Document ID: chunk:federal_register_of_legislation:F2024L01049:reg:9
Version: federal_register_of_legislation:F2024L01049
Segment Type: reg
Provision Reference: reg 9
Character Range: 4188–6641

9               Factors that must exist
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting neoplasm of the pituitary gland or death from neoplasm of the pituitary gland with the circumstances of a person's relevant service:
(1)          having undergone bilateral adrenalectomy for the treatment of Cushing syndrome due to a corticotroph pituitary adenoma before the clinical worsening of corticotroph pituitary adenoma;
Note 1: Bilateral adrenalectomy is the excision of both adrenal glands.
Note 2: Cushing disease is Cushing syndrome due to a corticotroph pituitary adenoma.
Note 3: A corticotroph is a cell of the anterior pituitary that secretes corticotropin (adrenocorticotrophic hormone (ACTH)), a hormone that stimulates secretion of corticosteroids from the adrenal cortex.
Note 4: An example of clinical worsening is Nelson syndrome.
(2)          taking one of the following gonadotropin-releasing hormone (GnRH) agonists at the time of pituitary apoplexy of a pre-existing pituitary adenoma:
(a)          goserelin;
(b)          leuprorelin/leuprolide;
(c)          nafarelin; or
(d)          triptorelin;
Note 1: Pituitary apoplexy is a clinical worsening of a pre-existing pituitary adenoma.
Note 2: Pituitary apoplexy is the sudden loss of blood supply to the pituitary gland, leading to tissue necrosis and loss of function.
(3)          taking one of the following hormones as part of a dynamic endocrine test, within the 4 days before pituitary apoplexy of a pre-existing pituitary adenoma:
(a)          gonadotropin-releasing hormone (GnRH)
(b)          growth hormone-releasing hormone (GHRH);
(c)          thyrotropin-releasing hormone (TRH); or
(d)          corticotropin-releasing hormone (CRH);
Note 1: Pituitary apoplexy is a clinical worsening of a pre-existing pituitary adenoma.
Note 2: Pituitary apoplexy is the sudden loss of blood supply to the pituitary gland, leading to tissue necrosis and loss of function.
Note 3: Dynamic endocrine tests assess the dynamic response of hormonal axes to aid diagnosis of endocrine disorders.
(4)          being obese for at least five years, at least 5 years before the clinical onset of pituitary adenoma;
Note 1: being obese in defined in the Schedule 1 dictionary.
(5)          inability to obtain appropriate clinical management for neoplasm of the pituitary gland before clinical worsening.