National Cancer Institute®
Last Modified: February 1, 2002
UI - 11523900
AU - Shimizu C; Yamane Y; Ishizuka T; Kijima H; Takano K; Takano A; Kubo M;
TI - Koike T Involvement of the cholinergic pathway in the pathogenesis of pituitary Cushing's syndrome.
SO - Endocr J 2001 Jun;48(3):303-9
AD - Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Transsphenoidal adenomectomy is currently the first choice for treatment of patients with pituitary ACTH-dependent Cushing's syndrome. However, pharmacotherapy is prescribed for some patients, e.g., unsuccessful surgery. We treated a woman in whom pituitary Cushing's syndrome was improved while she was on antimuscarinic cholinergic agents, atropine sulphate and pirenzepine hydrochloride. The diminished effect of anticholinergics on ACTH and cortisol was incidentally identified in an inferior petrosal sinus sampling procedure. A single intramuscular injection of atropine significantly decreased both ACTH (43.9 pg/ml to less than 12.0; normal, 12.0-40.0 pg/ml) and cortisol (29.9 microg/dl to 13.6; normal, 7.6-23.6 microg/dl). An M1-muscarinic receptor specific antagonist, pirenzepine hydrochloride, also had a diminishing effect on these hormones and this inhibiting effect was partially blocked by the simultaneous administration of an anticholinesterase agent, pyridostigmine bromide. Chronic oral ingestion of these agents led to improvement in clinical symptoms, and urinary 17-hydroxycorticosteroid and 17-ketosteroid levels were at normal to upper-normal levels. This is the first documentation of involvement of the cholinergic system in the pathogenesis of pituitary Cushing's syndrome.
UI - 11765417
AU - Iushkov PV; Gracheva IA; Marova EI
TI - [Functional morphology and prognosis of hormonally-active pituitary adenomas]
SO - Arkh Patol 2001 Sep-Oct;63(5):50-7
AD - Endocrinological Research Centre, 117036, Moscow.
This paper is a review of literature on the etiology, pathogenesis and morphogenesis (electron microscopy, immunocytochemistry) of pituitary adenomas (PA). Clinical manifestations of PA are considered depending on their structure. Approaches to the clinico-morphological classification of PA and factors of their prognosis are discussed.
UI - 11797351
AU - Fukushima Y; Oka H; Utsuki S; Fujii K
TI - [A symptomatic Rathke's cleft cyst with pituitary apoplexy: a case report]
SO - No Shinkei Geka 2001 Dec;29(12):1183-7
AD - Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
We encountered a rare case of symptomatic Rathke's cleft cyst associated with pituitary apoplexy. To our knowledge, six cases have been reported in the literature. The mechanism of this symptom is still obscure because of the rare pathological findings concerning Rathke's cleft cysts. Judging from the operative and the histopathologic findings, we speculate that pituitary apoplexy could occur due to hemorrhage from certain vessels such as compressed portal veins or newly organized vessels of the granulation tissue of the cyst wall.
UI - 11731862
AU - Kilic T; Ekinci G; Seker A; Elmaci I; Erzen C; Pamir MN
TI - Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information.
SO - Acta Neurochir (Wien) 2001 Nov;143(11):1103-26
AD - Marmara University Institute of Neurological Sciences, Istanbul, Turkey.
There is no agreed-upon schedule for MRI follow-up after pituitary adenoma removal via the transsphenoidal approach. Our aim was to establish a plan for MRI follow-up after pituitary surgery. Eighty pituitary adenoma cases (25 microadenomas, 30 macroadenomas that did not infiltrate the cavernous sinus, and 25 macroadenomas with cavernous sinus infiltration) were prospectively studied with MRI following tumor resection via the transsphenoidal approach. Each patient was imaged at 24 hours, at 3, 6 and 9 months, and at 1 year or more postsurgery. The parameters studied were residual tumor, synthetic packing material (Gelfoam) versus fat graft, and normal pituitary, hypophyseal stalk and optic chiasma. The size of the pituitary structure as a whole was also measured. The latter was studied quantitatively, and the findings for the rest of the parameters were evaluated qualitatively, based on the examiners' confidence in their assessment. The final MRI study, done at least 1 year postsurgery in all cases, was considered the reference MRI for all scans. MRI performed 24 hours after surgery was diagnostically accurate for residual tumor and valuable for visualizing normal sellar structures. The findings also showed that fat packing takes longer to resorb than Gelfoam, but produces no potentially confounding contrast enhancement. An algorithm based on the results is presented for postsurgical MRI assessment of pituitary adenoma patients in which the scan at 24 hours postsurgery is the major factor that determines the timing of later rechecks.
UI - 11585327
AU - Kim SK; Wang KC; Shin SH; Choe G; Chi JG; Cho BK
TI - Radical excision of pediatric craniopharyngioma: recurrence pattern and prognostic factors.
SO - Childs Nerv Syst 2001 Sep;17(9):531-6; discussion 537
AD - Division of Pediatric Neurosurgery, Cancer Research Institute, Seoul National University Children's Hospital, Korea.
