MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Pituitary' source. Sun, 21 Mar 2010 15:01:57 +0100 http://www.medworm.com/index.php?rid=3360761&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft382051222v354wx%2F We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years. The mean tumor size was 2.2 ± 0.2... Pituitary journals http://www.medworm.com/rss/comments.php?id=3360761 Wed, 10 Mar 2010 18:28:49 +0100 3360761 http://www.medworm.com/index.php?rid=3360762&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj106018620520455%2F Abstract  The aim of the study was to screen the malignancy in an acromegalic patient group and to determine whether there was any increased risk and the incidence of malignancy and its association with disease characteristics such as duration of disease, latency in diagnosis, and GH and IGF-1 levels. One hundred-five (65 female, 40 male) patients with acromegaly followed and treated at Cerrahpasa Medical School, Endocrinology and Metabolism outpatient clinic between 1983 and 2007 were included in this study. The patients were screened with colonoscopy, mammography, and thyroid and prostate ultrasonography (US). Malignancy was detected in 16 (15%) patients. Thyroid cancer was found in 5 patients (4.7%), breast cancer in 3 (2.8%), colon cancer in 2 (1.9%), lung cancer in 2 (... Pituitary journals http://www.medworm.com/rss/comments.php?id=3360762 Wed, 10 Mar 2010 18:28:48 +0100 3360762 http://www.medworm.com/index.php?rid=3313040&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu188613884k6044l%2F Conclusion: A half dose of dynamic resonance imaging contrast material increases the sensitivity of MRI detection of ACTH-secreting pituitary tumors. Content Type Journal ArticleDOI 10.1007/s11102-010-0222-yAuthors Lesly Portocarrero-Ortiz, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez” Department of Endocrinology Insurgentes Sur 3877 Col. La Fama Mexico City 14269 MexicoDulce Bonifacio-Delgadillo, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez” Department of Neuroradiology Insurgentes Sur 3877 Col. La Fama Mexico City 14269 MexicoArturo Sotomayor-González, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez” Department of Neurosurgery Insurgentes Sur 3877 Col. La Fama Mexico City 14269 MexicoArturo Ga... Pituitary journals http://www.medworm.com/rss/comments.php?id=3313040 Thu, 25 Feb 2010 08:00:45 +0100 3313040 http://www.medworm.com/index.php?rid=3308543&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk3114u65v5774v28%2F Abstract  Changes in LH and FSH levels were evaluated before and after metformin administration. In all 25 patients, plasma LH levels were significantly reduced after 3 months of metformin administration (500–1,500 mg/day). When patients were classified into a PCOS group (n = 12) or a non-PCOS group (n = 13), the reduction in LH levels only remained significant in the PCOS group. Plasma FSH levels were unchanged following metformin treatment when all patients were considered collectively and when patients were classified based on PCOS. LH/FSH ratio was significantly reduced only in the PCOS group. To examine the direct effect of metformin on gonadotropin-secreting cells, gonadotroph cell line, LβT2 was used for in vitro studies. Treatment of ... Pituitary journals http://www.medworm.com/rss/comments.php?id=3308543 Wed, 24 Feb 2010 06:54:39 +0100 3308543 http://www.medworm.com/index.php?rid=3270478&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa18664549600463n%2F Abstract  Detailed knowledge of the vascular anatomy of the anterior skull base is critical to successful surgery in this area. Whereas conventional neuronavigational approaches combine MRI (± contrast) for tumor visualization and CT (± C) for bony and vascular anatomy, we describe the Canadian and Austrian experiences using a novel protocol integrating MR angiography (MRA) into surgical neuronavigation to provide superior visualization of the carotid arteries. The pre-operative imaging protocol employs a T1-weighted, 3D fast spoiled gradient echo MRI (± C) for soft tissue anatomy, a plain CT for bony anatomy, and a 3D time-of-flight MR angiography for carotid anatomy. The series are imported into the Medtronic StealthStation® TREON® Treatment Guidance System; during in... Pituitary journals http://www.medworm.com/rss/comments.php?id=3270478 Fri, 12 Feb 2010 07:18:06 +0100 3270478 http://www.medworm.com/index.php?rid=3264221&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg10576107700n048%2F The objective of this report is to report a low-grade primary pituitary lymphoma, diagnostic problems and to give more evidence about the evolution of this rare disease. A 49 y.o. woman was referred to our clinic with symptoms of hypopituitarism. A diagnostic work-up showed mild anemia, an erythrocyte sedimentation rate of 122 mm/h and a negative Elisa test for HIV. Panhypopituitarism was confirmed and the MRI showed a 20 mm sellar and suprasellar enhancing mass with a thickening of the pituitary stalk, chiasmal compression and bitemporal hemianopsia. She underwent transsphenoidal resection only 10 months later for non medical reasons. During this period she was clinically asymptomatic on hormonal replacement therapy. A new MRI showed regression of the suprasellar exte... Pituitary journals http://www.medworm.com/rss/comments.php?id=3264221 Tue, 09 Feb 2010 17:47:20 +0100 3264221 http://www.medworm.com/index.php?rid=3241248&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa1317l09j84wm322%2F Abstract  GH and IGF-1 play an important role in the regulation of metabolism and body composition. In patients with uncontrolled acromegaly, cardiovascular morbidity and mortality are increased but are supposed to be normalised after biochemical control is achieved. We aimed at comparing body composition and the cardiovascular risk profile in patients with controlled acromegaly and controls. A cross-sectional study. We evaluated anthropometric parameters (height, weight, body mass index (BMI), waist and hip circumference, waist to height ratio) and, additionally, cardiovascular risk biomarkers (fasting plasma glucose, HbA1c, triglycerides, total cholesterol, HDL, LDL, and lipoprotein (a), in 81 acromegalic patients (58% cured) compared to 320 age- and gender-matched contro... Pituitary journals http://www.medworm.com/rss/comments.php?id=3241248 Wed, 03 Feb 2010 17:59:45 +0100 3241248 http://www.medworm.com/index.php?rid=3224028&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqh44k7t072t1l6x0%2F Abstract  Dopamine agonists are the treatment of choice for prolactinomas. However, there are still controversies concerning dose, treatment duration and criteria for drug withdrawal in different clinical situations. The aim of this study was to assess diagnostic and therapeutic approaches to prolactinomas among members of the Brazilian Society of Endocrinology and Metabolism (SBEM). SBEM members answered a questionnaire sent by e-mail that included 18 questions related to controversial issues about the management of prolactinomas. Among SBEM members, 721 (approximately 24% of total) answered the questionnaire. Concerning the diagnosis, 38% of the respondents stated that prolactin levels < 100 ng/ml would exclude the presence of a prolactinoma. Most of the... Pituitary journals http://www.medworm.com/rss/comments.php?id=3224028 Wed, 27 Jan 2010 19:58:12 +0100 3224028 http://www.medworm.com/index.php?rid=3154553&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fgv214n38l64u104w%2F Abstract  We treated 12 patients with pituitary apoplexy out of 103 patients with pituitary tumors from August 1994 to March 2008 in the Nishi-Kobe Medical Center. The male to female ratio was 1:2 and the average age was 43 years old, ranging from 19 to 73. The symptoms on presentation were a decrease of visual acuity in nine, headache in seven, endocrinological disturbance in six, visual field defect in seven, a febrile state in six, vomiting in four, oculomotor disturbance in two, abducens palsy in one, and transient altered consciousness in one. All patients underwent transsphenoidal surgery and, in four of these, surgery was conducted within 7 days after onset. All nine patients with a decrease in the visual acuity recovered (100%) and, in addition, complete o... Pituitary journals http://www.medworm.com/rss/comments.php?id=3154553 Tue, 05 Jan 2010 17:02:34 +0100 3154553 http://www.medworm.com/index.php?rid=3125377&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1u3526h77m763146%2F Abstract  Traumatic brain injury (TBI) is an important public health problem all over the world. The level of consciousness of the patients and the severity of the brain injury is commonly evaluated by the Glascow Coma Scale as mild, moderate and severe TBI. When we consider the high frequency of mild TBI (MTBI) among the all TBI patients the burden of the pituitary dysfunction problem in this group could not be ignored. However, one of the most important and still unresolved questions is which patients with MTBI should be screened for hypopituitarism? Another type of head trauma which could be considered as the subgroup of MTBI is sports related chronic repetitive head trauma. Therefore, in this review we will discuss the frequency, characteristics and current management o... Pituitary journals http://www.medworm.com/rss/comments.php?id=3125377 Sat, 26 Dec 2009 16:39:23 +0100 3125377 http://www.medworm.com/index.php?rid=3090724&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq786g22m7j002671%2F Abstract  The Endocrine Tumor Summit convened in December 2008 to address 6 statements prepared by panel members that reflect important questions in the treatment of acromegaly and carcinoid syndrome. Data pertinent to each of the statements were identified through review of pertinent literature by one of the 9-member panel, enabling a critical evaluation of the statements and the evidence supporting or refuting them. Three statements addressed the validity of serum growth hormone (GH) and insulin-like growth factor-I (IGF-I) concentrations as indicators or predictors of disease in acromegaly. Statements regarding the effects of preoperative somatostatin analog use on pituitary surgical outcomes, their effects on hormone and symptom control in carcinoid syndrome, and the ef... Pituitary journals http://www.medworm.com/rss/comments.php?id=3090724 Sun, 13 Dec 2009 06:43:05 +0100 3090724 http://www.medworm.com/index.php?rid=3090725&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F040u32306201m3v0%2F In conclusion, there is no clear evidence for increased breast cancer risk in female patients treated for either idiopathic hyperprolactinemia or prolactinomas. The uncertainty about the exact risk that is due to the relatively low number of breast cancer cases, should be overcome by pooling results in a future meta-analysis. Content Type Journal ArticleDOI 10.1007/s11102-009-0214-yAuthors O. M. Dekkers, Leiden University Medical Center Department of Endocrinology and Metabolic Diseases P.O. Box 9600 2300 RC Leiden The NetherlandsJ. A. Romijn, Leiden University Medical Center Department of Endocrinology and Metabolic Diseases P.O. Box 9600 2300 RC Leiden The NetherlandsA. de Boer, Utrecht University Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmac... Pituitary journals http://www.medworm.com/rss/comments.php?id=3090725 Sat, 12 Dec 2009 14:19:36 +0100 3090725 http://www.medworm.com/index.php?rid=3090726&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff5577727u470171l%2F Abstract  Pituitary tumors are prevalent in the general population, with a frequency of nearly 1 in 5. The cause of most pituitary tumors remains unknown, although a genetic contribution is recognized for some. We analyzed the Utah Population Data Base (UPDB), a resource combining a computerized genealogy of the Utah population with a statewide tumor registry, to investigate familial clustering of pituitary tumors. We analyzed the genetic relationships among 741 individuals diagnosed with benign or malignant pituitary tumors who had Utah genealogy data. To test for evidence of genetic contribution to predisposition, we compared average relatedness between all pairs of individuals with pituitary tumors with the expected relatedness in this population. We also estimated relat... Pituitary journals http://www.medworm.com/rss/comments.php?id=3090726 Sat, 12 Dec 2009 14:19:35 +0100 3090726 http://www.medworm.com/index.php?rid=3090727&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx342472435h55060%2F Abstract  The role of adrenal steroids in antioxidant regulation is not known. Previously, we demonstrated some Coenzyme Q10 (CoQ10) alterations in pituitary diseases, which can induce complex pictures due to alterations of different endocrine axes. Therefore we determined CoQ10 and Total Antioxidant Capacity (TAC) in pituitary-dependent adrenal diseases: 6 subjects with ACTH-dependent adrenal hyperplasia (AH); 19 with secondary isolated hypoadrenalism (IH), 19 with associated hypothyroidism (multiple pituitary deficiencies, MPH). CoQ10 was assayed by HPLC; TAC by the system metmyoglobin-H2O2, which, interacting with the chromogenous 2,2I-azinobis-(3-ethylbenzothiazoline-6-sulphonate), generates a spectroscopically revealed radical compound after a latency time (Lag) proporti... Pituitary journals http://www.medworm.com/rss/comments.php?id=3090727 Sat, 12 Dec 2009 14:19:34 +0100 3090727 http://www.medworm.com/index.php?rid=3064571&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa86m2w3q820102q0%2F Abstract  Only rarely do corticotroph pituitary tumors become invasive leading to symptoms caused by compression of cranial nerves and other local structures. When aggressive pituitary neuroendocrine tumors do develop, conventional treatment options are of limited success. A 50-year-old man developed a giant invasive corticotroph pituitary tumor 2 years after initial presentation. His tumor and symptoms failed to respond to maximal surgical, radio-surgical, radiation and medical therapy and a bilateral adrenalectomy was done. He subsequently developed rapid growth of his tumor leading to multiple cranial nerve deficits. He was administered salvage chemotherapy with capecitabine and temozolomide (CAPTEM), a novel oral chemotherapy regimen developed at our institution fo... Pituitary journals http://www.medworm.com/rss/comments.php?id=3064571 Thu, 03 Dec 2009 18:23:18 +0100 3064571 http://www.medworm.com/index.php?rid=3041297&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F4m17t88p17424162%2F Abstract  The expression of dopamine receptor subtypes has been reported in corticotroph adenomas, and this finding support the possibility for medical treatment of Cushing’s disease (CD) with dopamine agonists when conventional treatment has failed. The aim of this study was to evaluate the effectiveness of cabergoline (at doses of up 3 mg/week), alone or combined with relatively low doses of ketoconazole (up to 400 mg/day), in 12 patients with CD unsuccessfully treated by transsphenoidal surgery. After 6 months of cabergoline therapy, normalization of 24 h urinary free cortisol (UFC) levels occurred in three patients (25%) at doses ranging from 2–3 mg/week, whereas reductions ranging from 15.0 to 48.4% were found in the remaining. The addition ... Pituitary journals http://www.medworm.com/rss/comments.php?id=3041297 Fri, 27 Nov 2009 07:07:04 +0100 3041297 http://www.medworm.com/index.php?rid=2993206&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3157240q1703381v%2F Content Type Journal ArticleDOI 10.1007/s11102-009-0208-9Authors Takafumi Taguchi, Kochi University Kochi Medical School Kohasu, Oko-cho Nankoku JapanToshihiro Takao, Kochi University Kochi Medical School Kohasu, Oko-cho Nankoku JapanYasumasa Iwasaki, Kochi University Kochi Medical School Kohasu, Oko-cho Nankoku JapanKenichi Oyama, Toranomon Hospital Department of Hypothalamic & Pituitary Surgery Minato-ku Tokyo JapanShozo Yamada, Toranomon Hospital Department of Hypothalamic & Pituitary Surgery Minato-ku Tokyo JapanMari Inoue, Kochi University Kochi Medical School Kohasu, Oko-cho Nankoku JapanYoshio Terada, Kochi University Kochi Medical School Kohasu, Oko-cho Nankoku Japan Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=2993206 Fri, 13 Nov 2009 18:13:12 +0100 2993206 http://www.medworm.com/index.php?rid=2986612&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F771v2533k53v8t55%2F We report a patient with acromegaly and an unremarkable pituitary MR imaging who had negative work up for ectopic growth hormone-releasing hormone (GHRH) or GH secreting tumors. Transsphenoidal pituitary exploration revealed a pituitary adenoma located on the left side of the sella against the medial wall of the cavernous sinus extending posteriorly along the floor of the sella all the way to the right side. The acromegaly was treated with resection of the pituitary adenoma and normalization of serum insulin-like growth factor 1 (IGF-1) and GH levels. In a patient with acromegaly and unremarkable pituitary MR imaging, with no evidence of ectopic GH and GHRH production, transsphenoidal pituitary exploration is a reasonable approach and may result in clinical improvement and biochemica... Pituitary journals http://www.medworm.com/rss/comments.php?id=2986612 Tue, 10 Nov 2009 18:58:08 +0100 2986612 http://www.medworm.com/index.php?rid=2975093&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu3rl812148534417%2F This study assessed the efficacy and safety of self- or partner-administration of lanreotide in patients with acromegaly. This was a six-month, single-arm, open-label study conducted at 13 endocrinology clinics. Fifty-nine patients received deep subcutaneous lanreotide injections every 28 days. Twelve patients started on 120 mg lanreotide and forty-seven started on 90 mg lanreotide. At week 16, the dose was adjusted to 60, 90 or 120 mg based on insulin-like growth factor-1 (IGF-1) levels at week 12. Fifty-nine patients with acromegaly either switched from long-acting octreotide (switch; n = 33) or were somatostatin analogue treatment-naïve or not currently taking long-acting octreotide (“other”; n = 26). The