Pituitary disease:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Boston [u.a.]
Kluwer Acad. Publ.
2002
|
| Schriftenreihe: | Endocrine updates
18 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XXI, 276 S. Ill., graph. Darst. |
| ISBN: | 1402071221 |
Internformat
MARC
| LEADER | 00000nam a2200000zcb4500 | ||
|---|---|---|---|
| 001 | BV014515768 | ||
| 003 | DE-604 | ||
| 005 | 20021106 | ||
| 007 | t | ||
| 008 | 020603s2002 xxuad|| |||| 00||| eng d | ||
| 010 | |a 2002069475 | ||
| 020 | |a 1402071221 |9 1-402-07122-1 | ||
| 035 | |a (OCoLC)49860362 | ||
| 035 | |a (DE-599)BVBBV014515768 | ||
| 040 | |a DE-604 |b ger |e aacr | ||
| 041 | 0 | |a eng | |
| 044 | |a xxu |c US | ||
| 049 | |a DE-355 | ||
| 050 | 0 | |a RC658 | |
| 082 | 0 | |a 616.4/7 |2 21 | |
| 084 | |a YC 3800 |0 (DE-625)153217:12905 |2 rvk | ||
| 245 | 1 | 0 | |a Pituitary disease |c ed. by Michael C. Sheppard ... |
| 264 | 1 | |a Boston [u.a.] |b Kluwer Acad. Publ. |c 2002 | |
| 300 | |a XXI, 276 S. |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
| 337 | |b n |2 rdamedia | ||
| 338 | |b nc |2 rdacarrier | ||
| 490 | 1 | |a Endocrine updates |v 18 | |
| 650 | 4 | |a Pituitary Diseases |x diagnosis | |
| 650 | 4 | |a Pituitary Diseases |x therapy | |
| 650 | 4 | |a Pituitary gland |x Diseases | |
| 650 | 0 | 7 | |a Hypophysenkrankheit |0 (DE-588)4026390-3 |2 gnd |9 rswk-swf |
| 689 | 0 | 0 | |a Hypophysenkrankheit |0 (DE-588)4026390-3 |D s |
| 689 | 0 | |5 DE-604 | |
| 700 | 1 | |a Sheppard, Michael C. |e Sonstige |4 oth | |
| 830 | 0 | |a Endocrine updates |v 18 |w (DE-604)BV012381937 |9 18 | |
| 856 | 4 | 2 | |m HBZ Datenaustausch |q application/pdf |u http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009886384&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |3 Inhaltsverzeichnis |
| 999 | |a oai:aleph.bib-bvb.de:BVB01-009886384 | ||
Datensatz im Suchindex
| _version_ | 1804129316885233664 |
|---|---|
| adam_text | Contents
List of Figures xiii
List of Tables xv
Preface xvii
Contributing Authors xix
1
ETIOLOGY OF PITUITARY TUMOURS 1
Anthony P. Heaney, Shlomo Melmed
1.1 INTRODUCTION 1
1.2 PITUITARY TUMOR INITIATION 1
1.2.1 Tumor models 2
1.3 ONCOGENE ACTIVATION 4
1.3.1 Pituitary Tumor Transforming Gene (PTTG) 4
1.3.2 Activating gsp mutations 7
1.3.3 Activated cAMP response element binding proteins (CREB) 8
1.3.4 Protein Kinase A and C 8
1.3.5 Ras oncogenes 9
1.3.6 CyclinDl 9
1.4 TUMOR SUPPRESSOR GENES 9
1.4.1 Retinoblastoma (Rb) 9
1.4.2 Cyclin Dependent Kinase Inhibitors 10
1.4.2.1 P16/CDKN2A 10
1.4.2.2 P27 11
1.5 GROWTH FACTORS 11
1.5.1 Fibroblast Growth Factors (FGF s) 11
1.5.1.1 FGF 2 (Basic FGF) 11
1.5.1.2 FGF 4 12
1.5.2 Vascular Endothelial derived Growth Factor (VEGF) 12
1.5.3 Transforming Growth Factors (TGF s) 12
1.5.3.1 TGF /3 12
1.5.3.2 TGF a 13
1.6 ANGIOGENESIS 13
1.7 HYPOTHALAMIC FACTORS AND THEIR RECEPTORS 14
1.7.1 GHRH and Somatostatin 14
vi PITUITARY DISEASE
1.7.2 Corticotrophin releasing hormone (CRH) 14
