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Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...
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Cushing syndrome refers to the collection of clinical manifestations that arise when tissues are exposed to excessive amounts of cortisol or cortisol-like medications over an extended period. Cortisol, a glucocorticoid produced by the adrenal cortex, regulates metabolism, immune responses, and the body’s adaptation to stress. When its concentration remains chronically elevated, these physiological pathways become dysregulated, resulting in the characteristic features of the syndrome.Exogenous...
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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Pituitary incidentalomas--how often is too often?

Mara Carsote1, Corina Chirita, Anda Dumitrascu

  • 1Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy, 34-36 Bd. Aviatorilor, 011863 Bucharest, Romania.

Journal of Medicine and Life
|January 30, 2010
PubMed
Summary
This summary is machine-generated.

Nonfunctional pituitary microadenomas, or incidentalomas, typically do not change in size over time. Follow-up imaging with computed tomography scans may not be necessary for at least two years after diagnosis.

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Area of Science:

  • Endocrinology
  • Neurosurgery
  • Radiology

Background:

  • Pituitary microadenomas, often found incidentally via advanced imaging (CT, MRI), lack standardized follow-up protocols.
  • Their increasing prevalence necessitates understanding their natural history and optimal monitoring strategies.

Purpose of the Study:

  • To evaluate the dimensional changes and long-term evolution of nonfunctional pituitary microadenomas.
  • To determine appropriate follow-up imaging intervals for these incidentalomas.

Main Methods:

  • Retrospective observational study of 149 patients with nonfunctional pituitary microadenomas (max diameter 11 mm).
  • Hormonal assessments and computed tomography (CT) scans were performed initially and repeated over a mean follow-up of 29.75 months in 69 patients.

Main Results:

  • Microadenomas remained stable in size over the observation period, with no statistically significant diameter changes.
  • One microadenoma progressed to macroadenoma, and another was reclassified as a microprolactinoma; no pituitary apoplexy occurred.

Conclusions:

  • Nonfunctional pituitary microadenomas demonstrate stable dimensions, suggesting a low risk of significant progression in the short term.
  • Computed tomography surveillance can likely be deferred for at least two years post-diagnosis for incidentalomas.