oxytocin and Genetic-Diseases--Inborn

Hypopituitarism is defined as one or more partial or complete pituitary hormone deficiencies, which are related to the anterior and/or posterior gland and can have an onset in childhood or adulthood. The most common aetiology is a sellar or suprasellar lesion, often an adenoma, which causes hypopituitarism due to tumour mass effects, or the effects of surgery and/or radiation therapy. However, other clinical conditions, such as traumatic brain injury, and autoimmune and inflammatory diseases, can result in hypopituitarism, and there are also genetic causes of hypopituitarism. Furthermore, the use of immune checkpoint inhibitors to treat cancer is increasing the risk of hypopituitarism, with a pattern of hormone defects that is different from the classic patterns and depends on mechanisms that are specific for each drug. Moreover, autoantibody production against the pituitary and hypothalamus has been demonstrated in studies investigating the development or worsening of some cases of hypopituitarism. Finally, evidence suggests that posterior pituitary damage can affect oxytocin secretion. The aim of this Review is to summarize current knowledge on non-classic and emerging causes of hypopituitarism, so as to help clinicians improve early identification, avoid life-threatening events and improve the clinical care and quality of life of patients at risk of hypopituitarism.

Topics: Adenoma; Adrenocorticotropic Hormone; Autoimmune Hypophysitis; Brain Injuries, Traumatic; Dwarfism, Pituitary; Empty Sella Syndrome; Endocrine System Diseases; Genetic Diseases, Inborn; Humans; Hypoglycemia; Hypogonadism; Hypophysitis; Hypopituitarism; Hypothyroidism; Immune Checkpoint Inhibitors; Oxytocin; Pituitary Apoplexy; Pituitary Neoplasms; Subarachnoid Hemorrhage

Topics: Animals; Genetic Diseases, Inborn; Genetics, Behavioral; Humans; Nervous System Diseases; Oxytocin; Vasopressins

71 abortions after prenatal diagnosis of genetic defects have been performed between 1974 and 1983. Mean duration of pregnancy was 21 weeks, mean hospital stay 10 days. In 28 per cent an intraamnial prostaglandin induction was done, which was successful in 85 per cent. Extraamnial prostaglandin application was combined with oxytocin in 51 per cent, which was followed by abortion in 51 per cent within 26 hours. Primary hysterectomy was performed in 4 per cent and rupture of the membranes combined with oxytocin infusion in 6 per cent. Complication rate overall was 20 per cent. In 6 per cent the following complications have been observed: 1 perforation with lesion of intestine, 1 cervical rupture with hemorrhage, 1 colpaporrhexis, 1 shock. Pelveoperitonitis and rupture of the symphysis pubis in one case each (3 per cent). Other complications, like fever, hemorrhages and thrombophlebitis have been observed in 11 per cent. Midtrimester abortion after prenatal diagnosis of genetic defects should be done only in experienced clinics. Special importance in prophylaxis of complications of abortion has chorion biopsy to predate prenatal diagnosis in the 6th till 12th gestational week.

Topics: Abortion, Induced; Adult; Dinoprost; Female; Follow-Up Studies; Genetic Diseases, Inborn; Gestational Age; Humans; Hysterectomy; Intraoperative Complications; Oxytocin; Postoperative Complications; Pregnancy; Prenatal Diagnosis; Prostaglandins F