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Androgen deficiency in hypopituitary women: its consequences and management. 垂体功能减退妇女的雄激素缺乏症:其后果和处理方法。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-01-19 DOI: 10.1007/s11154-024-09873-1
Daniela Esposito, Åsa Tivesten, Catharina Olivius, Oskar Ragnarsson, Gudmundur Johannsson

Women with hypopituitarism have various degrees of androgen deficiency, which is marked among those with combined hypogonadotrophic hypogonadism and secondary adrenal insufficiency. The consequences of androgen deficiency and the effects of androgen replacement therapy have not been fully elucidated. While an impact of androgen deficiency on outcomes such as bone mineral density, quality of life, and sexual function is plausible, the available evidence is limited. There is currently no consensus on the definition of androgen deficiency in women and it is still controversial whether androgen substitution should be used in women with hypopituitarism and coexisting androgen deficiency. Some studies suggest beneficial clinical effects of androgen replacement but data on long-term benefits and risk are not available. Transdermal testosterone replacement therapy in hypopituitary women has shown some positive effects on bone metabolism and body composition. Studies of treatment with oral dehydroepiandrosterone have yielded mixed results, with some studies suggesting improvements in quality of life and sexual function. Further research is required to elucidate the impact of androgen deficiency and its replacement treatment on long-term outcomes in women with hypopituitarism. The lack of transdermal androgens for replacement in this patient population and limited outcome data limit its use. A cautious and personalized treatment approach in the clinical management of androgen deficiency in women with hypopituitarism is recommended while awaiting more efficacy and safety data.

患有垂体功能减退症的女性会出现不同程度的雄激素缺乏,其中以合并性腺功能减退症和继发性肾上腺功能不全的女性最为明显。雄激素缺乏的后果和雄激素替代疗法的效果尚未完全阐明。虽然雄激素缺乏对骨矿物质密度、生活质量和性功能等结果的影响是可信的,但现有证据有限。目前,关于女性雄激素缺乏症的定义尚未达成共识,对于垂体功能减退症合并雄激素缺乏症的女性是否应使用雄激素替代治疗仍存在争议。一些研究表明,雄激素替代可产生有益的临床效果,但有关长期益处和风险的数据尚缺。经皮睾酮替代疗法对垂体功能减退妇女的骨代谢和身体组成有一些积极影响。口服脱氢表雄酮治疗的研究结果不一,一些研究表明生活质量和性功能有所改善。要阐明雄激素缺乏及其替代治疗对垂体功能减退症女性患者长期疗效的影响,还需要进一步的研究。在这一患者群体中,由于缺乏用于替代治疗的透皮雄激素,且疗效数据有限,因此限制了透皮雄激素的使用。在等待更多疗效和安全性数据的同时,建议对患有垂体功能减退症的女性患者在雄激素缺乏的临床治疗中采取谨慎和个性化的治疗方法。
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引用次数: 0
New findings on brain actions of growth hormone and potential clinical implications. 生长激素脑作用的新发现及其潜在临床意义。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-07 DOI: 10.1007/s11154-023-09861-x
Jose Donato, John J Kopchick

Growth hormone (GH) is secreted by somatotropic cells of the anterior pituitary gland. The classical effects of GH comprise the stimulation of cell proliferation, tissue and body growth, lipolysis, and insulin resistance. The GH receptor (GHR) is expressed in numerous brain regions. Notably, a growing body of evidence indicates that GH-induced GHR signaling in specific neuronal populations regulates multiple physiological functions, including energy balance, glucose homeostasis, stress response, behavior, and several neurological/cognitive aspects. The importance of central GHR signaling is particularly evident when the organism is under metabolic stress, such as pregnancy, chronic food deprivation, hypoglycemia, and prolonged exercise. These particular situations are associated with elevated GH secretion. Thus, central GH action represents an internal signal that coordinates metabolic, neurological, neuroendocrine, and behavioral adaptations that are evolutionarily advantageous to increase the chances of survival. This review summarizes and discusses recent findings indicating that the brain is an important target of GH, and GHR signaling in different neuronal populations regulates essential physiological functions.