1.7.3 Thyrotrophin Releasing Hormone (TRH) 15
1.7.4 Gonadotrophin Releasing Hormone (GnRH) 15
1.8 HEREDITARY SYNDROMES 15
1.8.1 Multiple endocrine neoplasia 15
1.8.2 Carney Complex 16
1.8.3 McCune Albright syndrome 16
1.8.4 Familial acromegaly 16
1.9 ESTROGEN AND ESTROGEN RECEPTOR 17
1.10 TRANSCRIPTION FACTORS 17
2
PATHOLOGY OF THE PITUITARY 33
Ann Marie McNichol
2.1 INTRODUCTION 33
2.2 NORMAL ANTERIOR PITUITARY 34
2.2.1 Anterior pituitary development and cytodifferentiation 35
2.2.2 Neuropeptides, growth factors and cytokines. 36
2.3 PITUITARY ADENOMAS 37
2.3.1 Classification 37
2.3.2 Growth hormone secreting tumours 39
2.3.3 Prolactin secreting adenomas 40
2.3.4 TSH secreting adenomas 41
2.3.4.1 Corticotroph adenomas 41
2.3.5 Gonadotroph adenomas 42
2.3.6 Plurihormonal adenomas 42
2.3.7 Non functioning/silent adenomas 42
2.3.8 Other investigations 43
2.3.9 General immunohistochemistry 43
2.3.10 Pituitary hyperplasia 43
2.3.11 Other tumours 44
3
IMAGING THE PITUITARY 51
Dr. Julie EC. Olliff
3.1 IMAGING TECHNIQUES AND NORMAL ANATOMY 51
3.2 PATHOLOGY 54
3.2.1 Congenital 54
3.2.2 Pituitary Tumours 56
3.2.2.1 Adenoma 56
3.2.2.2 Craniopharyngioma 66
3.2.2.3 Meningioma 66
3.2.3 Other Tumours 66
4
NON FUNCTIONING PITUITARY TUMOURS 75
R.N.Clayton
4.1 INTRODUCTION 75
4.2 DEFINITION OF NON FUNCTIONING TUMOURS (NFA) 76
Contents vii
4.2.1 Histological classification of non functioning tumour 76
4.3 CYTOGENESIS OF NFA s 78
4.4 Incidence and prevalence of pituitary tumours 79
4.5 PRESENTATION AND EVALUATION OF NFA 81
4.5.1 Management of NFA s Surgery and Radiotherapy 83
4.6 WHAT SHOULD BE THE POLICY FOR USE OF RT FOR NFA S? 86
4.6.1 Hypopituitarism is associated with increased mortality. 86
5
PROLACTINOMA 95
A J Norris, J RE Davis
5.1 INTRODUCTION 95
5.2 PRODUCTION AND EFFECTS OF PROLACTIN 95
5.3 PRESENTATION 97
5.3.1 Endocrine Effects 97
5.3.2 Mass Effects of Pituitary Lesion 97
5.4 DIAGNOSIS 98
5.4.1 Biochemical Evaluation 98
5.4.2 Radiological Evaluation 99
5.5 TREATMENT 100
5.5.1 Why Treat? 100
5.5.2 Dopamine Agonists 101
5.5.3 Bromocriptine 101
5.5.4 Cabergoline 101
5.5.5 Quinagolide 102
5.5.6 Pituitary Surgery 103
5.5.7 Radiotherapy 104
5.5.8 Monitoring Treatment 104
5.5.9 Macroprolactinomas 105
5.5.10 Macroadenomas with Moderate Prolactin Excess 105
5.5.11 Microadenomas with Minimal Hyperprolactinaemia: No treat¬
ment? 105
5.5.12 Pregnancy 105
5.5.13 Hormone Replacement and Menopause 106
5.5.14 Resolution of Disease and Cessation of Treatment 107
6
ACROMEGALY 113
James Gibney, Ken KY Ho
6.1 INTRODUCTION 113
6.2 CLINICAL FEATURES OF ACROMEGALY 113
6.2.1 Effects on the cardiorespiratory system 114
6.2.2 Acromegaly and cancer risk 115
6.3 DIAGNOSIS OF ACROMEGALY 116
6.3.1 Approach to diagnosis 119
6.4 TREATMENT OF ACROMEGALY 119
6.4.1 Cure and remission of disease in acromegaly 119
6.4.2 Mortality and disease control 120
6.4.3 Treatment goals for acromegaly 121
viii PITUITARY DISEASE