key endpoints included the perce... Pituitary journals http://www.medworm.com/rss/comments.php?id=2975093 Sat, 07 Nov 2009 19:14:37 +0100 2975093 http://www.medworm.com/index.php?rid=2956312&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0g162x60256327l5%2F Abstract  Although there are international guidelines orienting physicians on how to manage patients with acromegaly, such guidelines should be adapted for use in distinct regions of the world. A panel of neuroendocrinologists convened in Mexico City in August of 2007 to discuss specific considerations in Latin America. Of major discussion was the laboratory evaluation of acromegaly, which requires the use of appropriate tests and the adoption of local institutional standards. As a general rule to ensure diagnosis, the patient’s GH level during an oral glucose tolerance test and IGF-1 level should be evaluated. Furthermore, to guide treatment decisions, both GH and IGF-1 assessments are required. The treatment of patients with acromegaly in Latin America is influenced by ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2956312 Fri, 30 Oct 2009 18:25:03 +0100 2956312 http://www.medworm.com/index.php?rid=2921728&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F35824g56318m7958%2F Abstract  Traumatic brain injury (TBI) has been recently recognized as a leading cause of pituitary dysfunction. Current data clearly demonstrated that sports related head trauma due to boxing, kickboxing, and soccer might results in pituitary hormone deficiencies, isolated growth hormone (GH) deficiency in particular. In the present report physiologic dose GH replacement therapy (GHRT) was performed in two GH deficient retired amateur boxers for the first time. The boxers received recombinant GH for 6 months. After 6 months of GHRT there were substantial improvements, but not complete normalization, in the body composition parameters, lipid profiles and quality of life scores in both boxers. These preliminary results suggest that GHRT may have beneficial effects ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2921728 Thu, 22 Oct 2009 06:06:57 +0100 2921728 http://www.medworm.com/index.php?rid=2913885&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd1wgw58uk037j123%2F We report the case of a 60 year old male who complained of headache and blurry vision—that progressed to left ophthalmoplegia and ptosis—after receiving a dose of leuprolide for Prostate cancer therapy. Imaging showed a hemorrhagic sellar mass. The patient underwent transsphenoidal debulking, and the tissue obtained demonstrated immunohistochemical staining for LH. A literature review revealed nine previously reported cases of pituitary apoplexy after GnRH agonist therapy for prostate cancer. In most cases, the sellar tissues stained for LH, consistent with a gonadotropinoma. The pathophysiology of these events is unclear, but recent animal models suggest possible explanations. The predominance of gonadotropinomas is important because they do not usually present with hyperse... Pituitary journals http://www.medworm.com/rss/comments.php?id=2913885 Tue, 20 Oct 2009 16:20:48 +0100 2913885 http://www.medworm.com/index.php?rid=2906261&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fpp008q4v08445682%2F We report our extensive experience with intramuscular injections of gonadotropins, one of the two methods used for this purpose. Eighty-seven married men (median age, 28 years) with either congenital (47 men) or acquired (40 men) HH were treated for a median of 26 months (range, 6–57) with intramuscular injections of gonadotropins (HCG/HMG) three times weekly for the purpose of achieving fertility. The outcome was assessed by achievement of one or more pregnancies. Of the 151 courses of HCG/HMG treatment administered to 87 patients, 85 courses (56.3%) were successful, resulting in 85 pregnancies (median pregnancy rate 2, range 1–10) in 35 patients (40%) while 52 cases did not achieve pregnancy. Responders had larger pretherapy testicular volume (9 ± 3.6 ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2906261 Fri, 16 Oct 2009 17:59:17 +0100 2906261 http://www.medworm.com/index.php?rid=2826089&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb5131788870t8083%2F We report the case of an 11-year-old Caucasian male who developed early adrenarche, hypertension and insulin resistance on GH therapy for SGA and profound short stature (ht −5 SD). This patient demonstrated a poor response to GH therapy and developed physical and biochemical findings of insulin resistance responsive to metformin therapy. He remained hypertensive, however, and continued to have elevated serum dehydroepiandrosterone sulfate levels. Urinary free cortisol excretion was subsequently found to be elevated. The diagnosis of Cushing’s disease was confirmed with inferior petrosal sinus sampling and pituitary MRI. The patient underwent partial adenohypophysectomy with resulting normalization of plasma cortisol levels and associated symptoms. Our patient’s diagnosis of Cus... Pituitary journals http://www.medworm.com/rss/comments.php?id=2826089 Mon, 21 Sep 2009 16:21:12 +0100 2826089 http://www.medworm.com/index.php?rid=2816197&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh4x211ll8w343310%2F Abstract  Inferior petrosal sinus sampling (IPSS) of ACTH with CRH stimulation helps distinguish pituitary ACTH-dependent Cushing’s syndrome from the ectopic ACTH syndrome (EAS). The usefulness of the paradoxical response of other pituitary hormones including prolactin to CRH remains controversial. Data from 33 IPSS procedures carried out at the Walton Centre for Neurology and Neurosurgery in Liverpool were analyzed. Patients were selected for this procedure if they had been diagnosed with ACTH dependent Cushing’s syndrome and the majority had no obvious pituitary adenoma on Magnetic Resonance Imaging. Satisfactory simultaneous bilateral catheterization was accomplished in 23/33 (success rate 70%). The diagnostic sensitivity of a basal central/peripheral ACTH ratio >... Pituitary journals http://www.medworm.com/rss/comments.php?id=2816197 Sat, 19 Sep 2009 05:52:51 +0100 2816197 http://www.medworm.com/index.php?rid=2810876&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F7419l83078588824%2F We report on a 74-year-old male patient who presented with progressive neuroophthalmologic symptoms soon after the administration of a long-acting gonadotropin-releasing hormone agonist for treatment of a prostate cancer. Imaging revealed a destructively growing and extensively calcified sellar mass inconsistent with a pituitary adenoma. A transseptal transsphenoidal tumor mass reduction yielded a histological diagnosis of a collision tumor comprised of a gonadotroph adenoma intermingled with osteochondroma. We discuss a potential causal relationship between the administration of the long-acting gonadotropin-releasing hormone agonist and the sudden appearance of the previously unsuspected sellar lesion. Although the association of these two tumors is very likely coincidental, the pos... Pituitary journals http://www.medworm.com/rss/comments.php?id=2810876 Thu, 17 Sep 2009 12:39:38 +0100 2810876 http://www.medworm.com/index.php?rid=2767321&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu4w465vlx2q82v67%2F Abstract  Arterial bleeding during transsphenoidal surgery for pituitary adenoma is known complication. This usually happens due to rupture of intracavernous carotid or delayed hemorrhage due to the carotico-cavernous fistula and/or pseudoaneurysm. There is also evidence that cavernous carotid aneurysms may occur with pituitary tumors, yet largest series failed to demonstrate any link between aneurysm formation and pituitary tumors. Usually such an aneurysm rupture results in formation of carotico-cavernous fistula. However, pituitary apoplexy and even epistaxis have been reported. In this paper we present a patient with recurrent pituitary adenoma and cavernous carotid artery aneurysm, which caused significant hemorrhage during the surgery. Although retrospective analysis ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2767321 Thu, 03 Sep 2009 06:35:49 +0100 2767321 http://www.medworm.com/index.php?rid=2744992&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn65g27467v2w6m70%2F This study evaluated the usefulness of sleeping midnight serum cortisol (SMNC) as a diagnostic test for hypercortisolemia. A simultaneously done midnight plasma ACTH level was used to classify the disease as ACTH dependent or independent. Standard biochemical tests, SMNC, midnight plasma ACTH and appropriate imaging evaluated patients with a clinical suspicion of Cushing’s syndrome. We evaluated 43 patients with CS comprising of 34 patients with Cushing’s disease (CD), 2 patients with thymic carcinoid producing ectopic CS, 5 patients with adrenal carcinoma and 2 with adrenal adenoma. Thirteen patients with clinical suspicion were also evaluated with the above tests and CS was ruled out. SMNC, midnight plasma ACTH and dexamethasone suppressed cortisol was collected from patients w... Pituitary journals http://www.medworm.com/rss/comments.php?id=2744992 Fri, 28 Aug 2009 15:02:20 +0100 2744992 http://www.medworm.com/index.php?rid=2735767&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Frlh60k186kr42176%2F Abstract  Lymphoma is one of the causative factors of hypothalamus–pituitary dysfunction, and intravascular large B-cell lymphoma (IVLBCL) is a subtype of primary extranodal neoplasm. A 69-year-old woman visited our hospital because of general fatigue. We diagnosed her with presumable non-functional primary pituitary adenoma and subsequent dysfunction. Eight months after, the patient revisited our hospital because of dyspnea. Though we conducted systemic investigations including chest and abdomen enhanced computer tomography, transbronchial lung biopsy, and bone marrow biopsy, the diagnosis was not confirmed. Inadvertently, a breast cancer was found, and the surgical specimen proved that the patient had double cancer—adenocarcinoma and IVLBCL. Rituximab, cyclophosphamide... Pituitary journals http://www.medworm.com/rss/comments.php?id=2735767 Tue, 25 Aug 2009 16:58:55 +0100 2735767 http://www.medworm.com/index.php?rid=2723678&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj0l225185769814t%2F Abstract  Pituitary tumors are challenging tumors in the sellar region. Surgical approaches to the pituitary have undergone numerous refinements over the last 100 years. The introduction of the endoscope have revolutionized pituitary surgery. The aim of this study is to report the results of a consecutive series of patients undergoing pituitary surgery using a pure endoscopic endonasal approach and to evaluate the efficacy and safety of this procedure. We reviewed the data of 228 consecutive patients who underwent endonasal transsphenoidal adenoma removal over an 10-year period. Pre- and post-operative hormonal status (at least 3 months after surgery) were analyzed and compared with clinical parameters presented by the patients. Tumor removal rate, endocrinological... Pituitary journals http://www.medworm.com/rss/comments.php?id=2723678 Thu, 20 Aug 2009 19:51:33 +0100 2723678 http://www.medworm.com/index.php?rid=2679917&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe6600651q126r437%2F In this study we report an adult male patient with NS who underwent both transsphenoidal and transcranial pituitary surgeries, conventional and stereotaxic radiotherapy and brachytherapy. Despite of the efforts to control tumor mass and growth, this macroadenoma displayed relentless growth and aggressive behavior. DNA extracted from the first two surgical samples, as well as DNA from peripheral blood leukocytes disclosed normal p53 sequence. DNA extracted from tumor samples obtained at surgeries performed after pituitary irradiation carried a somatic heterozygous mutation, consisting of a deletion of four cytosines between nucleotides 12,144–12,149 in exon 4 of the p53 gene. This frameshift mutation creates a stop codon in exon 4 excluding the expression of a functional protein from... Pituitary journals http://www.medworm.com/rss/comments.php?id=2679917 Tue, 04 Aug 2009 21:55:23 +0100 2679917 http://www.medworm.com/index.php?rid=2651542&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F028r767515631440%2F We describe the first two cases of hypopituitarism in prostate cancer subjects undergoing experimental therapy with ipilimumab. The clinical evidence strongly suggests that the prostate cancer subjects developed autoimmune hypophysitis as a consequence of anti-CTLA-4 treatment. High dose glucocorticoid treatment resulted in markedly improved symptoms, and resolution of focal symptoms and diabetes insipidus. One subject recovered pituitary-thyroid axis function after 9 months; however, both continue to require GC replacement. These cases highlight the importance of early screening and treatment for hypopituitarism in all subjects undergoing treatment with anti-CTLA-4 therapy to prevent a potentially fatal outcome from secondary adrenal insufficiency, a readily treatable disease.... Pituitary journals http://www.medworm.com/rss/comments.php?id=2651542 Tue, 28 Jul 2009 18:23:31 +0100 2651542 http://www.medworm.com/index.php?rid=3098076&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff721873t275m138w%2F In conclusion, Lan-Autogel was effective in controlling GH and IGF-1 hypersecretion in patients with acromegaly and showed a rapid onset of action. Content Type Journal ArticleDOI 10.1007/s11102-009-0191-1Authors Shlomo Melmed, Cedars-Sinai Medical Center Department of Medicine Los Angeles CA USADavid Cook, Oregon Health & Science University Department of Medicine Portland OR USAJochen Schopohl, Medizinische Klinik Innenstadt Division of Endocrinology Munich GermanyMiklos I. Goth, National Health Center Division of Endocrinology, 2nd Department of Medicine Budapest HungaryKaren S. L. Lam, University of Hong Kong Department of Medicine Hong Kong ChinaJosef Marek, Charles University 3rd Department of Medicine, 1st School of Medicine Prague Czech Republic Journal PituitaryOnline ... Pituitary journals http://www.medworm.com/rss/comments.php?id=3098076 Tue, 28 Jul 2009 18:23:29 +0100 3098076 http://www.medworm.com/index.php?rid=2651543&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff721873t275m138w%2F In conclusion, Lan-Autogel was effective in controlling GH and IGF-1 hypersecretion in patients with acromegaly and showed a rapid onset of action. Content Type Journal ArticleDOI 10.1007/s11102-009-0191-1Authors Shlomo Melmed, Cedars-Sinai Medical Center Department of Medicine Los Angeles CA USADavid Cook, Oregon Health & Science University Department of Medicine Portland OR USAJochen Schopohl, Medizinische Klinik Innenstadt Division of Endocrinology Munich GermanyMiklos I. Goth, National Health Center Division of Endocrinology, 2nd Department of Medicine Budapest HungaryKaren S. L. Lam, University of Hong Kong Department of Medicine Hong Kong ChinaJosef Marek, Charles University 3rd Department of Medicine, 1st School of Medicine Prague Czech Republic Journal PituitaryOnline ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2651543 Tue, 28 Jul 2009 18:23:29 +0100 2651543 http://www.medworm.com/index.php?rid=2638912&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F48025301r0211335%2F We present a patient with a Rathke’s cleft cyst who presented with rapidly progressive bilateral 6th nerve palsy. A 20-year-old woman with a history of cleft palate, hypertension, and hydronephrotic kidneys presented with a one month history of headache, associated with dizziness and diplopia on horizontal gaze. Examination was significant for profound bilateral 6th nerve palsies. Magnetic resonance imaging showed a hypodense mass that filled the sella and compressed the right cavernous sinus without contacting the optic chiasm. Pituitary function was normal. An endoscopic, transnasal transsphenoidal resection of the lesion was performed; microscopic examination revealed a Rathke’s cleft cyst. Surgical excision resulted in near complete resolution of the bilateral 6th nerve palsy... Pituitary journals http://www.medworm.com/rss/comments.php?id=2638912 Thu, 23 Jul 2009 16:42:13 +0100 2638912 http://www.medworm.com/index.php?rid=2516032&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9l5j730073hl627g%2F We present a series of eight collision sellar lesions indentified among 548 transsphenoidally resected pituitary adenomas in two Neurosurgical Departments. The histological studies confirmed a case of sarcoidosis within a non-functioning pituitary adenoma, a case of intrasellar schwannoma coexisting with growth hormone (GH) secreting adenoma, two Rathke’s cleft cysts combined with pituitary adenomas, three gangliocytomas associated with GH-secreting adenomas, and a case of a double pituitary adenoma. The pertinent literature is discussed with emphasis on pathogenetic theories of dual sellar lesions. Although there is no direct evidence to confirm the pathogenetic relationship of collision sellar lesions, the number of cases presented in literature makes the theory of an incidental ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2516032 Wed, 24 Jun 2009 06:11:23 +0100 2516032 http://www.medworm.com/index.php?rid=2477977&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy7j731662257328h%2F Abstract  Cushing’s disease is caused by an ACTH-producing pituitary tumor, and accounts for 10–15% of pituitary tumors. The majority of corticotroph tumors are microadenomas (<10 mm), and accurate histologic identification of these tumors can be challenging because of their small size and the presence of nests of normal corticotroph cells in the anterior pituitary. Retinoic acid has been shown to inhibit ACTH production and induce apoptosis in corticotroph tumor cells. The expression of the orphan nuclear receptor COUP-TFI antagonizes retinoic acid signaling and has been shown to be expressed in normal corticotroph cells, but absent in corticotroph tumor cell lines. We analyzed 34 corticotroph tumor specimens by immunohistochemistry using a goat polyclonal IgG ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2477977 Sat, 13 Jun 2009 07:56:30 +0100 2477977 http://www.medworm.com/index.php?rid=2477978&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu186366mp2458826%2F Abstract  The aim of this study was to assess the effects of replacement with recombinant human growth hormone (rhGH) in patients with GH deficiency (GHD) after treatment of acromegaly. Intervention study. Sixteen patients (8 men, age 56 years), treated for acromegaly by surgery and radiotherapy, with an insufficient GH response to insulin-induced hypoglycaemia, were treated with 1 year of rhGH replacement. Study parameters were assessed at baseline and after 1 year of rhGH replacement. Study parameters were cardiac function, body composition, bone mineral density (BMD), fasting lipids, glucose, bone turnover markers, and Quality of Life (QoL). During rhGH replacement IGF-I concentrations increased from −0.4 ± 0.7 to 1.0 ± 1.5 SD (P&nbs... Pituitary journals http://www.medworm.com/rss/comments.php?id=2477978 Fri, 12 Jun 2009 11:33:27 +0100 2477978 http://www.medworm.com/index.php?rid=2437766&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F96227l2k1249g530%2F We report the case of an 11-year-old girl who presented with diabetes insipidus and growth retardation, and was found to have an intra- and supra-sellar mass. Initial examination of the pituitary biopsy showed diffuse lymphocytic infiltration of the adenohypophysis and absent placental alkaline phosphatase expression, leading to a diagnosis of hypophysitis and glucocorticoid treatment. Because of the lack of clinical and radiological response, the pituitary specimen was re-examined, revealing this time the presence of scattered c-kit and Oct4 positive germinoma cells. The revised diagnosis prompted the initiation of radiotherapy, which induced disappearance of the pituitary mass. Immunological studies showed that the patient’s serum recognized antigens expressed by the patient’s ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2437766 Mon, 25 May 2009 05:49:10 +0100 2437766 http://www.medworm.com/index.php?rid=2432802&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw21410x1861052pv%2F Abstract  Hyponatremia is a frequent complication following subarachnoid hemorrhage (SAH), and is commonly attributed either to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome (CSW). The object of this study is to elucidate the clinical demographics and sequelae of hyponatremia due to CSW in subjects with aneurysmal SAH. Retrospective chart review of patients >18 years with aneurysmal SAH admitted between January 2004 and July 2007 was performed. Subjects with moderate to severe hyponatremia (serum sodium <130 mmol l−1) were divided into groups consistent with CSW and SIADH based on urine output, fluid balance, natriuresis, and response to saline infusion. Clinical demographics were compared. Of 31... Pituitary journals http://www.medworm.com/rss/comments.php?id=2432802 Fri, 22 May 2009 05:49:22 +0100 2432802 http://www.medworm.com/index.php?rid=2383944&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F45u8557u14k50503%2F Content Type Journal ArticleCategory LetterDOI 10.1007/s11102-009-0185-zAuthors John J. Orrego, Kaiser Permanente Department of Endocrinology and Metabolism 280 Exempla Circle Lafayette CO 80026 USA Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=2383944 Fri, 01 May 2009 06:51:22 +0100 2383944 http://www.medworm.com/index.php?rid=2383945&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fuh50581661m50t20%2F Abstract  The background and aim of the study is to evaluate insulin sensitivity in hyperprolactinemic subjects via euglycemic hyperinsulinemic clamp technique. Sixteen hyperprolactinemic subjects and 12 healthy subjects were included in the study. HOMA-B and HOMA-IR values of groups were calculated. Euglycemic hyperinsulinemic clamp technique was performed in both groups, and the M value of the groups was defined. Mann–Whitney U and chi-square tests were used in statistical analysis. Basal insulin level of hyperprolactinemic patients were higher than the control group (6.85 ± 4.68; 3.66 ± 0.88 μU/ml respectively; P < 0.05). Mean HOMA-IR and HOMA-B values of patients were higher than control group (1.49 ± 1.30; 0.78 ±... Pituitary journals http://www.medworm.com/rss/comments.php?id=2383945 Fri, 01 May 2009 06:51:21 +0100 2383945 http://www.medworm.com/index.php?rid=3098077&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F44r7pr56847u4710%2F Abstract  To determine utility of luteinizing hormone (LH) estimation, post intramuscular (IM) depot leuprolide in comparison with subcutaneous leuprolide stimulation test. Test for monitoring therapy in patients with gonadotropin dependent precocious puberty (GDPP). In seven patients of GDPP, who were treated with 11.25 mg depot leuprolide, the LH peak after subcutaneous (sc) test was compared with LH at hourly interval for 4 h after IM depot leuprolide for 13 tests and 3rd hour value for next ten tests. These two values were compared both before and after therapy. Before therapy, the mean ± SD LH peak after subcutaneous leuprolide stimulation test was 20.6 ± 7.85 IU/l (range 9.64–30.4 IU/l), and it was 27.3 ± 12.21&nbs... Pituitary journals http://www.medworm.com/rss/comments.php?id=3098077 Sun, 26 Apr 2009 05:48:43 +0100 3098077 http://www.medworm.com/index.php?rid=2371101&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F44r7pr56847u4710%2F Abstract  To determine utility of luteinizing hormone (LH) estimation, post intramuscular (IM) depot leuprolide in comparison with subcutaneous leuprolide stimulation test. Test for monitoring therapy in patients with gonadotropin dependent precocious puberty (GDPP). In seven patients of GDPP, who were treated with 11.25 mg depot leuprolide, the LH peak after subcutaneous (sc) test was compared with LH at hourly interval for 4 h after IM depot leuprolide for 13 tests and 3rd hour value for next ten tests. These two values were compared both before and after therapy. Before therapy, the mean ± SD LH peak after subcutaneous leuprolide stimulation test was 20.6 ± 7.85 IU/l (range 9.64–30.4 IU/l), and it was 27.3 ± 12.21&nbs... Pituitary journals http://www.medworm.com/rss/comments.php?id=2371101 Sun, 26 Apr 2009 05:48:43 +0100 2371101 http://www.medworm.com/index.php?rid=2371102&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3811x40377q32675%2F Abstract  Thyrotoxicosis might alter the hypothalamic-pituitary-adrenal (HPA) axis. We evaluated the effects of ghrelin and GHRP-6 on the HPA axis in 20 hyperthyroid patients and in 9 controls. Mean basal cortisol (μg/dl) and ACTH (pg/ml) levels were higher in hyperthyroidism (cortisol: 10.7 ± 0.7; ACTH: 21.5 ± 2.9) compared to controls (cortisol: 8.1 ± 0.7; ACTH: 13.5 ± 1.8). In thyrotoxicosis ∆ AUC cortisol values (μg/dl.90 min) after ghrelin (484 ± 80) and GHRP-6 (115 ± 63) were similar to controls (ghrelin: 524 ± 107; GHRP-6: 192 ± 73). A significant increase in ∆ AUC ACTH (pg/ml.90 min) after ghrelin was observed in thyrotoxicosis (4,189 ± 1,202) co... Pituitary journals http://www.medworm.com/rss/comments.php?id=2371102 Sun, 26 Apr 2009 05:48:42 +0100 2371102 http://www.medworm.com/index.php?rid=2367865&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F24u5013h31247n75%2F Abstract  The purpose of this study was to evaluate the effects of 5 years of GH substitution on cardiac structure and function, physical work capacity and blood pressure levels in adults with GH deficiency (GHD). Fourteen patients were clinically assessed every 3 months for 5 years. Transthoracic echocardiography and exercise test were performed at baseline, 24, 48 and 60 months. Blood pressure (BP) was measured by means of ambulatory monitoring of blood pressure at baseline, 6, 12, 24 and 60 months. Left ventricular mass and its index increased progressively during the 5 years of GH substitution (P = 0.008 and 0.007, respectively). There were no significant changes in all others cardiac parameters evaluated. It was observed a signifi... Pituitary journals http://www.medworm.com/rss/comments.php?id=2367865 Fri, 24 Apr 2009 07:15:46 +0100 2367865 http://www.medworm.com/index.php?rid=2366109&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg41r5x1324121071%2F Abstract  Despite the high resolution of magnetic resonance imaging (MRI) of the pituitary gland, up to 40% of cases of Cushing’s disease (CD) have normal MRI. Fused images of positron emission tomography and computed tomography (PET-CT) may have a potential diagnostic role in CD in general and in such cases in particular. Objective of this study is to explore the diagnostic potential of PET-CT for localization of adrenocorticotropin-secreting pituitary adenomas in CD. PET-CT was performed in 12 cases with de novo (7 cases) or persistent CD (5 cases) that were proven to have CD on biochemical, radiological and/or histopathological findings. These cases had a definite CD confirmed on histopathological and immunostaining examination of the subsequent transphenoidal surgical... Pituitary journals http://www.medworm.com/rss/comments.php?id=2366109 Thu, 23 Apr 2009 08:16:38 +0100 2366109 http://www.medworm.com/index.php?rid=2358198&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1x87j732569262t6%2F We report a young man who developed secondary visual loss and seizures after 6 months of medical treatment with cabergoline for giant prolactinoma. Magnetic resonance imaging of hypothalamic pituitary region revealed optic chiasmal and frontal lobe herniation into sella. There was marginal improvement in his vision after cabergoline dose reduction. The present case report highlights frontal lobe herniation in conjunction with optic chiasmal herniation as a very rare complication of medical therapy of giant prolactinoma. Different treatment options of this condition are being discussed. Content Type Journal ArticleCategory CASE REPORTDOI 10.1007/s11102-009-0179-xAuthors Dinesh Kumar Dhanwal, Maulana Azad Medical College Department of Medicine and Division of Endocrinology 115... Pituitary journals http://www.medworm.com/rss/comments.php?id=2358198 Tue, 21 Apr 2009 11:24:54 +0100 2358198 http://www.medworm.com/index.php?rid=2343425&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv672502164q05868%2F In conclusion, physical training recovered serum IGF-I showing no alteration of serum or pituitary GH levels. Content Type Journal ArticleDOI 10.1007/s11102-009-0178-yAuthors José Alexandre Curiacos de Almeida Leme, São Paulo State University (UNESP) Department of Physical Education Avenida 24A no. 1515 Caixa Postal 199 Bela Vista, Rio Claro São Paulo CEP 13506-900 BrazilMichel Barbosa de Araújo, São Paulo State University (UNESP) Department of Physical Education Avenida 24A no. 1515 Caixa Postal 199 Bela Vista, Rio Claro São Paulo CEP 13506-900 BrazilLeandro Pereira de Moura, São Paulo State University (UNESP) Department of Physical Education Avenida 24A no. 1515 Caixa Postal 199 Bela Vista, Rio Claro São Paulo CEP 13506-900 BrazilRicardo José Gomes, São Paulo State Univer... Pituitary journals http://www.medworm.com/rss/comments.php?id=2343425 Thu, 16 Apr 2009 05:49:48 +0100 2343425 http://www.medworm.com/index.php?rid=2333379&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg00j7210081v2270%2F We present a unique case of a young female who underwent resection and radiation treatment for a craniopharyngioma in 1988. With the exception of bitemporal visual loss and panhypopituitarism requiring hormone replacement therapy, the patient had a relatively uneventful course until 2005. At that time, she developed hearing loss and incapacitating vertigo, which was ultimately attributed to a temporal bone Langerhans histiocytosis. A year and a half later, she was noted to have a thyroid nodule, the pathology of which revealed papillary carcinoma. Seven months after that, she developed new auditory and vestibular symptoms attributable to an acoustic neuroma. This case is remarkable because neither Langerhans histiocytosis following radiation of a craniopharyngioma nor this distinctiv... Pituitary journals http://www.medworm.com/rss/comments.php?id=2333379 Thu, 09 Apr 2009 07:09:27 +0100 2333379 http://www.medworm.com/index.php?rid=2308385&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr44j72048p958427%2F We report a 59-year-old acromegalic woman, who presented with generalized bone pain, weakness, fatigue and foamy urine, who was found to have multiple myeloma (MM); and a 60-year-old acromegalic woman with dizziness, vomiting and abdominal pain, high blood pressure and splenomegaly that was posteriorly diagnosed as having Waldenstrom’s macroglobulinemia (WM). Acromegaly is an uncommon disease and epidemiological studies have provided increasingly debated evidence that elevated IGF-I levels might enhance the neoplastic risk, and that cancers constitute the third leading cause of mortality in acromegaly. It is known that GH and IGF-I can activate B cell lymphocytes, and that IGF-I receptor is universally expressed in MM cells. Although the complication of acromegaly with WM or MM in ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2308385 Wed, 01 Apr 2009 06:08:03 +0100 2308385 http://www.medworm.com/index.php?rid=2308386&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F4248008720515t8k%2F This study analyzes SSTR’s expression in somatotrophinomas, comparing to SA response, hormonal levels, and tumor volume. We analyzed 39 somatotrophinomas; 49% were treated with SA. The most expressed SSTR was SSTR5, SSTR3, SSTR2, SSTR1, and SSTR4, respectively. SSTR1 and SSTR2 had higher expression in patients that had normalized GH and IGF-I. SSTR3 was more expressed in patients with tumor reduction. There was a positive correlation between the percentage of tumor reduction and SSTR1, SSTR2 and SSTR3 expression. Also, a positive correlation between SSTR2 mRNA expression and the immunohistochemical reactivity of SSTR2 was found. Our study confirmed the association between the SA response to GH and IGF-I and the SSTR2. Additionally, this finding was also demonstrated in relation to... Pituitary journals http://www.medworm.com/rss/comments.php?id=2308386 Sat, 28 Mar 2009 09:08:51 +0100 2308386 http://www.medworm.com/index.php?rid=2277113&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F734w44q11642620q%2F In conclusion, imaging may prove unsatisfactory or even misleading for the etiologial diagnosis of ACTH-dependent Cushing’s syndrome and should therefore be interpreted only in context with results of hormonal dynamic testing. Content Type Journal ArticleDOI 10.1007/s11102-009-0174-2Authors Massimiliano Andrioli, University of Milan Chair of Endocrinology, Ospedale San Luca IRCCS, Istituto Auxologico Italiano Via Spagnoletto 3 20149 Milan ItalyFrancesca Pecori Giraldi, University of Milan Chair of Endocrinology, Ospedale San Luca IRCCS, Istituto Auxologico Italiano Via Spagnoletto 3 20149 Milan ItalyMartina De Martin, University of Milan Chair of Endocrinology, Ospedale San Luca IRCCS, Istituto Auxologico Italiano Via Spagnoletto 3 20149 Milan ItalyAgnese Cattaneo, University of M... Pituitary journals http://www.medworm.com/rss/comments.php?id=2277113 Wed, 18 Mar 2009 06:52:00 +0100 2277113 http://www.medworm.com/index.php?rid=2248730&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F35p4g474jm12r111%2F Abstract  We investigated the effectiveness of lanreotide for the treatment of active acromegaly in a retrospectively multicenter case series including 53 patients (24 male, 29 female; mean age at diagnosis, 49.5 ± 13.9 years) with acromegaly treated with lanreotide in nine different centers. Mean tumor diameter was 20 ± 13 mm; mean basal levels of growth hormone (GH) and insulin-like growth factor I (IGF-I) were 21.3 ± 26.3 and 579 ± 177 μg/l, respectively. The primary mode of treatment was surgery in 70% of patients. Twenty-nine patients received only lanreotide (Prolonged Release, Autogel), whereas 24 subjects were also treated with octreotide at another treatment stage. Primary therapy with lanreotide was admini... Pituitary journals http://www.medworm.com/rss/comments.php?id=2248730 Fri, 06 Mar 2009 10:51:30 +0100 2248730 http://www.medworm.com/index.php?rid=2248731&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft1u53731814q6338%2F We present a case of acute severe hepatitis in a patient with acromegaly receiving combination therapy with somatostatin analogs and pegvisomant. Hepatitis resolved completely 18 weeks after diagnosis of hypertransaminasemia without discontinuation of therapy and with a close clinical and biochemical follow-up. In this case, despite the severity of the hepatitis, therapy could be continued as hypertransaminasemia was gradually decreasing after the maximum peak. We also review the literature on toxic hepatitis associated to pegvisomant therapy analyzing the etiology, clinical predisposing factors and natural evolution. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-009-0173-3Authors A. Soto Moreno, Virgen del Rocio University Hospital Department of Endocrin... Pituitary journals http://www.medworm.com/rss/comments.php?id=2248731 Fri, 06 Mar 2009 10:51:27 +0100 2248731 http://www.medworm.com/index.php?rid=2221565&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv17x714h2415724j%2F Conclusions The addition of a transcranial component to the transsphenoidal approach offers additional visualization of critical neurovascular structures during giant pituitary adenoma resection. Complications rates are similar to other series in which complex pituitary adenomas are resected by other means. The above and below approach is both safe and effective and the immediate and long-term advantages of a single-stage approach justify its utility in this select group of patients. Content Type Journal ArticleDOI 10.1007/s11102-009-0171-5Authors Anthony L. D’Ambrosio, Columbia University Medical Center Department of Neurological Surgery, New York Presbyterian Hospital New York NY USAOmar N. Syed, Columbia University Medical Center Department of Neurological Surgery, New York Pr... Pituitary journals http://www.medworm.com/rss/comments.php?id=2221565 Thu, 26 Feb 2009 11:48:44 +0100 2221565 http://www.medworm.com/index.php?rid=2221566&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fnv34313q63481m2u%2F We report a case of SCO who presented with symptoms of visual blurring, weight loss, intermittent vomiting and excessive tiredness of several months duration. Investigations revealed a bitemporal visual field defect, a panhypopituitary hormonal profile and a large pituitary tumour with suprasellar extension. He underwent a successful trans-sphenoidal resection of the pituitary tumour but it subsequently recurred twice at 9 months interval which required further two debulking procedures. A diagnosis of SCO was made based on its unique histologic and staining properties. To date there are only ten reported cases of SCO in total with only two of these cases being recurrent. Our case displayed the most aggressive clinical course despite having a low Ki-67 index contrary to the previ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2221566 Wed, 25 Feb 2009 10:13:34 +0100 2221566 http://www.medworm.com/index.php?rid=2163095&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F954462kv0746ju12%2F We describe a case of a 57-year-old woman who presented with a large macroprolactinoma with suprasellar extension. She was initially treated with bromocriptine therapy with a resolution of symptoms, marked reduction in prolactin concentration and complete tumour shrinkage; a response which was subsequently maintained on cabergoline. After 8 years of dopamine agonist therapy, her prolactin concentration began to rise and there was symptomatic recurrence of her tumour despite escalating doses of cabergoline up to 6 mg weekly. Non-compliance was outruled by observed inpatient drug administration. The patient underwent surgical debulking followed by radiotherapy with good response. This case adds to the previous two cases of secondary resistance to cabergoline therapy in prolac... Pituitary journals http://www.medworm.com/rss/comments.php?id=2163095 Wed, 04 Feb 2009 13:45:57 +0100 2163095 http://www.medworm.com/index.php?rid=2159926&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl31317876w72m32t%2F Abstract  Long-acting somatostatin analogs (SSA) are widely used for the treatment of acromegaly achieving biochemical control of the disease in 50–75% of the patients. One of the goals of the treatment of acromegaly is the control of tumor growth, especially in patients in whom SSAs are used as first-line therapy. Over the recent years, there has been growing evidence that SSAs are able to induce tumor shrinkage in patients with acromegaly. However, most of the data are from patients under treatment with octreotide, either subcutaneously or intramuscularly with long-acting formulation, whereas the data on lanreotide SR or Autogel are very few. Indeed, octreotide and lanreotide, i.e. the two commercially available SSAs, show slight differences in pharmacokinetics and patt... Pituitary journals http://www.medworm.com/rss/comments.php?id=2159926 Tue, 03 Feb 2009 07:08:43 +0100 2159926 http://www.medworm.com/index.php?rid=2147145&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk1876x758550201u%2F Abstract  The knowledge of the normal anatomy and variations regarding the management of tumors of the sellar region is paramount to perform safe surgical procedures. The sellar region is located in the center of the middle cranial fossa; it contains complex anatomical structures, and is the site of various pathological processes: tumor, vascular, developmental, and neuroendocrine. We review the microsurgical anatomy (microscopic and endoscopic) of this region and discuss the surgical nuances regarding this topic, based on anatomical concepts. Content Type Journal ArticleDOI 10.1007/s11102-009-0167-1Authors Gustavo Rassier Isolan, Pontifical Catholic University of Paraná Department of Neurosurgery Curitiba BrazilPaulo Henrique Pires de Aguiar, State University of Sao Pa... Pituitary journals http://www.medworm.com/rss/comments.php?id=2147145 Thu, 29 Jan 2009 08:24:04 +0100 2147145 http://www.medworm.com/index.php?rid=2120607&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fd7362w1h6257287n%2F This report suggests that in well-selected patients the long-term risk of complications is low and with careful surveillance GH insufficiency can be replaced. Lifelong follow-up is mandatory. Content Type Journal ArticleDOI 10.1007/s11102-008-0163-xAuthors Charlotte Höybye, Karolinska University Hospital Department of Endocrinology, Metabolism and Diabetology 171 76 Solna, Stockholm SwedenTiit Rähn, Karolinska University Hospital Department of Neurosurgery 171 76 Solna, Stockholm Sweden Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=2120607 Mon, 19 Jan 2009 08:02:29 +0100 2120607 http://www.medworm.com/index.php?rid=2115172&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F57p67722v1226210%2F We report the history of an adolescent male who was diagnosed with a large invasive macroprolactinoma in 2002. He had severe bitemporal hemianopsia and hypopituitarism; prolactin levels at diagnosis were higher than 8,000 ng/ml. Medical therapy with cabergoline was initiated and resulted in decreased prolactin levels but not complete normalisation (maximal tolerated dose 3 mg/day). However, due to the worsening of the visual defect, the patient was operated in July 2004 through the trans-nasal approach and 2 years later through both the transcranial and the transphenoidal approaches. After the second surgery, a significant reduction of tumour mass was obtained. Immunohistochemistry for somatostatin receptors (sstr) subtypes showed a positive staining with the anti-sst... Pituitary journals http://www.medworm.com/rss/comments.php?id=2115172 Sat, 17 Jan 2009 09:00:16 +0100 2115172 http://www.medworm.com/index.php?rid=2094494&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr914365522350314%2F Abstract  For centuries tumors have been described which today with some confidence can be diagnosed as craniopharyngiomas. It was not until 1904 Erdheim described what he called ‘hypophysial duct tumors’, and which Cushing later gave the name craniopharyngioma. The first operation for this neoplasm took place in 1909. It soon became evident that the outcome of surgery was rather dismal with high mortality and morbidity rates—even after corticosteroid therapy became available around 1950. Radiotherapy was introduced and later refined as radiosurgery. This paper presents a short survey of the accumulation of knowledge of craniopharyngiomas. Content Type Journal ArticleDOI 10.1007/s11102-008-0165-8Authors J. Lindholm, Aarhus University Hospital Department of Endocrin... Pituitary journals http://www.medworm.com/rss/comments.php?id=2094494 Thu, 08 Jan 2009 08:58:13 +0100 2094494 http://www.medworm.com/index.php?rid=2086538&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3g89r47jw6m58324%2F We present an unusual case of primary central nervous system (CNS) lymphoma presenting with bilateral symmetric hypothalamic lesions causing diabetes insipidus and hypopituitarism. A 50-year-old male presented initially with mental status changes, polyuria and polydipsia. The patient was determined to have diabetes insipidus (DI) and significant anterior pituitary deficiencies resulting in symptomatic pleural and pericardial effusions. Brain MRI with contrast demonstrated bilateral enhancement of his hypothalamus extending to the optic tract. The extensive diagnostic workup that ensued on his initial presentation was non-diagnostic as he had no obvious site of involvement that was easily accessible to biopsy. With close follow-up, the patient had rapid radiographic progression of his... Pituitary journals http://www.medworm.com/rss/comments.php?id=2086538 Sat, 03 Jan 2009 06:47:52 +0100 2086538 http://www.medworm.com/index.php?rid=2072937&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv26g627016h5x622%2F In conclusion, although pituitary adenomas respond for the vast majority of sellar tumors, concomitant symptoms such as central diabetes insipidus and rapid tumor growth should raise the suspicion of a diverse diagnosis. The present report intend not only to show a rare case of sellar and suprasellar mixed GCT but also to remind clinicians that if laboratory findings do not fit into patient’s diagnosis (such as high testosterone levels in our patient), then the diagnosis should be reviewed. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0161-zAuthors Luiz Eduardo Armondi Wildemberg, Universidade Federal do Rio de Janeiro (UFRJ) Endocrinology Unit, Hospital Universitário Clementino Fraga Filho Rio de Janeiro BrazilLeonardo Vieira Neto, Universidade Federal... Pituitary journals http://www.medworm.com/rss/comments.php?id=2072937 Wed, 31 Dec 2008 09:34:15 +0100 2072937 http://www.medworm.com/index.php?rid=2072938&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F28612105k2275152%2F Abstract  Idiopathic isolated ACTH deficiency, congenital or acquired, is rare. It may be found in association with primary hypothyroidism. Here we describe four cases of acquired idiopathic isolated ACTH deficiency illustrating its importance and variable presentation. All cases had a structurally normal pituitary gland and persistently normal residual pituitary function. Three cases had co-existing primary hypothyroidism. We discuss the protean presentation of this rare but important condition, its treatment, associations, and possible aetiologies. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0164-9Authors M. J. Hannon, Cork University Hospital Department of Endocrinology and Metabolism Wilton, Cork IrelandD. J. O’Halloran, Cork University H... Pituitary journals http://www.medworm.com/rss/comments.php?id=2072938 Sun, 28 Dec 2008 07:05:48 +0100 2072938 http://www.medworm.com/index.php?rid=2064861&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu3n8578071257822%2F We describe three men with unusual presenting features of prolactin-secreting giant pituitary adenomas: prolonged and increasingly disturbing intolerance to light and noise; strange behavior and mood disturbances; and rhinorrhea followed by a finding of cerebrospinal fluid leakage. Treatment with dopamine agonist alleviated all symptoms, with concomitant suppression of plasma prolactin levels and a significant reduction in tumor mass. These cases emphasize the importance of considering unusual symptoms in the differential diagnosis of giant prolactinomas and the effectiveness of medical treatment. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0160-0Authors Simona Grozinsky-Glasberg, Institute of Endocrinology & Metabolism, Rabin Medical Center, Beilinson ... Pituitary journals http://www.medworm.com/rss/comments.php?id=2064861 Tue, 23 Dec 2008 08:10:10 +0100 2064861 http://www.medworm.com/index.php?rid=2051789&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F63502554p1586643%2F Conclusion    the GHR genotype could be useful in predicting dose and individual response to pegvisomant in acromegaly. Content Type Journal ArticleDOI 10.1007/s11102-008-0157-8Authors Antonio Bianchi, Catholic University Division of Endocrinology, School of Medicine Largo A. Gemelli, 8 00168 Rome ItalyGherardo Mazziotti, University of Brescia Department of Medical and Surgical Sciences Brescia ItalyLaura Tilaro, Catholic University Division of Endocrinology, School of Medicine Largo A. Gemelli, 8 00168 Rome ItalyVincenzo Cimino, Catholic University Division of Endocrinology, School of Medicine Largo A. Gemelli, 8 00168 Rome ItalyFlora Veltri, Catholic University Division of Endocrinology, School of Medicine Largo A. Gemelli, 8 00168 Rome ItalyEleonora Gaetani, Catholic Univer... Pituitary journals http://www.medworm.com/rss/comments.php?id=2051789 Wed, 17 Dec 2008 08:33:06 +0100 2051789 http://www.medworm.com/index.php?rid=2016472&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F22vr167604377385%2F Abstract  Oncogenes and tumor suppressor genes involved in most common cancers are not involved in the great majority of pituitary adenomas. Similarly, there is little evidence to suggest that the mutations involved in genetic syndromes associated with pituitary tumors (such as the gsp, MEN1, PKAR1A or AIP mutations) are common in sporadic tumors. A novel pituitary tumor transforming gene (PTTG, securin) has been identified which is over-expressed in most tumors—but it is unclear as to its causal role in oncogenesis. Cell signaling abnormalities have been identified in pituitary tumors but their genetic basis is unknown. However, both the Akt pathway and the MAPK pathway are over-expressed in many pituitary tumors, which results in the inhibition of cell cycle inhibitors.... Pituitary journals http://www.medworm.com/rss/comments.php?id=2016472 Fri, 05 Dec 2008 09:29:59 +0100 2016472 http://www.medworm.com/index.php?rid=2013166&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F63257g61264w0103%2F Abstract  Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are sometimes difficult to visualize, even with high-quality magnetic resonance imaging, due to their small size and variable location. Sampling the cavernous or inferior petrosal sinus is helpful for confirming the central origin of a tumor, but ectopic corticotroph adenomas in the paraseller region also typically exhibit a high central/peripheral plasma ACTH ratio. We experienced an extremely rare case of Cushing’s disease caused by an ACTH-secreting microadenoma located entirely inside the left cavernous sinus attached to the medial wall (ectopic pituitary adenoma) that was not visible by preoperative MRI. In this case, the microadenoma was completely removed and an endocrinologic cure was achiev... Pituitary journals http://www.medworm.com/rss/comments.php?id=2013166 Wed, 03 Dec 2008 08:18:39 +0100 2013166 http://www.medworm.com/index.php?rid=2013165&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn934g6u6u7255670%2F Abstract  Hormone secretion by somatotropinomas, corticotropinomas and prolactinomas exhibits increased pulse frequency, basal and pulsatile secretion, accompanied by greater disorderliness. Increased concentrations of growth hormone (GH) or prolactin (PRL) are observed in about 30% of thyrotropinomas leading to acromegaly or disturbed sexual functions beyond thyrotropin (TSH)-induced hyperthyroidism. Regulation of non-TSH pituitary hormones in this context is not well understood. We there therefore evaluated TSH, GH and PRL secretion in 6 patients with up-to-date analytical and mathematical tools by 24-h blood sampling at 10-min intervals in a clinical research laboratory. The profiles were analyzed with a new deconvolution method, approximate entropy, cross-approximate en... Pituitary journals http://www.medworm.com/rss/comments.php?id=2013165 Wed, 03 Dec 2008 08:18:39 +0100 2013165 http://www.medworm.com/index.php?rid=1959485&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Few41503992061550%2F Abstract  The β subunit of human chorionic gonadotropin (β-hCG) is a marker of malignancies. Recent studies have also reported its expression in pituitary adenomas, although its significance is unclear. In this retrospective study, the authors quantitatively investigated the immunohistochemical expression of β-hCG in 123 patients undergoing surgery for pituitary adenomas and explored its relationship to the rest of the endocrine function, tumour recurrence and Ki-67 nuclear labelling. Based on the endocrine profile and immunohistochemistry, the pituitary adenomas were grouped into non-functioning (NFPA; N = 78) and functioning pituitary adenomas (N = 45). The latter included, 20 growth hormone (GH), 12 prolactin (PRL), 8 adreno-corticotrophin hormone (A... Pituitary journals http://www.medworm.com/rss/comments.php?id=1959485 Thu, 13 Nov 2008 16:06:32 +0100 1959485 http://www.medworm.com/index.php?rid=1959486&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F74078161585w0qtg%2F Abstract  While surgery remains the first-line treatment of most aggressive pituitary adenomas, medical therapy is important as second-line or adjunctive therapy in a large proportion of patients. Dopamine agonists (DAs) are the best treatment for prolactinomas, but when DAs are not tolerated, new somatostatin receptor subtype 5 (SSTR5) inhibitors may offer an alternative in the future. Unfortunately, these are unlikely to be effective in DA-resistant prolactinomas. In acromegaly, the existing somatostatin analogs, octreotide and lanreotide, will remain the medical treatment of choice for the foreseeable future. There is an urgent need for medical therapies in Cushing’s disease, and the SSTR5 analogs could offer an effective treatment in a proportion of patients within the ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1959486 Wed, 12 Nov 2008 22:25:06 +0100 1959486 http://www.medworm.com/index.php?rid=1959487&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fn44q2u782347587n%2F Abstract  Aggressive pituitary adenomas are notoriously difficult to manage due to their size, invasiveness, speed of growth and high frequency of recurrence. Except for prolactinomas, surgery (usually transsphenoidal but sometimes transcranial) is the first-line option, but re-growth of aggressive tumors is almost inevitable and monitoring and repeat surgery is required to control symptoms. In prolactinomas, dopamine agonists are the first-line treatment and they normalize prolactin levels in most patients even with macroprolactinomas. Somatostatin analogues offer another pharmacotherapy for pituitary adenomas either for primary therapy, pre-operatively to reduce the tumor volume and make it more amenable to surgical removal, or post-surgery to control re-expansion. When s... Pituitary journals http://www.medworm.com/rss/comments.php?id=1959487 Wed, 12 Nov 2008 22:25:05 +0100 1959487 http://www.medworm.com/index.php?rid=1944900&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F2102q74481kj1l17%2F Content Type Journal ArticleCategory LetterDOI 10.1007/s11102-008-0152-0Authors S. Benvenga, Università di Messina Sezione di Endocrinologia del Dipartimento Clinico Sperimentale di Medicina e Farmacologia 98125 Messina ItalyS. Cannavò, Università di Messina Sezione di Endocrinologia del Dipartimento Clinico Sperimentale di Medicina e Farmacologia 98125 Messina ItalyF. Trimarchi, Università di Messina Sezione di Endocrinologia del Dipartimento Clinico Sperimentale di Medicina e Farmacologia 98125 Messina ItalyF. Guarneri, Università di Messina Istituto di Dermatologia 98125 Messina Italy Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1944900 Thu, 06 Nov 2008 00:41:45 +0100 1944900 http://www.medworm.com/index.php?rid=1911047&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv8403u01722171x2%2F We report the case of an adolescent girl presenting with headache, diabetes insipidus and central thyro-gonadic insufficiency with no history of infection, in whom the intra-operative diagnosis of primary pituitary abscess was made. Bacterial cultures indicated infection with Streptococcus spp. One year after neurosurgery and antibiotic therapy, recovery of diabetes insipidus and pituitary insufficiency was documented except for persistence of subnormal growth hormone secretion. Post-surgery, pituitary magnetic resonance imaging revealed an empty sella syndrome. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0150-2Authors Carmen Emanuela Pepene, University of Medicine and Pharmacy Department of Endocrinology Cluj-Napoca RomaniaIoana Ilie, University of Medi... Pituitary journals http://www.medworm.com/rss/comments.php?id=1911047 Sat, 25 Oct 2008 08:54:54 +0100 1911047 http://www.medworm.com/index.php?rid=1911048&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl71h6g3uh380rg55%2F Abstract  Pituitary carcinoma is characterized by the presence of systemic or central nervous system metastases rather than malignant histological features, making it an anomaly amongst carcinomas. In contrast, aggressive or atypical pituitary adenomas often have a relatively bland histological appearance despite their malignant growth patterns. We now report a case of a 67-years-old male with a giant pituitary tumor with overt pathologic and phenotypic features of malignancy, but the absence of metastases, that evolved from a benign non-functioning gonadotroph macroadenoma treated 10 years earlier. This case represents the first report of a pituitary adenoma with overt malignant histology that does not meet criteria for classification as pituitary carcinoma, helping to com... Pituitary journals http://www.medworm.com/rss/comments.php?id=1911048 Fri, 24 Oct 2008 06:55:04 +0100 1911048 http://www.medworm.com/index.php?rid=1905173&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb012t36484h1l0p3%2F In conclusion, the medical treatment with dopaminergic compounds is effective and safe in patients with prolactinoma with onset in childhood, allowing preservation of the anterior pituitary function. Content Type Journal ArticleDOI 10.1007/s11102-008-0149-8Authors Shrikrishna V. Acharya, K E M Hospital Parel Mumbai 400012 Maharashtra IndiaRaju A. Gopal, K E M Hospital Parel Mumbai 400012 Maharashtra IndiaTushar R. Bandgar, K E M Hospital Parel Mumbai 400012 Maharashtra IndiaShashank R. Joshi, K E M Hospital Parel Mumbai 400012 Maharashtra IndiaPadma S. Menon, K E M Hospital Parel Mumbai 400012 Maharashtra IndiaNalini S. Shah, K E M Hospital Department of Endocrinology Parel Mumbai 400012 Maharashtra India Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pit... Pituitary journals http://www.medworm.com/rss/comments.php?id=1905173 Thu, 23 Oct 2008 05:54:22 +0100 1905173 http://www.medworm.com/index.php?rid=1905172&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu445u406vt8n8722%2F Content Type Journal ArticleCategory Guest EditorialDOI 10.1007/s11102-008-0148-9Authors Mark E. Molitch, Northwestern University Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine Chicago IL 60611 USAAshley B. Grossman, Barts and the London School of Medicine Centre for Endocrinology London UK Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1905172 Thu, 23 Oct 2008 05:54:22 +0100 1905172 http://www.medworm.com/index.php?rid=1905171&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc0h51635777507x1%2F In this report we emphasize the opportunity of considering the uncommon causes of chronic GH-excess in the initial diagnostic process, such as GHRH hypersecretion, especially in the presence of ambiguous pituitary neuroimaging. This topic may have an important clinical significance in order to plan the most cost-effective diagnostic procedures and management and to avoid unnecessary pituitary neurosurgery. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0146-yAuthors E. Verrua, University of Milan Unit of Endocrinology, Department of Medical Sciences, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena Via F. Sforza 35 20122 Milan ItalyC. L. Ronchi, University of Milan Unit of Endocrinology, Department of Medical Sciences, Fondazione IR... Pituitary journals http://www.medworm.com/rss/comments.php?id=1905171 Thu, 23 Oct 2008 05:54:22 +0100 1905171 http://www.medworm.com/index.php?rid=1905174&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F30663n142172747v%2F Abstract  Although pituitary tumors are mostly benign, they share certain molecular events with more malignant neoplasia, although their precise pathogenesis is far from established. The acquisition of new functional characteristics during their evolution suggests a multistep process that leads to tumor transformation. Mutations in classical tumor suppressor genes or oncogenes are infrequently associated with pituitary tumorigenesis. However, alterations in different signaling pathways, especially those involved in pituitary gland development, have emerged as significant features in pituitary adenomas. In particular, changes in inhibitory components of the β-catenin pathway and its relationship to the cadherin family of peptides may well play an important role in tumorigen... Pituitary journals http://www.medworm.com/rss/comments.php?id=1905174 Thu, 23 Oct 2008 05:54:21 +0100 1905174 http://www.medworm.com/index.php?rid=1870270&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj706157553j52478%2F Abstract  A 58-year-old previously healthy man presented with diplopia of rapid onset over a few days. Examination demonstrated bilateral sixth and right fourth cranial nerve palsy. MR imaging showed a large sellar mass with significant destruction of the pituitary fossa. Laboratory tests revealed very high serum prolactin (2,483 ng/dl, reference range 3–13 ng/dl). Dopamine agonist therapy was initiated with significant decline in PRL levels; however, nausea, fatigue, and anorexia developed. Within a few weeks the patient developed renal failure and hypercalcemia. Urine protein electrophoresis revealed large free monoclonal kappa peaks while extensive plasmocytosis was evident in bone marrow aspirates. On bone scan numerous lytic lesions were present. A transsphenoid... Pituitary journals http://www.medworm.com/rss/comments.php?id=1870270 Fri, 10 Oct 2008 08:17:43 +0100 1870270 http://www.medworm.com/index.php?rid=1855551&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw0357862u1886313%2F In conclusion, this MRI study provides first evidence that acromegalic patients exhibit disturbances of the macroscopic brain tissue architecture. Furthermore, acromegalic patients may have an increased risk of neurovascular pathology, likely due to secondary metabolic and vascular comorbidities. Content Type Journal ArticleDOI 10.1007/s11102-008-0143-1Authors C. Sievers, Max Planck Institute of Psychiatry Department of Endocrinology Kraepelinstr. 2-10 80804 Munich GermanyP. G. Sämann, Max Planck Institute of Psychiatry Department of Magnetic Resonance Imaging Kraepelinstr. 2-10 80804 Munich GermanyT. Dose, Max Planck Institute of Psychiatry Department of Endocrinology and Department of Magnetic Resonance Imaging Kraepelinstr. 2-10 80804 Munich GermanyC. Dimopoulou, Max Planck Inst... Pituitary journals http://www.medworm.com/rss/comments.php?id=1855551 Sat, 04 Oct 2008 09:29:46 +0100 1855551 http://www.medworm.com/index.php?rid=1828831&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fbu352658522249tr%2F Conclusion Most GHD patients have intact posterior pituitary function. This case report highlights the powerful anti-natriuretic properties of GH. Endocrine physicians should be alert to this in patients with fixed DI and an abnormal thirst threshold. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0144-0Authors Shivani Misra, St Bartholomew’s Hospital Department of Endocrinology London EC1A 7BE UKLinda Brown Johnston, St Bartholomew’s Hospital Department of Endocrinology London EC1A 7BE UKWilliam Martyn Drake, St Bartholomew’s Hospital Department of Endocrinology London EC1A 7BE UK Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1828831 Wed, 24 Sep 2008 08:30:52 +0100 1828831 http://www.medworm.com/index.php?rid=1811051&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu573168543404268%2F We describe a women with cystic fibrosis who presented with secondary amenorrhea as a consequence of Chiari-I malformation and resultant hydrocephalus. The biochemical picture was characterized by hypogonadotropic hypogonadism. Resolution of the amenorrhea was observed to occur following 3rd ventriculostomy. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0142-2Authors Sampath Satish Kumar, Leeds Teaching Hospitals NHS Trust Department of Endocrinology D Floor, Brotherton Wing, Leeds General Infirmary, Great George Street Leeds LS1 3EX UKPaul Chumas, Leeds Teaching Hospitals NHS Trust Department of Neurosurgery Leeds UKDaniel Peckham, Leeds Teaching Hospitals NHS Trust Department of Respiratory Medicine Leeds UKAshley Guthrie, Leeds Teaching Hospitals NHS Trus... Pituitary journals http://www.medworm.com/rss/comments.php?id=1811051 Thu, 18 Sep 2008 06:44:49 +0100 1811051 http://www.medworm.com/index.php?rid=1789991&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl282rn83p437ug41%2F Content Type Journal ArticleCategory ErratumDOI 10.1007/s11102-008-0141-3Authors Bernhard Schaller, University of Paris Departments of Neurosurgery Paris FranceNora Sandu, University of Paris Departments of Neurosurgery Paris FranceGiulia Ottaviani, University of Milano Centro ‘‘Lino Rossi’’ Research Center for the Study and Prevention of the Unexpected Perinatal Death and SIDS, Institute of Pediatrics and Neonatology Milan ItalyAndreas Filis, Erlangen GermanyChristoph Noethen, Erlangen GermanyMichael Buchfelder, Erlangen GermanyFor the Trigemino-Cardiac-Reflex-Examination-Group (T.C.R.E.G.), Paris France Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1789991 Fri, 12 Sep 2008 07:54:03 +0100 1789991 http://www.medworm.com/index.php?rid=1742026&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh78635t247g85457%2F Abstract  Leptin is a key mediator in the maintenance of neuroendocrine homeostasis. The aim of this study was to determine the changes in serum leptin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO) levels in patients with hyperprolactinemia. The study consists of 16 consecutive patients with high prolactin (PRL) levels (group I) and a control group of 11 normoprolactinemic patients (group II). Pituitary tumor tissues of patients in groups I and II were analyzed for immunohistochemical (IHC) expression of prolactin and leptin. Group I has significantly higher levels of leptin than group II (P < 0.001). There is a strong correlation between PRL and leptin concentrations in group I. However, there were no statistically significant diff... Pituitary journals http://www.medworm.com/rss/comments.php?id=1742026 Thu, 28 Aug 2008 15:37:51 +0100 1742026 http://www.medworm.com/index.php?rid=1713571&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu345gxr378g03tr0%2F We present a complex case of a recurrent ependymoma of the parasellar region which has been difficult to clinically manage due to its tendency to recurrence. Our patient has had four operations over the last 28 years, with external beam radiotherapy, but still has residual tumor and is currently panhypopituitary and with significant visual loss. We believe there is considerable uncertainty as to the optimal management of any future progression, which seems likely, and are currently considering the use of radiosurgery with careful sparing of the optic chiasm, or possibly the chemotherapeutic agent temozolomide. Our case emphasises the recurrent nature of this rare but difficult tumor. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0139-xAuthors Rosie B... Pituitary journals http://www.medworm.com/rss/comments.php?id=1713571 Fri, 15 Aug 2008 09:06:29 +0100 1713571 http://www.medworm.com/index.php?rid=1688715&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx3m160781445gq2l%2F Abstract  In 1886 Pierre Marie used the term “acromegaly” for the first time and gave a full description of the characteristic clinical picture. However several others had already given clear clinical descriptions before him and sometimes had given the disease other names. After 1886, it gradually became clear that pituitary enlargement (caused by a pituitary adenoma) was the cause and not the consequence of acromegaly, as initially thought. Pituitary adenomas could be found in the great majority of cases. It also became clear that acromegaly and gigantism were the same disease but occurring at different stages of life and not different diseases as initially thought. At the end of the 19th and beginning of the 20th century most information was derived from case descript... Pituitary journals http://www.medworm.com/rss/comments.php?id=1688715 Wed, 06 Aug 2008 05:55:29 +0100 1688715 http://www.medworm.com/index.php?rid=1654951&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fc24453r251260070%2F Conclusion Our study provides strong evidence suggesting that, regardless of initial prolactin level, preoperative dopamine agonist therapy is not detrimental. In fact, pretreatment with dopamine agonist drugs, possibly by inducing tumor regression, seemed to improve the surgeon’s ability to resect a greater percentage of the tumor and led to better control of the prolactin level. Content Type Journal ArticleDOI 10.1007/s11102-008-0135-1Authors Michael E. Sughrue, University of California at San Francisco Department of Neurological Surgery San Francisco CA USAEdward F. Chang, University of California at San Francisco Department of Neurological Surgery San Francisco CA USAJ. Blake Tyrell, University of California at San Francisco Department of Medicine San Francisco CA USASandeep K... Pituitary journals http://www.medworm.com/rss/comments.php?id=1654951 Thu, 24 Jul 2008 09:19:05 +0100 1654951 http://www.medworm.com/index.php?rid=1642132&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl602535t2j442027%2F Conclusion We found a lower than expected prevalence of gsp mutations in somatotropinomas and a similar prevalence in NFPA compared to previous studies from other countries. Content Type Journal ArticleDOI 10.1007/s11102-008-0136-0Authors Giselle Fernandes Taboada, Universidade Federal do Rio de Janeiro (UFRJ) Serviço de Endocrinologia do Hospital Universitário Clementino Fraga Filho Rua Nascimento Silva, 555/101, Ipanema Rio de Janeiro Brazil 22421-020Ana Lúcia Osório Tabet, Universidade Estadual do Rio de Janeiro Serviço de Endocrinologia do Hospital Universitário Pedro Ernesto Rio de Janeiro BrazilLuciana A. Naves, Universidade de Brasília Serviço de Endocrinologia do Hospital Universitário de Brasília Brasília BrazilDenise Pires de Carvalho, Universidade Federal do Rio ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1642132 Sat, 19 Jul 2008 13:59:49 +0100 1642132 http://www.medworm.com/index.php?rid=1638906&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F436q3320788557n4%2F Abstract  Ideal surgical treatment of craniopharyngiomas remains a major challenge for neurosurgeons. Craniopharyngiomas grow in the deep-seated hypothalamic area that is paramount for vegetative, emotional and endocrine function, and for maintaining worthwhile life. The benign histological nature of craniopharyngiomas belies their biological behavior and the propensity to recur is a major threat. Surgical treatment has to weigh the risk of hypothalamic damage against the risk of tumor recurrence or progression. Both aggressive surgery and conservative minor surgery followed by radiotherapy has been proclaimed by the proponents of different schools. During the past decade, the pendulum has swung back to surgery with the attempt at radical removal. Refined neurosurgical tech... Pituitary journals http://www.medworm.com/rss/comments.php?id=1638906 Fri, 18 Jul 2008 06:30:24 +0100 1638906 http://www.medworm.com/index.php?rid=1577040&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu7645787h2435373%2F Abstract  We hypothesize that Pio Pico, the last Mexican Governor of California, had acromegaly between at least ages 43 to 57, from 1844 to 1858, before Pierre Marie published the clinical description of acromegaly in 1886. Pico’s probable growth hormone-secreting pituitary tumor likely infarcted spontaneously after 1858. The tumor infarction resulted in burnt-out acromegaly and probably restored normal pituitary function. Pearce Bailey published the first account of pituitary tumor infarction only in 1898. Pico’s undiagnosed, misunderstood, profoundly acromegalic appearance was widely misinterpreted, leading to pervasive, degrading, and highly prejudicial comments. This landmark case study in neuroendocrinology provides the opportunity to re-examine elements of 19th c... Pituitary journals http://www.medworm.com/rss/comments.php?id=1577040 Thu, 03 Jul 2008 08:26:56 +0100 1577040 http://www.medworm.com/index.php?rid=1575012&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Flj61w07416l634np%2F Abstract  Ergot-derived dopamine receptor agonists, especially pergolide and cabergoline, have been associated with an increased risk of valvular heart disease in patients treated for Parkinson’s disease. Cabergoline at lower doses than those employed in Parkinson’s disease is widely used in patients with prolactinomas, because of its high efficacy and tolerability; however, its safety with regard to