生长激素(GH)由垂体前叶的促生长细胞分泌。生长激素的经典作用包括刺激细胞增殖、组织和身体生长、脂肪分解和胰岛素抵抗。生长激素受体(GHR)在许多脑区表达。值得注意的是,越来越多的证据表明,在特定的神经元群体中,gh诱导的GHR信号调节多种生理功能,包括能量平衡、葡萄糖稳态、应激反应、行为和一些神经/认知方面。中枢GHR信号的重要性在机体处于代谢应激时尤为明显,如妊娠、慢性食物剥夺、低血糖和长时间运动。这些特殊情况与生长激素分泌升高有关。因此,中枢生长激素作用代表了一种内部信号,它协调代谢、神经、神经内分泌和行为适应,这些适应在进化上有利于增加生存机会。这篇综述总结并讨论了最近的研究结果,表明大脑是生长激素的重要靶点,不同神经元群中的GHR信号调节着基本的生理功能。
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引用次数: 0
Fertility issues in hypopituitarism. 垂体功能减退症的生育问题。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-14 DOI: 10.1007/s11154-023-09863-9
Julie Chen, Julia J Chang, Esther H Chung, Ruth B Lathi, Lusine Aghajanova, Laurence Katznelson

Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.

与垂体功能正常的妇女相比,患有垂体功能减退症的妇女生育率较低,妊娠结局也较差。尽管使用了辅助生殖技术和激素替代品,但这些差异依然存在。对于性腺功能减退的妇女,可以使用外源性促性腺激素来成功诱导排卵。有人认为,在生长激素缺乏的情况下补充生长激素可增强生殖功能,但其在垂体功能低下妇女中的常规应用仍不明确,需要进一步研究。在本综述中,我们将讨论垂体功能减退症妇女生育的临床方法。
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引用次数: 0
Progress, challenges and perspectives in the management of hypopituitarism. 垂体功能减退症治疗的进展、挑战和前景。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-05-27 DOI: 10.1007/s11154-024-09889-7
Cesar Luiz Boguszewski, Sebastian Neggers

Hypopituitarism is a rare endocrine disorder characterized by insufficient hormone secretion from the pituitary gland. This condition leads to deficient production of one or more pituitary hormones, including growth hormone (GH), thyroid-stimulating hormone (TSH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), adrenocorticotropic hormone (ACTH), and antidiuretic hormone (ADH), also called arginine vasopressin (AVP). Symptoms vary widely and are often not, late recognized.Diagnosis typically involves a thorough clinical evaluation, hormone level assessments, and neuroimaging studies to identify underlying causes. Treatment aims to replace deficient hormones and address the underlying cause and related complications when possible. In this special issue we address diagnosis, comorbidities, and management of hypopituitarism. We hope that it will help healthcare professionals to manage their patients.

垂体功能减退症是一种罕见的内分泌疾病,其特点是垂体激素分泌不足。这种疾病会导致一种或多种垂体激素分泌不足,包括生长激素(GH)、促甲状腺激素(TSH)、黄体生成素(LH)、促卵泡激素(FSH)、促肾上腺皮质激素(ACTH)和抗利尿激素(ADH),也称为精氨酸加压素(AVP)。诊断通常包括全面的临床评估、激素水平评估和神经影像学研究,以确定潜在的病因。治疗的目的是补充缺乏的激素,并在可能的情况下解决根本原因和相关并发症。在本特刊中,我们将讨论垂体功能减退症的诊断、并发症和治疗。希望能对医护人员管理患者有所帮助。
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引用次数: 0
Diagnosis and management of secondary adrenal crisis. 继发性肾上腺危象的诊断和处理。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-02-27 DOI: 10.1007/s11154-024-09877-x
Luciana Martel-Duguech, Jonathan Poirier, Isabelle Bourdeau, André Lacroix

