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NCI CANCERLIT® Search: Pituitary Tumor - September 2001
Last Modified: November 1, 2001

Table of Contents

CancerMail from the National Cancer Institute

1
UI - 21200154
AU - Iglesias A; Arias M; Brasa J; Paramo C; Conde C; Fernandez R
TI - MR imaging findings in granular cell tumor of the neurohypophysis: a difficult preoperative diagnosis.
SO - Eur Radiol 2000;10(12):1871-3
AD - Unidad de Resonancia Magnetica (MEDTEC), Hospital Xeral-Cies, Vigo, Spain.
Granular cell tumor is a rare neoplasm arising within the neurohypophysis. We describe the MR imaging findings in two symptomatic patients. In one patient with history of panhypopituitarism, MR images showed a large sellar and suprasellar mass. The other patient presented with acute loss of vision in her left eye, and MR images showed a suprasellar mass with compression of the optic chiasm.

2
UI - 21237085
AU - Bubl R; Hugo HH; Hempelmann RG; Barth H; Mehdorn HM
TI - Granular-cell tumour: a rare suprasellar mass.
SO - Neuroradiology 2001 Apr;43(4):309-12
AD - Department of Neurosurgery, University of Kiel, Weimarer Strasse 8, 24106 Kiel, Germany. buhlr@nch.uni-kiel.de
Granular-cell tumour is a rare suprasellar space occupying lesion, which usually presents with visual deterioration, endocrine deficits or headache. We present two women with extraordinarily large tumours, measuring 3.8 and 4.0 cm in diameter. In both cases the tough, vascular tumour could be removed only subtotally.

3
UI - 21224269
AU - Safer JD; Colan SD; Fraser LM; Wondisford FE
TI - A pituitary tumor in a patient with thyroid hormone resistance: a diagnostic dilemma.
SO - Thyroid 2001 Mar;11(3):281-91
AD - Section of Endocrinology, Metabolism, and Diabetes, Boston University School of Medicine, Massachusetts 02118, USA. jsafer@bu.edu
Resistance to thyroid hormone (RTH) is due to mutations in the beta-isoform of the thyroid hormone receptor (TR-beta). RTH patients display inappropriate secretion of thyrotropin-releasing hormone (TRH) from the hypothalamus and thyrotropin (TSH) from the anterior pituitary, despite elevated levels of thyroid hormone thyroxine (T4) and triiodothyronine (T3). Thyrotropin-secreting tumors are presumed to represent clonal expansion of abnormal cells. Because the diagnosis of TSH-secreting tumors tends to be delayed and curative surgical resection remains under 50%, early diagnosis is paramount. Current diagnostic strategies suggest that RTH patients are distinguishable from patients with TSH-secreting pituitary tumors by the use of standard laboratory tests and imaging. Here, we present a woman in whom the standard evaluation for inappropriate TSH secretion was insufficient to distinguish these entities. The patient had a low-normal TRH stimulation test and an unmeasurable alpha-glycoprotein subunit level; however, a pituitary magnetic resonance imaging (MRI) revealed an adenoma. More testing using a T3 suppression test supported a RTH diagnosis and a R438H mutation was found in the TR-beta gene. To our knowledge, this represents the first report of an apparently incidental pituitary adenoma in the setting of documented resistance to thyroid hormone. As such, it raises the question of whether RTH predisposes to pituitary hyperplasia and adenoma development.

4
UI - 21291094
AU - Angioi-Duprez K; Maalouf T; George JL
TI - [Gyrate atrophy and craniopharyngioma: a case report]
SO - J Fr Ophtalmol 2001 May;24(5):513-6
AD - Service d'Ophtalmologie B, CHU Nancy-Brabois, rue du Morvan, 54511 Vandoeuvre Cedex.
We report the case of a 13-year-old girl who developed a craniopharyngioma and a gyrate atrophy. No genetic link between these two diseases has ever been reported. This case recalls the characteristic features of gyrate atrophy.

5
UI - 21371362
AU - Buxton N; Robertson I
TI - Lymphocytic and granulocytic hypophysitis: a single centre experience.
SO - Br J Neurosurg 2001 Jun;15(3):242-5, discussion 245-6
AD - Department of Neurosurgery, University Hospital, Nottingham NG7 2UH, UK. neilbuxton@doctors.org.uk
Lymphocytic and granulocytic hypophysitis are rare pituitary masses. A series of five dealt with at a single centre is presented and discussed. Retrospective analysis of pathology records revealed the cases. Of pituitary mass lesions dealt with in this centre, 0.8% have the diagnosis. Five females presented, one pregnant at the time of presentation, three presenting with signs and symptoms of panhypopituitarism, and two with visual problems. All were treated by surgical means. All had good postoperative visual function, but all were panhypopituitary. Follow-up was for a mean of 4 years and 1 month. This rare condition should be treated by surgical means to obtain a diagnosis. Further treatment of residual tumour can be with corticosteroids. Good visual function should be expected, but so should permanent loss of pituitary function.

6
UI - 21371372
AU - Thomson S; Chakrabarty A; Marks P
TI - Ependymoma of the neurohypophysis.
SO - Br J Neurosurg 2001 Jun;15(3):277-8
AD - Department of Neurosurgery, Leeds General Infirmary, 1 Great George Street, Leeds LS1, UK. SJTho@aol.com
There are two reported cases of ependymomas arising in the pituitary fossa; one in a human, the other in a horse. Both died during their stay in hospital. The case presented here is the first published case of a patient who is well 3 months after surgery.