The purpose of our study was to investigate the pattern of recurrence and the prognostic factors for recurrence of pediatric craniopharyngiomas after radical excision. A series of 36 patients with craniopharyngiomas (21 boys and 15 girls; age range 1-15 years; mean 7.3 years) were reviewed. All patients had undergone radical excision without radiotherapy. The mean follow-up period was 52 months (range 1-149 months). Tumors recurred in 14 patients within 83 months (mean 31.4 months). The overall 5-year recurrence-free survival rate was 55%. Regular neuroimaging follow-up detected tumor recurrence while the lesions were still small before symptoms developed (P<0.05). At the first surgical procedure, the optic nerve/chiasm (n=23) was the most common adhesion site. The most frequent sites of recurrence were the optic nerve/chiasm (n=6) and the pituitary fossa (n=6). Tumor location was the single significant clinical predictor of recurrence. The 5-year recurrence-free survival rate was 39% for those who had an intrasellar tumor component and 81% for those who did not (P<0.05). The Ki-67 labeling indices (LIs) of primary tumors did not have prognostic value for recurrence. Recurrent tumors tended to have higher Ki-67 LIs than their primary counterparts. On the basis of this study, we concluded that craniopharyngiomas with intrasellar components should be followed cautiously and the necessity for regular follow-up should be emphasized, even when the tumor is "totally" resected.
UI - 11564379
AU - Stavrou S; Kleinberg DL
TI - Rheumatic manifestations of pituitary tumors.
SO - Curr Rheumatol Rep 2001 Oct;3(5):459-63
AD - NYU School of Medicine, 423 East 23rd Street, New York, NY 10010, USA. firstname.lastname@example.org
Pituitary tumors may cause rheumatologic problems as a result of under production or overproduction of one pituitary hormone. Excessive growth hormone causes destruction of cartilage by a direct action. Facial and acral changes and arthralgias may be some of the first symptoms of acromegaly. The arthritis associated with acromegaly is often devastating. Carpal tunnel syndrome is very common in patients with acromegaly. Adrenocorticotropin (ACTH) has indirect effects via the action of glucocorticoid on bones, muscles, and the immune system. Proximal muscle weakness is a characteristic feature of Cushing's syndrome. Patients with Cushing's syndrome commonly have osteopenia and osteoporosis that lead to an increase in bone fractures. Avascular necrosis is associated with exogenous steroid administration. The effects of too much glucocorticoid or too rapid withdrawal can be severe. Gonadotropins act via the gonadal steroids and protect bone mass from loss. Prolactin is less involved in rheumatologic disease; the data for which are limited in humans. Pituitary tumors can have manifestations similar to rheumatologic disorders and should be included in the differential diagnosis of these diseases.
UI - 11782869
AU - Vierhapper H; Nardi A; Bieglmayer C
TI - The use of the pyridostigmine growth hormone-releasing hormone stimulation test to detect growth hormone deficiency in patients with pituitary adenomas.
SO - Metabolism 2002 Jan;51(1):34-7
AD - Clinical Division of Endocrinology and Metabolism, Department of Internal Medicine III, Institute for Medical Computer Sciences, University of Vienna, Vienna, Austria.
The pyridostigmine (PD)/growth hormone-releasing hormone (GHRH) stimulation test was used to determine growth hormone (GH) secretion in patients with pituitary adenomas prior to (n = 55) and after (n = 72) transsphenoidal adenomectomy, as well as in 98 controls. In controls, maximum concentrations of GH showed a strong negative relationship both with body mass index (BMI) and age. Having calculated the 95% confidence intervals for maximum GH concentrations to be expected for any given age and BMI according to a statistical model, we compared these individually predicted ranges to GH concentrations actually observed in patients with pituitary disease during PD/GHRH stimulation. Preoperatively and postoperatively, a maximum GH concentration below the calculated confidence intervals was seen in 29 of 55 (52%) and in 57 of 72 (79%) of these patients, respectively. In the remaining patients, maximum GH concentrations were in or above the range defined by these confidence intervals. Our results indicate that maximum concentrations of GH during the PD/GHRH test depend to a large extent on the individuals' age and BMI. The results obtained with the PD/GHRH stimulation must, in each individual patient, be compared with a large control group taking into account both age and BMI. In individuals older then 55 years and with a BMI greater than 35 kg/(2), the diagnosis of GH deficiency cannot safely be made, at least not with this test. Copyright 2002 by W.B. Saunders Company
UI - 11813510
AU - Velkeniers B
TI - From prolactin cell to prolactinoma.
SO - Verh K Acad Geneeskd Belg 2001;63(6):561-73; discussion 574-6
AD - A.Z.-Vrije Universiteit Brussel Vakgroep Inwendige Geneeskunde Laarbeeklaan 101-B 1090 Brussel.
The pathogenesis, diagnosis and treatment of common pituitary neoplasms is based on the understanding of the differentiated hormone expression by specific pituitary cell types and of the central hypothalamic, peripheral and local control of their hormonal secretion (endocrine, autocrine, paracrine regulation). Tumorigenesis is the result of a complex multistep process. It is likely that a molecular genetic alteration initially leads to cell transformation. Nevertheless the transformed cell is dependent on hormonal and/or growth factor stimulation for tumor progression. This cascade is responsible for autonomic hormone secretion, and cell proliferation. PRL cells do not behave identically in terms of cell function. Functional diversity among PRL cells is documented in vitro, in terms of basal and synthetic capacity and in respect to responsiveness to dopamine and oestrogen regulation. These in vitro observations can be extended to the in vivo situation. In the intact pituitary, PRL cells differ in their relative content of PRL and their response to secretagogues. These differences relate to their topographical localization within the pituitary. Prolactinoma are mainly composed of cells with a high basal synthetic and secretory capacity and arise preferentially in the peripheral parts of the hypophysis. It is therefore tempting to postulate that the "in situ milieu" within the pituitary is relevant for the development of prolactinoma. By stimulating growth in certain areas, there is an increased probability of mutation. At the same time growth of a mutated PRL cell could be stimulated.
