National Cancer Institute®
Last Modified: October 1, 2002
UI - 12107205
AU - Landman RE; Horwith M; Peterson RE; Khandji AG; Wardlaw SL
TI - Long-term survival with ACTH-secreting carcinoma of the pituitary: a case report and review of the literature.
SO - J Clin Endocrinol Metab 2002 Jul;87(7):3084-9
AD - Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
A 48-yr-old woman was evaluated 21 yr after receiving treatment for an ACTH-secreting metastatic pituitary carcinoma. She had been diagnosed with Cushing's disease 35 yr earlier at the age of 14 yr and had undergone bilateral adrenalectomy. Six years later she developed Nelson's syndrome, which was treated with resection of a pituitary adenoma followed by radiotherapy to the sella turcica. Eight years later she was found to have craniospinal metastases with three remote intracerebral lesions. Two of these lesions were surgically resected and stained positive for ACTH by immunofluorescence. She subsequently received whole-brain radiotherapy and is doing well 21 yr later with no lesions seen on magnetic resonance imaging and no evidence of recurrent metastatic disease. We present this case in detail along with a literature review of ACTH-secreting pituitary carcinoma.
UI - 1868737
AU - Milne R; Vessey M
TI - The association of oral contraception with kidney cancer, colon cancer, gallbladder cancer (including extrahepatic bile duct cancer) and pituitary tumours.
SO - Contraception 1991 Jun;43(6):667-93
AD - Department of Public Health and Primary Care, Radcliffe Infirmary, Oxford, England.
This paper reviews the evidence for a relationship between oral contraceptive use and certain neoplasms: cancers of the kidney, colon and gallbladder (including the extrahepatic bile ducts) and tumours (benign or malignant) of the pituitary. Special reference is made to controlled epidemiological studies, both case-control and cohort. There is no convincing evidence that oral contraceptive use is causally related, either negatively or positively, to any of the tumours studied.
UI - 6768957
AU - May P; Proper S; Ourednik J; Schneider G; Ertel N
TI - Blunted prolactin response to hypoglycemia in patients with hypothalamic-pituitary disease and in subjects receiving estrogen.
SO - Metabolism 1980 Apr;29(4):340-5
The prolactin response to hypoglycemia was evaluated in 22 control subjects and 8 patients with hypothalamic-pituitary disease but normal basal serum prolactin levels. Eighteen of the 22 control subjects demonstrated at least a twofold prolactin rise in response to hypoglycemia. In contrast to the control subjects, none of the 8 patients demonstrated a prolactin response to hypoglycemia. This blunted prolactin response to hypoglycemia was the only endocrine abnormality in 3 of these 8 patients. In an attempt to better determine the sensitivity of the prolactin response to hypoglycemia as an index of early pituitary disease, the effect of a short course of estrogen on the prolactin response to hypoglycemia was examined. Estrogen was selected because of its known acute stimulatory effect on pituitary mitosis and chronic effects that lead to pituitary tumor formation in rodents. Accordingly, diethylstilbestrol (DES) 5 mg t.i.d. was administered orally to 6 normal men for 3 days, a period known to stimulate pituitary mitotic activity in rodents. Diethylstilbestrol treatment caused significant elevation of the baseline prolactin (8 +/- 2 versus 18 +/- 3 ng/ml, p less than 0.05); however, the prolactin response to hypoglycemia was blunted (8 +/- 2--30 +/- 10 ng/ml, p less than 0.05, before DES; 18 +/- 3--20 +/- 5 ng/ml after DES, p greater than 0.05). This estrogen-induced blunted prolactin response to hypoglycemia resembled the blunted prolactin response to hypoglycemia found in patients with hypothalamic-pituitary disease.
UI - 7374834
AU - Lamberts SW
TI - [Oral contraceptives and prolactin-producing hypophyseal tumors]
SO - Ned Tijdschr Geneeskd 1980 Jan 26;124(4):111-3
UI - 7193811
AU - Teperman L; Futterweit W; Zappulla R; Malis LI
TI - Oral contraceptive history as a risk indicator in patients with pituitary tumors with hyperprolactinemia: a case comparison study of twenty patients.
SO - Neurosurgery 1980 Dec;7(6):571-3
This report presents a retrospective case comparison study of 20 hyperprolactinemic patients with pituitary adenomas treated at the Mount Sinai Hospital (1976-1079). An association between oral contraceptive (OC) use and 20 subjects with pituitary tumors was substantiated using discordant paired analysis. The comparison group consisted of appendectomy patients admitted during the same time period and matched for sex and age. The estimated relative risk was 4.0 (P less than 0.025). This study suggests that there is a significant association between OC use and pituitary tumors associated with hyperprolactinemia.
UI - 7081323
AU - Maheux R; Jenicek M; Cleroux R; Beauregard H; De Muylder X; Gratton NM;
TI - Van Campenhout J Oral contraceptives and prolactinomas: a case-control study.
