60.4%的人出现了不良反应,最常见的是局部疼痛(54.0%)、发热(33.3%)和头痛(18.4%),还有一例脱发和两例持续疲劳:结论:在我们的人群中,SARS-CoV-2 感染率为 35.2%,包括 14% 需要住院治疗的中度和重度病例。疫苗接种是普遍和安全的。
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引用次数: 0
Hypopituitarism and bone disease: pathophysiology, diagnosis and treatment outcomes. 垂体功能减退症和骨病:病理生理学、诊断和治疗效果。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-05-06 DOI: 10.1007/s11102-024-01391-2
Amit Akirov, Yaron Rudman, Maria Fleseriu

Hypopituitarism is a rare but significant endocrine disorder characterized by the inadequate secretion of one or more pituitary hormones. The intricate relationship between hypopituitarism and bone health is a topic of growing interest in the medical community. In this review the authors explore associations between hypopituitarism and bone health, with specific examination of the impact of growth hormone deficiency, central hypogonadism, central hypocortisolism, and central hypothyroidism. Pathogenesis, diagnosis, and treatment options as well as challenges posed by osteopenia, osteoporosis, and fractures in hypopituitarism are discussed.

垂体功能减退症是一种罕见但严重的内分泌疾病,其特点是一种或多种垂体激素分泌不足。垂体功能减退症与骨骼健康之间错综复杂的关系是医学界日益关注的话题。在这篇综述中,作者探讨了垂体功能减退症与骨骼健康之间的关系,并具体研究了生长激素缺乏症、中枢性性腺功能减退症、中枢性皮质醇功能减退症和中枢性甲状腺功能减退症的影响。作者还讨论了垂体功能减退症的发病机制、诊断和治疗方案,以及骨质疏松、骨质疏松症和骨折所带来的挑战。
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引用次数: 0
Impact of medical therapy for hormone-secreting Pituitary tumors on bone. 激素分泌型垂体瘤的药物治疗对骨骼的影响。
IF 3.3 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-12-01 Epub Date: 2024-07-05 DOI: 10.1007/s11102-024-01421-z
Pamela U Freda

Purpose: Bone health is often impaired in patients with hormone-secreting pituitary tumors. Since medical therapy is central to their care, understanding how its use impacts on this is highly important.

Methods: This review summarizes a systemmatic review of the literature on the effects of medical therapies for hormone-secreting pituitary tumors on bone.

Results: In acromegaly, medical therapy lowers bone turnover marker (BTM) levels, consistent with correction of the high bone turnover of active disease, and overall, areal bone mineral density (aBMD) does not change or increases. Somatostatin-receptor ligand (SRL) and pegvisomant-treated acromegaly patients have persistently reduced volumetric BMD and microarchitectural abnormalities of the peripheral skeleton, deficits that are similar to those in surgically-treated patients. Fracture risk remains elevated in medically-treated acromegaly patients but in conjunction with biochemical control the risk is lessened. Treatment of prolactin-secreting tumors with dopamine agonists is associated with improvements in aBMD, but this does not always fully normalize despite effective medical treatment of the prolactinoma. In one cross-sectional study, prolactinoma patients had lower total volumetric BMD and impaired microarchitecture suggesting that bone microstructure does not fully normalize despite dopamine agonist therapy. Cross-sectional studies show a high rate of VF in patients with prolactin-secreting tumors that is lowered on cabergoline therapy, but still the fracture rate of men and postmenopausal women is higher than that of controls in some studies. Studies on the effects of modern-day medical therapy for Cushing's disease on bone are lacking.

Conclusion: More research is needed on the effectsof medical therapies for hormone secreting pituitary tumors on bone health.

目的:分泌激素的垂体瘤患者的骨骼健康往往受到损害。由于药物治疗是治疗的核心,因此了解药物治疗对骨骼健康的影响非常重要:本综述总结了有关激素分泌性垂体瘤药物疗法对骨骼影响的系统性文献:结果:在肢端肥大症患者中,药物疗法可降低骨转换标志物(BTM)水平,这与纠正活动性疾病的高骨转换率是一致的。体生长抑素受体配体(SRL)和培维索胺治疗的肢端肥大症患者的体积骨密度(BMD)持续降低,外周骨骼的微结构异常,这些缺陷与手术治疗的患者相似。接受药物治疗的肢端肥大症患者骨折风险仍然较高,但在生化控制的同时,骨折风险也会降低。使用多巴胺激动剂治疗泌乳素分泌瘤与改善甲状旁腺畸形有关,但尽管对泌乳素瘤进行了有效的药物治疗,甲状旁腺畸形并不总是完全恢复正常。在一项横断面研究中,泌乳素瘤患者的总容积 BMD 较低,且微结构受损,这表明尽管接受了多巴胺激动剂治疗,骨的微结构并没有完全恢复正常。横断面研究显示,催乳素分泌瘤患者的 VF 发生率较高,但在卡贝戈林治疗后,VF 发生率有所降低,但在一些研究中,男性和绝经后女性的骨折发生率仍高于对照组。关于库欣病的现代医学疗法对骨骼影响的研究还很缺乏:关于激素分泌型垂体瘤的药物疗法对骨骼健康的影响,还需要更多的研究。
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引用次数: 0
期刊
Pituitary
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