UI - 11579678
AU - Tziortzioti V; Ruebel KH; Kuroki T; Jin L; Scheithauer BW; Lloyd RV
TI - Analysis of beta-catenin mutations and alpha-, beta-, and gamma-catenin expression in normal and neoplastic human pituitary tissues.
SO - Endocr Pathol 2001 Summer;12(2):125-36
AD - Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN, USA.
The cadherin-catenin system mediates Ca(2+)-dependent cell-cell adhesion, and genetic alterations in these molecules play a significant role in multistage carcinogenesis. Mutations in the beta-catenin gene, mostly affecting exon 3, have been detected in malignant cell lines and in primary tumors. Immunohistochemical abnormalities in alpha-, beta-, and gamma-catenin have been reported in malignant and benign tumors, and nuclear localization of beta-catenin has been associated with mutations in exon 3 of this gene. Mutational analysis of exon 3 of the beta-catenin gene was undertaken by polymerase chain reaction (PCR) and sequencing using genomic DNA extracted from frozen tissues, including 4 normal pituitaries, 22 pituitary adenomas, and one pituitary carcinoma. Frozen sections from these cases were used for immunohistochemical detection of beta-catenin. We also analyzed immunohistochemical expression of alpha-, beta-, and gamma-catenin by paraffin sections from 154 pituitary tumors, including 148 adenomas and 6 carcinomas. Genomic DNA was extracted from paraffin sections of 2 gonadotroph tumors showing nuclear staining for beta-catenin and was used for PCR and sequencing of exon 3 of the beta-catenin gene. No mutations in exon 3 of the beta-catenin gene were found in any of the 23 cases analyzed by PCR and sequencing. In addition, the 2 cases studied by paraffin section immunohistochemistry, with nuclear staining for beta-catenin, were negative for mutations in this exon. Normal pituitary expressed all three catenin proteins. Immunostaining usually showed a membranous pattern of reactivity and was generally stronger in normal pituitary than in the adjacent adenomas. Stains for alpha-catenin were positive in fewer tumors than for beta-catenin. The lowest frequency immunopositive tumors and the weakest immunostaining was for gamma-catenin. All medically treated prolactinomas were negative for gamma-catenin, whereas treated growth hormone adenomas were less often positive for both alpha- and gamma-catenin than for untreated tumors. The percentage of positive cases for beta-catenin was the same in these two groups. Most pituitary carcinomas were negative for both alpha- and gamma-catenin but were beta-catenin positive. These results indicate that (i) mutations in exon 3 of the beta-catenin gene are uncommon in pituitary tumors, and (ii) expression of alpha-, beta-, and gamma-catenin is decreased in pituitary adenomas compared to normal pituitary tissues.
UI - 11579682
AU - Klencki M; Kurnatowska I; Slowinska-Klencka D; Lewinski A; Pawlikowski M
TI - Correlation between PCNA expression and AgNOR dots in pituitary adenomas.
SO - Endocr Pathol 2001 Summer;12(2):163-9
AD - Department of Thyroidology, Institute of Endocrinology, Medical University of Lodz, Dr. Sterling St. 3, 91-425 Lodz, Poland.
Nucleolar organizer regions are segments of DNA associated with argyrophilic proteins (AgNORs). Our previous findings showed that the number, the area, and the intranuclear localization of AgNOR dots differ according to tumor aggressiveness and to the hormone-immunopositivity of pituitary adenomas. Proliferating cell nuclear antigen (PCNA) is a nuclear protein, whose expression is correlated with cell proliferation. The aim of the present paper was to examine PCNA-labeling indexes in pituitary adenomas and to correlate them with AgNOR dots in various immunohistochemical types of the tumors. Histological slides from 32 pituitary tumors and one normal pituitary were silver-stained and analyzed with a computerized system for microscopic image analysis. We found that the percentage of PCNA-positive cells did not differ significantly among examined groups of monohormonal adenomas. However, tumors immunopositive for alpha-subunit (alpha-SU) showed a significantly higher (p < 0.05) PCNA index than adenomas immunonegative for that unit. PCNA index in recurrent tumors was significantly higher than in primary adenomas. There was a moderate positive correlation between the PCNA index and the mean area of AgNOR dots and a similar correlation between the PCNA index and the area of the biggest dot in the nucleus. The obtained results reveal that the PCNA indexes and estimated parameters of AgNOR dots differ according to tumor aggressiveness.
UI - 11579683
AU - Munscher A; Schmid M; Saeger W; Schreiber S; Ludecke DK
TI - GH-, PRL-, POMC-, beta-TSH-, beta-LH-, beta-FSH-mRNA in gonadotroph adenomas of the pituitary by in situ hybridization in comparison with immunostaining and clinical data.
SO - Endocr Pathol 2001 Summer;12(2):171-80
AD - Institute of Pathology, Marienkrankenhaus, Alfredstr. 9, D-22087 Hamburg, Germany.