7
UI - 21376183
AU - Milker-Zabel S; Debus J; Thilmann C; Schlegel W; Wannenmacher M
TI - Fractionated stereotactically guided radiotherapy and radiosurgery in the treatment of functional and nonfunctional adenomas of the pituitary gland.
SO - Int J Radiat Oncol Biol Phys 2001 Aug 1;50(5):1279-86
AD - Department of Clinical Radiology, Radiation Therapy, University of Heidelberg, Heidelberg, Germany. Stefanie_Milker-Zabel@med.uni-heidelberg.de
PURPOSE: We evaluated survival rates and side effects after fractionated stereotactically guided radiotherapy (SCRT) and radiosurgery in patients with pituitary adenoma. METHODS AND MATERIALS: Between 1989 and 1998, 68 patients were treated with FSRT (n = 63) or radiosurgery (n = 5) for pituitary adenomas. Twenty-six had functional and 42 had nonfunctional adenomas. Follow-up included CT/MRI, endocrinologic, and ophthalmologic examinations. Mean follow-up was 38.7 months. Seven patients received radiotherapy as primary treatment and 39 patients received it postoperatively for residual disease. Twenty-two patients were treated for recurrent disease after surgery. Mean total dose was 52.2 Gy for SCRT, and 15 Gy for radiosurgery. RESULTS: Overall local tumor control was 93% (60/65 patients). Forty-three patients had stable disease based on CT/MRI, while 15 had a reduction of tumor volume. After FSRT, 26% with a functional adenoma had a complete remission and 19% had a reduction of hormonal overproduction after 34 months' mean. Two patients with STH-secreting adenomas had an endocrinologic recurrence, one with an ACTH-secreting adenoma radiologic recurrence, within 54 months. Reduction of visual acuity was seen in 4 patients and partial hypopituitarism in 3 patients. None of the patients developed brain radionecrosis or radiation-induced gliomas. CONCLUSION: Stereotactically guided radiotherapy is effective and safe in the treatment of pituitary adenomas to improve local control and reduce hormonal overproduction.

8
UI - 21394060
AU - Ahmad AM; Guzder R; Wallace AM; Thomas J; Fraser WD; Vora JP
TI - Circadian and ultradian rhythm and leptin pulsatility in adult GH deficiency: effects of GH replacement.
SO - J Clin Endocrinol Metab 2001 Aug;86(8):3499-506
AD - Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool, United Kingdom L7 8XP. draahmad@yahoo.com
Leptin contributes to the regulation of body weight in healthy individuals and is secreted by adipocytes in a diurnal pattern, with superimposed pulsatility. The circulating leptin concentration is increased in both normally obese and untreated adult GH deficiency, a syndrome characterized by increased adiposity. Leptin circadian rhythm is preserved in adult GH deficiency patients; however, an ultradian rhythm and pulsatility has previously not been reported. Alterations in plasma leptin concentration in obese individuals and adult GH deficiency patients after GH replacement have been attributed to changes in body fat mass. In our present study leptin circadian and ultradian rhythm, leptin pulsatility and its relationship with body fat mass were examined in 12 adult GH deficiency patients (6 men) before and 1 month after GH replacement. All subjects with adult GH deficiency had hypopituitarism subsequent to pituitary surgery and were stabilized on conventional pituitary hormone replacement. Plasma leptin was measured over 24 h at 30-min intervals, and changes in body composition were recorded using bioelectrical impedance. The 24-h mean leptin concentration decreased from 2.04 +/- 0.04 nmol/liter in untreated adult GH deficiency patients to 1.64 +/- 0.03 nmol/liter after 1 month of GH replacement (P < 0.0001). Before GH replacement, patients demonstrated a significant mean leptin circadian rhythm (P < 0.001), with a mesor of 2.05 +/- 0.03 nmol/liter and a superimposed ultradian frequency of 2.0 +/- 0.1 cycles/d. After GH replacement, the circadian rhythm was preserved (P < 0.001), but mesor decreased to 1.65 +/- 0.01 nmol/liter (P < 0.0001), and leptin ultradian frequency increased to 16.0 +/-0.2 cycles/d (P < 0.0001). Pulse analysis (ULTRA) revealed 3.1 +/- 0.9 pulses/24 h in untreated adult GH deficiency patients, which significantly increased to 9.9 +/- 2.2 pulses/24 h after 1 month of GH replacement (P < 0.001). There was no significant change in body mass index or body fat mass after 1 month of GH replacement. The body fat percentage significantly reduced from 36.5 +/- 2.8% to 35.5 +/- 2.7% after 1 month of GH replacement (P < 0.05). This change in body fat percentage was explained by a significant increase in lean body mass, from 56.2 +/- 2.8 kg at baseline to 57.4 +/- 2.7 kg after 1 month (P < 0.05). A significant correlation was observed between plasma leptin and body fat percentage at baseline and 1 month after GH replacement (both, r = 0.7; P < 0.01) in the absence of a significant correlation between leptin and body fat mass before and after GH replacement (P = 0.13 and P = 0.11, respectively). Thus, untreated adult GH deficiency is associated with elevated 24-h leptin concentration, preserved circadian rhythm, and decreased pulsatility. The secretory pattern is restored after GH replacement, with a significant reduction in the 24-h mean leptin concentration, maintenance of circadian rhythm, and increased pulsatility. This GH-induced change in the leptin secretory pattern precedes significant changes in body fat mass and may therefore be independent of changes in adipose tissue. Restoration of leptin pulsatility may be of clinical benefit, and our data could lead to novel approaches for leptin manipulation in the future.

