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Abramson Cancer CenterNCI CANCERLIT® Search: Pituitary Tumor - February 2002
National Cancer Institute®
Last Modified: February 1, 2002
Table of Contents
1
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.
2
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.
3
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.
4
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.
5
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.
6
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.
stavrs01@popmail.med.nyu.edu
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.
7
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
8
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.
9
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.
10
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.
11
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.
12
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.
13
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.
14
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. saeki@med.m.chiba-u.ac.jp
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.
15
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.
16
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
17
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. atkinson.john@mayo.edu
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.
18
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.
19
UI - 11302682
AU - Mursch K
TI -
Ultrasonography.
SO - J Neurosurg 2001 Apr;94(4):689
20
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.
bbjbonet@fhalcorcon.es
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.
21
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.
22
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.
23
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.
24
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.
25
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.
26
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.
27
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.
28
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. larner-a@wcnn-tr.nwest.nhs.uk
29
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
30
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.
rickchr@uni-muenster.de
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.
31
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. janew@mpipsykl.mpg.de
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.
32
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.
33
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.
34
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.
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