SO - Am J Obstet Gynecol 1982 May 15;143(2):134-8
The increase in the number of newly diagnosed cases of prolactinomas seems to coincide with the use of oral contraceptives during the past two decades. The following retrospective case-control study was undertaken in an attempt to disprove a null hypothesis of relationship between oral contraceptive use and prolactinomas. Each of 70 patients operated upon for removal of a prolactinoma was closely matched for age, gravidity, and year of final diagnosis with one patient in each of three control groups. The control groups selected were constituted, respectively, of patients with secondary amenorrhea and normal prolactin levels, patients with normal ovulatory cycles consulting for infertility, and subjects without medical or gynecologic problems. No statistically significative differences were found in the exposure rates to oral contraceptives among four groups. This study thus failed to reveal a significant association between prolactinomas and oral contraceptives but, given the sample size, a relative risk lower than 3.32 cannot be demonstrated or disproved.
UI - 7168914
AU - Cunningham JR; Gidwani GP; Gupta MS; Duchesneau PM; Schumacher OP
TI - Prolactin-secreting pituitary adenoma: occurrence following prenatal exposure to diethylstilbestrol.
SO - Cleve Clin Q 1982 Winter;49(4):249-54
UI - 6833458
AU - Ho KY; Smythe GA; Lazarus L
TI - Prolactin response to dopamine synthesis inhibition using monoiodotyrosine in subjects on oral contraceptives and patients with pathological hyperprolactinemia.
SO - J Clin Endocrinol Metab 1983 Apr;56(4):692-6
UI - 6839760
AU - Hulting AL; Werner S; Hagenfeldt K
TI - Oral contraceptive steroids do not promote the development or growth of prolactinomas.
SO - Contraception 1983 Jan;27(1):69-73
Seventy women with prolactinomas, age 19-38 years, were studied in order to evaluate a possible relationship between the use of steroidal oral contraceptives (o.c.) and the development of prolactin-producing adenomas. Sixty-seven patients were admitted for investigation because of menstrual bleeding disturbances and three patients because of galactorrhea. Forty-three patients (61%) had used o.c. Thirty-six out of forty-three women (83%) experienced their menstrual disturbances and/or galactorrhea when using o.c. or immediately after discontinuing the pill. Patients who had used o.c. had shorter duration of symptoms, lower S-prolactin levels and less pronounced enlargement of the sella turcica. These tendencies indicate that o.c. lead to an earlier manifestation of clinically latent prolactin-producing tumours. With or without previous o.c., the patients showed a low total fertility rate, indicating a notably long, clinically undiagnosed period of disease. The accumulated usage of o.c. by the women with prolactinomas was not higher than among the total female population of the same age in Sweden. Furthermore, patients on o.c. for several years did not show a more advanced form of the disease than women who had not taken the pill. Thus, the present study provides no support for the hypothesis that o.c. promote the growth of prolactin-producing pituitary adenomas.
UI - 6879408
AU - Hyde-Rowan MD; Roessmann U; Brodkey JS
TI - Vasospasm following transsphenoidal tumor removal associated with the arterial changes of oral contraception.
SO - Surg Neurol 1983 Aug;20(2):120-4
A case of fatal cerebral vasospasm after transsphenoidal removal of a pituitary macroadenoma with suprasellar extension is reported. On the second postoperative day the patient developed headache, lethargy, and cardiorespiratory arrest. Five days later, after recovery from this episode, she developed signs of involvement of the left hemisphere. At that time she demonstrated severe cerebral vasospasm, which was worse in the left supraclinoid segment of the internal carotid artery, and she died 19 days postoperatively. Postmortem examination showed left hemispheric and hypothalamic infarction with subsequent herniation. In addition, pathologic arterial changes usually related to use of oral contraceptives were present.
UI - 6120108
AU - Jones JR; Kemmann E; Norwood PK
TI - Oral contraceptive exposure of amenorrheic women with and without prolactinomas.
SO - Int J Gynaecol Obstet 1981 Oct;19(5):381-7
The purpose of this study was to determine the extent of oral contraceptive (OC) exposure of women with secondary amenorrhea of hypothalamic-pituitary etiology. In 93 of 126 women with secondary amenorrhea sufficient data were obtained regarding menstrual history and OC exposure: 26 patients had evidence of a prolactinoma, an additional 26 patients had idiopathic hyperprolactinemia without evidence of a pituitary tumor, and 41 had "pure" dysfunction hypothalamic-pituitary amenorrhea. After stratification by age at diagnosis and parity the estimated odds ratio for past oral contraceptive usage showed no differences among the three groups (odds ratios between 0.74 and 1.48). Using the chi-square test the proportion of subjects who had regular menses before oral contraceptive intake and developed anovulation immediately after discontinuance ("post pill amenorrhea") in the three groups also showed no difference (x2 = 0.60, P = 0.74). These data indicate that non-ovulatory patients are likely to have been exposed to OC, and do not indicate that patients with prolactinomas differ in the extent of their OC exposure from other specified groups of patients with secondary.
UI - 11949829
AU - Schefter JK; Allen G; Cmelak AJ; Johnson M; Toms S; Duggan D; Blevins LS
TI - The utility of external beam radiation and intracystic 32P radiation in the treatment of craniopharyngiomas.
SO - J Neurooncol 2002 Jan;56(1):69-78
AD - The Pituitary Center at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN 37232-6303, USA.