In situ hybridization (ISH) enables the visualization of specific mRNA for pituitary hormones. Our collection consists of 40 surgically removed pituitary adenomas that were classified as follicle stimulating hormone/luteinizing hormone (FSH/LH) cell adenomas by structure and by immunostaining (IH) for all pituitary hormones. All forty adenomas were regarded as clinically inactive. The aim of our study was to examine nonfunctioning adenomas by ISH for demonstration of mRNAs for all pituitary hormones. The results were compared with proliferation markers, invasiveness and clinical data. ISH detected signals for all pituitary hormones at a range of 30% for prolactin (PRL) to 85% for proopiomelanocortin (POMC). mRNA for beta-FSH was detected in 70% and beta-LH mRNA in 43% of adenomas. Thirty-three percent of adenomas revealed negative mRNA detection for beta-LH but positive hormone content. The majority of adenomas (75%) expressed more than two mRNAs simultaneously, mostly the combination of POMC mRNA together with beta-FSH mRNA and one to four others. Comparison with clinical data showed no significant differences except for one adenoma with a high Ki-67 index (> 2.1% positive nuclei). This adenoma showed very high signals for PRL and beta-TSH mRNA.
UI - 11579684
AU - Komatsubara K; Tahara S; Umeoka K; Sanno N; Teramoto A; Osamura RY
TI - Immunohistochemical analysis of p27 (Kip1) in human pituitary glands and in various types of pituitary adenomas.
SO - Endocr Pathol 2001 Summer;12(2):181-8
AD - Department of Neurosurgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
p27 (Kip1) plays regulatory roles in the cell cycle by inhibiting the activity of cyclin dependent kinases (CDKs). This immunohistochemical study is aimed at elucidating the expression of p27 in human pituitary and in various types of pituitary adenomas in order to clarify its role in the regulation of proliferation. Sixteen normal pituitary glands and 179 human pituitary adenomas were used for immunohistochemical studies. The tissues were fixed in 10% formalin and embedded in paraffin. Indirect peroxidase method was performed after heat-induced antigen retrieval using a monoclonal antibody against p27 protein. p27 protein was expressed in the nuclei of all 16 normal human pituitary glands. p27 protein was also expressed in 128 of 179 cases of pituitary adenomas (71.5%). A marked decrease of p27 expression was noted in ACTH-secreting adenomas, 8/20 (40.0%), compared with other types of pituitary adenomas--GH-secreting adenomas, 35/46 (76.1%); PRL-secreting adenomas, 22/33 (66.7%); TSH-secreting adenomas, 8/11 (72.7%); and nonfunctioning adenomas, 55/69 (79.7%). These results suggest that p27 may play some role in the regulation of proliferation in all types of pituitary adenomas. The lower levels of p27 in ACTH-secreting adenoma is of particular interest with respect to the intermediate lobe-derived pituitary tumor developed in p27 knockout mice.
UI - 11814004
AU - Freitag SK; Miller NR; Brem H
TI - Recurrent ectopic craniopharyngioma.
SO - Br J Neurosurg 2001 Dec;15(6):511-3
AD - Neuro-Ophthalmology Unit, Wilmer Eye Institute, and Department of Ophthalmology, Johns Hopkins Medical Institutions, Baltimore, USA.
A 66-year-old woman developed an asymptomatic mass in the right frontal lobe 5 years after undergoing a right frontal craniotomy and removal of a craniopharyngioma. The mass progressively enlarged over the next 3 years, during which time it became multiloculated and partially cystic. Repeat craniotomy was performed 8 years after the original operation, at which time the mass was found to be an ectopic craniopharyngioma. The lesion probably resulted from seeding of tumour cells along the surgical tract at the time of the initial surgery.
UI - 11814008
AU - Saeki N; Murai H; Kubota M; Fujimoto N
TI - Oedema along the optic tracts due to pituitary metastasis.
SO - Br J Neurosurg 2001 Dec;15(6):523-6
AD - Department of Neurological Surgery, Chiba University School of Medicine, Chiba City, Japan. email@example.com
The MRI finding of oedema along the optic tract has been reported in patients with craniopharyngioma, as a useful diagnostic sign among common pituitary tumours. We report two patients with pituitary metastasis with this MRI finding. A 59-year-old woman and a 54-year-old man had diabetes insipidus and extraocular impairment due to a pituitary metastasis tracts. To our knowledge, this is the first MRI report of oedema along the optic pathway due to pituitary metastasis. Our cases and review of literature indicate that this MRI sign is non-specific. Appearance of the oedema well corresponded to the initiation of visual complaint, which make a good contrast to reported clinical presentations of craniopharyngioma. Clinical significance and pathomechanism of this MRI sign are discussed.
UI - 11769028
AU - West WM
TI - Images and diagnoses. Craniopharyngioma.
SO - West Indian Med J 2001 Sep;50(3):222, 248
AD - Department of Surgery, Radiology, Anaesthesia and Intensive Care (Section of Radiology), University of the West Indies, Kingston 7, Jamaica.
UI - 11745074
AU - Noga C; Prayson RA; Kowalski R; Sweeney PJ; Mayberg M
TI - Metastatic adenocarcinoma to a pituitary adenoma.
SO - Ann Diagn Pathol 2001 Dec;5(6):354-60
AD - Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Metastatic tumor to a pituitary adenoma has rarely been documented in the literature. We report a case of a 60-year-old man who presented with a history of progressive blurred vision and an incomplete homonymous hemianopsia. Magnetic resonance imaging showed a 5 cm heterogeneous mass which focally was contrast enhancing, involving the sella turcica and extending into the right cavernous sinus region. After worsening symptoms, repeat magnetic resonance imaging showed an increase in size of the lesion. Histologically, the mass consisted of a metastatic adenocarcinoma to a nonsecreting pituitary adenoma. The carcinoma stained focally positive with antibodies to carcinoembryonic antigen, cytokeratin 20, and p53 (60% of tumor cells), and did not stain with antibody to cytokeratin 7. The histologic appearance and immunohistochemical profile of the metastasis suggests a colorectal primary. Copyright 2001 by W.B. Saunders Company
UI - 10883916
AU - Atkinson JL; Kasperbauer JL; James EM; Lane JI; Nippoldt TB
TI - Transcranial-transdural real-time ultrasonography during transsphenoidal resection of a large pituitary tumor. Case report.