cardiac valve disease is unknown. In order to assess the prevalence of cardiac valve regurgitation in patients with prolactinomas treated with long-term cabergoline, we performed a prospective and multicentric study including four university centers in the province of Quebec. A transthoracic echocardiogram was performed in 70 patients with prolactinomas treated with cabergo... Pituitary journals http://www.medworm.com/rss/comments.php?id=1575012 Wed, 02 Jul 2008 15:35:00 +0100 1575012 http://www.medworm.com/index.php?rid=1575011&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fv24q050q86157082%2F Abstract  There are scant prospective studies defining improvements in critical outcome measures with hormone replacement in hypopituitarism secondary to brain injury. We review the tests of cognition and physical function and summarize their use for subjects that are deficient in anterior hormone production during anterior pituitary hormone replacement in brain injury and propose these as the minimal tests that are feasible for a physician to perform in a clinical setting. We summarize the studies conducted to assess outcome measures after brain injury and also report preliminary findings for improvements in cognition and physical function in subjects with brain injury and GH deficiency. Content Type Journal ArticleDOI 10.1007/s11102-008-0133-3Authors Sorin G. Beca, Un... Pituitary journals http://www.medworm.com/rss/comments.php?id=1575011 Wed, 02 Jul 2008 15:35:00 +0100 1575011 http://www.medworm.com/index.php?rid=1559898&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fqjh465g870205308%2F Content Type Journal ArticleCategory LetterDOI 10.1007/s11102-008-0132-4Authors Bernhard Schaller, University of Paris Departments of Neurosurgery Paris FranceNora Sandu, University of Paris Departments of Neurosurgery Paris FranceGiulia Ottoviani, University of Milano Centro “Lino Rossi” Research Center for the Study and Prevention of the Unexpected Perinatal Death and SIDS, Institute of Pediatrics and Neonatology Milan ItalyAndreas Filis, Erlangen GermanyChristoph Noethen, Erlangen GermanyMichael Buchfelder, Erlangen GermanyFor the Trigemino-Cardiac-Reflex-Examination-Group (T.C.R.E.G.), Paris France Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1559898 Sat, 28 Jun 2008 08:11:43 +0100 1559898 http://www.medworm.com/index.php?rid=1466745&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fq5n161142q347717%2F We present the case of a 46-year-old woman with acromegaly currently being treated with the growth hormone (GH) receptor antagonist pegvisomant showing strongly fluctuating IGF-I levels. We prospectively measured estradiol, IGF-I, IGF-I binding protein, acid labile subunit, basal endogenous GH, binding protein and pegvisomant levels for 6 months every week. Estradiol levels showed a strongly negative correlation with IGF-I (r = −0.733, P < 0.001), and less so with ALS (r = −0.433, P < 0.05) and IGFBP3 (r = −0.590, P < 0.01). Estradiol was not significantly correlated with endogenous GH or pegvisomant levels. Likewise, IGF-I did not correlate with endogenous GH or pegvisomant levels. In our patient, endogeno... Pituitary journals http://www.medworm.com/rss/comments.php?id=1466745 Fri, 23 May 2008 05:52:30 +0100 1466745 http://www.medworm.com/index.php?rid=1463302&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk2221m1223g05715%2F Abstract  Though it was appreciated at a very early time that removal of gonads had evident consequences, the anatomy and function of the gonads were essentially unknown in the Antiquity. It was not until around 1600 that men like Vesalius, de Graaf and Leeuwenhoek initiated rational studies on the structure and function of the gonads. The close relationship between gonads and hypothalamus/pituitary was recognized less than 100 years ago. The last pituitary hormone with gonadotroph effect was discovered a generation ago. This paper briefly describes some major points in the development of our knowledge of the pituitary-gonadal function. Considering the huge number of studies involved, this review reflects but a tiny fraction of the work laid down over millennia within ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1463302 Wed, 21 May 2008 06:00:52 +0100 1463302 http://www.medworm.com/index.php?rid=1448645&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fw518152t227l7452%2F Abstract  The complex pathophysiology of traumatic brain injury (TBI) involves not only the primary mechanical event but also secondary insults such as hypotension, hypoxia, raised intracranial pressure and changes in cerebral blood flow and metabolism. It is increasingly evident that these initial insults as well as transient events and treatments during the early injury phase can impact hypothalamic-pituitary function both acutely and chronically after injury. In turn, untreated pituitary hormonal dysfunction itself can further hinder recovery from brain injury. Secondary adrenal insufficiency, although typically reversible, occurs in up to 50% of intubated TBI victims and is associated with lower systemic blood pressure. Chronic anterior hypopituitarism, although reversi... Pituitary journals http://www.medworm.com/rss/comments.php?id=1448645 Thu, 15 May 2008 06:10:38 +0100 1448645 http://www.medworm.com/index.php?rid=1445538&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl4520868h68n7558%2F Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0129-zAuthors Ambar Basu, Christie Hospital Department of Endocrinology Manchester UKGeorg Brabant, Christie Hospital Department of Endocrinology Manchester UKKanna K. Gnanalingham, Salford Royal Hospital Department of Neurosurgery, Greater Manchester Neuroscience Centre Salford Greater Manchester M6 8HD UK Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1445538 Tue, 13 May 2008 21:17:43 +0100 1445538 http://www.medworm.com/index.php?rid=1425852&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy7xm716362273x23%2F Conclusions Our pilot study suggests that decreasing the glucocorticoid replacement dose to ~15 mg/day is beneficial in terms of patients’ body composition, lipid profile and quality of life. Content Type Journal ArticleDOI 10.1007/s11102-008-0126-2Authors Karina Danilowicz, Hospital de Clínicas Division of Endocrinology Avenida Córdoba 2351, 5° piso, 1120 Ciudad Autónoma de Buenos Aires ArgentinaOscar Domingo Bruno, Hospital de Clínicas Division of Endocrinology Avenida Córdoba 2351, 5° piso, 1120 Ciudad Autónoma de Buenos Aires ArgentinaMarcos Manavela, Hospital de Clínicas Division of Endocrinology Avenida Córdoba 2351, 5° piso, 1120 Ciudad Autónoma de Buenos Aires ArgentinaReynaldo Manuel Gomez, Hospital de Clínicas Division of Endocrinology Avenida Córdoba 2... Pituitary journals http://www.medworm.com/rss/comments.php?id=1425852 Tue, 06 May 2008 16:13:53 +0100 1425852 http://www.medworm.com/index.php?rid=1425851&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F876r4417l10v5231%2F Abstract  Ectopically ACTH producing tumors may be difficult to localize by conventional radiology and functional imaging may be helpful. Case 1: 31-year-old man was diagnosed with ectopic ACTH-dependent Cushing’s syndrome (ECS). Thorax CT revealed a 1.3 cm nodular opacity in upper left lobe, suggestive of residual lesion. [18F] fluoro-2-deoxy-d-glucose ([18F] FDG) positron emission tomography ([18F] FDG PET) scan revealed mild glycolytic metabolic activity. Pathological examination confirmed an ACTH-positive carcinoid tumor. Case 2: 53-year-old woman presented with very rapid onset ECS. Pituitary MRI was normal. Thorax CT revealed no tumoral lesion. Abdominal and pelvic MRI showed images suggestive of hepatic and iliac, femoral and lumbar secondary implants. [18F] FDG... Pituitary journals http://www.medworm.com/rss/comments.php?id=1425851 Tue, 06 May 2008 16:13:53 +0100 1425851 http://www.medworm.com/index.php?rid=1401934&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3230lw4701651272%2F Abstract  The usual first treatment for Cushing’s disease is surgical removal of the pituitary adenoma. In patients in whom surgery is unsuccessful or who decline an operation, radiation to the pituitary offers the possibility of remission. No form of radiation delivery results in immediate control of cortisol production. Thus, until radiation treatment becomes effective, medical therapy to lower cortisol production is indicated. The time to remission with radiation therapy cannot be predicted, medical therapy should be discontinued every 6 months to assess response to radiation treatment; a normal 24 h urine free cortisol being the optimal outcome. There are no prospective studies comparing the results among the different types of radiation delivery. The type o... Pituitary journals http://www.medworm.com/rss/comments.php?id=1401934 Fri, 25 Apr 2008 10:20:13 +0100 1401934 http://www.medworm.com/index.php?rid=1401935&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft28131357386387r%2F Abstract  With the stricter endocrine definitions of cure following conventionally planned and fractionated radiotherapy for functioning pituitary adenomas, together with the move in the profession (since the advent of high quality MRI) to postpone radiation therapy until macroscopic disease appears after surgery, it is now realised that cure rates following conventional radiotherapy approximate three out of four rather than the >90% cited for more than a decade. Patients with persistent active tumours may be successfully further treated by focal radiation therapy by one of the stereotactic focal techniques. We have experience of such re-treatment radiation therapy in 50 patients. With careful case selection, we here demonstrate that in acromegaly, for example, normalisa... Pituitary journals http://www.medworm.com/rss/comments.php?id=1401935 Fri, 25 Apr 2008 10:20:12 +0100 1401935 http://www.medworm.com/index.php?rid=1388535&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx02w0115v0nn82u7%2F Conclusions The data from this study indicate that the GnRH test is unhelpful in the clinical assessment of the HP axis in patients with HP disease. Content Type Journal ArticleDOI 10.1007/s11102-008-0124-4Authors N. K. Chammas, King’s College Hospital Endocrine Unit London SE5 9PJ UKS. M. Chambers, King’s College Hospital Clinical Biochemistry London SE5 9PJ UKP. E. Harris, King’s College Hospital Endocrine Unit London SE5 9PJ UK Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1388535 Sat, 19 Apr 2008 14:48:14 +0100 1388535 http://www.medworm.com/index.php?rid=1388534&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ff2546602038585w3%2F Abstract  The foundation for the diagnosis of growth hormone (GH) deficiency in childhood must be auxology, that is, the comparison of the child’s growth pattern to that of established norms for gender and ethnicity. It is only in those growing considerably more slowly than average that testing for GHD makes sense. Assessment of laboratory tests, whether static, for example, the measurement of growth factors or their binding proteins, or dynamic, for example, secretagogue-stimulated GH secretion is confirmatory. One must be cognizant of the assay used to determine GH, for there may be a 3-fold difference in the concentration of GH among commercially-available assays. Controversy still exists concerning the measurement of spontaneous GH release and whether sex-steroid prim... Pituitary journals http://www.medworm.com/rss/comments.php?id=1388534 Sat, 19 Apr 2008 14:48:14 +0100 1388534 http://www.medworm.com/index.php?rid=1385617&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F608214826v2q6434%2F Abstract  Published data on the effects of androgen deficiency and testosterone administration on body composition in men and women are reviewed. In experimental paradigms, androgen deprivation decreases lean body mass and increases fat mass in men, and physiologic replacement reverses these abnormalities. The anabolic effects of testosterone administration on muscle in men are well-established, and current understanding of the underlying mechanisms are discussed. Randomized, placebo-controlled studies have been performed to investigate the effects of testosterone administration on body composition in a number of male hypogonadal states, including HIV-associated weight loss, supraphysiologic glucocorticoid administration, aging and obesity, with variable outcomes, and the r... Pituitary journals http://www.medworm.com/rss/comments.php?id=1385617 Fri, 18 Apr 2008 15:01:52 +0100 1385617 http://www.medworm.com/index.php?rid=1385618&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F50636657p4641372%2F Abstract  Following a century of evolution and refinements in standard surgical techniques, the vast majority of operations for pituitary adenoma to date are performed utilizing transsphenoidal approaches. From current large series one obtains the impression that certainly less than 10% of these tumors require craniotomies. However, still several tumors, which’s volume is mainly localized outside of the sella require transcranial approaches, of which the pterional and subfrontal routes are the most widely used. The goal of surgical treatment is rapid eradication of the tumor mass, decompression of visual pathways and elimination of hormonal oversecretion whilst preserving the normal gland and avoiding potential surgical complications. Even with microsurgical techniques an... Pituitary journals http://www.medworm.com/rss/comments.php?id=1385618 Fri, 18 Apr 2008 15:01:49 +0100 1385618 http://www.medworm.com/index.php?rid=1383252&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fl7745l1527v2m52v%2F Conclusions Pituitary MRI study of patients with Cushing disease treated by adrenalectomy remains difficult. In practice, interpretation of MRI studies by a well-experienced reader should be preferred, unless a final decision can be reached by consensus between two and several readers. Content Type Journal ArticleDOI 10.1007/s11102-008-0123-5Authors Hélène Bahurel-Barrera, Cochin Hospital, Faculté René Descartes, Paris 5 University Department of Radiology A Paris FranceGuillaume Assie, Cochin Hospital, Faculté René Descartes, Paris 5 University, Centre de Référence des Maladies Rares de la Surrénale Department of Endocrinology Paris FranceStéphane Silvera, Cochin Hospital, Faculté René Descartes, Paris 5 University Department of Radiology A Paris FranceXavier Bertagna, C... Pituitary journals http://www.medworm.com/rss/comments.php?id=1383252 Thu, 17 Apr 2008 15:11:33 +0100 1383252 http://www.medworm.com/index.php?rid=1383253&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F464822064x01r3k5%2F Abstract  Secondary adrenal insufficiency (SAI) is a clinical disorder that results from hypothalamic or hypophyseal damage or from prolonged administration of supraphysiological doses of glucocorticoids. Since glucocorticoids are widely used for a variety of diseases, the prevalence of SAI is by far exceeding that of primary adrenal insufficiency. Although the presentation of adrenal insufficiency may be insidious and difficult to recognize, an appropriate adrenocortical hormone replacement could lead to a normal quality of life and longevity can be achieved. The spectrum of adrenal insufficiency ranges from overt adrenal crises to subtle dysfunctions in asymptomatic patients who may be at risk of developing acute adrenal insufficiency since their hypothalamic-pituitary-ad... Pituitary journals http://www.medworm.com/rss/comments.php?id=1383253 Thu, 17 Apr 2008 15:11:32 +0100 1383253 http://www.medworm.com/index.php?rid=1383254&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fu717160725115jm2%2F Abstract  In the vast majority of cases, basal serum GH and IGF-1 levels are markedly increased in patients with obvious clinical signs and symptoms of acromegaly. The oral glucose tolerance test (OGTT) is useful for diagnosis in the minority of patients who have weak GH hypersecretion. The cutoff for a “normal” GH nadir in the OGTT remains to be agreed. The type of GH assay, its sensitivity, the type of standard used by the manufacturer, the patient’s age and especially gender, must all be taken into account. Recent studies using new highly sensitive assays suggest an upper normal GH nadir of 0.71 μg/l for female healthy patients, but no “universal” cut-off has yet been defined for healthy males (from 0.057 to 0.25 μg/l). The 1 μg/l cutoff propos... Pituitary journals http://www.medworm.com/rss/comments.php?id=1383254 Thu, 17 Apr 2008 15:11:31 +0100 1383254 http://www.medworm.com/index.php?rid=1380427&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fy086126106411415%2F Abstract  Central hypothyroidism (CH) is a rare cause of hypothyroidism due to an insufficient stimulation of an otherwise normal thyroid gland and it is caused by either pituitary (secondary hypothyroidism) or hypothalamic (tertiary hypothyroidism) defects. The diagnosis of CH is usually suggested by the finding of lowered thyroid hormone concentrations, associated with inappropriately low/normal TSH levels. Restoration and maintenance of euthyroidism represent the therapeutic goals in all forms of CH. On these basis, the vast majority of patients with CH is treated with standard levo-thyroxine (L-T4) therapy which is tailored according to FT4 circulating levels that should be maintained in the normal range. Content Type Journal ArticleDOI 10.1007/s11102-008-0122-6Author... Pituitary journals http://www.medworm.com/rss/comments.php?id=1380427 Wed, 16 Apr 2008 14:58:43 +0100 1380427 http://www.medworm.com/index.php?rid=1368710&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft2mv645202u88706%2F Abstract  Cardiac arrhythmias are rare during transsphenoidal surgery and is often secondary to stimulation of the trigeminal nerve endings that supply the nasal passages and cavernous sinus walls. Authors report a patient with Acromegaly, who developed transient asystole, during the dissection of the adenoma extending into the left cavernous sinus wall. In such cases, the use of prophylactic atropine may help to avoid such a complication. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0118-2Authors Ahmed H. Abou-Zeid, Hope Hospital Department of Neurosurgery, Greater Manchester Neuroscience Centre Salford, Greater Manchester M6 8HD UKJulian R. E. Davis, University of Manchester School of Medicine, Endocrine Sciences Research Group Manchester UKTar... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368710 Fri, 11 Apr 2008 06:15:48 +0100 1368710 http://www.medworm.com/index.php?rid=1368709&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F3p2g786330352546%2F Abstract  In several respects prolactin is unique among anterior pituitary hormones. The primary regulation of prolactin secretion is mediated through hypothalamic inhibition, and the diagnosis of hyperprolactinemia can be established without the use of stimulation or suppression tests. Documenting the presence of hyperprolactinemia is not difficult–the challenge is in identifying the cause of the hormone hypersecretion. With immunoradiometric assays falsely low levels of prolactin are occasionally seen in patients with macroadenomas and very high serum prolactin (the hook effect). Macroprolactin should be suspected when a patient with hyperprolactinemia does not present with typical clinical symptoms, and all hyperprolactinemic sera should be screened for macroprolactin.... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368709 Fri, 11 Apr 2008 06:15:48 +0100 1368709 http://www.medworm.com/index.php?rid=1368712&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa1134j360k42413n%2F Abstract  Based on previous consensus statements, it has been widely accepted that the diagnosis of adult growth hormone deficiency (GHD) must be shown biochemically by provocative tests of GH secretion; in fact, the measurement of IGF-I as well as of other markers was considered unable to distinguish between normal and GHD subjects. The Insulin Tolerance Test (ITT) was indicated as that of choice and severe GHD defined by a GH peak lower than 3 μg/l. It is now recognized that, although normal IGF-I levels do not rule out severe GHD, very low IGF-I levels in patients highly suspected for GHD (i.e. patients with childhood-onset severe GHD or with multiple hypopituitarism acquired in adulthood) can be considered as definite evidence for severe GHD. However, patients sus... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368712 Fri, 11 Apr 2008 06:15:47 +0100 1368712 http://www.medworm.com/index.php?rid=1368711&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj5n2023nx3t54p85%2F Abstract  Female hypogonadism refers to deficient or abnormal function of the hypothalamic–pituitary–ovarian axis that clinically presents with menstrual cycle disturbances. Female hypogonadism can be due to a congenital or acquired cause, and the defect can be at the level of the hypothalamus, pituitary or ovary. A careful history, physical exam and selected laboratory testing can often determine the locus of the defect and whether it results from a structural or hormonal problem. Laboratory testing generally relies on basal hormone levels; however, timing of blood sampling in relation to menses is important to interpretation of the data. Content Type Journal ArticleDOI 10.1007/s11102-008-0109-3Authors Micol S. Rothman, University of Colorado at Denver and Health Sc... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368711 Fri, 11 Apr 2008 06:15:47 +0100 1368711 http://www.medworm.com/index.php?rid=1368713&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F24g68pk70384j635%2F Abstract  The hypothalamic–pituitary–gonadal (HPG) axis regulates the development, endocrine and reproductive function of the gonads throughout all phases of life. Male hypogonadism is defined an inadequate gonadal function, as manifested by deficiency in gametogenesis and/or secretion of gonadal hormones. In most cases, male hypogonadism is diagnosed through detailed history, physical examination and a few basic hormonal evaluations. In selected cases, however, additional tests are needed to define the aetiology and the extent of HPG axis dysfunction. These include semen analysis, pituitary imaging studies, genetic studies, bone densitometry, testicular ultrasonography, testicular biopsy and hormonal dynamic testing. The stimulation tests of the HPG are of particular i... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368713 Fri, 11 Apr 2008 06:15:46 +0100 1368713 http://www.medworm.com/index.php?rid=1368715&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh6v3535136u66820%2F Abstract  This paper outlines the interferences of the most widely used drugs with hypothalamo-pituitary-adrenal function and the related laboratory parameters, with the purpose of providing practical help to clinicians during testing for hypo- or hypercortisolemic states. Content Type Journal ArticleDOI 10.1007/s11102-008-0114-6Authors Alberto Giacinto Ambrogio, University of Milan Istituto Auxologico Italiano, Ospedale San Luca, IRCCS via Spagnoletto 3 20149 Milan ItalyFrancesca Pecori Giraldi, University of Milan Istituto Auxologico Italiano, Ospedale San Luca, IRCCS via Spagnoletto 3 20149 Milan ItalyFrancesco Cavagnini, University of Milan Istituto Auxologico Italiano, Ospedale San Luca, IRCCS via Spagnoletto 3 20149 Milan Italy Journal PituitaryOnline ISSN 157... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368715 Fri, 11 Apr 2008 06:15:45 +0100 1368715 http://www.medworm.com/index.php?rid=1368714&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Frh6121727u8jl246%2F Abstract  Several studies have reported a close association between traumatic brain injury (TBI) and pituitary dysfunction, and expert panels have recently proposed recommendations for hormone assessment and replacement for pituitary insufficiency after TBI. Given the high incidence of TBI, identification of reliable predictors is of utmost importance in order to secure a cost-effective screening strategy. It has not yet been possible to identify early hormone alterations as a useful tool for the prediction of long-term post-traumatic hypopituitarism, whereas indicators of increased trauma severity have been reported as predictive in an increasing number of studies. Outcome studies have moreover indicated that post-traumatic hypopituitarism is of clinical significance, whic... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368714 Fri, 11 Apr 2008 06:15:45 +0100 1368714 http://www.medworm.com/index.php?rid=1368716&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F9428w1347757k050%2F Abstract  Medications commonly cause hyperprolactinemia and their use must be differentiated from pathologic causes. The most common medications to cause hyperprolactinemia are the antipsychotic agents, although some of the newer atypical antipsychotics do not do so. Other medications causing hyperprolactinemia include antidepressants, antihypertensive agents, and drugs which increase bowel motility. Often, the medication-induced hyperprolactinemia is symptomatic, causing galactorrhea, menstrual disturbance, and erectile dysfunction. In the individual patient, it is important differentiate hyperprolactinemia due to a medication from a structural lesion in the hypothalamic–pituitary area. This can be done by stopping the medication temporarily to determine if the prolactin... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368716 Fri, 11 Apr 2008 06:15:44 +0100 1368716 http://www.medworm.com/index.php?rid=1368717&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1104810tlm23k556%2F Abstract  Systemic illnesses are associated with alterations in the hypothalamic–pituitary–peripheral hormone axes, which represent part of the adaptive response to stressful events and may be influenced by type and severity of illness and/or pharmacological therapy. The pituitary gland responds to an acute stressful event with two secretory patterns: adrenocorticotropin (ACTH), prolactin (PRL) and growth hormone (GH) levels increase, while luteinizing hormone (LH), follicle-stimulating hormone (FSH) and thyrotropin (TSH) levels may either decrease or remain unchanged, associated with a decreased activity of their target organ. In protracted critical illness, there is a uniformly reduced pulsatile secretion of ACTH, TSH, LH, PRL and GH, causing a reduction in serum leve... Pituitary journals http://www.medworm.com/rss/comments.php?id=1368717 Fri, 11 Apr 2008 06:15:43 +0100 1368717 http://www.medworm.com/index.php?rid=1366435&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F1155403q63135622%2F Conclusions Based on clinical and radiological grounds, the diagnosis was consistent with lymphocytic hypophysitis associated with subacute thyroiditis. This is only the second report of this combination in the absence of autoimmunity and the first report of LH and thyroiditis with associated aseptic meningitis in the absence of tissue autoantibodies. We propose a possible viral illness as the unifying aetiological cause Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0119-1Authors Sarina Lim, Waikato Hospital Department of Endocrinology Hamilton New ZealandMarianne S. Elston, Royal North Shore Hospital Cancer Genetics Unit, Kolling Institute of Medical Research Sydney AustraliaMichael J. Swarbrick, Waikato Hospital Radiology Department Hamilton New ZealandJo... Pituitary journals http://www.medworm.com/rss/comments.php?id=1366435 Thu, 10 Apr 2008 07:07:09 +0100 1366435 http://www.medworm.com/index.php?rid=1358288&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F5116438877658261%2F Abstract  Radiotherapy has been used as primary or adjuvant treatment in a number of non-adenomatous masses arising from within the sella. It is particularly important in the therapeutic algorithm of craniopharyngiomas and meningiomas and has also been used in chordomas/chordosarcomas and less commonly, in other lesions. This review describes the place of irradiation in the management of these masses. Content Type Journal ArticleDOI 10.1007/s11102-008-0116-4Authors N. Karavitaki, Churchill Hospital Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism Old Rd, Headington Oxford OX3 7LJ UK Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1358288 Fri, 04 Apr 2008 16:53:24 +0100 1358288 http://www.medworm.com/index.php?rid=1339914&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh1517620h6486681%2F Abstract  As more evidence gathers regarding the beneficial effect of growth hormone replacement therapy (GHRT) on body composition and other parameters in adults with childhood-onset growth hormone deficiency (GHD), questions emerge regarding whether or not GHRT should be discontinued following cessation of statural growth, and the effect of GHRT during the transition period on body composition and related parameters. This review discusses the effect of discontinuation of GHRT following attainment of adult stature, and the treatment and dose effect when GHRT is reinstated. We also review data regarding who should receive GHRT, the criteria for diagnosing persistent GHD, dosing of GHRT and the possibility of a GH ‘holiday’. Content Type Journal ArticleDOI 10.1007/s111... Pituitary journals http://www.medworm.com/rss/comments.php?id=1339914 Sat, 29 Mar 2008 09:00:55 +0100 1339914 http://www.medworm.com/index.php?rid=1336120&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F382808v0g37l5085%2F Abstract   Content Type Journal ArticleDOI 10.1007/s11102-008-0103-9Authors Andrea Giustina, University of Brescia Department of Medical and Surgical Sciences Brescia Italy Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1336120 Fri, 28 Mar 2008 08:51:06 +0100 1336120 http://www.medworm.com/index.php?rid=1336119&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb4m07781hkp32531%2F Abstract  Transsphenoidal surgery has evolved much over nearly 100 years. Initially operations were performed often without any input from endocrinology colleagues, and without preoperative imaging, operative magnification and illumination. Advances in the understanding of the biology of pituitary tumours, close co-operation between endocrinologists, surgeons and oncologists, and huge advances in imaging and surgical techniques have led to the evolution of the current transsphenoidal operation to the pituitary fossa to the point where a ‘cure’ is often possible with low complication rates. The indications, contraindications of transsphenoidal surgery will be discussed, together with nature of the surgical approach and how it can be applied to particular pituitary t... Pituitary journals http://www.medworm.com/rss/comments.php?id=1336119 Fri, 28 Mar 2008 08:51:06 +0100 1336119 http://www.medworm.com/index.php?rid=1336121&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fth003102r1563971%2F Abstract  Acromegaly is a condition characterized by growth hormone (GH) and insulin-like growth factor-1 (IGF-1) hypersecretion, and is associated with boney overgrowth, and soft tissue abnormalities due to anabolic, lipolytic, and sodium retaining actions of GH. GH and IGF-1 excess is associated with alterations in body composition, including an increase in body water and lean body mass, and a reduction in body fat. Achievement of biochemical control of the disease results in a reduction in body water and fat-free mass, and an increase in body fat. BMD is generally increased in acromegaly, though the anabolic effect of GH excess on bone is reduced, if not negated, by the presence of hypogonadism, particularly with regard to the trabecular compartment. Further studies are ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1336121 Fri, 28 Mar 2008 08:51:02 +0100 1336121 http://www.medworm.com/index.php?rid=1317445&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa88535417745653g%2F Conclusions These two cases, one somatotroph and one thyrotroph adenoma, are an illustration that clinically silent pituitary adenomas may in rare circumstances evolve over time and become active, as previously demonstrated in silent corticotroph adenomas. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0085-7Authors Tania Daems, University Hospital Antwerp Department of Endocrinology Wilrijkstraat 10 2650 Edegem BelgiumJohan Verhelst, Middelheim Hospital Antwerp Department of Endocrinology Antwerp BelgiumAlex Michotte, University Hospital Vrije Universiteit Brussel Department of Pathology Brussel BelgiumPascale Abrams, University Hospital Antwerp Department of Endocrinology Wilrijkstraat 10 2650 Edegem BelgiumDirk De Ridder, University Hospital Antwerp Departm... Pituitary journals http://www.medworm.com/rss/comments.php?id=1317445 Wed, 19 Mar 2008 11:13:40 +0100 1317445 http://www.medworm.com/index.php?rid=1307536&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F968002728jh23264%2F Abstract  The development of extracranial approaches to the anterior skull base has been a process in development for over a 100 years. Many neurosurgical (and non-neurosurgical) pioneers have contributed to its evolution. In this paper, we will review the major contributors and contributions to this evolving field. Content Type Journal ArticleDOI 10.1007/s11102-008-0095-5Authors Ashley E. Grosvenor, Stanford University Department of Neurosurgery 300 Pasteur Dr. Stanford CA 94305 USAEdward R. Laws, Stanford University Department of Neurosurgery 300 Pasteur Dr. Stanford CA 94305 USA Journal PituitaryOnline ISSN 1573-7403Print ISSN 1386-341X (Source: Pituitary) Pituitary journals http://www.medworm.com/rss/comments.php?id=1307536 Fri, 14 Mar 2008 07:01:03 +0100 1307536 http://www.medworm.com/index.php?rid=1304481&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe31wh8020l0t6675%2F Abstract  Many patients with prolactin secreting pituitary tumors have decreased bone mineral. The bone loss is associated with an increase in bone resorption and is secondary to prolactin-induced hypogonadism. In both sexes trabecular bone in the spine and hip is more affected than cortical bone in the distal radius. Normalization of prolactin and restoration of gonadal function increases bone density but is not associated with normalization of bone mass. It is not known whether the bone loss in hyperprolactinemic subjects represents a failure to achieve peak bone mass or is due to accelerated bone loss. Despite low bone density hyperprolactinemic subjects do not demonstrate increased fractures. The association between prolactin, weight gain and obesity suggests that prola... Pituitary journals http://www.medworm.com/rss/comments.php?id=1304481 Thu, 13 Mar 2008 07:06:16 +0100 1304481 http://www.medworm.com/index.php?rid=1304482&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fwpv326354u347605%2F Abstract  Evaluation of pituitary function is essential before pituitary surgery. In hyperprolactinaemic patients with a pituitary macrolesion, tumoral secretion of prolactin must be distinguished from ‘disconnection’ hyperprolactinaemia; serum prolactin >200 mcg/l is virtually diagnostic of a macroprolactinoma whereas levels <80 mcg/l usually indicate ‘disconnection’. The prolactin ‘hook effect’ should be excluded. A minimum set of pre-operative endocrine tests should include serum electrolytes, cortisol (at 08.00–09.00 h), free-T4, TSH, prolactin, oestradiol/testosterone, LH, FSH and IGF-1. Some clinicians will choose to perform pre-operative Synacthen or insulin tolerance testing to further define ACTH reserve. If basal cortisol, Synacth... Pituitary journals http://www.medworm.com/rss/comments.php?id=1304482 Thu, 13 Mar 2008 07:06:15 +0100 1304482 http://www.medworm.com/index.php?rid=1289619&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F0526878776904823%2F Abstract  Hypothalamic injury from acquired structural damage due to infiltrative disease, tumor, or their treatment aftereffects frequently results in the development of an obesity syndrome characterized by a rapid, unrelenting weight gain that may be accompanied by severe hyperphagia. Weight gain occurs from the disruption of the normal homeostatic functioning of the hypothalamic centers responsible for controlling satiety and hunger and regulating energy balance with resulting hyperphagia, autonomic imbalance, reduction of energy expenditure, and hyperinsulinemia. Curtailment of weight increase has traditionally