Activin by Woodruff T.K.

By Woodruff T.K.

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Because pituitary development follows midline cell migration from the nasopharyngeal Rathke’s pouch, midline craniofacial disorders may be associated with pituitary dysplasia. Acquired pituitary failure in the newborn also can be caused by birth trauma, including cranial hemorrhage, asphyxia, and breech delivery. 19 CHAPTER 2 Pituitary dysplasia movements. Defects in the X-linked KAL gene impair embryonic migration of GnRH neurons from the hypothalamic olfactory placode to the hypothalamus. Genetic abnormalities, in addition to KAL mutations, also can cause isolated GnRH deficiency.

Drug-induced inhibition or disruption of dopaminergic receptor function is a common cause of hyperprolactinemia (Table 2-9). Thus, antipsychotics and antidepressants are a relatively common cause of mild hyperprolactinemia. Most patients receiving risperidone have elevated prolactin levels, sometimes exceeding 200 ug/L. Methyldopa inhibits dopamine synthesis and verapamil blocks dopamine release, also leading to hyperprolactinemia. Hormonal agents that induce PRL include estrogens and TRH. CHAPTER 2 (see below).

MRI is generally superior to CT for evaluating cystic structure and tissue components of craniopharyngiomas. CT is useful to define calcifications and evaluate invasion into surrounding bony structures and sinuses. Treatment usually involves transcranial or trans­ sphenoidal surgical resection followed by postoperative radiation of residual tumor. Surgery alone is curative in less than half of patients because of recurrences due to adherence to vital structures or because of small tumor deposits in the hypothalamus or brain parenchyma.

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