eMedicine Specialties > Pediatrics: General Medicine > Endocrinology

Hyperpituitarism: Follow-up

Author: Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Coauthor(s): Melanie Shim, MD, Clinical Instructor, Department of Pediatrics, Division of Pediatric Endocrinology, University of California at Los Angeles School of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2008

Follow-up

Inpatient & Outpatient Medications

  • After surgical treatment of Cushing disease, patients require daily hydrocortisone replacement therapy (8-10 mg/m2/d and education about stress dosing) from the time of surgery until their hypothalamic-pituitary-adrenal functions recover, which usually occurs 6-12 months after surgery.

Complications

  • The incidence of post-operative hypopituitarism is about 3% in patients with microadenomas and increases slightly with invasiveness of tumor.
  • Parasellar radiotherapy can lead to panhypopituitarism, optic nerve and optic chiasm injury, delayed radiation injury of the brain, or increased risk of a second brain tumor and epilation (loss of facial or scalp hair).

Prognosis

  • The postoperative PRL value, obtained 1-2 days after surgery, accurately predicts outcome. Undetectable level (<2 µg/L) predicts cure with more than 90% probability, whereas higher values within the reference range indicate incomplete removal of the adenoma. Surgery has a good outcome, with a long-term surgical cure rate approaching 82% for all prolactinomas with very low morbidity and no mortality.
  • Corticotropinoma: The criteria for cure of Cushing disease are undetectable plasma cortisol concentration in the morning (<1 µg/mL) and corticotropin concentration of less than 5 pg/mL over 24 consecutive hours measured 4-7 days after surgery (at least 24 h after withdrawal of exogenous hydrocortisone or 48 h after exogenous prednisone). Initial remission rates (1-y) of 70-98% and long-term (10-y) success rates of 50-98% have been reported.
  • GH-secreting adenoma: The preferred primary treatment for the patient with acromegaly is surgery, with the surgical cure rate approaching 83% in the largest series.1 Basal serum GH levels obtained immediately after surgery indicate the risk of tumor recurrence in children with GH-releasing adenomas. One recent series reported that immediate postoperative GH values of approximately 50 ng/mL were more likely to be associated with tumor recurrence than values near 15 ng/mL.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize and treat coexisting pituitary hormone hyposecretion or hypersecretion
  • Failure to monitor for and detect tumor recurrence after surgical or medical treatment
 


More on Hyperpituitarism

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Differential Diagnoses & Workup: Hyperpituitarism
Treatment & Medication: Hyperpituitarism
Follow-up: Hyperpituitarism
Multimedia: Hyperpituitarism
References
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References

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Further Reading

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Keywords

hyperpituitarism, pediatric pituitary adenomas, primary hypersecretion of pituitary hormones, prolactinoma, corticotropinoma, somatotropinoma, thyrotropinoma, Cushing disease, Cushing's disease, Cushing syndrome, Cushing's syndrome, pituitary disease, pituitary microadenoma, hypogonadism, hypoadrenalism, hypothyroidism, Hashimoto thyroiditis, amenorrhea, gynecomastia, gigantism, multiple endocrine neoplasia type 1, MEN, McCune-Albright syndrome, MAS, neurofibromatosis, tuberous sclerosis, Carney complex, growth failure, hirsutism, adrenarche, acne, pubertal arrest, pubertal failure, pubertal delay, galactorrhea, short stature, gynecomastia, hypertension

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Contributor Information and Disclosures

Author

Robert J Ferry Jr, MD, Chief, Division of Pediatric Endocrinology and Diabetes, Le Bonheur Children's Medical Center, University of Tennessee Health Science Center at Memphis and St Jude Children's Research Hospital; Lieutenant Colonel (Medical Corps), 162nd Area Support Medical Company, Army National Guard
Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society
Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching

Coauthor(s)

Melanie Shim, MD, Clinical Instructor, Department of Pediatrics, Division of Pediatric Endocrinology, University of California at Los Angeles School of Medicine
Melanie Shim, MD is a member of the following medical societies: American Diabetes Association and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Thomas A Wilson, MD, Professor of Clinical Pediatrics, Department of Pediatrics; Director of Pediatric Endocrinology, Division of Pediatric Endocrinology, Department of Pediatrics, State University of New York at Stony Brook
Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

George P Chrousos, MD, FAAP, MACP, MACE, Professor and Chair, Department of Pediatrics, Athens University Medical School
George P Chrousos, MD, FAAP, MACP, MACE is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Lawson-Wilkins Pediatric Endocrine Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD, Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas and Arkansas Children's Hospital
Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research
Disclosure: Genentech, Inc. Honoraria Speaking and teaching; Pfiser, Inc. Honoraria Consulting

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