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    Evaluation and follow-up of patients diagnosed with hypophysitis: A cohort study
    (2024) Hacıoğlu, Ayşa; Karaca, Züleyha; Uysal, Serhat; Özkaya, Hande Mefkure; Kadıoğlu, Pınar; Soyluk Selçukbiricik, Özlem; Gül, Nurdan; Yarman, Sema; Köksalan, Damla; Selek, Alev; Cantürk, Zeynep; Çetinarslan, Berrin; Çorapçıoğlu, Demet; Şahin, Mustafa; Şah Ünal, Fatma Tuğçe; Babayeva, Afruz; Aktürk, Müjde; Çiftçi, Sema; Pişkinpaşa, Hamide; Dökmetaş, Hatice Sebile; Dökmetaş, Meriç; Şahin, Onur; Eraydın, Ayten; Fenkçi, Semin; Öztürk, Sadettin; Akarsu, Ersin; Omma, Tülay; Erkan, Buruç; Burhan, Şebnem; Pehlivan Koroğlu, Esma; Saygılı, Füsun; Kılıç Kan, Elif; Atmaca, Ayşegül; Elbüken, Gülşah; Alphan Uç, Ziynet; Görar, Süheyla; Hekimsoy, Zeliha; Pekkolay, Zafer; Bostan, Hayri; Bayram, Fahri; Yorulmaz, Göknur; Şener, Selçuk Yusuf; Turan, Kübra; Çelik, Özlem; Doğruel, Hakan; Ertörer, Eda; Turhan İyidir, Özlem; Topaloğlu, Ömercan; Cansu, Güven Barış; Ünlühizarcı, Kürşad; Keleştimur, Fahrettin
    Objective: Primary hypophysitis might be challenging to diagnose, and there is a lack of evidence regarding optimal treatment strategies due to rarity of the disease. We aim to investigate the clinical features and compare the outcomes of different management strategies of primary hypophysitis in a large group of patients recruited on a nationwide basis. Design: A retrospective observational study. Methods: The demographic, clinical, and radiologic features and follow-up data were collected in study protocol templates and analyzed. Results: One hundred and thirteen patients (78.8% female, median age: 36 years) were included. Lymphocytic (46.7%) and granulomatous hypophysitis (35.6%) were the prevailing subtypes out of 45 patients diagnosed after pathologic investigations. Headache (75.8%) was the most common symptom, and central hypogonadism (49.5%) was the most common hormone insufficiency. Of the patients, 52.2% were clinically observed without interventions, 18.6% were started on glucocorticoid therapy, and 29.2% underwent surgery at presentation. Headache, suprasellar extension, and chiasmal compression were more common among glucocorticoid-treated patients than who were observed. Cox regression analysis revealed higher hormonal and radiologic improvement rates in the glucocorticoid-treated group than observation group (hazard ratio, 4.60; 95% CI, 1.62-12.84 and HR, 3.1; 95% CI, 1.40-6.68, respectively). The main indication for surgery was the inability to exclude a pituitary adenoma in the presence of compression symptoms, with a recurrence rate of 9%. Conclusion: The rate of spontaneous improvement might justify observation in mild cases. Glucocorticoids proved superior to observation in terms of hormonal and radiologic improvements. Surgery may not be curative and might be considered in indeterminate, treatment-resistant, or severe cases.
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    How does pregnancy affect the patients with pituitary adenomas: A study on 113 pregnancies from Turkey
    (Springer, 2018) Cihan Karaca, Züleyha; Yarman, Sema; Özbaş, I.; Kadıoğlu, Pınar; Aktürk, Müjde; Kılıçlı, Fatih; Dökmetaş, Hatice Sebile; Çolak, Ramis; Atmaca, Hulusi; Cantürk, Zeynep; Altuntaş, Yüksel; Çolak Özbey, Neşe; Hatipoğlu, Nihal; Tanrıverdi, Fatih; Ünlühızarcı, Kürşad; Keleştimur, Fahrettin
    Objective Data regarding pregnancies in relation to pituitary tumors are limited. The effects of pregnancy on pituitary adenomas and the effects of adenoma itself (hormonal activity, mass effects and pituitary insufficiency) and/or treatment on the ongoing gestation and developing fetus were evaluated. Methods The study was a retrospective study. A questionnaire involving questions regarding medical history before index gestation, history of related pregnancy, result of index gestation and postpartum follow-up of the patients was filled by the investigator in one of the eight Referral Endocrinology Centers from Turkey. Results One hundred and thirteen (83 prolactinoma, 21 acromegaly, 8 NFPA and 1 plurihormonal pituitary adenoma) pregnancies of 87 (60 prolactinoma, 19 acromegaly, 7 NFPA and 1 plurihormonal pituitary adenoma) patients were reviewed. The clinically important pregnancy-related tumor growth of pituitary adenomas was found to be low in previously treated adenomas. Prolactinomas were more likely to increase in size during pregnancy especially if effective prior treatment was lacking. The risk of hypopituitarism is also minimal due to pituitary adenomas during pregnancy. The results of pregnancies did not differ in patients who were on medical treatment or not for prolactinomas and acromegaly during gestation. Neural tube defect and microcephaly associated with maternal cabergoline use; Down syndrome and corpus callosum agenesis associated with maternal bromocriptine use; unilateral congenital cataract, craniosynostosis and microcephaly associated with maternal acromegaly were detected for the first time. Conclusion Medical treatment can be safely done stopped in patients with prolactinoma and acromegaly when pregnancy is confirmed and reinstituted when necessary. Prospective studies may help to determine the effects of medical treatment during gestation on the mother and fetus.