9
UI - 21394079
AU - Shimon I; Rubinek T; Bar-Hava I; Nass D; Hadani M; Amsterdam A; Harel G
TI - Ovarian hyperstimulation without elevated serum estradiol associated with pure follicle-stimulating hormone-secreting pituitary adenoma.
SO - J Clin Endocrinol Metab 2001 Aug;86(8):3635-40
AD - Institutes of Endocrinology, Sheba Medical Center, Tel-Hashomer 52621, Israel. i_shimon@netvision.net.il
We report a unique case of a 28-yr-old woman with a gonadotroph adenoma secreting FSH, presented with ovarian hyperstimulation, without elevation of serum estradiol. She presented with abdominal pain and large ovaries (both 10 cm in diameter) with multiple follicular cysts shortly after discontinuing oral contraceptive pills. She had a supranormal PRL level of 71 microg/liter (normal, <20), FSH of 8.4-9.2 IU/liter (normal for follicular phase, 2.4-10), LH of 0.01 IU/liter (normal, 1.6-9.3), estradiol of 108 pmol/liter (normal for follicular phase, 80-790), and free alpha-subunit level of 0.11 microg/liter (normal, <1.8). A nuclear magnetic resonance study revealed invasive pituitary macroadenoma, 30 mm in diameter. Dopamine agonist (cabergoline) treatment normalized serum PRL but had no affect on FSH levels. A transsphenoidal surgery was performed, and most of the adenoma was resected. One month after surgery the patient resumed menstruation, and the hormonal profile included serum FSH of 6.3 IU/liter, LH of 2.1 IU/liter, estradiol of 156 pmol/liter, and PRL of 10 microg/liter. The excised adenoma tissue exhibited intense immunostaining for FSH and secreted this hormone to culture medium. Stimulation with TRH (both in vivo preoperatively and in vitro study of the excised tumor) had no effect on FSH secretion from the adenoma. Estradiol did not suppress FSH release from cultured adenoma cells. Patient serum samples showed significant FSH bioactivity when tested in a human granulosa cell line. This case is remarkable because the ovarian hyperstimulation related to the FSH-secreting adenoma was not associated with high levels of serum estradiol, probably due to insufficient LH production by the normal pituitary. Thus, it supports the two-cell, two-gonadotropin theory, that both FSH and LH are necessary for normal ovarian estrogen production.

10
UI - 21394103
AU - Persani L; Borgato S; Lania A; Filopanti M; Mantovani G; Conti M; Spada A
TI - Relevant cAMP-specific phosphodiesterase isoforms in human pituitary: effect of Gs(alpha) mutations.
SO - J Clin Endocrinol Metab 2001 Aug;86(8):3795-800
AD - Institute of Endocrine Sciences, University of Milan, Istituto Auxologico Italiano IRCCS, Milan 20145, Italy. persani@auxologico.it
Both cAMP production by adenylyl cyclase and cAMP degradation by phosphodiesterases account for intracellular cAMP levels. We previously demonstrated an increased phosphodiesterase activity in GH-secreting adenomas bearing the gsp oncogene. Here we characterize both the activity and the expression of cAMP-specific phosphodiesterase genes in the human pituitary and in gsp+ and gsp- GH-secreting adenomas and analyze the impact of this intracellular feedback mechanism on the levels of cAMP-responsive element-binding protein phosphorylation. Normal pituitary and gsp- GH-secreting adenomas showed similar phosphodiesterase activities, and 7-fold higher levels were observed in gsp+ tumors. In these tumors the increased activity was mainly owing to isobutyl-methyl-xanthine-sensitive phosphodiesterase 4 and to isobutyl-methyl-xanthine-insensitive isoforms. By semiquantitative RT-PCR, all phosphodiesterase 4 transcripts were expressed in the normal and tumoral pituitary. However, the levels of phosphodiesterase 4C and 4D messenger RNAs were significantly higher in gsp+ than in gsp- GH-secreting adenomas and normal pituitary. Expression of the thyroid-specific isobutyl-methyl-xanthine-insensitive phosphodiesterase 8B was absent in the normal pituitary but detectable in almost all GH-secreting adenomas and higher in gsp+ (P < 0.02). Therefore, this study provides a characterization of phosphodiesterase expression in human pituitary and demonstrates a dramatic induction of the cAMP-specific phosphodiesterases 4C and phosphodiesterases 4D and phosphodiesterases 8B in gsp+ GH-secreting adenomas. Similar levels of cAMP-responsive element-binding protein phosphorylation were observed in gsp- and gsp+ GH-secreting adenomas; however, phosphodiesterase blockade caused an increase in cAMP-responsive element-binding protein phosphorylation that was significantly higher in gsp+ than in gsp- adenomas. Because cAMP-responsive element-binding protein represents the principal end point of the cAMP pathway, these results suggest that the enhanced phosphodiesterase activity may have a significant impact on the phenotypic expression of gsp mutations.

11
UI - 21394120
AU - Kearney T; Navas de Gallegos C; Chrisoulidou A; Gray R; Bannister P; Venkatesan S; Johnston DG
TI - Hypopituitarsim is associated with triglyceride enrichment of very low-density lipoprotein.
SO - J Clin Endocrinol Metab 2001 Aug;86(8):3900-6
AD - Department of Metabolic Medicine, St. Mary's Hospital, Imperial College of Science, Technology, and Medicine, Paddington, London, United Kingdom. t.kearney@ic.ac.uk
The dyslipidemia associated with hypopituitarism may contribute to increased vascular mortality. The atherogenic potential of lipoproteins is determined not only by concentration but also by their composition. We therefore studied very low-density lipoprotein composition and apolipoprotein B kinetics in 16 hypopituitary subjects and 16 controls. Hypopituitarism was associated with reduced high-density lipoprotein cholesterol (0.98[0.82-1.18] vs. 1.35[1.15-1.41] mmol/liter, P < 0.001) and increased triglyceride concentrations (1.64[1.09-2.77] vs. 1.12[0.66-1.67] mmol/liter, P = 0.01). Total (P = 0.76) and low-density lipoprotein cholesterol (P = 0.56) concentrations were similar. Very low-density lipoprotein- triglyceride was significantly increased (1.48[1.02-2.55] vs. 0.9[0.31-2.30] mmol/liter, P = 0.004), but very low-density lipoprotein cholesterol levels were similar (P = 0.93). The molar ratios of very low-density lipoprotein-triglyceride:apolipoprotein B (6193[4283-9566] vs. 3599[3188-6854], P = 0.005) and very low-density lipoprotein-triglyceride:cholesterol (2.8[1.98-3.78] vs. 1.6[1.44-2.80], P < 0.003) were significantly increased; very low-density lipoprotein-cholesterol:apolipoprotein B molar ratios (P = 0.93) were similar. Very low-density lipoprotein apolipoprotein B fractional synthetic rate (a measure of apolipoprotein B catabolism, P = 0.42) and pool size (P = 0.63) were similar. The very low-density lipoprotein apolipoprotein B absolute synthetic rate (a measure of apolipoprotein B synthesis) tended to be higher in hypopituitarism (17.7[2.91-19.50] vs. 26.6[19.64-28.05] mg/kg per day, P = 0.24) but failed to reach statistical significance. The absolute synthetic rate, and hence very low-density lipoprotein production, correlated with very low-density lipoprotein triglyceride:apolipoprotein B ratio (P = 0.02, Rs = 0.63), suggesting that triglyceride enrichment of very low-density lipoprotein is important in the mechanism underlying very low-density lipoprotein overproduction in hypopituitarism. Because triglyceride-enriched lipoproteins are proatherogenic, this may contribute to the vascular mortality observed in hypopituitarism. The reasons for these observations are unknown; GH deficiency or routine endocrine replacement may be important.