Adrenal crisis (AC) is a life threatening acute adrenal insufficiency (AI) episode which can occur in patients with primary AI but also secondary AI (SAI), tertiary AI (TAI) and iatrogenic AI (IAI). In SAI, TAI and IAI, AC may develop when the HPA axis is unable to mount an adequate glucocorticoid response to severe stress due to pituitary or hypothalamic disruption. It manifests as an acute deterioration in multi-organ homeostasis that, if untreated, leads to shock and death. Despite the availability of effective preventive strategies, its prevalence is increasing in patients with SAI, TAI and IAI due to more frequent exogenous steroid administration, pituitary immune-related effects of immune checkpoint inhibitors and opioid use in pain management. The delayed diagnosis of acute AI which remains infrequently suspected increases the risk of AC. Its main precipitating factors are infections, emotional distress, surgery, cessation or reduction in GC doses, pituitary infarction or surgical cure of endogenous Cushing's syndrome. In patients not known previously to have SAI/TAI/IAI, recognition of its symptoms, signs, and biochemical abnormalities can be challenging and cause delay in proper diagnosis and therapy. Effective therapy of AC is rapid intravenous administration of hydrocortisone (initial bolus of 100 mg followed by 200 mg/24 h as continuous infusion or bolus of 50 mg every 6 h) and 0.9% saline. In diagnosed patients, preventive education in sick-day rules adjustment of glucocorticoid replacement and hydrocortisone parenteral self-administration must be performed repeatedly by trained health care providers. Strategies to improve the adequate preventive education in patients at risk for secondary AI should be promoted in collaboration with various medical specialist societies and patients support associations.

肾上腺危象(AC)是一种危及生命的急性肾上腺功能不全(AI)发作,可发生于原发性肾上腺功能不全(AI)患者,也可发生于继发性肾上腺功能不全(SAI)、三级肾上腺功能不全(TAI)和先天性肾上腺功能不全(IAI)患者。在 SAI、TAI 和 IAI 中,当垂体或下丘脑功能紊乱导致 HPA 轴无法对严重应激做出充分的糖皮质激素反应时,就会出现 AC。它表现为多器官稳态的急性恶化,如不及时治疗,会导致休克和死亡。尽管已经有了有效的预防策略,但由于外源性类固醇用药更加频繁、免疫检查点抑制剂对垂体免疫相关的影响以及在疼痛治疗中使用阿片类药物,急性脑缺氧在 SAI、TAI 和 IAI 患者中的发病率仍在上升。急性 AI 的诊断延迟(很少被怀疑)会增加 AC 的风险。其主要诱发因素包括感染、情绪困扰、手术、停止或减少 GC 剂量、垂体梗死或内源性库欣综合征的手术治疗。对于以前不知道自己患有 SAI/TAI/IAI 的患者来说,识别其症状、体征和生化异常可能具有挑战性,从而导致延误正确的诊断和治疗。AC 的有效治疗方法是快速静脉注射氢化可的松(首次 100 毫克,随后连续输注 200 毫克/24 小时,或每 6 小时 50 毫克)和 0.9% 生理盐水。对于确诊患者,必须由经过培训的医护人员反复进行病假规则调整糖皮质激素替代和氢化可的松肠外自我给药的预防教育。应与各种医学专家协会和患者支持协会合作,推广改善对有继发性人工流产风险的患者进行适当预防教育的战略。
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引用次数: 0
Special features on insulin resistance, metabolic syndrome and vascular complications in hypopituitary patients. 垂体功能减退患者的胰岛素抵抗、代谢综合征和血管并发症专题。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-01-25 DOI: 10.1007/s11154-023-09872-8
Heraldo M Garmes

Pituitary hormone deficiency, hypopituitarism, is a dysfunction resulting from numerous etiologies, which can be complete or partial, and is therefore heterogeneous. This heterogeneity makes it difficult to interpret the results of scientific studies with these patients.Adequate treatment of etiologies and up-to-date hormone replacement have improved morbidity and mortality rates in patients with hypopituitarism. As GH replacement is not performed in a reasonable proportion of patients, especially in some countries, it is essential to understand the known consequences of GH replacement in each subgroup of patients with this heterogeneous dysfunction.In this review on hypopituitarism, we will address some particularities regarding insulin resistance, which is no longer common in these patients with hormone replacement therapy based on current guidelines, metabolic syndrome and its relationship with changes in BMI and body composition, and to vascular complications that need to be prevented taking into account the individual characteristics of each case to reduce mortality rates in these patients.