SO - J Neurosurg 2000 Jul;93(1):129-31
AD - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, 55905, USA. firstname.lastname@example.org
Ultrasonography has been used in neurosurgical operative procedures for several decades. The authors report the case of a large pituitary tumor that was subtotally resected using endoscopy via the transnasal-transsphenoidal approach, with the aid of transcranial real-time ultrasound. To our knowledge, this is the first reported case in which intraoperative transcranial-transdural real-time ultrasound was used to facilitate the resection of a skull base tumor.
UI - 11012567
AU - Courtney CH; McAllister AS; McCance DR; Bell PM; Hadden DR; Leslie H;
TI - Sheridan B; Atkinson AB Comparison of one week 0900 h serum cortisol, low and standard dose synacthen tests with a 4 to 6 week insulin hypoglycaemia test after pituitary surgery in assessing HPA axis.
SO - Clin Endocrinol (Oxf) 2000 Oct;53(4):431-6
AD - Sir George E Clark Metabolic Unit, Regional Endocrine Laboratory, Royal Victoria Hospital, Belfast, UK.
OBJECTIVE: To compare the use of 0900 h serum cortisol and both low and standard dose Synacthen tests, one week after pituitary surgery with an insulin hypoglycaemia test performed 4-6 weeks after surgery in assessing the integrity of the hypothalamic-pituitary-adrenal (HPA) axis. DESIGN: 0900 h basal serum cortisol was measured on days 6 and 7 after pituitary surgery (24 h off replacement hydrocortisone) followed by a low dose Synacthen test (1 microg intravenously) on day 6 and a standard dose Synacthen test (250 microg intramuscularly) on day 7. Three to 5 weeks later an insulin hypoglycaemia test was performed on all patients. Both low and standard dose Synacthen tests were performed on control subjects using an identical protocol. SUBJECTS: Forty-two patients (21 male, 21 female), median age 49 years (range 23-73) who had pituitary surgery (Cushing's disease excluded). One patient had undergone repeat surgery for residual tumour and was studied following each operation. Sixteen healthy normal volunteers, median age 37 years (range 21-55). MEASUREMENTS: Serum cortisol measured by radioimmunoassay. RESULTS: Two standard deviations below the mean serum cortisol (logarithmic transformation) in the normal volunteers 30 minutes after low dose Synacthen (1 microg) was 496 nmol/l and after standard dose Synacthen (250 microg) was 504 nmol/l. A normal response was therefore taken as serum cortisol > 500 nmol/l at 30 minutes in both tests (using 496 and 504 nmol/l did not alter results). 0900 h serum cortisols 1 week after surgery were > 250 nmol/l in 31 patients and 29 of these had a normal response to hypoglycaemia (peak serum cortisol > 550 nmol/l). Of the remaining two patients, one had 0900 h serum cortisol on day 6 and 7 after surgery of 405 and 441 nmol/l with a peak serum cortisol response to hypoglycaemia of 451 nmol/l; the other patient had 0900 h serum cortisols of 416 and 251 nmol/l and a peak cortisol response to hypoglycaemia of 498 nmol/l. All eight patients who had a 0900 h serum cortisol < 100 nmol/l failed a subsequent insulin hypoglycaemia test. Seven discrepancies were noted between the low dose Synacthen test and the insulin hypoglycaemia test in the 41 patients who had both tests. In six of these, a subnormal response to low dose Synacthen was followed by a normal response to hypoglycaemia. Three discrepancies were noted between the standard dose Synacthen test and the insulin hypoglycaemia test in the 40 patients who had both tests. In all three cases a normal response to Synacthen was followed by a subnormal response to hypoglycaemia. CONCLUSIONS: A 0900 h serum cortisol < 100 nmol/l (24 h off replacement hydrocortisone) indicated ACTH deficiency and need for lifelong steroid replacement. A 0900 h serum cortisol > 450 nmol/l one week after pituitary surgery is highly suggestive of a normal cortisol response to hypoglycaemia. A 0900 h serum cortisol between 250 and 450 nmol/l one week after pituitary surgery permits safe withdrawal of steroid therapy pending an insulin hypoglycaemia test 1 month after surgery. Patients with 0900 h serum cortisol between 100 and 250 nmol/l should continue replacement steroids until definitive testing. Low dose and standard dose Synacthen tests 1 week after pituitary surgery are unreliable and should not be used.
UI - 11730593
AU - Bonet Serra B; Garcia Perez A; Quintanar Rioja A; Lopez Lafuente J;
TI - Alaves Buforn M; Echavarri Olavarria F [Precocious puberty and pituitary incidentaloma]
SO - An Esp Pediatr 2001 Dec;55(6):561-4
AD - Unidad de Pediatria, Universidad Rey Juan Carlos, Spain. email@example.com
The case of an 9-year-old girl with precocious puberty and a non-functioning pituitary adenoma is described. A review of the literature on the incidence, evolution and therapeutic options of pituitary incidentalomas in children and adults is performed.