12
UI - 21394133
AU - Lee EJ; Kotlar TJ; Ciric I; Lee MK; Lim SK; Lee HC; Huh KB; Mayo KE; Jameson JL
TI - Absence of constitutively activating mutations in the GHRH receptor in GH-producing pituitary tumors.
SO - J Clin Endocrinol Metab 2001 Aug;86(8):3989-95
AD - Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA.
The molecular events leading to the development of GH-producing pituitary tumors remain largely unknown. We hypothesized that activating mutations of the GHRH receptor might occur in a subset of GH-producing pituitary tumors. Genomic DNA samples from 54 GH-producing pituitary tumor tissues were screened for mutations of the GHRH receptor. Eleven homozygous or heterozygous nucleotide substitutions [169G > A (A57T), 338C > T (P113L), 363G > T (E121D), 409C > T (H137Y), 547G > A (D183N), 673G > A (V225I), 749G > A (W250X), 760G > A (V254M), 785G > A (S262N), 880G > A (G294R), 1268G > A (C423Y)] were found in 12 patients (22.2%). The 169G > A substitution (A57T) appears to be a polymorphism (4 patients, 7.4%). E121D and V225I were each found in 2 patients. In 1 patient with the V225I sequence, the substitution was not found in genomic DNA from peripheral leukocytes, suggesting a somatic mutation. A patient with a heterozygous W250X mutation was homozygous for the C423Y substitution. These variant GHRH receptors were studied in transfected TSA-201 cells to evaluate the functional consequences of the amino acid changes. None of the GHRH receptor variants was associated with basal elevation of intracellular cAMP. GHRH induced variable cAMP responses. With the W250X and G294R variants, there was no cAMP stimulation by GHRH, indicating that the mutations are inactivating. Expression of the W250X GHRH receptor on the cell membrane was severely decreased and GHRH binding to the G294R GHRH receptor was impaired. Although GHRH receptor variants are common in GH- producing pituitary adenomas, constitutively activating mutations, as a mechanism for GH-producing pituitary tumors appear to be rare.

13
UI - 21404637
AU - Cheung K; Lee TJ
TI - Craniopharyngioma involving supfrasellar region and sphenoid sinus: case report.
SO - Chang Gung Med J 2001 Jun;24(6):383-7
AD - Department of Otolaryngology, Chang Gung Memorial Hospital, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, R.O.C.
Craniopharyngiomas are benign, epithelial, slow-growing neoplasms that generally develop either in the suprasellar region or in both the suprasellar and intrasellar regions. They rarely occurs in the infrasellar region. Based on embryologic development of adenohypophysis, the tumor can arise along the path of the craniopharyngeal duct. We report on an 8- year-old boy who presented to us with headache and anorexia for several weeks during May 1999. Brain MRI revealed a huge sphenoid tumor. The tumor was completely excised by functional endoscopic sinus surgery on 12th August 1999. The postoperative course was smooth and no evidence of tumor recurrence was found on his latest follow-up visit in February, 2000. From the clinical experience with this case, functional endoscopic sinus surgery is an alternative and a less-harmful surgical procedure for this kind of benign sphenoid tumor. Moreover, embryology development, epidemiology, clinical presentation, diagnostic method and treatment of craniopharyngioma are discussed.

14
UI - 21347502
AU - Abe T; Ludecke DK
TI - Effects of preoperative octreotide treatment on different subtypes of 90 GH-secreting pituitary adenomas and outcome in one surgical centre.
SO - Eur J Endocrinol 2001 Aug;145(2):137-45
AD - Department of Neurosurgery, Showa University School of Medicine, Tokyo, Japan. takumi@med.showa-u.ac.jp
OBJECTIVE: To investigate the possible impact of pretreatment with octreotide on different subtypes of GH-secreting pituitary adenomas and on the outcome of transnasal surgery. METHODS: We reviewed a consecutive series of 90 acromegalic patients treated with octreotide alone before transnasal surgery. On the basis of magnetic resonance imaging, the tumours were classified into four groups: group A, microadenoma (n=7); group B, transnasally resectable macroadenoma (n=21); group C, invasive, potentially transnasally resectable macroadenoma (n=43); group D, non-resectable grossly invasive macroadenoma (n=19). All patients were treated for at least 3 months before surgery, with a mean daily dose of 221+/-31 microg octreotide. The mean follow-up was 51.7+/-1.4 months. The comparative group included 57 acromegalic patients who were not receiving octreotide treatment. RESULTS: After pretreatment with octreotide, tumour shrinkage was clearly observed in 28 of the 90 patients (31%). At surgery, the tumours after octreotide treatment were more often white or grey in colour (91% compared with 75%) and were observed to be slightly more often fluid or soft in texture (86% compared with 79%) than those in the comparative series. Endocrinological remission was achieved in all patients in group A, 95.2% in group B, and 81.4% in group C. In only 10 of the 14 patients with tumour shrinkage in group C, endocrinological remission was also achieved (71.4%). In the comparative series, endocrinological remission was achieved in 92.9% of group A, 87.5% of group B, and 73.9% of group C. CONCLUSIONS: Octreotide treatment slightly improved the already relatively high rate of endocrinological remission in invasive, potentially transnasally resectable macroadenomas. The rate of tumour shrinkage was found to decrease with extrasellar size. With the exception of tumour growth in approximately 7% of invasive adenomas and pituitary apoplexy in one patient, there was no disadvantage associated with the octreotide pretreatment.