垂体激素缺乏症(垂体功能减退症)是一种由多种病因导致的功能障碍,可以是完全性的,也可以是部分性的,因此具有异质性。对病因的充分治疗和最新的激素替代改善了垂体功能减退症患者的发病率和死亡率。由于没有对相当一部分患者进行 GH 替代治疗,尤其是在一些国家,因此有必要了解 GH 替代治疗对患有这种异质性功能障碍的各个亚组患者的已知后果。在这篇关于垂体功能减退症的综述中,我们将讨论胰岛素抵抗的一些特殊性(根据现行指南,胰岛素抵抗在接受激素替代治疗的患者中已不再常见)、代谢综合征及其与体重指数(BMI)和身体成分变化的关系,以及血管并发症,这些并发症需要根据每个病例的个体特征加以预防,以降低这些患者的死亡率。
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引用次数: 0
Morbidities and mortality among hospitalized patients with hypopituitarism: Prevalence, causes and management. 垂体功能减退症住院病人的发病率和死亡率:发病率、原因和管理。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-05-27 DOI: 10.1007/s11154-024-09888-8
Fahim Ebrahimi, Lukas Andereggen, Emanuel R Christ

Hypopituitarism is a highly heterogeneous multisystem disorder that can have a major impact on long-term morbidity and mortality, but even more so during acute medical conditions requiring hospitalization. Recent studies suggest a significant in-hospital burden with prolonged length of stay, increased rate of intensive care unit (ICU) admission, and initiation of mechanical ventilation - all of which may lead to an increased risk of in-hospital mortality. On the one hand, patients with hypopituitarism are often burdened by metabolic complications, including obesity, hypertension, dyslipidemia, and hyperglycemia, which alone, or in combination, are known to significantly alter relevant physiological mechanisms, including metabolism, innate and adaptive immune responses, coagulation, and wound healing, thereby contributing to adverse in-hospital outcomes. On the other hand, depending on the extent and the number of pituitary hormone deficiencies, early recognition of hormone deficiencies and appropriate management and replacement strategy within a well-organized multidisciplinary team are even stronger determinants of short-term outcomes during acute hospitalization in this vulnerable patient population. This review aims to provide an up-to-date summary of recent advances in pathophysiologic understanding, clinical implications, and recommendations for optimized multidisciplinary management of hospitalized patients with hypopituitarism.

垂体功能减退症是一种高度异质性的多系统疾病,可对长期发病率和死亡率产生重大影响,但在需要住院治疗的急性病中影响更大。最近的研究表明,垂体功能减退症患者住院时间延长、入住重症监护室(ICU)的比例增加以及开始使用机械通气,这些都会给患者带来沉重的负担,并可能导致院内死亡风险增加。一方面,垂体功能减退症患者通常会有代谢并发症,包括肥胖、高血压、血脂异常和高血糖,这些并发症单独或合并出现时会显著改变相关的生理机制,包括新陈代谢、先天性和适应性免疫反应、凝血和伤口愈合,从而导致不良的院内预后。另一方面,根据垂体激素缺乏的程度和数量,在一个组织良好的多学科团队中及早识别激素缺乏并采取适当的管理和替代策略,对这一易受伤害的患者群体在急性住院期间的短期预后具有更大的决定性作用。本综述旨在总结对垂体功能减退症住院患者的病理生理学认识、临床影响和多学科优化管理建议方面的最新进展。
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引用次数: 0
Subclinical central hypothyroidism in patients with hypothalamic-pituitary disease: does it exist? 下丘脑-垂体疾病患者的亚临床中枢性甲状腺功能减退症:存在吗?
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2024-02-07 DOI: 10.1007/s11154-024-09876-y
Julio Abucham, Manoel Martins