BACKGROUND: The management of craniopharyngiomas has historically been controversial in terms of the extent of initial surgical resection and the use of additional treatments. Various options include radical excision versus a more conservative surgical approach followed by external beam radiation; most recently, intracystic 32P radiation has been used in selected patients. METHODS: We reviewed our experience with 25 patients with craniopharyngiomas treated between 1984 and 1999 to assess the effectiveness of external beam radiation and intracystic 32P radiation therapy in preventing progression and recurrence of local disease. RESULTS: All patients underwent surgery as a component of initial therapy for their histologically-proven craniopharyngiomas. Fifteen patients additionally received external beam radiation. Forty-five percent of patients who underwent incomplete resections followed by external beam radiation required additional therapy. In contrast, 80% of patients who had incomplete resections without post-operative external beam radiation required further treatment. Seven patients had intracystic 32P colloid injections. Neither of the two patients receiving 32P intracystic radiation as part of their initial therapy needed further treatment. Only one of the five patients receiving 32P intracavitary radiation for disease progression following initial therapy required further intervention. Of the remaining four patients, three enjoyed responses to treatment and one had stable disease. CONCLUSIONS: Our observations support the use of external beam radiation for prevention of tumor progression in adults unable to receive a complete surgical resection. Our results additionally suggest that intracystic 32P radiation results in control of cystic components of craniopharyngiomas in the majority of cases.
UI - 12140091
AU - Hucumenoglu S; Kaya H; Kotiloglu E; Erdem G; Demiray E; Ekicioglu G
TI - AgNOR values are not helpful in the differential diagnosis of pituitary adenomas.
SO - Clin Neurol Neurosurg 2002 Sep;104(4):293-9
AD - SSK Ankara Training and Research Hospital, Department of Pathology, Hosdere C. No. 164/3 06550 Y. Ayranci, Ankara, Turkey. firstname.lastname@example.org
Nucleolar organizer regions (NOR) are chromosomal segments in which ribosomal RNA is encoded. AgNOR technique, which reveals these regions, has rarely been used in the diagnosis and preceding the prognosis of pituitary adenoma. The purpose of this study was to determine and evaluate the correlation of hormonal profile with AgNOR counts, the correlation of recurrence with AgNOR counts, and to determine the consistency between the evaluations of the two independent observers. This study covers 33 patients with pituitary adenoma. The slides were stained with hematoxylin and eosin. Silver colloid method was used for NOR, and immunohistochemistry for hormone expressions. Consistency was significant between the two pathologists (for hormonal profile, the Kappa test was used and P<0.001; for AgNOR count, intra-class correlation coefficient was 0.83). There was no significant correlation between mean AgNOR counts and hormone expressions (P>0.05), and there was also no correlation between mean AgNOR counts and tumor sizes (P>0.05). While no difference between recurrent and non-recurrent patients was found with respect to mean AgNOR numbers (P>0.05), nucleolar silver staining in the form of AgNOR clusters was more frequently detected in recurrent cases.
UI - 12140100
AU - Czirjak S; Bezzegh A; Gal A; Racz K
TI - Intraoperative bilateral cavernous sinus sampling for ACTH measurements during transsphenoidal pituitary surgery in patients with Cushing's disease.
SO - Clin Neurol Neurosurg 2002 Sep;104(4):334-8
AD - National Institute of Neurosurgery, Semmelweis University, Budapest, Hungary.
Intraoperative bilateral cavernous sinus sampling combined with rapid ACTH measurement was performed in a pilot study in seven patients with Cushing's disease during transsphenoidal pituitary surgery before and immediately after removal of the ACTH-producing pituitary microadenoma. Before tumor removal a gradient in ACTH concentrations greater than 1.5:1 toward the side of the tumor was found in six patients whereas ACTH concentrations in the right and left cavernous sinuses were similar in one patient with a midline tumor. Immediately after tumor removal, six of seven patients showed variable decreases in ACTH levels in the ipsilateral and/or contralateral side, whereas in one patient the ACTH levels in cavernous sinuses failed to reflect successful tumor removal. These results indicate that intraoperative bilateral cavernous sinus sampling combined with rapid ACTH measurement may be useful to confirm and lateralize ACTH-producing pituitary microadenomas during surgery, but ACTH levels measured immediately after tumor removal do not always predict surgical cure.
UI - 12140106
AU - Kemaloglu S; Ozkan U; Ziyal I; Bukte Y; Ceviz A
TI - Coexistence of a cerebellopontine epidermoid cyst with a pituitary adenoma.
SO - Clin Neurol Neurosurg 2002 Sep;104(4):364-6
AD - Department of Neurosurgery, School of Medicine, Dicle University, Diyarbakir, Turkey. email@example.com
We report on an 18-year-old girl with the coexistence of an epidermoid cyst in the cerebellopontine angle (CPA) with a pituitary adenoma. The clinical course and histopathological characteristics were reviewed. The patient presented with headache, vision loss and amenorea. Computerised tomographic (CT) scan and magnetic resonance imaging (MRI) examinations demonstrated a solid sellar lesion with supra-sellar extension. There was another mass lesion in the CPA with prepontine extension. The tumours were removed surgically. Histopathological examination revealed an epidermoid cyst in the prepontine area and a pituitary adenoma in the sellar region. This has been the second case to be reported in the literature with the coexistence of an epidermoid cyst and a pituitary adenoma.
UI - 12197795
AU - Mason PW; Krawiecki N; Meacham LR
TI - The use of dextroamphetamine to treat obesity and hyperphagia in children treated for craniopharyngioma.
