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Diagnostic value of 18F-dihydroxyphenylalanine positron emission tomography for growth hormone-producing pituitary adenomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Univ...
Source: Pituitary - November 13, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Acromegaly with negative pituitary MRI and no evidence of ectopic source: the role of transphenoidal pituitary exploration?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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,...
Source: Pituitary - November 10, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Effectiveness of self- or partner-administration of an extended-release aqueous-gel formulation of lanreotide in lanreotide-naïve patients with acromegalyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 =&nb...
Source: Pituitary - November 7, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Management of acromegaly in Latin America: expert panel recommendationsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 evalua...
Source: Pituitary - October 30, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Hypopituitarism due to sports related head trauma and the effects of growth hormone replacement in retired amateur boxersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - October 22, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Apoplexy in non functioning pituitary adenoma after one dose of leuprolide as treatment for prostate cancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 event...
Source: Pituitary - October 20, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Outcome of gonadotropin therapy for male infertility due to hypogonadotrophic hypogonadismEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 pr...
Source: Pituitary - October 16, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Cushing disease as possible cause of persistent growth failure despite growth hormone therapy in a small for gestational age maleEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - September 21, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Inferior petrosal sinus ACTH and prolactin responses to CRH in ACTH-dependent Cushing’s syndrome: a single centre experience from the United KingdomEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Sa...
Source: Pituitary - September 19, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Sellar collision tumor involving pituitary gonadotroph adenoma and chondroma: a potential clinical diagnosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - September 17, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Overview of vascular complications of pituitary surgery with special emphasis on unexpected abnormalityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - September 3, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Diagnostic efficacy of midnight cortisol and midnight ACTH in the diagnosis and localisation of Cushing’s syndromeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 clinica...
Source: Pituitary - August 28, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Primary sellar lymphoma: intravascular large B-cell lymphoma diagnosed as a double cancer and improved with chemotherapy, and literature review of primary parasellar lymphomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 confirme...
Source: Pituitary - August 25, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary centerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 h...
Source: Pituitary - August 20, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Possible role of a radiation-induced p53 mutation in a Nelson’s syndrome patient with a fatal outcomeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 be...
Source: Pituitary - August 4, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Anti-CTLA-4 antibody therapy associated autoimmune hypophysitis: serious immune related adverse events across a spectrum of cancer subtypesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - July 28, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Rapid and sustained reduction of serum growth hormone and insulin-like growth factor-1 in patients with acromegaly receiving lanreotide Autogel® therapy: a randomized, placebo-controlled, multicenter study with a 52 week open extensionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Depa...
Source: Pituitary - July 28, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Rathke’s cleft cyst presenting as bilateral abducens nerve palsyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - July 23, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Collision sellar lesions: experience with eight cases and review of the literatureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 i...
Source: Pituitary - June 24, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Immunohistochemistry of COUP-TFI: an adjuvant diagnostic tool for the identification of corticotroph microadenomasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - June 13, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Limited effects of growth hormone replacement in patients with GH deficiency during long-term cure of acromegalyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - June 12, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Pituitary and systemic autoimmunity in a case of intrasellar germinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 r...
Source: Pituitary - May 25, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Prevalence and clinical demographics of cerebral salt wasting in patients with aneurysmal subarachnoid hemorrhageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - May 22, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Pituicytoma and isolated ACTH deficiencyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Pituitary - May 1, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Evaluation of insulin sensitivity in hyperprolactinemic subjects by euglycemic hyperinsulinemic clamp techniqueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ±&n...
Source: Pituitary - May 1, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Utility of single luteinizing hormone determination 3 h after depot leuprolide in monitoring therapy of gonadotropin-dependent precocious pubertyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ±&...
Source: Pituitary - April 26, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Ghrelin and GHRP-6-induced ACTH and cortisol release in thyrotoxicosisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - April 26, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Effects of 5 years of growth hormone (GH) replacement therapy on cardiac parameters and physical performance in adults with GH deficiencyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - April 24, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

The diagnostic value of fused positron emission tomography/computed tomography in the localization of adrenocorticotropin-secreting pituitary adenoma in Cushing’s diseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - April 23, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Brain and optic chiasmal herniations into sella after cabergoline therapy of giant prolactinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Art...
Source: Pituitary - April 21, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Effects of physical training on serum and pituitary growth hormone contents in diabetic ratsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - April 16, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Multiple head and neck tumors following treatment for craniopharyngiomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 symp...
Source: Pituitary - April 9, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Hematologic neoplasias and acromegalyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: Pituitary - April 1, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Acromegaly: correlation between expression of somatostatin receptor subtypes and response to octreotide-lar treatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 SST...
Source: Pituitary - March 28, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Differential diagnosis of ACTH-dependent hypercortisolism: imaging versus laboratoryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Mar...
Source: Pituitary - March 18, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Efficacy of long-term lanreotide treatment in patients with acromegalyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 o...
Source: Pituitary - March 6, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Self-limited acute hepatotoxicity caused by pegvisomantEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 evolut...
Source: Pituitary - March 6, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Simultaneous above and below approach to giant pituitary adenomas: surgical strategies and long-term follow-upEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Departme...
Source: Pituitary - February 26, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Recurrent spindle cell oncocytoma of the pituitary, a case report and review of literatureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Pituitary - February 25, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Secondary resistance to cabergoline therapy in a macroprolactinoma: a case report and literature reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 un...
Source: Pituitary - February 4, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Effects of lanreotide SR and Autogel on tumor mass in patients with acromegaly: a systematic reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - February 3, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

The implications of microsurgical anatomy for surgical approaches to the sellar regionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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/s11102-009-0167-1Author...
Source: Pituitary - January 29, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Adjuvant Gamma Knife radiosurgery in non-functioning pituitary adenomas; low risk of long-term complications in selected patientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Pituitary - January 19, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Efficacy of the combined cabergoline and octreotide treatment in a case of a dopamine-agonist resistant macroprolactinomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 su...
Source: Pituitary - January 17, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Craniopharyngioma: historical notesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 accumulatio...
Source: Pituitary - January 8, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Primary CNS lymphoma with bilateral symmetric hypothalamic lesions presenting with panhypopituitarism and diabetes insipidusEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Pituitary - January 3, 2009 Category: Endocrinology Tags: Pituitary Source Type: journals

Sellar and suprasellar mixed germ cell tumor mimicking a pituitary adenomaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, Univer...
Source: Pituitary - December 31, 2008 Category: Endocrinology Tags: Pituitary Source Type: journals

Isolated acquired ACTH deficiency and primary hypothyroidism: a short series and reviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 10.1...
Source: Pituitary - December 28, 2008 Category: Endocrinology Tags: Pituitary Source Type: journals

Unusual clinical presentations of giant prolactinomasEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Jour...
Source: Pituitary - December 23, 2008 Category: Endocrinology Tags: Pituitary Source Type: journals

Growth hormone receptor polymorphism and the effects of pegvisomant in acromegalyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Gemell...
Source: Pituitary - December 17, 2008 Category: Endocrinology Tags: Pituitary Source Type: journals