been refractory to usual dietary and lifestyle interventions. Pharmacotherapy targeting insulin secretion and augmenting sympathetic output have been attempted t... Pituitary journals http://www.medworm.com/rss/comments.php?id=1289619 Sat, 08 Mar 2008 10:07:43 +0100 1289619 http://www.medworm.com/index.php?rid=1289620&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr717q01j36g41228%2F Abstract  The activity of the pituitary–adrenal axis can profoundly impact on body composition. This is dramatically seen in Cushing’s syndrome (CS) but changes in body composition are also implicated in depression and alcoholic pseudocushing’s. The pathophysiological mechanisms underlying these changes remain poorly understood. Changes to body composition in CS include increased fat mass, decreased bone mass, thinning of the skin and reduced lean mass. Why these tissues are affected so dramatically is unclear. Additionally, the change in body composition between individuals varies considerably for reasons which are only now becoming evident. This paper reviews the phenotypic changes with altered pituitary–adrenal axis activity and discusses the mechanisms involved.... Pituitary journals http://www.medworm.com/rss/comments.php?id=1289620 Fri, 07 Mar 2008 06:58:30 +0100 1289620 http://www.medworm.com/index.php?rid=1287208&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk40l723790j12546%2F We report the case of a 62-year-old man with CS due to ectopic ACTH production by small cell carcinoma of the prostate. He presented with severe hypercortisolism and associated symptoms. Plasma neuron specific enolase (NSE) was grossly elevated. Despite performing a laparoscopic bilateral adrenalectomy, the patient died as a result of sepsis with multi-organ failure. Post-mortem immunohistochemical staining of prostate tumor tissue showed ACTH expression. ACTH staining was also performed in four additional patients with small cell carcinoma of the urinary tract without CS. None of these additional cases showed a positive staining for ACTH. Although a rare cause of ectopic ACTH production, neuroendocrine prostate carcinoma should be considered in male patients with Cushing’s syndro... Pituitary journals http://www.medworm.com/rss/comments.php?id=1287208 Thu, 06 Mar 2008 16:50:17 +0100 1287208 http://www.medworm.com/index.php?rid=1284512&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fr2lk6066x6435604%2F We present a further case of sellar paraganglioma. The patient is a 17-year-old man who developed headache, visual blurring, and diplopia. MRI showed a sellar lesion. Trans-nasal trans-sphenoid biopsy showed features of paraganglioma. He was treated by Stereotactic radiotherapy. Four months after treatment he developed bone metastases which was palliated by radiation, zoledronic acid, and chemotherapy. This is the first case of sellar paraganglioma showing metastases to bone. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-008-0099-1Authors K. P. Haresh, All India Institute of Medical Sciences Department of Radiotherapy and Oncology Ansari Nagar New Delhi 110 029 IndiaR. Prabhakar, All India Institute of Medical Sciences Department of Radiotherapy and Oncology A... Pituitary journals http://www.medworm.com/rss/comments.php?id=1284512 Wed, 05 Mar 2008 07:58:39 +0100 1284512 http://www.medworm.com/index.php?rid=1284513&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh674vm04613761x1%2F Abstract  While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later postoperative periods. In the early period, which spans the first few weeks after surgery, both monitoring of anterior and posterior pituitary function and managing neurosurgical issues are the focus of care. Potential disruption of pituitary-adrenal function is covered with perioperative glucocorticoids. Various strategies exist for ensuring the integrity of this axis, but typically this is done by measuring a morning cortisol on the 2nd or 3rd postoperative days. Patients with levels <10 μg/l should continue therapy ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1284513 Wed, 05 Mar 2008 07:58:38 +0100 1284513 http://www.medworm.com/index.php?rid=1249970&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fg226283253702986%2F Abstract  Transsphenoidal surgery is the treatment of choice for NFPA but is seldom curative. The management of patients in whom residual tumor is detected after surgery is not clear-cut. Radiation therapy is effective in controlling tumor mass in the majority of patients, but is associated with long term complications that call for restriction of its use to patients at high risk for tumor growth. New radiation techniques may prove to be safer while retaining the effectiveness of conventional radiotherapy, however longer follow-up is necessary to confirm this assumption. For now, it appears to be safe to withhold radiation and carefully follow patients with small tumor remnants, whereas large remnants from invasive tumors should be considered for radiotherapy. Nevertheless,... Pituitary journals http://www.medworm.com/rss/comments.php?id=1249970 Wed, 20 Feb 2008 16:04:00 +0100 1249970 http://www.medworm.com/index.php?rid=1249969&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F8767577252856882%2F Abstract  Pituitary surgery is a continuous evolving speciality of the neurosurgeons’ armamentarium, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pituitary pathophysiology. What we consider “pure” endoscopic transsphenoidal surgery is a procedure performed through the nose and the sphenoid bone, with the endoscope alone throughout the whole approach to visualize the surgical target area and without the use of any transsphenoidal retractor. It offers some advantages due to the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle are provided with an increased panoramic vision inside the surgical area. Concerning results in terms of mass removal, relief of clinical symptoms, ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1249969 Wed, 20 Feb 2008 16:03:59 +0100 1249969 http://www.medworm.com/index.php?rid=1231668&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft71717j641762m68%2F Conclusions QOL is impaired in women with microprolactinoma treated with dopamine agonists, and was inversely associated with the PRL levels. This latter finding reinforces the importance of providing adequate disease control for these patients in order to avoid the adverse consequences of hyperprolactinemia on QOL. Content Type Journal ArticleDOI 10.1007/s11102-008-0091-9Authors Erika Cesar de Oliveira Naliato, Federal University of Rio de Janeiro (UFRJ), Hyperprolactinemia Unit, Clementino Fraga Filho University Hospital (HUCFF) Division of Endocrinology, Department of Internal Medicine Rio de Janeiro BrazilAlice Helena Dutra Violante, Federal University of Rio de Janeiro (UFRJ), Hyperprolactinemia Unit, Clementino Fraga Filho University Hospital (HUCFF) Division of Endocrinology,... Pituitary journals http://www.medworm.com/rss/comments.php?id=1231668 Wed, 13 Feb 2008 16:12:40 +0100 1231668 http://www.medworm.com/index.php?rid=1231667&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fb186630g797r0032%2F Abstract  Deficiencies in anterior pituitary hormones secretion ranging from subtle to complete occur following radiation damage to the hypothalamic–pituitary (h–p) axis, the severity and frequency of which correlate with the total radiation dose delivered to the h–p axis and the length of follow up. Selective radiosensitivity of the neuroendocrine axes, with the GH axis being the most vulnerable, accounts for the high frequency of GH deficiency, which usually occurs in isolation following irradiation of the h–p axis with doses less than 30 Gy. With higher radiation doses (30–50 Gy), however, the frequency of GH insufficiency substantially increases and can be as high as 50–100%. Compensatory hyperstimulation of a partially damaged h–p axis may restor... Pituitary journals http://www.medworm.com/rss/comments.php?id=1231667 Wed, 13 Feb 2008 16:12:40 +0100 1231667 http://www.medworm.com/index.php?rid=1231666&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fk6352mt381l51k62%2F Abstract  Hypopituitarism usually occurs as the result of a pituitary tumour or as a consequence of its treatment. If, however, pituitary imaging is negative then an alternative diagnosis should be sought. Patients are often diagnosed as having idiopathic hypopituitarism when imaging is normal. Our objective is to highlight the importance of screening for hemochromatosis in patients with presumed ‘idiopathic’ hypopituitarism. Our patients presented initially with biochemical hypopituitarism and, after initial investigation and normal imaging, were labelled as having idiopathic disease. They subsequently developed iron overload in cardiac and hepatic tissue respectively requiring regular venesection to deplete body stores. Genetic analysis revealed homozygosity for the C2... Pituitary journals http://www.medworm.com/rss/comments.php?id=1231666 Wed, 13 Feb 2008 16:12:40 +0100 1231666 http://www.medworm.com/index.php?rid=1231665&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F318146154l1g2h10%2F Abstract  Approximately half of patients with HIV-infection develop abnormal body fat distribution, characterized by increased abdominal, breast, and dorsocervical adiposity and decreased fat in the limbs and face in association with antiretroviral therapy. Changes in fat distribution are associated with dyslipidemia, insulin resistance, and increased cardiovascular risk in patients with HIV lipodystrophy. Growth hormone secretion is reduced and responses to standardized stimulation testing altered, suggesting relative growth hormone deficiency in this population. Growth hormone secretion is characterized by normal pulse frequency, but decreased pulse amplitude, pulse width, and trough GH levels compared to weight matched, non-HIV-infected patients. Abnormalities in GH secr... Pituitary journals http://www.medworm.com/rss/comments.php?id=1231665 Wed, 13 Feb 2008 16:12:40 +0100 1231665 http://www.medworm.com/index.php?rid=1172482&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F106n7w35rj0014um%2F We present a case of primary central nervous system (CNS) large B cell lymphoma that manifested as pituitary apoplexy. A 45-year-old woman presented with headache, and then rapidly developed a third nerve palsy and bitemporal hemianopsia. Imaging suggested a pituitary macroadenoma, with spontaneous necrosis, extending into the suprasellar region, compressing the optic chiasm and invading the right cavernous sinus. The patient underwent transsphenoidal resection which revealed a vascular, firm tumor. An aggressive decompression of the optic chiasm was performed with complete resolution of both visual fields and third nerve palsy. Final pathology showed B cell lymphoma. Systemic work-up including bone marrow aspiration and CSF studies showed no other foci of lymphoma, and the patient ... Pituitary journals http://www.medworm.com/rss/comments.php?id=1172482 Mon, 21 Jan 2008 16:12:01 +0100 1172482 http://www.medworm.com/index.php?rid=1145474&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fa8128232p14847t2%2F We examined six prolactinomas and eight normal pituitary glands using oligonucleotide GeneChip microarrays, reverse transcription-real time quantitative polymerase chain reaction using 10 prolactinomas, and proteomic analysis to examine protein expression in four prolactinomas. Microarray analyses identified 726 unique genes that were statistically significantly different between prolactinomas and normal glands, whereas proteomic analysis identified four differently up-regulated and 19 down-regulated proteins. Several components of the Notch pathway were altered in prolactinomas, and there was an increased expression of the Pit-1 transcription factor, and the survival factor BAG1 but decreased E-cadherin and N-cadherin expression. Taken together, expression profiling and proteomic an... Pituitary journals http://www.medworm.com/rss/comments.php?id=1145474 Wed, 09 Jan 2008 16:07:50 +0100 1145474 http://www.medworm.com/index.php?rid=1139369&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fx01t15015301675n%2F Abstract  The development of an esthesioneuroblastoma outside to the region in which olfactory epithelium exists is extremely rare. Only nine cases were reported in the previous literatures. The author presents a 40 years-old man with ectopic esthesioneuroblastoma in sella turcica. In contrast to the previous nine cases, our case presented unusual presentations—CSF rhinorrhea and meningitis. Endoscopic transphenoid approach with removal of tumor and repair of dura defect followed by radiotherapy offered a good result in this case. Moreover, differential diagnosis and the origin of the ectopic esthsioneuroblastoma would be discussed. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-007-0081-3Authors Jiann-Her Lin, Tri-Service General Hospital Departmen... Pituitary journals http://www.medworm.com/rss/comments.php?id=1139369 Sun, 06 Jan 2008 14:57:00 +0100 1139369 http://www.medworm.com/index.php?rid=1139368&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fe7012814v8823g26%2F In conclusion, frequent relapses of Cushing’s disease, aggressive growth of macroadenoma, Nelson’s syndrome after adrenalectomy or persistently high ACTH levels should prompt the clinician to consider the possibility of pituitary corticotroph carcinomas. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11102-007-0080-4Authors Agatha A. van der Klaauw, Leiden University Medical Center Department of Endocrinology and Metabolism, C4-R P.O. Box 9600 2300 RC Leiden The NetherlandsTina Kienitz, Charité University Medicine Campus Mitte Clinical Endocrinology, Department of Internal Medicine, Gastroenterology, Hepatology and Endocrinology Berlin GermanyChristian J. Strasburger, Charité University Medicine Campus Mitte Clinical Endocrinology, Department of Internal Medicine... Pituitary journals http://www.medworm.com/rss/comments.php?id=1139368 Sun, 06 Jan 2008 14:56:59 +0100 1139368 http://www.medworm.com/index.php?rid=1139371&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fh85r51rgl6w61443%2F Abstract  Growth-hormone hypersecretion, acromegaly, is associated with reduced life expectancy. First line treatment remains surgery, but remission rates vary between 50% and 90%. In case of lack of surgical remission or recurrence, somatostatin agonists can be proposed. However, about 30% of patients are partially or totally resistant to this treatment. The growth hormone receptor antagonist pegvisomant currently needs more prolonged follow-up studies. Conventional radiotherapy and radiosurgery are two radiation treatment modalities that can be proposed to these resistant patients. Reported rates of remission for conventional radiotherapy range between 50% and 60% in patients with acromegaly, with a time to remission delayed by several years, and adverse effects including... Pituitary journals http://www.medworm.com/rss/comments.php?id=1139371 Fri, 04 Jan 2008 19:51:05 +0100 1139371 http://www.medworm.com/index.php?rid=1139370&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2F93267143k5h56rt8%2F Abstract  External beam radiotherapy has been used in the management of pituitary adenomas for nearly a century, preventing tumor regrowth following surgery for non-functioning pituitary adenomas and suppressing functional hypersecretion in those which are hormonally active. However, it has been linked with a number of potentially significant complications including formation of secondary intracranial tumors, cognitive impairment, hypopituitarism and cerebrovascular disease, as well as increased mortality. Radiation may cause a variety of vascular injuries and hemodynamic changes to the cerebral vasculature, and several authors have reported cerebrovascular complications and an increase in cerebrovascular mortality in patients receiving radiotherapy for pituitary and othe... Pituitary journals http://www.medworm.com/rss/comments.php?id=1139370 Fri, 04 Jan 2008 19:51:05 +0100 1139370 http://www.medworm.com/index.php?rid=1079291&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Ft2477758777t5788%2F Abstract  Pituitary adenomas comprise 10–15% of primary intracranial tumours but the mechanisms leading to tumour development are yet to be clearly established. The retinoblastoma pathway, which regulates the progression through the cell cycle, is often deregulated in different types of tumours. We studied the cyclin-dependent kinase inhibitor p16INK4A gene expression at mRNA level in human pituitary adenomas. Forty-six tumour specimens of different subtypes, 21 clinically non-functioning, 12 growth hormone-secreting, 6 prolactin-secreting, 6 adrenocorticotropin-secreting, and 1 thyrotropin-secreting tumours were studied. All clinically non-functioning and most of the hormone-secreting tumours were macroadenomas (38/46). The RT–PCR assay and electrophoresis of the PCR-pr... Pituitary journals http://www.medworm.com/rss/comments.php?id=1079291 Thu, 06 Dec 2007 16:30:40 +0100 1079291 http://www.medworm.com/index.php?rid=1079290&cid=s_33309_15_f&fid=33309&url=http%3A%2F%2Fwww.springerlink.com%2Fcontent%2Fj68525wq87781322%2F We describe the sequential development of Cushing’s disease, apoplexy and aggressive pituitary tumor in the same patient. A 31-year old male presented with eutopic ACTH dependent Cushing’s syndrome which failed initial pituitary surgery. He underwent subsequent bilateral adrenalectomy for control of hypercortisolism. An episode of pituitary apoplexy then occurred which was followed by the development of a null-cell pituitary tumor. This second tumor exhibited an aggressive behavior with invasion into the surrounding structures and systemic spread clinically. This case provides important evidence for the hypotheses of the pathogenesis of aggressive pituitary tumors which could have arisen from surviving adenoma cells following apoplexy or as a de novo development of pituitary carc... Pituitary journals http://www.medworm.com/rss/comments.php?id=1079290 Thu, 06 Dec 2007 16:30:40 +0100 1079290