SO - Arch Pediatr Adolesc Med 2002 Sep;156(9):887-92
AD - Inova Fairfax Hospital for Children, Fairfax, Va, USA
BACKGROUND: Obesity and attention difficulties are known complications following surgical treatment for craniopharyngioma. Treatments to date have been largely disappointing. OBJECTIVE: To examine the use of the central nervous system stimulant dextroamphetamine sulfate to regulate appetite and subsequent weight gain in children treated for craniopharyngioma. SETTING: A multidisciplinary clinic specializing in pediatric brain tumors. PATIENTS: Five consecutive patients with significant weight gain and poor attention following surgical treatment for craniopharyngioma were selected for the study. INTERVENTION: Children enrolled in the study were treated with dextroamphetamine, and growth, laboratory, and behavioral assessments were conducted for 24 months. RESULTS: Mean +/- SD body mass index (weight in kilograms divided by height in meters squared) increased from 21 +/- 3.5 before the operation to 32 +/- 2.8 by the start of the protocol. Body mass indices remained stable throughout the protocol. No changes were observed in insulin levels or caloric intake, but the children were more active when taking dextroamphetamine. Parents noted a significant improvement in hyperactivity (mean +/- SD, 1.2 +/- 0.4 to 0.6 +/- 0.2; P =.05), scored with the Conners Parent and Teacher Rating Scales. Teachers noted a similar improvement. CONCLUSIONS: During dextroamphetamine treatment, weight gain stabilized in children who had experienced obesity following surgical resection for craniopharyngioma. In addition, parents and teachers noted significant improvements in children's overall activity and attention. Further studies are needed to determine if the improvements are stable and if earlier intervention can prevent the initial obesity.
UI - 12197494
AU - Mastronardi L; Guiducci A
TI - Are nonfunctioning pituitary adenomas extending into the cavernous sinus aggressive and/or invasive?
SO - Neurosurgery 2002 Aug;51(2):521-2; discussion 522
UI - 12193874
AU - Roux FX; Page P; Nataf F; Devaux B; Djian MC; Joly LM
TI - [The endonasal approach to pituitary adenomas: experience in 105 procedures]
SO - Ann Endocrinol (Paris) 2002 Jun;63(3):187-92
AD - Service de Neurochirurgie, Department de Neuro Anesthesie Reanimation, Centre Hospitalier Sainte-Anne, 1 rue Cabanis, 75014 Paris, France. firstname.lastname@example.org
OBJECTIVE: The endonasal approach to the sella turcica is supposed to simplify surgical techniques and reduce the risk and sequelae linked to removal of pituitary adenomas. We report our experience with 105 procedures using this approach. Method: The series included 45 men and 60 women, aged 17 to 83 years. Their intrasellar lesions were: 43 non-functional adnomas, 37 prolactinomas, 7 GH- adenomas, 9 corticotrop adenomas, 9 miscellaneous lesions (abscess, Rathke cleft cysts, empty sella). Mean duration of the procedures was 50 minutes. Mean hospital stay was 4 days. RESULTS: There were no deaths. Morbidity included: 1 (0.95%) rhinorrhea associated with meningitis which cured without sequelae, 11 (10.5%) transient diabetes insipidus lasting no longer than 48 hours, 2 cases of permanent diabetes insipidus (1 non-functional macroadenoma, 1 pituitary abscess), 1 transient hyposmia (3 months), 2 transient nasal obstructions. There were no cases of septal perforation, nasal deformation, partial or complete mucosal anesthesia, nasal pain, dental pain, or epistaxis. CONCLUSION: This surgical approach is easier to perform and causes less rhinological sequelae than the sublabial transsphenoidal approach. It allows an as effective tumor removal than the latter. Hospitalization stay is significantly shortened.
UI - 12193879
AU - Rebai R; Rekik N; Boudawara MZ; Khannous M; Bahloul K; Chaari S; Abid M;
TI - Ben Mansour H [Ectopic prolactinoma of the sphenoidal sinus: case report]
SO - Ann Endocrinol (Paris) 2002 Jun;63(3):226-30
AD - Service de Neurochirurgie, Tunisie, France.
A 34-year-old woman was hospitalized for exploration of amenorrhea and galactorrhea. She had experienced primary sterility, diagnosed 11 years earlier. Endocrine tests demonstrated hyperprolactinemia (serum prolactin 594 ng/ml). Magnetic resonance imaging (MRI) showed a soft tissue mass located within the posterior part of the sphenoidal sinus. The pituitary gland appeared normal. Medical treatment with bromocriptine was unsuccessful. Transsphenoidal tumor resection was performed. Histology reported adenoma, which was consistent with prolactin-producing tumor demonstrated by immunohistochemical staining for prolactin. Because of the persistence of hyperprolactinemia related to an intra-sphenoidal tumor remnant, bromocriptine (15 mg/d) was initiated. Menses ensued and prolactin level declined (49 ng/ml). One year later, the tumor remnant had disappeared on the MRI and the patient became pregnant. Ectopic adenomas of the sphenoidal sinus are of particular interest due to the diagnostic difficulties encountered. Nevertheless, the nature of the lesion can be determined from the endocrine manifestations. Some of these tumors respond to medical treatment, similar to intra sellar tumors. Surgery remains however the only means of obtaining definitive diagnosis and cure.