15
UI - 21396386
AU - Kurotani R; Yasuda M; Oyama K; Egashira N; Sugaya M; Teramoto A; Osamura RY
TI - Expression of interleukin-6, interleukin-6 receptor (gp80), and the receptor's signal-transducing subunit (gp130) in human normal pituitary glands and pituitary adenomas.
SO - Mod Pathol 2001 Aug;14(8):791-7
AD - Department of Pathology, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
Interleukin-6 (IL-6) is an important cytokine in cell proliferation and differentiation in several organs. It has also been reported that IL-6 plays a role in secretion or release of pituitary hormones in pituitary hormone-secreting cells and pituitary adenomas, but convincing data in situ have not yet been reported. In this study, we examined the participation of IL-6 in the production of pituitary hormones and the differences between human normal pituitary glands and pituitary adenomas by determination of the localization or expression of IL-6, IL-6 receptor (IL-6R, gp80), and the signal-transducing subunit (gp130) of the receptor using immunohistochemical staining and RT-PCR. IL-6 was mainly expressed in ACTH- and FSH/LH-secreting cells in normal pituitary glands, as shown by double staining. gp 80 and gp130 were coexpressed in almost all GH- and PRL-secreting cells and in approximately 30% of FSH/LH-secreting cells. RT-PCR showed that IL-6 mRNA was expressed in only one of all the pituitary adenomas examined, whereas gp 80 and gp 130 mRNAs were detected in all these pituitary adenomas. In conclusion, IL-6 was mainly expressed in ACTH- and FSH/LH-secreting cells, and the receptors were expressed in GH-, PRL- and FSH/LH-secreting cells in human normal pituitary glands. Furthermore, our data emphasized that the mechanism of IL-6 function in human pituitary adenoma cells is distinct from that in normal pituitary cells.

16
UI - 21413243
AU - Edal AL
TI - [Radiological classification of pituitary adenomas]
SO - Ugeskr Laeger 2001 Aug 13;163(33):4349-53
AD - Odense Universitetshospital, rontgendiagnostisk afdeling. Anette.Edal@ouh.fyns-amt.dk
Magnetic resonance imaging (MRI) is the modality of choice in the diagnosis of pituitary pathology. A chronological outline and discussion of the radiological classifications of pituitary adenomas applied so far are presented, with a review in depth of the up-to-date classifications based on MRI. SIPAP is an MR classification used in Scandinavia. It is basically a six-figure number describing the extrasellar extension of the adenoma. Together with tumour size, it is a useful and simple method for registration of pituitary adenomas.

17
UI - 21232095
AU - McCutcheon IE; Kitagawa RH; Sherman SI; Bruner JM
TI - Adenocarcinoma of the salivary gland metastatic to the pituitary gland: case report.
SO - Neurosurgery 2001 May;48(5):1161-5; discussion 1165-6
AD - Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA. imccutch@notes.mdacc.tmc.edu
OBJECTIVE AND IMPORTANCE: A case of metastasis to the pituitary gland from a ductal adenocarcinoma of the salivary gland is presented. Metastasis to this site is rare, and a salivary gland source has never previously been described. CLINICAL PRESENTATION: This patient presented with hypopituitarism, including diabetes insipidus. INTERVENTION: A craniotomy was performed to alleviate visual loss. The histological features of the sellar tumor were identical to those of a tumor removed from the parotid gland 18 months earlier. CONCLUSION: Although intrasellar tumors originating from embryonic rests of salivary gland tissue have been reported, metastasis from a malignant neoplasm arising within a true salivary gland is also possible and should not be excluded from consideration for patients in whom a salivary gland-like tumor is discovered in the sella turcica.

18
UI - 21280981
AU - Nishio S; Morioka T; Suzuki S; Takeshita I; Fukui M; Iwaki T
TI - Pituitary tumours in adolescence: clinical behaviour and neuroimaging features of seven cases.
SO - J Clin Neurosci 2001 May;8(3):231-4
AD - Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. shunji@ns.med.kyushu-u.ac.jp
The clinicopathologic features of seven paediatric patients with pituitary adenomas (2 male, 5 female; mean age 14.3 years) were reviewed. There were three non-functioning adenomas, three prolactinomas, and one growth hormone producing adenoma. Five patients presented with visual field deficits, and six patients had endocrine symptoms, which included menstrual irregularities in all female patients, pubertal delay in two females, and growth delay and gigantism in one case each. On neuroimaging studies, five adenomas showed parasellar extension, while the remaining two prolactinomas were intrasellar microadenomas. While two patients with prolactinomas received good results with bromocriptine treatment alone, the remaining five patients underwent either craniotomy or transsphenoidal surgery. Postoperatively, visual disturbances improved markedly in all patients. Two patients also received replacement hormonal therapy. While six patients have been stable for 3.6 years on average, one non-functioning tumour recurred 2 years after the initial transcranial subtotal resection of the tumour. Although there are still many unknowns concerning the biology and optimal treatments for paediatric pituitary adenomas, many of them are assumed to be relatively rapidly growing tumours, while others merely have an earlier tumour genesis than in adults. Copyright 2001 Harcourt Publishers Ltd.

19
UI - 21280997
AU - Nishio S; Morioka T; Fujiwara S; Fukui M
TI - Prolactinoma with preferential infrasellar extension: a report of two cases.
SO - J Clin Neurosci 2001 May;8(3):287-9
AD - Department of Neurosurgery, Neurological Institute, Faculty of Medicine, Kyushu University, Fukuoka, Japan. shunji@ns.med.kyushu-u.ac.jp
The authors describe two male patients with prolactinomas which were incidentally found either during the course of a complete work up for headache or after minor head trauma. Since these tumours were located mainly in the sphenoid bone and did not show any upward growth to the suprasellar region, they were initially thought to be a primary skull base tumour; however, the serum prolactin levels of these patients were 1,179 ng/ml and 3,260 ng/ml, respectively. The authors thus emphasise the need to recognise this peculiar infrasellar growth pattern of prolactinoma. Copyright 2001 Harcourt Publishers Ltd.