UI - 11733836
AU - Fonseca AL; Souto AA; Domingues F; Vaisman M; Gadelha MR; Chimelli L;
TI - Santos MJ; Violante AH [Hormonal dysfunction of nonpituitary lesions from midline and perisellar area]
SO - Arq Neuropsiquiatr 2001 Dec;59(4):905-12
AD - Servico de Neurocirurgia, Hospital Universitario Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
OBJECTIVE: To analyse clinical and/or laboratorial preoperative hormonal dysfunction, of the nonpituitary intracranial lesions from midline and parasellar area. METHOD: Forty-four patients were evaluated with nonpituitary intracranial lesions, who had images studies (computed tomography or magnetic resonance) and preoperative basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests). These patients were divided in two groups. Group I - 34 lesions from midline: 11 craniopharyngiomas, 8 meningiomas, 3 germinomas, 3 tumors of sphenoid sinus, 2 empty sella syndrome, 2 pylocitic astrocytomas, 1 giant aneurysm, 2 mucoceles, 1 III ventricle diverticulum and 1 Rathke's cleft cyst; Group II - 10 lesions from parasellar area: 9 meningiomas and 1 giant aneurysm. RESULTS: In group I, 25/34 (73.5%) patients showed laboratorial hormonal deficit (14 without clinical manifestations) 18/34 (52.9%) hyperprolactinemia (5 with galactorreia) and 8 (53.3%) showed growth hormone deficiency in 15 megatests available in this group; 3 (8.8 %) patients presented central diabetes insipidus (CDI). In group II, 6/10 (60%) patients showed laboratorial hormonal deficit (5 without clinical manifestations), 1 (10%) hyperprolactinemia and 1 growth hormone deficiency (single megatest realized in this group); no patient had preoperative CID. CONCLUSIONS: The presence of nonspecific or poorly valorized clinical manifestations, does not indicate absence of hormonal dysfunction; in this present serie, 19/38 (50%) patients with laboratorial abnormalities, didn't show clinical manifestations. Hormonal dysfunction is frequent in sellar and perisellar nonpituitary lesions, specially involving midline.
UI - 11824143
AU - Jurado S
TI - [A 50-year old patient with macroprolactinoma]
SO - Schweiz Rundsch Med Prax 2002 Jan 9;91(1-2):27-8
AD - Medizinische Universitats-Poliklinik, Kantonsspital Basel.
UI - 11810383
AU - Minniti G; Jaffrain-Rea ML; Esposito V; Santoro A; Moroni C; Lenzi J;
TI - Tamburrano G; Cassone R; Cantore G Surgical treatment and clinical outcome of GH-secreting adenomas in elderly patients.
SO - Acta Neurochir (Wien) 2001 Dec;143(12):1205-11
AD - Division of Neurosurgery, IRCCS NEUROMED University of Rome, Pozzilli, Italy.
Patients older than 65 years represent 3-5% of all acromegalic patients. The old age of the patients and the higher incidence of cardiovascular and metabolic complications related to acromegaly could increase the intra- and peri-operative risk, so that medical treatment is usually recommended as a therapy of choice. The aim of this retrospective study was to investigate the impact of transsphenoidal surgery in a series of 22 elderly patients with active acromegaly, with special regard to anaesthesiological risk, peri-operative complications, and clinical outcome. Despite an increased anesthesiological risk being present in 16/22 patients, no complication occurred during surgery. Similarly, no post-operative mortality or major complications were observed. Biochemical cure, defined at 6 months by glucose-suppressed plasma GH levels below 1 ng/ml and normal age-corrected IGF-I value levels, was achieved in 68% of patients and no recurrence of disease was observed in the subsequent follow-up (mean 5.2+/-2.1 years). A significant cardiovascular improvement was observed in cured patients, with a decrease of left ventricular mass index (91.3+/-20.1 vs 115.9+/-15.0 g/m(2); P<0.005), as measured by echocardiography, as well as a slight but significant decrease of systolic and diastolic blood pressure values (130.0+/-12.1 mmHg vs 137.6+/-13.5 mmHg P<0.05; and 84.2+/-6.4 mmHg vs 88.8+/-7.5 mmHg P<0.05, respectively). A significant post-operative improvement of glucose tolerance was also observed in this group. We conclude that transsphenoidal surgery, if well planned and carefully performed, is safe and able to induce a significant cardiovascular and metabolic improvement even in elderly acromegalic patients.
UI - 11603573
AU - Matsuura I; Saeki N; Kubota M; Murai H; Yamaura A
TI - Infarction followed by hemorrhage in pituitary adenoma due to endocrine stimulation test.
SO - Endocr J 2001 Aug;48(4):493-8
AD - Department of Neurological Surgery, Chiba University School of Medicine, Japan.