6.4.4 Approach to treatment 121
6.4.4.1 Surgery 121
6.4.4.2 Radiotherapy 121
6.4.5 Medical Treatment 122
6.4.5.1 Dopamine (D2) receptor agonists 122
6.4.5.2 Somatostatin analogues 122
6.4.5.3 GH receptor antagonists 123
6.5 SUMMARY 124
7
CUSHING S DISEASE 127
Professor A. Brew Atkinson
7.1 CLINICAL HISTORY 127
7.1.1 Minnie G 127
7.1.2 Clinical Features 128
7.1.3 Infections in Cushing s syndrome 131
7.1.4 Vascular complications 132
7.1.5 Sexual Dysfunction 132
7.1.6 Psychiatric Manifestations 132
7.2 CHILDHOOD CUSHING S SYNDROME 132
7.3 INTERMITTENT, PERIODIC AND CYCLICAL CUSHING S SYN¬
DROME 133
7.4 ALTERNATIVE DIAGNOSES TO CUSHING S SYNDROME 134
7.5 BIOCHEMICAL DIAGNOSIS OF CUSHING S SYNDROME 135
7.5.1 Serum cortisol 13 6
7.5.2 Salivary cortisol 136
7.5.3 Urinary cortisol 136
7.5.4 Low dose dexamethasone suppression test 136
7.5.5 Single dose dexamethasone suppression test 137
7.5.6 Other methods 137
7.6 DIFFERENTIAL DIAGNOSIS OF CUSHING S SYNDROME 137
7.7 THERAPEUTIC INTERVENTION AND FOLLOW UP OF CUSH¬
ING S DISEASE 145
7.7.1 Pituitary surgery 145
7.8 METHODS TO DETERMINE WHETHER PITUITARY SURGERY
HAS BEEN CURATIVE 146
7.8.1 Clinical assessment 146
7.8.2 Unmeasurable early serum cortisol 146
7.8.3 Serum or urinary cortisol 147
7.8.4 Pituitary irradiation 148
7.8.5 Bilateral adrenalectomy 149
7.8.6 Choice of Therapy 150
7.8.7 Drug therapy 150
7.8.8 Nelson s Syndrome 151
7.8.9 Conclusions on therapy and follow up 152
7.9 SUMMARY 152
8
THYROTROPIN SECRETING PITUITARY ADENOMAS 167
Paolo Beck Peccoz M.D., Luca Persani, MD
Contents ix
8.1 INTRODUCTION 167
8.2 OCCURRENCE 168
8.3 PATHOLOGY AND MOLECULAR ASPECTS 168
8.4 CLINICAL MANIFESTATIONS 171
8.5 LABORATORY AND BIOCHEMICAL FINDINGS 172
8.5.1 Serum thyroid hormone and TSH levels 172
8.5.2 Pitfalls in thyroid hormone and TSH determinations. 173
8.5.3 Other useful biochemical parameters. 174
8.6 DYNAMIC TESTING 175
8.7 IMAGING STUDIES AND LOCALIZATION OF THE TUMOR 175
8.8 DIFFERENTIAL DIAGNOSIS 176
8.9 TREATMENT AND OUTCOME 177
8.10 CRITERIA OF CURE AND FOLLOW UP 179
9
CRANIOPHARYNGIOMA 185
Professor P.H. Baylis, Steven G. Ball
9.1 INTRODUCTION 185
9.2 PATHOLOGY 185
9.2.1 Adamantinous craniopharyngioma 186
9.2.2 Papillary craniopharyngioma 188
9.3 EPIDEMIOLOGY 188
9.4 AETIOLOGY 189
9.5 DIAGNOSIS 189
9.5.1 Radiology 191
9.5.2 Differential diagnosis 191
9.6 TREATMENT OF PRIMARY CRANIOPHARYNGIOMA 191
9.6.1 Surgery 192
9.6.2 Adjuvant radiotherapy 192
9.6.3 Radiosurgery 193
9.6.4 Intracystic brachytherapy 194
9.6.5 Intracystic bleomycin 194
9.7 TREATMENT OUTCOMES IN CRANIOPHARYNGIOMA 194
9.7.1 Overall standard outcome data 195
9.7.2 Surgery: gross total excision or sub total resection? 195
9.7.3 Adjuvant radiotherapy 196
9.7.4 Endocrine outcomes of craniopharyngioma 196
9.8 THE MANAGEMENT OF RECURRENT DISEASE 197
9.8.1 Monitoring of recurrent disease 198
9.8.2 Surgery for recurrent disease 198
9.8.3 Adjuvant radiotherapy and radiosurgery in recurrent disease 198