20
UI - 21408611
AU - Bret P; Jouvet A; Madarassy G; Guyotat J; Trouillas J
TI - Visceral cancer metastasis to pituitary adenoma: report of two cases.
SO - Surg Neurol 2001 May;55(5):284-90
AD - Service de Neurochirurgie B, Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France.
BACKGROUND: We report two cases of metastases from visceral cancers to pituitary adenomas, and review the literature. CASE DESCRIPTION: Two female patients, aged 75 and 87 years, underwent transesophageal surgery for presumably benign pituitary adenomas. Using extensive immunostaining studies, histopathological examination showed that the surgical specimens from both patients were composed of metastatic deposits within gonadotropin adenomas. Fourteen cases of metastases to pituitary adenomas have been mentioned in 11 reports in the literature. In all cases, the correct diagnosis was made after autopsy or histopathological studies, even in patients known to suffer from visceral malignancies. In our cases, immunohistochemical studies were conclusive in characterizing the two distinct tumor components. The pathogenetic mechanisms favoring the development of metastases in pituitary adenomas are discussed, especially those altering the normal hypophyseal circulation. CONCLUSION: Neurosurgeons performing pituitary surgery should be aware of the possibility of metastases in pituitary adenomas.

21
UI - 21364023
AU - Pitale SU; Lee JM; Origitano T; Emanuele NV
TI - An unusual pituitary mass presenting with panhypopituitarism and hyponatraemia.
SO - Postgrad Med J 2001 Aug;77(910):530-1, 539-40
AD - Loyola University Medical Center, Maywood, Illinois 60153, USA. spitale@luc.edu

22
UI - 21403061
AU - Nakabayashi H; Sunada I; Hara M
TI - Immunohistochemical analyses of cell cycle-related proteins, apoptosis, and proliferation in pituitary adenomas.
SO - J Histochem Cytochem 2001 Sep;49(9):1193-4
AD - Department of Neurosurgery, Saiseikai Ibaraki Hospital, 1-1-24 Mitsukeyama, Ibaraki, Osaka K 573-0701, Japan. nakabayashi@kcat.zaq.ne.jp
To analyze the cell cycle regulatory mechanisms in the growth of pituitary adenomas, we investigated immunohistochemically the expression of the cell cycle-related proteins cyclin A and p27 in 48 pituitary adenomas. The frequency of apoptosis and the proliferative potential were also examined. The percentage of apoptotic cells was evaluated by immunohistochemical analysis using the anti-single-strand DNA antibody. The proliferative potential was assessed using the anti-Ki-67 antibody. The mean cyclin A labeling index (LI) for the non-recurrent group was 1.03% and for the recurrent group 2.31%. A positive linear correlation between cyclin A LI and Ki-67 LI was found. The mean p27 LI for the non-recurrent group was 67.4% and for the recurrent group 47.0%. There were significant differences in cyclin A LI and p27 LI between the non-recurrent group and the recurrent group. The mean apoptotic rate for the non-recurrent group was 0.87% and for the recurrent group 1.05%. There was no significant difference. Multivariate regression analysis revealed that high cyclin A LI and high Ki-67 LI were significant factors for shorter progression-free survival. The results suggest that the cyclin A LI is a useful prognostic factor in pituitary adenomas. (J Histochem Cytochem 49:1193-1194, 2001)

23
UI - 21405592
AU - Lui WM; Leung GK; Hui Y; Lee KK; Fan YW
TI - Endonasal endoscopic removal of growth-hormone-secreting pituitary adenomas.
SO - Hong Kong Med J 2001 Jun;7(2):189-92
AD - Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Trans-sphenoidal removal of pituitary tumours using the endonasal endoscopic technique, a novel application, is herein reported in five consecutive patients with growth-hormone-secreting pituitary adenomas seen at a teaching hospital in Hong Kong. All five patients demonstrated complete tumour removal on postoperative imaging and hormonal assessment following the procedure. Surgical morbidity and symptoms were minimal; postoperative obstructive nasal packing was not required with this technique, which greatly improved patient comfort. Preliminary experience suggests that the endonasal endoscopic approach is a safe and effective alternative to the conventional trans-septal microscopic method for the treatment of pituitary tumour. A randomised controlled trial comparing these two approaches is currently underway at this institution.

24
UI - 97358159
AU - Delgrange E; Trouillas J; Maiter D; Donckier J; Tourniaire J
TI - Sex-related difference in the growth of prolactinomas: a clinical and proliferation marker study.
SO - J Clin Endocrinol Metab 1997 Jul;82(7):2102-7
AD - Department of Internal Medicine and Endocrinology, University Hospital UCL of Mont-Godinne, Yvoir, Belgium.
Prolactinomas in women commonly present as small intrasellar tumors, but are usually much larger in men. This discrepancy has generally been attributed to differences in the delay before diagnosis. However, studies comparing clinical and pathological correlates of growth of these tumors in both sexes are lacking. We conducted a retrospective study comparing 45 men and 51 women bearing prolactinoma to determine whether the predominance of large tumors in men was due to a delay in diagnosis or, rather, to a fundamental sex-related difference in tumor growth. Basal PRL levels (mean +/- SEM, 2789 +/- 573 ng/mL) and mean tumor diameter (26 +/- 2 mm) were significantly higher in men than in women (292 +/- 74 ng/mL and 10 +/- 1 mm, respectively; P < 0.001), but were not correlated to the age at diagnosis or the duration of symptoms. Giant tumors (n = 8) occurred in males only. The frequencies of bromocriptine-resistant tumors (30 vs.5%; P < 0.01) and invasive macroadenomas (52 vs.27%; P < 0.001) were significantly greater in men than those in women. Lastly, macroprolactinomas in males exhibited higher indexes of proliferating cells by Ki-67 immunoreactivity (2.6 +/- 1.1% of positive nuclei) than did similar tumors in female patients (0.4 +/- 0.2%; P = 0.08). We conclude that the predominance of large prolactinomas in men is due to a high frequency of rapidly growing tumors, which are often invasive and frequently bromocriptine resistant.