UI - 10404841
AU - Nakamura S; Ohtsuru A; Takamura N; Kitange G; Tokunaga Y; Yasunaga A;
TI - Shibata S; Yamashita S Prop-1 gene expression in human pituitary tumors.
SO - J Clin Endocrinol Metab 1999 Jul;84(7):2581-4
AD - Department of Neurosurgery, Nagasaki University School of Medicine, Japan.
A novel type of pituitary-specific transcription factor, Prophet of Pit-1 (Prop-1) gene (PROP1), expresses in just early embryonic stage in mouse and closely related as a causative gene in combined pituitary hormone deficiency. We studied PROP1 expression to further clarify its correlation with tumorigenesis and biological behavior in human pituitary adenomas. Eighteen pituitary adenomas and three normal pituitary glands were examined for the expression of PROP1 and POU1F1 by using RT-PCR Pituitary adenomas were diagnosed as non-functioning adenomas (n = 11), prolactinomas (n=5), GH-producing adenoma (n = 1) and ACTH-producing adenoma (n = 1). One of non-functioning adenomas was pituitary carcinoma with cerebellar metastasis and CSF dissemination. Our results demonstrated PROP1 expression in all pituitary tumors examined, in contrast, POU1F1 was detected in 14 of pituitary tumors. PROP1 was also expressed in normal pituitary gland, however, it was not in normal brain tissue, glioblastomas (cell lines and tumor tissues) and meningioma. Our data indicated that PROP1 expression was observed constantly both in the pituitary tumors and normal human adult pituitary tissues, suggesting that PROP1 is an essential transcriptional factor for pituitary specific gene expression in human. Therefore, detection of PROP1 might be a useful indicator for differentiating pituitary adenomas, regardless of their hormonal phenotypes, from other brain tumors.
UI - 11709386
AU - Sarkar PK; Manapuzha R; Ahmad S; Ritch AE
TI - Fluctuating confusional state due to massive macro-prolactinoma resulting in obstructive hydrocephalus.
SO - Age Ageing 2001 Sep;30(5):426-8
UI - 12093137
AU - Walker DG; Ohaegbulam C; Black PM
TI - Frameless stereotaxy as an alternative to fluoroscopy for transsphenoidal surgery: use of the InstaTrak-3000 and a novel headset.
SO - J Clin Neurosci 2002 May;9(3):294-7
AD - Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Our aim was to evaluate the applicability of an electromagnetic-based frameless stereotactic system for use in transsphenoidal surgery. The system utilizes a novel headset that acts as a replaceable fiducial frame as well as a fixation point for the system's transmitter. It can replace the fluoroscope as a guide to navigation in the sphenoid sinus and sella. The system was used in a consecutive series of 11 patients undergoing transsphenoidal surgery. It was used in conjunction with intraoperative fluoroscopy. We found the Instatrak-3000 to correlate well with lateral fluoroscopic images, and provide additional information in the axial and coronal planes.The InstaTrak-3000 frameless stereotactic system is accurate and obviates the need for intraoperative fluoroscopy during transsphenoidal surgery. Compared to other frameless systems, it avoids the use of fiducial skin markers and head fixation. In common with other frameless stereotactic systems, it provides additional information important for safely approaching the sella and avoids intraoperative radiation exposure for the patient and operating room staff. Copyright 2002 Published by Elsevier Science Ltd.
UI - 12296634
AU - Pollock BE; Nippoldt TB; Stafford SL; Foote RL; Abboud CF
TI - Results of stereotactic radiosurgery in patients with hormone-producing pituitary adenomas: factors associated with endocrine normalization.
SO - J Neurosurg 2002 Sep;97(3):525-30
AD - Department of Neurological Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. email@example.com
OBJECT: The goal of this study was to determine factors associated with endocrine normalization after radiosurgery is performed in patients with hormone-producing pituitary adenomas. METHODS: Between 1990 and 1999, 43 patients with hormone-producing pituitary adenomas underwent radiosurgery: 26 patients with growth hormone (GH)-producing tumors, nine with adrenocorticotrophic hormone-producing tumors, seven with tumors that produced prolactin (PRL) alone, and one with a tumor that secreted both GH and PRL. The median patient age was 42 years. Thirty-seven patients (86%) had undergone surgery earlier and in 30 (70%) there was tumor extension into the cavernous sinus. The product-limit method was used to calculate endocrine normalization while patients were not receiving any hormone-suppressive medication. The median follow-up period after radiosurgery was 36 months (range 12-108 months). In 20 patients (47%) there was normalization of hormone secretion at a median of 14 months (range 2-44 months) after radiosurgery; no correlation was found between tumor type and cure. Actuarial cure rates were 20, 32, and 61% at 1, 2, and 4 years posttreatment. Multivariate analysis demonstrated that the absence of hormone-suppressive medications at the time of radiosurgery (relative risk 8.9, 95% confidence interval [CI] 1.2-68.7, p = 0.04) and maximum radiation doses greater than 40 Gy (relative risk 3.9, 95% CI 1.3-11.7, p = 0.02) correlated with an endocrine cure. A new anterior pituitary deficiency developed in seven patients (16%), temporal lobe necrosis was identified in two patients, an asymptomatic internal carotid artery stenosis was detected in two patients, and unilateral blindness occurred in one patient. CONCLUSIONS: Radiosurgery provides an endocrine cure for many patients with persistent or recurrent hormone-producing pituitary adenomas. Further study is needed to determine whether pituitary hormone-suppressive medications have a radioprotective effect.