9.8.4 Options for recurrent cystic disease: drainage or intracystic
therapy 199
9.8.5 Systemic treatments for recurrent and resistant disease: cy
totoxic and immunomodulatory therapy 199
9.9 AN INTEGRATED APPROACH TO THE MANAGEMENT OF
CRANIOPHARYNGIOMA 201
x PITUITARY DISEASE
10
PITUITARY INCIDENTALOMA 207
Mark E. Molitch, M.D. i
10.1 INTRODUCTION 207
10.2 TYPES OF PITUITARY MASS LESIONS 207
10.3 AUTOPSY FINDINGS 208
10.4 CT AND MRI SCANS IN NORMAL INDIVIDUALS 210
10.5 DIAGNOSTIC EVALUATION 211
10.5.1 Endocrinologic Evaluation 211
10.5.2 Radiologic Evaluation 213
10.6 RECOMMENDATIONS 214
10.7 SUMMARY 215
11
PITUITARY SURGERY 221
Professor J.A.H. Wass
11.1 HISTORY OF PITUITARY SURGERY 221
11.2 AIMS 221
11.3 TECHNIQUES OF SURGERY 222
11.4 PREPARATION FOR OPERATION 222
11.5 RISKS OF SURGERY 223
11.6 TECHNICAL ASPECTS OF SURGERY 223
11.7 TRANSCRANIAL SURGERY TECHNICAL ASPECTS 224
11.8 RESULTS OF PITUITARY SURGERY 225
11.8.1 Non Functioning Adenoma 225
11.8.2 Acromegaly 225
11.8.3 Cushing s Disease 225
11.8.4 Prolactinomas 226
11.9 PITUITARY APOPLEXY 226
11.10 PITUITARY RE EXPLORATION 226
11.11 COMPLICATIONS OF TRANSPHENOIDAL SURGERY 226
11.11.1 Nasal Complications 227
11.11.2 Impaired Pituitary Function 227
11.11.3 CSF Leakage 227
11.11.4 Visual Deterioration 227
11.11.5 Meningitis 227
11.11.6 Syndrome of Inappropriate Anti diuretic Hormone Release
(SIADH) 228
11.12 COMPLICATIONS OF TRANSFRONTAL SURGERY 228
11.12.1 Frontal Lobe Damage 228
11.12.2 Optic Nerve Damage 228
11.12.3 Vascular Damage 228
11.12.4 Hypothalamic Damage 228
11.13 SURGICAL EXPERIENCE 229
11.14 FUTURE 230
12
RADIOTHERAPY FOR PITUITARY TUMOURS 233
RN. Plowman
Contents xi
13
TESTING OF HYPOTHALAMO PITUITARY AXIS 247
John J. Orrego, Ariel L. Barkan
13.1 INTRODUCTION 247
13.2 PROLACTINOMA 248
13.3 ACROMEGALY 248
13.4 CUSHING S SYNDROME 249
13.5 TSH SECRETING PITUITARY ADENOMA 250
13.6 NONFUNCTIONING PITUITARY ADENOMA 251
13.7 DIABETES INSIPIDUS 251
13.8 GH DEFICIENCY IN ADULTS 252
13.9 ACTH DEFICIENCY 253
13.10 HYPOTHYROIDISM 254
13.11 HYPOGONADISM 255
13.12 HYPOTHALAMIC PITUITARY AXIS TESTING 256
13.12.1 Oral glucose tolerance test (OGTT) 256
13.12.2 TRH stimulation test 256
13.12.3 GnRH stimulation test 257
13.12.4 GHRH stimulation test 257
13.12.5 Arginine stimulation test 257
13.12.6 Low dose DST 258
13.12.7 Standard high dose DST 258
13.12.8 Metyrapone test 258
13.12.9 CRH stimulation test 259
13.12.1O^CTH stimulation test 259
13.12.1 Insulin tolerance test (ITT) 259
13.12.1 domiphene stimulation test 260
13.12.13?luid deprivation/DDAVP test 260
List of Figures
1.1 Model of pituitary tumorigenesis 5
2.1 Schematic representation of the distribution of the vari¬
ous hormone producing cell types in a transverse section
of the human pituitary gland. 35
2.2 Pituitary adenoma from a patient with evidence of hyper
prolactinaemia. 39
2.3 Staining patterns in GH cell adenoma 40
3.1 (a) Coronal T1 weighted MM scan of the pituitary fossa.
