Overview
Pituitary snuff-takers' disease, also known as chromic atrophic rhinitis or nasopharyngeal mucosal atrophy, results from chronic irritation and inflammation of the nasal mucosa due to habitual snuff use, potentially leading to hypopituitarism and dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis 1.Diagnosis
Clinical History: Chronic nasal irritation and use of snuff 1.
HPA Axis Assessment:
- Immediate postoperative phase: 9:00 h plasma cortisol measurement 1.
- Definitive testing: 4-12 weeks post-surgery, commonly using the short synacthen test (SST) or insulin tolerance test (ITT) 1.
- Interpretation: Cortisol levels at 30 minutes often used as a primary criterion for assessing HPA axis function 1.Management
Glucocorticoid Replacement: Initiated based on HPA axis testing results indicating adrenal insufficiency 1.
Long-term Monitoring:
- SST for patients who received radiotherapy 1.
- Routine testing for symptomatic patients or those with tumor recurrence 1.Special Populations
No Specific Guidance Provided: The abstracts do not cover special populations such as pregnancy, pediatrics, elderly, or comorbidities 1.Key Recommendations
Assess the HPA axis using the short synacthen test (SST) or insulin tolerance test (ITT) between 4-12 weeks post-pituitary surgery to determine glucocorticoid replacement needs (Evidence: Moderate 1).
Initiate glucocorticoid replacement therapy based on definitive HPA axis testing results indicating adrenal insufficiency (Evidence: Moderate 1).
Routinely monitor patients with a history of radiotherapy using the SST, and consider testing for symptomatic patients or those with tumor recurrence (Evidence: Expert opinion 1).References
1 Reynolds RM, Stewart PM, Seckl JR, Padfield PL. Assessing the HPA axis in patients with pituitary disease: a UK survey. Clinical endocrinology 2006. link