A 63-year-old man, who presented with visual field loss due to pituitary tumor, received an intravenous bolus injection of thyrotropin and gonadotropin releasing hormones and insulin as a preoperative evaluation. He complained of severe headache and nausea 2 hours after injection. Emergent CT scan showed no evidence of intratumoral hemorrhage. The next day, his visual field became null. MR images revealed heterogeneous mixed intensity lesions. Under diagnosis of pituitary apoplexy, he underwent transsphenoidal tumor removal 30 hours after onset. Intraoperative and pathological findings showed tumor hemorrhage and adjacent necrotic change. Fourteen cases with sufficient clinical detail in the literature are reviewed: All of the cases had macroadenoma with suprasellar extension. Testing agents were gonadotropin and thyrotropin releasing hormones in 92.9% and 85.7% of cases, respectively. Headache was an initial symptom and started within two hours in all cases but one. Half of the cases showed no change on CT scan. However, tumor hemorrhage was evidenced in 92.9% of cases with or without necrosis due to ischemic change, intraoperatively or pathologically. It is speculated that pituitary apoplexy often starts with infarction possibly due to vasoactive effect of testing agents and later develops into hemorrhage. Therefore, it is necessary to observe patients closely at least a few hours after endocrine stimulation test, and MR imaging may make an earlier diagnosis for the pituitary apoplexy since CT scan often shows no density change in the pituitary adenoma.
UI - 11603575
AU - Abe M; Sawabe Y; Mochizuki Y; Sunaga S; Izumiyama H; Matsumoto K;
TI - Kushima M; Taniyama M; Ban Y; Sano T Corticotroph cell adenoma without typical manifestations of Cushing's disease presenting with cavernous sinus syndrome following pituitary apoplexy.
SO - Endocr J 2001 Aug;48(4):503-7
AD - Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan.
This report presents a unique case of corticotroph cell adenoma in a 30-year-old man without acromegaly or features typical of Cushing's disease, who developed cavernous sinus syndrome following pituitary apoplexy. Magnetic resonance imaging revealed a large intrasellar/suprasellar mass with pituitary hemorrhage and extension of a hematoma to the anterior base of the skull. Urgent transnasal pituitary surgery revealed an acidophilic pituitary adenoma, with immunoreactivity for ACTH and GH and expression of proopiomelanocortin (POMC) and GH messenger ribonucleic acid (mRNA) demonstrated by in situ hybridization. To our knowledge, a silent corticotroph cell adenoma with GH production has never been reported. This type of adenoma may potentially enlarge and develop tumoral hemorrhage because it is free of endocrinological symptoms.
UI - 11783414
AU - Jankiewicz-Wika J; Pawlikowski M; Zawirski M; Stepien H
TI - [Pituitary adenoma penetrating the sphenoidal sinus and nasal cavity: a case report]
SO - Neurol Neurochir Pol 2001 Jul-Aug;35(4):727-32
AD - Instytutu Endokrynologii Akademii Medycznej w Lodzi.
We describe a case of pituitary adenoma penetrating to the sphenoidal sinus and nasal cavity in a patient with recurrent nasal polyps. Histopathological examination of the removed polyps revealed transitional carcinoma. CT and MRI of the head showed a solid tumour filling the spheniodal sinus and the sella, penetrating to posterior ethmoid cells and superior nasal duct. In hormonal investigations increased concentration of prolactin (PRL) was found. Histopathological examination performed after neurosurgical operation revealed pituitary adenoma, and the diagnosis of pituitary adenoma was established. About 30% of tumour cells gave positive reaction with anti-PRL antibody in the immunocytochemical investigation. The immunocytochemical investigation of the nasal polips was also done--similarly about 30% of cells showed strong positive reaction with anti-PRL antibody. The investigations indicate the presence of pituitary macroadenoma (prolactinoma), manifesting initially as nose tumour. Considering cases of ectopic pituitary adenomas covered with transitional epithelium (for example some nasal tumours and paranasal sinuses tumours) immunocytochemical investigations are recommended in such cases.
UI - 11795931
AU - Rodewald A; Kittner T; Hahn G
TI - The Carney complex: a rare differential diagnosis in cases with pituitary adenoma and testicular Sertoli cell tumour.
SO - Clin Radiol 2001 Dec;56(12):993-6
AD - Department of Radiology, University of Dresden, Dresden, Germany.
UI - 11807202
AU - Larner AJ
TI - A developing visual field defect.
SO - Postgrad Med J 2002 Feb;78(916):106, 112-3
AD - Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK. firstname.lastname@example.org
UI - 11481087
AU - Orts Costa JA; Camara Gomez R; Laiz Marro B; Ceron Perez JA
TI - [Hyperprolactinemia coexisting with hypophyseal adenoma or microadenoma]
SO - Med Clin (Barc) 2001 Jul 7;117(5):196
UI - 11563625
AU - Rickert CH; Scheithauer BW; Paulus W
TI - Chromosomal aberrations in pituitary carcinoma metastases.
SO - Acta Neuropathol (Berl) 2001 Aug;102(2):117-20
AD - Institute of Neuropathology, University Clinics Munster, Germany. email@example.com
Four pituitary carcinoma metastases [two adrenocorticotropic hormone (ACTH) and prolactin cell tumors each] were studied by comparative genomic hybridization. Chromosomal gains were found in all four carcinoma metastases, but losses only in the two prolactin cell carcinoma metastases. Overall, pituitary carcinoma metastases showed an average of 8.3 chromosomal imbalances per tumor (7 gains vs 1.3 losses), 10 in prolactin cell carcinoma metastases (7.5 gains vs 2.5 losses) and 6.5 in ACTH cell carcinoma metastases (6.5 gains vs 0 loss). The most common changes were gains of chromosome 5, 7p, and 14q (in three tumors each). High-level gains were found on 13q22-qter and 14q (two cases each) and on 1q, 3p, 7, 8, 9p, and 21q (one case each). To date, gains of chromosome 14q have not been reported among pituitary tumors. It remains to be shown whether gain of 14q is associated with malignant progression and metastatic dissemination of pituitary carcinomas.