(b) Sagittal Tl weighted MM scan of the pituitary. 52
3.2 (a) Sagittal Tl weighted scan of the pituitary following
intravenous gadolinium (b) T2 sagittal scan 53
3.3 Tl weighted scan of a patient with hypopituitarism 55
3.4 Coronal and sagittal Tl weighted scan of the pituitary fossa 57
3.5 The empty sella 58
3.6 Coronal Tl weighted MRI scan showing a microadenoma 59
3.7 Coronal Tl weighted image of cavernous sinus invasion 60
3.8 ACTH secreting adenoma in Cushing s disease 62
3.9 High signal intensity suggesting haemorrhage within a lesion 64
3.10 Pituitary adenoma presenting with symptoms and signs
of pituitary apoplexy 65
3.11 High signal intensity in scans of craniopharyngioma 67
3.12 Meningioma projecting into the sella turcica (1) 68
3.13 Meningioma with normal pituitary visible on scan 69
4.1 Hypothetical cytogenetic origin of NFA s based on model
of normal pituitary cell differentiation. 78
4.2 Management team that should be available to all patients
with suspected pituitary mass lesion. 83
6.1 Prevalence of various signs and symptoms in acromegaly 114
6.2 Relationship between mean GH and IGF I concentra¬
tions in acromegaly 118
xiv PITUITARY DISEASE
7.1 Suppression of serum cortisol after HDD 140
7.2 Serum cortisol rise after CRH stimulation in 23 patients
with pituitarydependent Cushing s syndrome and 1 with
ectopic ACTH syndrome. 141
8.1 Influences of previous thyroid ablation on the size and
pattern of growth of TSH producing adenomas 169
8.2 Treatment of one patient with TSH producing adenoma
with long acting somatostatin analogs 178
9.1 Craniopharyngioma consisting of solid and cystic ele¬
ments, disrupting the diencephalon. 186
9.2 Adamantinous craniopharyngioma and Papillary cranio¬
pharyngioma 187
9.3 (a) Sagittal T1MRI demonstrating cystic retrochiasmatic
suprasellar craniopharyngioma distorting hypothalamus
and third ventricle, (b) Axial Tl MRI demonstrating
mixed solid cystic papillary craniopharyngioma. 190
9.4 Coronal Tl MRI demonstrating recurrent cystic cranio¬
pharyngioma following primary treatment with surgery
and EBRT 200
9.5 Integrated management of craniopharyngioma. 201
10.1 MRI scan, carried out to rule out lesions of internal au¬
ditory canals causing vertigo. 208
10.2 Flow diagram indicating the approach to the patient found
to have a pituitary incidentaloma. 216
11.1 Surgical approaches to the pituitary 224
11.2 Success and failure rates of Surgery with time 229
12.1 Axial enhanced CT scans of a recurrent pituitary ade¬
noma in the right cavernous sinus, following previous
surgery and conventional radiotherapy. 237
12.2 Axial enhanced CT scans of a recurrent pituitary ade¬
noma in the right cavernous sinus, following previous
surgery and conventional radiotherapy. After stereotac
tic radiosurgery 238
List of Tables
1.1 Candidate genes in pituitary tumorigenesis Activating
Mutations 3
1.2 Candidate genes in pituitary tumorigenesis Tumor Sup¬
pressor Genes 4
2.1 Immunohistochemical classification of pituitary adenomas 38
4.1 Non adenomatous mass lesions in the pituitary fossa 76
4.2 Histological Classification of NFA s 77
4.3 Incidence and prevalence figures for major clinical sub¬
types of pituitary tumours 80
4.4 Frequency of tumour subtypes 80
5.1 Major physiological regulators of prolactin secretion 96
5.2 Causes of hyperprolactinaemia 99
6.1 Studies examining the prevalence of colonic neoplasia in
acromegaly since 1988 117
6.2 Causes of failure of suppression of GH during OGTT 119
6.3 Mortality in successfully treated and unsuccessfully treated
acromegaly 121
6.4 Studies investigating long term outcome of radiotherapy
using normalisation of IGF I as outcome 122
7.1 Clinical Features of the Syndrome as collated by Cushing 129
7.2 Clinical Features of Cushing s Syndrome 130
7.3 Discriminant Indices of Clinical Features in Cushing s
Syndrome 131
