Hypophyseninsuffizienz

Zusammenfassung

Vorgestellt werden neue Publikationen aus dem Jahr 2005, die geplante Datenbank zur Hypophyseninsuffizienz nach Schädel-Hirn-Trauma (SHT) oder Subarachnoidalblutung (SAB) und das neue prospektive Kraniopharyngeom-Register CranioNet. Einige wichtige Botschaften: Als häufige Folge eines SHT oder einer SAB ist die Hypophyseninsuffizienz in der Nachbetreuung dieser Patienten zu beachten. Patienten mit Kraniopharyngeom haben sehr häufig eine Hypophyseninsuffizienz, wobei präoperative Hormonausfälle postoperativ fortbestehen. Die GH-Peaks beim GHRH-Arginintest und in geringerem Ausmaß auch beim Insulin-Toleranz-Test (ITT) korrelieren negativ mit dem Body-Mass-Index (BMI). Die langfristige GH-Therapie bei Erwachsenen mit nachgewiesenem GH-Mangel ist eine etablierte evidenzbasierte Therapie mit hoher Effektivität und Sicherheit, welche die Morbidität dieser Patienten reduziert. Die adäquate GH-Substitution verbessert die beeinträchtigte Lebensqualität der Patienten mit GH-Mangel.

Summary

Some new publications in 2005 are diskussed and the planned data-bank on hypopituitarism after head-brain trauma (HBT) or subarachnoid bleeding (SAB) as well as the new prospective craniopharingioma registry CranioNet are presented. Several important lessons are mentioned: hypopituitarism should be considered in the follow-up care of patients after SHT or SAB. Patients with craniopharyngioma very frequently have hypopituitarism, preoperatively existing hormonal deficiencies persisting postoperatively. Growth hormone (GH) peaks in the growth hormone-releasing hormone arginine test and, to a lesser degree, also in the insulin tolerance test correlate negatively with the body mass index (BMI). Long-term administration of GH in adults deficient in GH is an established evidence-based treatment of high efficacy and safety which reduces the mortality of such patients. Adequate GH substitution improves the impaired quality of life of patients who are deficient in GH.

Literatur

• 1 Agha A, Phillips J, O’Kelly P, Tormey W, Thompson C J. The natural history of post-traumatic hypopituitarism: implications for assessment and treatment.  Am J Med. 2005;  118 1416
• 2 Agha A, Sherlock M, Brennan S. et al . Hypothalamic-pituitary dysfunction after irradiation of nonpituitary brain tumors in adults.  J Clin Endocrinol Metab. 2005b;  90 6355-6360
• 3 Aimaretti G, Ambrosio M R, Di Somma C. et al . Residual pituitary function after brain injury-induced hypopituitarism: a prospective 12-month study.  J Clin Endocrinol Metab. 2005;  90 6085-6092
• 4 Biller B MK, Samuels M H, Zagar A. et al . Sensitivity and Specificity of Six Test for the Diagnosis of Adult GH Deficiency.  J Clin Endocrinol Metab. 2002;  87 2067-2079
• 5 Corneli G, Di Somma C, Baldelli R. et al . The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index.  Eur J Endocrinol. 2005;  153 257-264
• 6 Ghigo E, Masel B, Aimaretti G. et al . Consensus guidelines on screening for hypopituitarism following traumatic brain injury.  Brain Inj. 2005;  19 711-724
• 7 Karavitaki N, Brufani C, Warner J T. et al . Craniopharyngiomas in children and adults: systematic analysis of 121 cases with long-term follow-up.  Clin Endocrinol (Oxf). 2005;  62 397-409
• 8 Kendall-Taylor P, Jonsson P J, Abs R. et al . The clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngeoma compared with adult-onset craniopharyngeoma.  Eur J Endocrinol. 2005;  152 557-567
• 9 Leal-Cerro A, Flores J M, Rincon M. et al . Prevalence of hypopituitarism and growth hormone deficiency in adults long-term after severe traumatic brain injury.  Clin Endocrinol (Oxf). 2005;  62 525-532
• 10 Mah P M, Webster J, Jonsson P. et al . Estrogen replacement in women of fertile years with hypopituitarism.  J Clin Endocrinol Metab. 2005;  90 5964-5969
• 11 Qu X D, Gaw Gonzalo I T. et al . Influence of body mass index and gender on growth hormone (GH) responses to GH-releasing hormone plus arginine and insulin tolerance tests.  J Clin Endocrinol Metab. 2005;  90 1563-1569
• 12 van Thiel S W, Romijin J A, Pereira A M. et al . Effects of Testosterone Replacement in Androgen-Deficient Women with Hypopituitarism: A Randomized, Double-Blind, Placebo-Controlled Study.  J Clin Endocrinol Metabol. 2005;  90 3295-3303
• 13 Verhelst J, Kendall-Taylor P, Erfurth E M. et al . Baseline characteristics and response to 2 years of growth hormone (GH) replacement of hypopituitary patients with GH deficiency due to adult-onset craniopharyngeoma in comparison with patients with nonfunctioning pituitary adenoma: data from KIMS (Pfizer Internationale Metabolic Database).  J Clin Endocrinol Metab. 2005;  90 4636-4643