Central hypothyroidism (CH) is characterized by decreased thyroid hormone production due to insufficient stimulation of an otherwise normal thyroid gland by TSH. In patients with established hypothalamic-pituitary disease, a low FT4 concentration is considered highly specific, although poorly sensitive, for the diagnosis of CH. That would be comparable to diagnosing primary hypothyroidism in patients at risk only when serum FT4 concentrations are below the reference range, missing all patients with subclinical primary hypothyroidism and preventing proper therapy in patients in which thyroxine replacement is clearly beneficial. Cardiac time intervals, especially the isovolumic contraction time (ICT), have been considered the gold standard of peripheral thyroid hormone action. Using Doppler echocardiography, we have previously shown a very high proportion of prolonged ICT in patients with hypothalamic-pituitary disease and serum FT4 levels indistinguishable from controls. As ICT decreased/normalized after thyroxine-induced increases in FT4 concentrations within the normal reference range, prolonged ICT was considered a bona fide diagnostic biomarker of subclinical CH. Those findings challenge the usual interpretation that FT4 concentrations in the mid-reference range exclude hypothyroidism in patients with hypothalamic-pituitary disease. Rather, subclinical central hypothyroidism, a state analogous to subclinical primary hypothyroidism, seems to be frequent in patients with hypothalamic-pituitary disease and normal FT4 levels. They also challenge the notion that thyroid function is usually the least or the last affected in acquired hypopituitarism. The relevance of Doppler echocardiography to correctly diagnose and monitor replacement therapy in both clinical and subclinical forms of CH should improve quality of life and decrease cardiovascular risk, as already demonstrated in patients with clinical and subclinical primary hypothyroidism.

中枢性甲状腺功能减退症(CH)的特点是由于促甲状腺激素对原本正常的甲状腺刺激不足而导致甲状腺激素分泌减少。在已确诊患有下丘脑-垂体疾病的患者中,低FT4浓度被认为对CH的诊断具有高度特异性,但敏感性较差。这相当于只有当血清FT4浓度低于参考范围时,才对高危患者进行原发性甲减诊断,从而漏诊了所有亚临床原发性甲减患者,并妨碍了对甲状腺素替代明显有益的患者进行适当治疗。心脏时间间期,尤其是等容收缩时间(ICT),一直被认为是外周甲状腺激素作用的黄金标准。我们曾使用多普勒超声心动图显示,在下丘脑-垂体疾病患者中,ICT延长的比例非常高,而血清FT4水平与对照组无异。由于在甲状腺素诱导下FT4浓度升高后,ICT下降/正常化在正常参考范围内,因此ICT延长被认为是亚临床CH的真正诊断生物标志物。这些发现对通常认为下丘脑-垂体疾病患者的FT4浓度在参考值范围中段就可以排除甲减的解释提出了质疑。相反,亚临床中枢性甲减(一种类似于亚临床原发性甲减的状态)似乎经常出现在下丘脑-垂体疾病和FT4水平正常的患者中。他们还对甲状腺功能通常在获得性垂体功能减退症中受影响最小或最后受影响的观点提出了质疑。多普勒超声心动图对于正确诊断和监测临床和亚临床甲状腺功能减退症的替代治疗具有重要意义,它可以提高生活质量,降低心血管风险,这一点在临床和亚临床原发性甲状腺功能减退症患者身上已经得到了证实。
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引用次数: 0
Cognition and psychological wellbeing in hypopituitary patients. 垂体功能减退患者的认知和心理健康。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-26 DOI: 10.1007/s11154-023-09869-3
Syed Ali Imran, Michael Wilkinson