7.4 Symptoms and signs of Cushing s syndrome in 59 chil¬
dren and adolescents 133
7.5 Alternative diagnoses to endogenous Cushing s syndrome 134
7.6 Combined results of CRH and high dose dexamethasone
tests in 23 confirmed pituitary cases who had both tests
performed. 142
8.1 Clinical characteristics of patients with TSH oma 172
xvi PITUITARY DISEASE
8.2 Biochemical data on patients with TSH oma reported in
the Literature. 173
8.3 Differential diagnosis between TSH secreting adenomas
(TSH omas) and resistance to thyroid hormones (RTH) 177
9.1 Clinical and pathological characteristics of adamantinous
and papillary variants of craniopharyngioma 186
9.2 Clinical presentation of craniopharyngioma 189
9.3 Pre operative factors associated with poor outcome in
radical surgery for craniopharyngioma 192
9.4 Factors associated with increased rate of recurrent dis¬
ease 197
10.1 Lesions of the Sella Turcica and Parasellar Areas 209
10.2 Frequency of Pituitary Adenomas Found at Autopsy 210
10.3 Natural History of Untreated Pituitary Incidentalomas 215
|
| any_adam_object | 1 |
| building | Verbundindex |
| bvnumber | BV014515768 |
| callnumber-first | R - Medicine |
| callnumber-label | RC658 |
| callnumber-raw | RC658 |
| callnumber-search | RC658 |
| callnumber-sort | RC 3658 |
| callnumber-subject | RC - Internal Medicine |
| classification_rvk | YC 3800 |
| ctrlnum | (OCoLC)49860362 (DE-599)BVBBV014515768 |
| dewey-full | 616.4/7 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 616 - Diseases |
| dewey-raw | 616.4/7 |
| dewey-search | 616.4/7 |
| dewey-sort | 3616.4 17 |
| dewey-tens | 610 - Medicine and health |
| discipline | Medizin |
| format | Book |
| fullrecord | <?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01503nam a2200421zcb4500</leader><controlfield tag="001">BV014515768</controlfield><controlfield tag="003">DE-604</controlfield><controlfield tag="005">20021106 </controlfield><controlfield tag="007">t</controlfield><controlfield tag="008">020603s2002 xxuad|| |||| 00||| eng d</controlfield><datafield tag="010" ind1=" " ind2=" "><subfield code="a">2002069475</subfield></datafield><datafield tag="020" ind1=" " ind2=" "><subfield code="a">1402071221</subfield><subfield code="9">1-402-07122-1</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(OCoLC)49860362</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)BVBBV014515768</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-604</subfield><subfield code="b">ger</subfield><subfield code="e">aacr</subfield></datafield><datafield tag="041" ind1="0" ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="044" ind1=" " ind2=" "><subfield code="a">xxu</subfield><subfield code="c">US</subfield></datafield><datafield tag="049" ind1=" " ind2=" "><subfield code="a">DE-355</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">RC658</subfield></datafield><datafield tag="082" ind1="0" ind2=" "><subfield code="a">616.4/7</subfield><subfield code="2">21</subfield></datafield><datafield tag="084" ind1=" " ind2=" "><subfield code="a">YC 3800</subfield><subfield code="0">(DE-625)153217:12905</subfield><subfield code="2">rvk</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Pituitary disease</subfield><subfield code="c">ed. by Michael C. Sheppard ...</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="a">Boston [u.a.]</subfield><subfield code="b">Kluwer Acad. Publ.</subfield><subfield code="c">2002</subfield></datafield><datafield tag="300" ind1=" " ind2=" "><subfield code="a">XXI, 276 S.</subfield><subfield code="b">Ill., graph. Darst.