UI - 7750482
AU - Rauch C; Li JY; Croissandeau G; Berthet M; Peillon F; Pagesy P
TI - Characterization and localization of an immunoreactive growth hormone-releasing hormone precursor form in normal and tumoral human anterior pituitaries.
SO - Endocrinology 1995 Jun;136(6):2594-601
AD - INSERM U-223, Faculte de Medecine Pitie-Salpetriere, Paris, France.
Arguments favor an in situ synthesis of GH-releasing hormone (GHRH) in the normal and tumoral human anterior pituitary. These tissues may express human (h) GHRH messenger RNA, contain hGHRH-(1-44)-NH2, and secrete in vitro an immunoreactive form (ir-form) of the peptide. Here, we characterize and localize the precursor of hGHRH in human anterior pituitary tissues using RIAs specific for the C-terminus or the midportion of hGHRH-(1-44)-NH2, size-exclusion chromatography, HPLC, Western blotting, and immunocytochemistry. The anterior pituitary ir-forms were compared to those found in hypothalamus, posterior pituitary, and GHRH-secreting endocrine pancreatic tumors. Three ir-forms of hGHRH with mol wt of 30-45, and 5 kilodaltons (kDa) were detected. The 30- to 45-kDa ir-form was very likely to consist of hGHRH bound to proteins. The 5-kDa ir-form represented mature forms of hGHRH. It was the major form in tissues actively synthesizing and/or secreting hGHRH. Nontumoral anterior pituitaries contained significant amounts of mature hGHRH. The 10-kDa form was identified as a hGHRH precursor ir-form. In addition to its expected presence in the hypothalamus and GHRH-secreting tumors, normal and tumoral human anterior pituitaries contained an identical ir-form of the hGHRH precursor. Cells immunoreactive for the hGHRH precursor were observed in pituitary adenomas. Evidence for precursor and mature ir-forms of hGHRH in anterior pituitary tissues provides conclusive arguments for the endogenous synthesis of the neuropeptide.
UI - 12201824
AU - Hauache OM; Rocha AJ; Maia AC; Maciel RM; Vieira JG
TI - Screening for macroprolactinaemia and pituitary imaging studies.
SO - Clin Endocrinol (Oxf) 2002 Sep;57(3):327-31
AD - Department of Endocrinology, Fleury Diagnostic Center, Sao Paulo, Brazil. firstname.lastname@example.org
OBJECTIVE: Hyperprolactinaemia is caused by high levels of monomeric, dimeric or macro forms of prolactin in circulation, the monomeric form being predominant in patients with prolactinomas. Macroprolactinaemia, however, is common and is associated with asymptomatic cases. In this study, we reviewed our records regarding clinical and imaging investigations in patients who were found to have hyperprolactinaemia predominantly due to the presence of macroprolactin and compared them with the findings observed in patients whose prolactin molecular size consisted predominantly of the monomeric form. PATIENTS AND METHODS: We conducted a retrospective study of 113 consecutive patients (nine men and 104 women, aged 19-67 years, median age 39 years) with hyperprolactinaemia who were screened for the presence of macroprolactin by polyethylene glycol precipitation and/or chromatography and submitted to pituitary magnetic resonance imaging (MRI) and/or computerized tomography (CT). RESULTS: Fifty-two of 113 patients (46%) had hyperprolactinaemia due to macroprolactin, whereas the remaining 61 patients (54%) had their hyperprolactinaemia confirmed by the predominance of the monomeric form. Both groups shared similar mean prolactin levels (79.9 +/- 63.6 micro g/l, median of 62.0 micro g/l, and 97.9 +/- 155.4 micro g/l, median of 61.0 micro g/l, respectively). Of the patients with macroprolactinaemia, 46% had no symptoms of hyperprolactinaemia, whereas only 10% of the patients who screened negative for macroprolactin were asymptomatic. There was an association between macroprolactinaemia and negative pituitary imaging findings: normal pituitary images were found in 78.9% of patients who had macroprolactinaemia and in 25% of patients with monomeric hyperprolactinaemia. In addition, none of the patients with macroprolactinoma (seven cases) had macroprolactinaemia. CONCLUSIONS: The presence of macroprolactinaemia does not exclude the possibility of a pituitary adenoma and consequently may not prevent pituitary imaging studies. However, our data demonstrate that all asymptomatic patients who screened positive for macroprolactin had normal pituitary imaging studies. Patient samples showing hyperprolactinaemia should be first tested for macroprolactin, before the patient is submitted to imaging studies. We suggest that imaging studies should be ordered in patients with macroprolactinaemia when indicated by clinically relevant features. As a result, unnecessary anxiety and costly medical procedures may be prevented.
UI - 12201834
AU - Blackhurst G; Strachan MW; Collie D; Gregor A; Statham PF; Seckl JE
TI - The treatment of a thyrotropin-secreting pituitary macroadenoma with octreotide in twin pregnancy.