Hypopituitarism (HP) frequently occurs in patients presenting with sellar masses and despite recent advances in therapeutic options, HP patients consistently suffer from impaired quality of life due to psychological distress and cognitive dysfunction. These neurocognitive complications tend to persist in spite of surgical or biochemical remission of the disease making it especially challenging to segregate the effect of HP per se from other comorbidities such as the effect of tumour, surgery, radiation therapy, or complications caused by excess hormone production. Regardless, there is ample evidence to suggest that receptors for various pituitary hormones are abundantly expressed in key areas of central nervous system that are associated with memory and behaviour function and HP is also associated with poor sleep which can further exacerbate neurocognitive dysfunction. There is also evidence that hormonal replacement in HP patients partially restores these neurocognitive functions and improves sleep disorders. However, there is a need for creating better awareness among healthcare providers interacting with HP patients to enhance an earlier recognition of these disorder and their impact on quality of life despite initial remission. Importantly, there is a need to not only develop better and more cost-effective replacement therapies that would closely mimic the physiological hormonal release patterns, but also develop coping strategies for HP patients suffering from these complications.

垂体功能减退症(HP)经常发生在蝶窦肿块患者身上,尽管近年来治疗方案不断改进,但由于心理压力和认知功能障碍,HP 患者的生活质量始终受到影响。这些神经认知并发症往往在手术或生化治疗缓解后仍会持续存在,因此将高泌乳素血症本身的影响与其他合并症(如肿瘤、手术、放疗的影响或激素分泌过多引起的并发症)区分开来尤其具有挑战性。无论如何,有大量证据表明,各种垂体激素的受体大量表达于中枢神经系统中与记忆和行为功能有关的关键区域,而 HP 还与睡眠质量差有关,这可能会进一步加剧神经认知功能障碍。也有证据表明,对 HP 患者进行激素替代可部分恢复这些神经认知功能并改善睡眠障碍。然而,有必要提高与 HP 患者打交道的医疗服务提供者的认识,以便更早地识别这些疾病及其对生活质量的影响,尽管这些疾病在初期有所缓解。重要的是,我们不仅需要开发更好、更经济的替代疗法,使其接近生理荷尔蒙的释放模式,还需要为患有这些并发症的 HP 患者制定应对策略。
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引用次数: 0
Diagnosing and treating the elderly individual with hypopituitarism. 诊断和治疗患有垂体功能减退症的老年人。
IF 6.9 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Pub Date : 2024-06-01 Epub Date: 2023-12-27 DOI: 10.1007/s11154-023-09870-w
Andrea Corsello, Rosa Maria Paragliola, Roberto Salvatori

Hypopituitarism in the elderly is an underestimated condition mainly due to the non-specific presentation that can be attributed to the effects of aging and the presence of comorbidities. Diagnosis and treatment of hypopituitarism often represent a challenging task and this is even more significant in the elderly. Diagnosis can be insidious due to the physiological changes occurring with aging that complicate the interpretation of hormonal investigations, and the need to avoid some provocative tests that carry higher risks of side effects in this population. Treatment of hypopituitarism has generally the goal to replace the hormonal deficiencies to restore a physiological balance as close as possible to that of healthy individuals but in the elderly this must be balanced with the risks of over-replacement and worsening of comorbidities. Moreover, the benefit of some hormonal replacement therapies in the elderly, including sex hormones and growth hormone, remains controversial.

老年人垂体功能减退症是一种被低估的疾病,这主要是由于衰老的影响和合并症的存在而导致的非特异性表现。垂体功能减退症的诊断和治疗往往是一项极具挑战性的任务,这一点在老年人身上体现得更为明显。由于随着年龄增长而发生的生理变化会使激素检查的解释变得复杂,而且需要避免一些对老年人群具有较高副作用风险的刺激性检查,因此诊断可能很隐蔽。治疗垂体功能减退症的目标通常是补充缺乏的荷尔蒙,以恢复尽可能接近健康人的生理平衡,但对于老年人来说,这必须与过度补充荷尔蒙和合并症恶化的风险相平衡。此外,一些激素替代疗法(包括性激素和生长激素)对老年人的益处仍存在争议。
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引用次数: 0
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