</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="b">n</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="b">nc</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="490" ind1="1" ind2=" "><subfield code="a">Endocrine updates</subfield><subfield code="v">18</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Pituitary Diseases</subfield><subfield code="x">diagnosis</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Pituitary Diseases</subfield><subfield code="x">therapy</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Pituitary gland</subfield><subfield code="x">Diseases</subfield></datafield><datafield tag="650" ind1="0" ind2="7"><subfield code="a">Hypophysenkrankheit</subfield><subfield code="0">(DE-588)4026390-3</subfield><subfield code="2">gnd</subfield><subfield code="9">rswk-swf</subfield></datafield><datafield tag="689" ind1="0" ind2="0"><subfield code="a">Hypophysenkrankheit</subfield><subfield code="0">(DE-588)4026390-3</subfield><subfield code="D">s</subfield></datafield><datafield tag="689" ind1="0" ind2=" "><subfield code="5">DE-604</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Sheppard, Michael C.</subfield><subfield code="e">Sonstige</subfield><subfield code="4">oth</subfield></datafield><datafield tag="830" ind1=" " ind2="0"><subfield code="a">Endocrine updates</subfield><subfield code="v">18</subfield><subfield code="w">(DE-604)BV012381937</subfield><subfield code="9">18</subfield></datafield><datafield tag="856" ind1="4" ind2="2"><subfield code="m">HBZ Datenaustausch</subfield><subfield code="q">application/pdf</subfield><subfield code="u">http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009886384&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA</subfield><subfield code="3">Inhaltsverzeichnis</subfield></datafield><datafield tag="999" ind1=" " ind2=" "><subfield code="a">oai:aleph.bib-bvb.de:BVB01-009886384</subfield></datafield></record></collection> |
| id | DE-604.BV014515768 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T19:03:12Z |
| institution | BVB |
| isbn | 1402071221 |
| language | English |
| lccn | 2002069475 |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-009886384 |
| oclc_num | 49860362 |
| open_access_boolean | |
| owner | DE-355 DE-BY-UBR |
| owner_facet | DE-355 DE-BY-UBR |
| physical | XXI, 276 S. Ill., graph. Darst. |
| publishDate | 2002 |
| publishDateSearch | 2002 |
| publishDateSort | 2002 |
| publisher | Kluwer Acad. Publ. |
| record_format | marc |
| series | Endocrine updates |
| series2 | Endocrine updates |
| spelling | Pituitary disease ed. by Michael C. Sheppard ... Boston [u.a.] Kluwer Acad. Publ. 2002 XXI, 276 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Endocrine updates 18 Pituitary Diseases diagnosis Pituitary Diseases therapy Pituitary gland Diseases Hypophysenkrankheit (DE-588)4026390-3 gnd rswk-swf Hypophysenkrankheit (DE-588)4026390-3 s DE-604 Sheppard, Michael C. Sonstige oth Endocrine updates 18 (DE-604)BV012381937 18 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009886384&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pituitary disease Endocrine updates Pituitary Diseases diagnosis Pituitary Diseases therapy Pituitary gland Diseases Hypophysenkrankheit (DE-588)4026390-3 gnd |
| subject_GND | (DE-588)4026390-3 |
| title | Pituitary disease |
| title_auth | Pituitary disease |
| title_exact_search | Pituitary disease |
| title_full | Pituitary disease ed. by Michael C. Sheppard ... |
| title_fullStr | Pituitary disease ed. by Michael C. Sheppard ... |
| title_full_unstemmed | Pituitary disease ed. by Michael C. Sheppard ... |
| title_short | Pituitary disease |
| title_sort | pituitary disease |
| topic | Pituitary Diseases diagnosis Pituitary Diseases therapy Pituitary gland Diseases Hypophysenkrankheit (DE-588)4026390-3 gnd |
| topic_facet | Pituitary Diseases diagnosis Pituitary Diseases therapy Pituitary gland Diseases Hypophysenkrankheit |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=009886384&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV012381937 |
| work_keys_str_mv | AT sheppardmichaelc pituitarydisease |