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The most common neuroendocrine disorder is pituitary disease, which includes pituitary tumors or other lesions in the pituitary gland. The pituitary gland is an endocrine gland located at the base of the brain, and is about the size of a pea.
Tumors in the pituitary can either have mass effects, meaning the growing size of the tumor presses on surrounding structures and disrupts normal function, or the tumor can alter the production of hormones. These tumors can either cause an over production of hormones, or interfere with the normal function of the pituitary resulting in a decrease in hormones.
A common neuroendocrine disorder in women, although they can also be seen in men, is a prolactinoma. Prolactinomas are tumors that secrete prolactin, a hormone that normally regulates lactation in women. These tumors are usually detected earlier in women, compared to men, because they cause more manifestations in women. These include infertility, reproductive dysfunction, and increased lactation and breast milk production.
Two neuroendocrine disorders that are more common in women are Cushing’s disease and lymphocytic hypophysitis. Cushing’s disease is a disorder where the pituitary produces an excess of ACTH resulting in elevated cortisol levels. Cortisol is a hormone normally released in the body in response to stress. Prolonged exposure to cortisol excess can cause multiple manifestations including weight gain, obesity, and muscle weakness. And while Cushing’s disease can affect both genders, it occurs more often in women. Lymphocytic hypophysitis is an inflammatory, most likely an autoimmune-based, disease of the pituitary gland. It often presents in the postpartum period in women and can manifest most commonly as dysfunction or loss of pituitary hormone secretion.
Finally, an individual can suffer from deficiencies of any of the pituitary hormones. Since the pituitary controls ovarian function, reproduction in women can be directly impacted. The pituitary hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are among the most sensitive to disruption in pituitary disease, which can result in amenorrhea, or a loss of periods, as well as infertility, or difficulty getting pregnant.
Brigham and Women’s Hospital has a multidisciplinary neuroendocrine clinic where a neuroendocrinologist and a neurosurgeon work together. Dr. Ursula Kaiser and Dr. Whitney Woodmansee are the neuroendocrinologists and Dr. Edward Laws is the neurosurgeon in this center. These physicians work as a team in the clinic, so a patient can be seen and evaluated by the neuroendocrinologist and the neurosurgeon in the same visit and care can be coordinated by the team. This arrangement allows the neuroendocrinologist to address the endocrine and medical issues, such as hormone testing and medications, and the neurosurgeon to discuss and answer and questions regarding potential surgery. During the visit, the woman can expect to have a complete neuroendocrine evaluation, including a history, physical, and laboratory testing and also a neurosurgical evaluation, usually including an MRI scan or other imaging as indicated.
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