SO - Clin Endocrinol (Oxf) 2002 Sep;57(3):401-4
AD - Endocrinology Unit, Molecular Medicine Centre, University of Edinburgh, UK. email@example.com
TSH-secreting pituitary tumours are rare but difficult to treat due to a combination of refractory hyperthyroidism and low surgical cure rates. We describe the case of a 21-year-old woman who, despite twin pregnancy, became euthyroid and had dramatic tumour shrinkage on octreotide treatment. To our knowledge, this is the first description of the use of octreotide for a TSH-secreting pituitary adenoma throughout pregnancy.
UI - 12172918
AU - Figarella-Branger D; Dufour H; Fernandez C; Bouvier-Labit C; Grisoli F;
TI - Pellissier JF Pituicytomas, a mis-diagnosed benign tumor of the neurohypophysis: report of three cases.
SO - Acta Neuropathol (Berl) 2002 Sep;104(3):313-9
AD - Service d'Anatomie Pathologique et de Neuropathologie, Hopital de la Timone, chemin de l'Armee d'Afrique, 13005 Marseille, France. Dominique.Figarella-Branger@medecine.univ-mrs.fr
Pituicytoma is a rare benign primary tumor of the neurohypophysis, occurring in the sellar and suprasellar spaces. We report here three new cases with immunohistochemical and electron microscopic study. Particular attention was paid to the expression of some cell adhesion molecules. These tumors were characterized by bundles of elongated cells strongly immunoreactive to anti-vimentin, S-100 protein, neural cell adhesion molecule and neuron-specific enolase antibodies. Glial fibrillary acidic protein (GFAP) was not recorded. It expressed the very late antigen alpha2 (VLAalpha2), but not VLAalpha5, and lacked epithelial markers expression (epithelial membrane antigen, E-cadherin), and specific neuronal markers (synaptophysin, chromogranin, neurofilament). Staining for pituitary hormones was negative. At the ultrastructural level, tumor/blood vessel basal lamina and cytoplasmic intermediate filaments were observed but desmosome or pericellular basal lamina were lacking. In one case few secretory granules were recorded. Differential diagnoses include granular cell tumors, pilocytic astrocytomas and spindle cell tumors such as solitary fibrous tumors, fibroblastic meningiomas and schwannomas. However, the unique pattern of antigenic expression and ultrastructural features of pituicytomas distinguish this rare tumor. As a subpopulation of pituicytes (which are distinctive glial cells of the neurophypophysis), some pituicytomas do not expressed GFAP. This suggests that pituicytomas presumably arise from pituicytes at various stages of their differentiation.
UI - 12027873
AU - Lania A; Gangi E; Romoli R; Losa M; Travaglini P; Meringolo D; Ambrosi
TI - B; Faglia G; Beck-Peccoz P; Spada A Impaired estrogen-induced negative feedback on gonadotropin secretion in patients with gonadotropin-secreting and nonfunctioning pituitary adenomas.
SO - Eur J Clin Invest 2002 May;32(5):335-40
AD - University of Milan, Ospedale Maggiore IRCCS, San Raffaele IRCCS, Milan, Italy.
BACKGROUND: Several in vitro studies suggest that gonadotropin-secreting pituitary adenomas (Gn-omas) and non functioning pituitary adenomas (NFPA) originate from gonadotroph cells. Patients with Gn-oma and NFPA frequently show abnormal gonadotropin response to TRH. The aim of the study was to investigate whether the estrogen-induced negative feedback is operating in either patients with Gn-oma or NFPA. MATERIALS AND METHODS: Serum gonadotropin levels were evaluated at 24 h after ethinylestradiol administration (1 mg per os; EE2 test) in seven patients with a diagnosis of Gn-oma, based on the presence of high follicle-stimulating hormone (FSH) and/or lutenising hormone (LH) levels with normal or high levels of sex steroids, in 22 patients with NFPA with normal or low levels of gonadotropin and sex steroids, and 30 sex- and age-matched healthy subjects. A normal response to EE2 test was arbitrarily defined as a serum LH and FSH decrease of at least 40 and 30% below basal levels. RESULTS: Among patients with Gn-oma, only one had a normal FSH inhibition and another, a normal LH inhibition. Among the 22 patients with NFPA, the EE2 test caused a normal FSH or LH reduction in 10 and 15, respectively, while a normal reduction of both FSH and LH was observed in nine. CONCLUSIONS: The study demonstrates that estrogen-induced negative feedback of gonadotropin secretion is disrupted in almost all patients with Gn-oma and in half of those with NFPA. This defective feedback is reminiscent of the resistance to thyroid hormones and glucocorticoids observed in patients with thyroid-stimulating hormone- (TSH-) and adrenocorticotropic hormone- (ACTH-)secreting adenomas, respectively.
UI - 12235306
AU - Pearce JM
TI - Pituitary tumours and acromegaly (Pierre Marie's disease).
SO - J Neurol Neurosurg Psychiatry 2002 Oct;73(4):394
AD - firstname.lastname@example.org
UI - 11081197
AU - Jin L; Kulig E; Qian X; Scheithauer BW; Young WF Jr; Davis DH; Seidah
TI - NG; Chretien M; Lloyd RV Distribution and regulation of proconvertases PC1 and PC2 in human pituitary adenomas.