UI - 11751072
AU - Winkelmann J; Pagotto U; Theodoropoulou M; Tatsch K; Saeger W; Muller A;
TI - Arzberger T; Schaaf L; Schumann EM; Trenkwalder C; Stalla GK Retention of dopamine 2 receptor mRNA and absence of the protein in craniospinal and extracranial metastasis of a malignant prolactinoma: a case report.
SO - Eur J Endocrinol 2002 Jan;146(1):81-8
AD - Department of Neurology, Max-Planck-Institute of Psychiatry, Kraepelinstrasse 10, 80804 Munich, Germany. firstname.lastname@example.org
OBJECTIVES: The case presented here describes the clinical evolution of a malignant prolactinoma with occurrence of intra- and extra-cranial metastases. In this case, the presence of dopamine 2 receptor (D2R) was studied at the mRNA and protein level, in order to understand the pathological background of the resistance to treatment with different dopamine agonists. DESIGN: Together with an extensive description of the clinical history of this case, a combination of in vitro and in vivo techniques was performed to provide the basis of the dopamine resistance developed in the course of the disease. METHOD: A comparison of the D2R was performed in specimens obtained at presentation of the disease compared with autoptic specimens derived from local invasion and metastasis using in situ hybridization and immunohistochemical techniques. RESULTS: Intact D2R mRNA was found in the primitive tumor and metastatic tissues, whereas protein for the same receptor was present only in the tissues derived from neurosurgical operations and not in the metastases obtained post-mortem. CONCLUSION: This is the first report of the absence of D2R protein despite the retention of the transcript in an advanced stage of a malignant prolactinoma. The findings of this single case suggest the hypothesis that postranscriptional mechanisms may contribute to the development of dopamine resistance in prolactinomas.
UI - 11715487
AU - Zhang X; Gu J; Fei Z
TI - [Transsphenoidal microsurgical removal of suprasellar extension pituitary adenomas]
SO - Zhonghua Yi Xue Za Zhi 1999 Nov;79(11):819-21
AD - Department of Neurosurgery, Xi-Jing Hospital, Fourth Military Medical University, Xi'an 710032.
OBJECTIVE: To probe the diagnosis, transsphenoidal microsurgical technique and outcomes of patients with suprasellar extension pituitary adenomas (SEPA). METHODS: A total of 248 patients suffering from SEPA were diagnosed by CT or MRI scanning in our department. All adenomas had suprasellar extension (extension size: > 10 mm). The tumors were removed via sphenoidal approach under a microscope. RESULTS: The gross total removal of adenoma was achieved in 196 patients (79.0%), and subtotal removal in 41 patients (16.5%). Partial removal was carried out in the remaining 11 patients (4.4%) with fibrous or dumbbell-shaped adenomas. There were no deaths after surgery. Long-term follow-up observation (median: 3.5 years) in 227 patients revealed good recovery in 176 (77.5%) and late recurrence in 51 (22.5%). Those patients with tumor recurrence underwent reoperation, drug therapy and radiosurgery either alone or in combination. CONCLUSION: Except for fibrous and dumbbell-shaped ones, microsurgical technique via transsphenoidal approach is a safe and effective way to remove SEPA.
UI - 11743045
AU - Umeoka K; Sanno N; Oyama K; Tahara S; Kurotani R; Ikuyama S; Nakashima
TI - M; Watanabe T; Osamura RY; Teramoto A Immunohistochemical analysis of RCAS1 in human pituitary adenomas.
SO - Mod Pathol 2001 Dec;14(12):1232-6
AD - Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
It has been reported that RCAS1 (receptor-binding cancer antigen expressed on SiSO cells) acts as a ligand for a receptor present on normal peripheral lymphocytes and induces apoptotic cell death. It is expressed in uterine and ovarian carcinomas, especially in invasive cancers. This immunohistochemical study is aimed to elucidate the expression of RCAS1 in human pituitary adenomas in order to clarify its role in their proliferative regulation and invasiveness. Five normal pituitary glands, 50 human pituitary adenomas, and one malignant glioma were subjected to immunohistochemical studies. In normal pituitary glands, immunostaining of RCAS1 and MIB-1 was not found. In malignant glioma, large numbers of cell nuclei were positive for MIB-1 (MIB-1 index: 28%), and RCAS1 was detected both in the cytoplasm and on the membrane of the tumor cells. Expression of RCAS1 was noted in 48% of pituitary adenomas immunohistochemically (60.0% of growth hormone-secreting adenomas, 60.0% of prolactin-secreting adenomas, 42.9% of adrenocorticotrophin-secreting adenomas, 40.0% of thyroid-stimulating hormone-secreting adenomas, 33.3% of nonfunctioning adenomas, and 44.4% of gonadotropin-subunit-positive adenomas). It showed no correlation with tumor type, size, and invasiveness. The statistically significant relationship between RCAS1 and MIB-1 positivity was identified in our study. These results suggest that expression of RCAS1 as well as MIB-1 positivity predict the growth potential of individual pituitary adenomas.
UI - 11826670
AU - Pieters GF
TI - [Diagnostic image (72). An adult woman with coarsening of the face. Acromegaly]
SO - Ned Tijdschr Geneeskd 2002 Jan 19;146(3):115
AD - Universitair Medisch Centrum St Radboud, afd. Endocriene Ziekten, Postbus 9101, 6500 HB Nijmegen.
A 45-year-old woman with acromegaly went into remission after pituitary surgery.