25
UI - 20452414
AU - Pinzone JJ; Katznelson L; Danila DC; Pauler DK; Miller CS; Klibanski A
TI - Primary medical therapy of micro- and macroprolactinomas in men.
SO - J Clin Endocrinol Metab 2000 Sep;85(9):3053-7
AD - Neuroendocrine Unit and the General Clinical Research Center, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
The presentation and long-term therapeutic responses of PRL-secreting pituitary tumors in men have been only partially studied. Gender-specific differences in tumor size at clinical presentation and possible differences in tumor biology in men compared to women make it important to determine treatment outcomes of male patients with prolactinomas. We performed a retrospective review of men with prolactinomas medically managed at Massachusetts General Hospital between 1980 and 1997. We identified 46 male patients with prolactinomas managed with medical therapy alone. Twelve patients had microadenomas, defined as a serum PRL level greater than 15 ng/mL and a normal pituitary scan or a tumor smaller than 1 cm. Thirty-four patients had macroprolactinomas, defined by a serum PRL greater than 200 ng/mL and pituitary adenoma larger than 1 cm. Bromocriptine, quinagolide, and/or cabergoline were administered as medical therapy. All patients had at least one follow-up visit, and the most recent serum PRL measurement after initiating dopamine agonist therapy was reported. Baseline clinical characteristics for patients with macroprolactinomas and microprolactinomas showed a larger proportion of patients with macroprolactinomas reporting a history of headache (74% vs. 0%), whereas the prevalence of sexual dysfunction and testosterone deficiency was similar between the two groups. Median serum PRL at presentation was 99 ng/mL (range, 16-385 ng/mL) vs. 1,415 ng/mL (range, 387-67,900 ng/mL), in the microprolactinoma and macroprolactinoma groups, respectively. A normal PRL level was achieved in a similar percentage of men with microprolactinomas vs. macroprolactinomas (83% vs. 79%, respectively). Although the majority of patients in both groups were treated with bromocriptine, a comparable number of patients with microprolactinomas vs. macroprolactinomas achieved a normal PRL level with cabergoline therapy. The response rates for bromocriptine and cabergoline were similar in both groups. No patient with a microprolactinoma required hormone replacement therapy, in contrast to patients with macroprolactinomas, who required thyroid, testosterone, and/or glucocorticoid replacement therapy. No patient had evidence of an increase in tumor size during therapy. In summary, we investigated the clinical presentation and treatment outcome in men with prolactinomas. We found that normalization of serum PRL levels occurs in approximately 80% of men with prolactinomas. Of importance, dopamine agonist administration yielded similar biochemical remission rates in men with microprolactinomas and macroprolactinomas.

26
UI - 20454218
AU - Talreja D; Wolfe L; Aronoff D
TI - The syndrome of inappropriate thyroid hormone secretion.
SO - Tenn Med 2000 Sep;93(9):336-7
AD - Vanderbilt Medical Center, Nashville, USA.

27
UI - 21188965
AU - Rone JK
TI - Vanderbilt Morning Report.
SO - Tenn Med 2001 Apr;94(4):116

28
UI - 21195540
AU - Delgrange E; Donckier JE
TI - Practical classification of prolactinomas for clinical use.
SO - J Clin Endocrinol Metab 2001 Apr;86(4):1838-9

29
UI - 21317198
AU - Cheng WY; Chang CS; Shen CC; Wang YC; Sun MH; Hsieh PP
TI - Endoscope-assisted microsurgery for treatment of a suprasellar craniopharyngioma presenting precocious puberty.
SO - Pediatr Neurosurg 2001 May;34(5):247-51
AD - Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan. ns@vghtc.gov.tw
Being the most common childhood tumor to involve the hypothalamus and pituitary gland, craniopharyngioma, a histologically benign tumor, is usually related to growth retardation and hypogonadism. The presentation of precocious puberty is very rare for a hypothalamic craniopharyngioma. Here, we report such a case. The female patient had presented with symptoms of menarche and breast development since she was 6 years old. Hormonal therapy with a gonadotropin-releasing hormone analogue was instituted to cease precocious puberty but was unsuccessful. Magnetic resonance imaging of the sella showed a 1-cm tumor in the hypothalamic area. Through a pterional approach, the tumor was removed en bloc with endoscope-assisted microsurgery. After the operation, our patient's symptoms improved, so the hormone therapy was discontinued. This extremely unique association of craniopharyngioma and precocious puberty, the causes and mechanisms involved along with the advantages of endoscope-assisted microsurgery are discussed. Copyright 2001 S. Karger AG, Basel

30
UI - 21340673
AU - Kranzinger M; Jones N; Rittinger O; Pilz P; Piotrowski WP; Manzl M; Galvan G; Kogelnik HD
TI - Malignant glioma as a secondary malignant neoplasm after radiation therapy for craniopharyngioma: report of a case and review of reported cases.
SO - Onkologie 2001 Feb;24(1):66-72
AD - Institut fur Radiotherapie und Radio-Onkologie, St.-Johannes-Spital, Landeskliniken Salzburg, Salzburg. m.kranzinger@lks.at
BACKGROUND: The development of a secondary neoplasm in childhood cancer survivors attains growing importance due to the reported excellent survival and therefore the long exposure to potentially carcinogenic effects of treatment. CASE REPORT: We report a 14-year-old girl in whom a large craniopharyngioma (CP) was diagnosed. After surgery, radiation therapy (RT) was given for residual tumour. Discrete progression necessitated further surgery, resulting in permanent tumour control. Soon after the second surgery hypothalamic-pituitary dysfunction developed together with obesity. Supportive hormone therapy was initiated. Growth hormone (GH) therapy was also given for 15 months. Four years after the diagnosis, a cerebropontine anaplastic astrocytoma WHO grade III was detected, with the main lesion being at the dorsal edge of the irradiated area. The girl died 1 month later from this secondary presumably radiation-induced tumour. Only recently a second child with RT for a CP was diagnosed with malignant glioma in our hospital. CASE REPORTS IN THE LITERATURE: 12 other cases of malignant glioma have been reported after RT for CP. Including our present cases, the mean latency period was 10.7 years (median 9.6 years). However, the shortest latency periods were found in patients who had received GH therapy. In numerous cases, the secondary tumour was seen at the edge of the irradiated volume, and not in the region with the highest absorbed dose. CONCLUSIONS: Therapy-induced secondary gliomas after treatment of CP or other intracranial tumours are rare but dramatic late events with a very poor prognosis. Including our own 2 patients, we reviewed 14 cases of CP with occurrence of a secondary, probably radiation-induced malignant glioma. The short latency periods for patients treated with GH is remarkable. We therefore suspect that GH therapy may accelerate the development of a secondary brain tumour. We are reluctant to recommend GH therapy in conventionally irradiated CP patients. In order to seriously answer the questions about therapy-induced secondary neoplasms, a life-long follow-up is mandatory for all patients who are survivors of childhood cancer. Copyright 2001 S. Karger GmbH, Freiburg