SO - Pituitary 1999 May;1(3-4):187-95
AD - Department of Laboratory Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Pituitary adenomas are members of the family of neuroendocrine cells and tumors which have secretory granules containing chromogranins/secretogranins and other proteins. Pituitary adenomas express the neuroendocrine specific proconvertases PC1 (also known as PC3) and PC2, which are important for the proteolytic processing of chromogranins/secretogranins molecules. We examined the distribution of PC1 and PC2 in primary cultures of 20 pituitary adenomas and analyzed the regulation of the proconvertase mRNAs and proteins by various secretagogues including hypothalamic hormones and phorbol ester to determine the role of PC1 and PC2 in CgA processing in pituitary adenomas. Although PC2 was present in all adenomas, there was a differential distribution of PC1 with PRL adenomas expressing lower levels of PC1 compared to other adenoma types by RT-PCR analysis, in situ hybridization and immunostaining. Treatment of primary cultures of pituitary adenomas with phorbol 12-myristrate 13-acetate (PMA) resulted in an increase in pancreastatin (PST) secretion in most pituitary adenomas and increased PC1 mRNA and protein expression in gonadotroph adenomas, but not in other types of adenomas. Analysis of a human pituitary adenoma cell line, immortalized by recombinant defective adenovirus (HP75), which expressed chromogranin A, FSH, PC1 and PC2 showed that PST was secreted by these immortalized cells. Treatment with TGF beta 1 resulted in an increase in PST secretion and in PC1 mRNA and protein. These results indicate that a) there is a differential distribution of PC1 in human pituitary adenomas with PRL adenomas expressing very little PC1 mRNA and protein and b) that PC1 expression in gonadotropin hormone-producing adenomas is regulated by PMA and TGF beta 1. These findings support the observation that chromogranin A is a substrate for the endoproteinase PC1 in human pituitary adenoma cells.
UI - 11859832
AU - Perez Falero RA; Bermejo Sanchez JC; Dejongh Cobo E
TI - Image-guided transorbital roof craniotomy via a suprabrow approach: a surgical series of 72 patients.
SO - Neurosurgery 2001 Dec;49(6):1485-6; discussion 1487
UI - 11859833
AU - Mariniello G; Bonavolonta G; Cappabianca P; de Divitiis E
TI - Image-guided transorbital roof craniotomy via a suprabrow approach: a surgical series of 72 patients.
SO - Neurosurgery 2001 Dec;49(6):1486-7
UI - 11883703
AU - Beinfeld MC; Wang W
TI - CCK processing by pituitary GH3 cells, human teratocarcinoma cells NT2 and hNT differentiated human neuronal cells evidence for a differentiation-induced change in enzyme expression and pro CCK processing.
SO - Life Sci 2002 Feb 1;70(11):1251-8
AD - Department of Pharmacology and Experimental Therapeutics, Tufts University School of Medicine, Boston, MA 02111, USA. Margery.Beinfeld@tufts.edu
Human teratocarcinoma Ntera2/c 1.D1 (NT2) cells express very low levels of the prohormone convertase enzyme PC1, moderate levels of PC2 and significant levels of PC5. When infected with an adenovirus which expresses rat CCK mRNA, several glycine-extended forms were secreted that co-eluted with CCK 33, 22 and 12. Amidated CCK is not produced because these cells appear to lack the amidating enzyme. Pituitary GH3 cells express high levels of PC2 and PC5. CCK adenovirus-infected GH3 cells secrete amidated versions of the same peptides as NT2 cells. Differentiation of NT2 cells into hNT cells with retinoic acid and mitotic inhibitors increased expression of PC5 and decreased expression of PCI and PC2. CCK adenovirus-infected differentiated hNT cells also secrete glycine extended CCK products and the major molecular form produced co-eluted with CCK 8 Gly. These experiments demonstrate that the state of differentiation of this neuronal cell line influences its expression of PC 1,2, and 5 and its cleavage of pro CCK and suggests that these cells may make an interesting model to study how differentiation alters prohormone processing. These results also support the hypothesis that PC5 in differentiated neuronal cells is capable of processing pro CCK to glycine-extended CCK 8.
UI - 7923822
AU - Hashimoto K; Koga M; Kouhara H; Arita N; Hayakawa T; Kishimoto T; Sato B
TI - Expression patterns of messenger ribonucleic acids encoding prohormone convertases (PC2 and PC3) in human pituitary adenomas.
SO - Clin Endocrinol (Oxf) 1994 Aug;41(2):185-91
AD - Department of Medicine III, Osaka University Hospital, Suita-shi, Japan.
OBJECTIVE: Prohormone convertases (PC2 and PC3) have been reported to play an important role for prohormone processing in rodent pituitaries. However, expression of mRNAs encoding these enzymes has not been characterized in human pituitaries. In addition, altered or insufficient prohormone processing has been reported in some human pituitary adenomas. Thus, the expression patterns of these mRNAs in non-tumorous and tumorous human pituitaries should be examined. DESIGN: Total RNAs were extracted from non-tumorous or tumorous human pituitaries to analyse PC2 and PC3 mRNA expression. SAMPLES: Five ACTH producing adenomas, 11 GH producing adenomas, one PRL producing adenoma and five non-functioning adenomas were obtained at surgery. Two non-tumorous pituitaries were also included in this study. MEASUREMENTS: The contents were quantitatively measured by Northern blot analysis using rat PC3 cDNA or human PC2 cDNA as a probe. The method was also developed fo