Partial Hypopituitarism in Patients With Sturge-Weber Syndrome

Hypothalamic-pituitary dysfunction in Sturge-Weber syndrome: case report and review of the literature

OBJECTIVES

Sturge-Weber syndrome (SWS) is a rare neurocutaneous disorder that is characterized by a segmental dermatomal facial port-wine stain birthmark and is frequently accompanied by ipsilateral brain and eye abnormalities. We present a case of a patient with SWS who exhibited hypogonadotropic hypogonadism, growth hormone (GH) deficiency, and central hypothyroidism at the age of 20 despite the absence of radiographic findings in the pituitary and hypothalamus.

CASE PRESENTATION

A 20-year-old male with SWS with epilepsy and Klippel-Trenaunay syndrome presents with delayed pubertal development, short stature, and obesity. Upon further examination, he was found to have biochemical and clinical evidence of hypogonadism, hypothyroidism, and GH deficiency. A pituitary MRI displayed no abnormalities of the pituitary or hypothalamus. Treatment with testosterone cypionate and levothyroxine was initiated. Despite successful pubertal induction, IGF-1 levels have remained low and treatment with recombinant human growth hormone (rhGH) is now being considered for metabolic benefits.

CONCLUSIONS

This case emphasizes the importance of endocrine evaluation and treatment of hormonal deficiencies in patients with SWS despite the absence of radiographic findings.

GNAQ mutations drive port wine birthmark-associated Sturge-Weber syndrome: A review of pathobiology, therapies, and current models

Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models.

Risk of Mental Illnesses in Patients With Hypopituitarism: A Nationwide Population-Based Cohort Study

OBJECTIVE

The associations of mental illnesses and hypopituitarism have been reported. But, pituitary disorders are rare. The epidemiological studies have rarely addressed these associations between pituitary disorder and mental illnesses. Until now, no cohort study has been conducted to investigate the association.

METHODS

We performed a nationwide, retrospective cohort study using the Taiwanese National Health Insurance Program dataset to analyze this relationship. In total, 1,194 patients diagnosed with hypopituitarism between 2000 and 2013 were identified. For the control group, 4,776 individuals without hypopituitarism and psychotic diseases were matched (1:4) according to age, sex, and index date. A Cox proportional hazards model was used to determine the adjusted hazard ratio (aHR).

RESULTS

Patients with hypopituitarism had a significantly higher risk of incident depression and anxiety disorders than those without hypopituitarism. The aHRs of depressive and anxiety disorders were 2.98 and 1.67, respectively, for the hypopituitarism cohort. Furthermore, the risk of both hypopituitarism-associated depressive and anxiety disorders was significantly high in female subjects and subjects aged ≥18 years. A statistically significant increase was not observed in the risk of bipolar disorders, dementia, or schizophrenia in the hypopituitarism group compared with the control group.

CONCLUSION

Although psychiatric morbidities were uncommon for the hypopituitarism cohort, the risk of developing depressive and anxiety disorders was significantly higher in those with hypopituitarism than in those without hypopituitarism.