31
UI - 21382807
AU - Knerr I; Schuster S; Nomikos P; Buchfelder M; Dotsch J; Schoof E; Fahlbusch R; Rascher W
TI - Gene expression of adrenomedullin, leptin, their receptors and neuropeptide Y in hormone-secreting and non-functioning pituitary adenomas, meningiomas and malignant intracranial tumours in humans.
SO - Neuropathol Appl Neurobiol 2001 Jun;27(3):215-22
AD - Departments of Paediatrics and Neurosurgery, University of Erlangen-Nuremberg, Germany.
The aim of this study was to assess human intracranial tumours for their gene expression pattern of the vasoactive peptide adrenomedullin (AM), its receptor (AM-R) and leptin, which exerts multiple biological effects including proliferation and angiogenesis via the leptin receptor (OB-Rb). Gene activity of neuropeptide Y (NPY) was monitored additionally. We investigated whether there was a characteristic gene expression pattern of AM and leptin in different intracranial tumours, depending on their proliferation activity and biological behaviour. We investigated 35 non-functioning pituitary adenomas (including eight null cell, four silent plurihormonal, 23 silent gonadotroph adenomas), seven somatotropinomas, seven prolactinomas, eight meningiomas, five astrocytomas, two glioblastoma multiformes and unaffected temporal lobe (n = 8). Quantitative reverse transcriptase-polymerase chain reaction (TaqMan RT-PCR) was performed. AM mRNA was detectable in all tumour specimens. AM/GAPDH (glyceraldehyde-3-phosphate dehydrogenase) ratio was significantly higher in somatotropinomas, as was AM/CD31 ratio in prolactinomas, compared with inactive adenomas (P < 0.05). AM-R mRNA was found in all tumour subgroups in small quantities but, in general, higher in tumours than in temporal lobe tissue, respectively. AM-R/CD31 ratio was significantly higher in prolactinomas than in inactive adenomas (P < 0.05). Leptin was detectable in very low quantities in each subgroup. OB-Rb gene expression was found in all tumour subgroups, OB-Rb/GAPDH ratio was highest for meningiomas (P < 0.0001, compared with temporal lobe). NPY mRNA was detectable in temporal lobe in higher quantities than in tumours (P < 0.0001), and almost undetectable in prolactinomas and astrocytomas. Our data demonstrate that AM and AM-R, NPY, as well as leptin and OB-Rb, are expressed in various intracranial tumours in humans but their particular function has to be elucidated further. At present, there is no evidence for a cross-talk on transcriptional level between the peptidergic vasodilative system AM and the putative angiogenic and proliferation affecting factor leptin.

32
UI - 21390886
AU - Zhang Q; Yang Z; Bu G
TI - [Endoscopic transsphenoidal approach in surgical treatment of pituitary adenomas]
SO - Zhonghua Er Bi Yan Hou Ke Za Zhi 1998 Apr;33(2):97-9
AD - Third Affiliated Hospital of Bethune University of Medical Sciences, Changchun, 130031.
OBJECTIVE: To recognize the indications and the value of endoscopic transsphenoidal approach in surgical treatment of pituitary adenomas. METHODS: The management of pituitary adenomas in 24 patients was reviewed. RESULTS: Endoscopic transnasal transspheniodal approach was used successfully in 24 cases and endoscopic transseptal transsphenoidal approach was used successfully in 4 cases, total tumor resection in 23 cases and subtotal resection in 1 case were achieved. CONCLUSION: This new technique offered a simple and rapid access to the sella turcica, and also, direct visualization which improve the surgeon's ability to resect tumors, it is a safe, valuable and efficient procedure for removing pituitary adenomas. The indications and management of the complications of endoscopic pituitary surgery were discussed.

33
UI - 21243859
AU - Cappabianca P; Briganti F; Cavallo LM; de Divitiis E
TI - Pseudoaneurysm of the intracavernous carotid artery following endoscopic endonasal transsphenoidal surgery, treated by endovascular approach.
SO - Acta Neurochir (Wien) 2001;143(1):95-6
AD - Department of Neurosurgery, Federico II University, Naples, Italy.

34
UI - 21380385
AU - Nakamizo A; Inamura T; Nishio S; Inoha S; Ishibashi H; Fukui M
TI - Neuroendoscopic treatment of cystic craniopharyngioma in the third ventricle.
SO - Minim Invasive Neurosurg 2001 Jun;44(2):85-7
AD - Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. nakamizo@ns.med.kyushu-u.ac.jp
The third ventricle is a relatively uncommon location for craniopharyngiomas. Generally, craniotomy has been considered the procedure of choice in such cases. We describe a girl in whom a cystic third ventricular craniopharyngioma was successfully treated by evacuation of the cyst contents via a flexible neuroendoscope and precise placement of an Ommaya reservoir catheter within the tumor.

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