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Journal Article 2007; 28(4): 438-444 PubMed PMID: 17693972 Citation  Keywords:  ACTH-Secreting Pituitary Adenoma:pathology, Adenoma:pathology, Adolescent, Adult, Aged, Child, Endoscopy:adverse effects, Female, Growth Hormone-Secreting Pituitary Adenoma:pathology, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Minimally Invasi.   

AIM OF THE STUDY: The paper presents endoscopic surgical technique used in the treatment of hormonally active pituitary adenomas and assessment of the method in terms of its effectiveness and safety.

MATERIAL AND METHODS: In 217 cases the surgery was performed due to pituitary adenomas applying the technique developed by Jho and Carrau, with our own modifications. 70 patients were treated for hormonally active adenomas. The group consisted of 36 somatotrophic adenomas, 21 prolactinomas and 13 corticotrophic adenomas. There were 51 females and 19 males with mean age of 42.6 years (range 11-77 years). The follow-up period was between 7 and 56 months (mean - 34 months). The effectiveness and occurrence of complications were confirmed on the basis of neurosurgical, laryngological, endocrinological, ophthalmological examinations and neuroimaging.

RESULTS: Biochemical and neurosurgical criteria for complete resection were obtained in 21 (58.3%) of 36 patients with all somatotrophic adenomas. In the group of prolactinomas complete resection was achieved in 17 (80.9%) of 21 patients. Of the 13 patients with Cushing's disease 11 (84.6%) were cured. In the studied group there were no deaths. In the postoperative course only 2 (2.8%) patients suffered liquorrhoeas and new anterior lobe pituitary insufficiency was noted in 8 (11.4%) cases. Meningitis was noted in 1 (1.4%) case and another 1 (1.4%) patient had epistaxis which required repeated endoscopic surgery.

CONCLUSIONS: Endoscopic technique is an effective method of treatment of hormonally active pituitary adenomas. It is characterised as being minimal invasive and has a low severe complication rate....

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Comparative Study 2007; 28(2): 166-169 PubMed PMID: 17435668 Citation  Keywords:  Adiponectin:blood, Animals, Inflammation:chemically induced, Injections, Intraperitoneal, Lipopolysaccharides, Male, Pituitary Adenylate Cyclase-Activating Polypeptide:administration & dosage, Rats, Rats, Inbred WKY,.   

BACKGROUND: Pituitary adenylate cyclase activating peptide (PACAP 38) is a neuropeptide with anti-inflammatory activity. Vasoactive intestinal peptide (VIP)/PACAP receptors are found in immune cells, endocrine glands and also in adipose tissue. Adiponectin is an adipocyte-derived protein hormone which possesses anti-inflammatory, antidiabetic and antiatherogenic properties. The aim of this study was to examine the influence of PACAP 38 on adiponectin release in basal conditions and during lipopolysaccharide (LPS)-induced acute inflammation.

METHODS: Male Wistar-Kyoto rats were divided into four groups which received intraperitoneal injections of 0.9% NaCl, LPS, PACAP 38 or LPS+PACAP 38, respectively. Serum adiponectin concentrations were measured using an ELISA test.

RESULTS: LPS administration did not change adiponectin concentration; however, PACAP 38 administered alone decreased serum adiponectin concentration after 2 h (p<0.05) and 4 h (p<0.01). In the group that received LPS+PACAP38, compared with LPS alone, no difference in adiponectin concentration was observed.

CONCLUSIONS: We conclude that PACAP 38 may directly modulate adiponectin secretion by adipocytes in basal conditions....

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Case Reports 2006; 27(6): 733-736 PubMed PMID: 17187002 Citation  Keywords:  Adrenocorticotropic Hormone:blood, Female, Follicle Stimulating Hormone:secretion, Gonadotrophs:pathology, Humans, Hydrocortisone:blood, Magnetic Resonance Imaging, Middle Aged, Neoplasms, Multiple Primary:pathology, Pituitary ACTH Hypersecretion:blood, P.   

OBJECTIVE AND IMPORTANCE: We encountered a Cushing's disease patient whose surgically removed pituitary macroadenoma was not an ACTH-producing, but rather a gonadotroph adenoma. Cure was obtained only after a tiny microadenoma, overlooked on preoperative studies, was removed by a 2nd operation from a compressed thin normal anterior pituitary gland.

CLINICAL PRESENTATION: This 45-year-old woman with Cushing syndrome presented with diabetes mellitus and steroid psychosis. Endocrinological examinations suggested Cushing's disease and MRI disclosed an invasive macroadenoma (22 mm in diameter) with suprasellar extension.

INTERVENTION: Despite total removal of the invasive macroadenoma by transsphenoidal surgery, her elevated serum cortisol- and ACTH levels failed to decrease. Histologic study of the surgical specimen disclosed that the tumor was a silent FSH-producing, rather than an ACTH-producing adenoma. Detailed re-evaluation of pre- and postoperative MRI suggested the presence of a 3-mm microadenoma on the left side of a thin compressed normal gland. Venous sampling of the cavernous sinus confirmed this suspicion. In a 2nd operation an ACTH-producing microadenoma was removed from inside the thin remaining compressed normal pituitary gland and endocrinological cure of Cushing's disease was achieved.

CONCLUSION: Although double adenomas, being a non-ACTH producing macroadenoma associated with an ACTH producing tiny microadenoma, are extremely rare in patients with Cushing's disease, detailed preoperative MRI evaluation is necessary to avoid missing tiny adenomas hidden in a compressed normal pituitary gland which is the cause of Cushing's disease, especially when a macroadenoma is found in patient with Cushing's disease....

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Journal Article 2006; 27(Suppl 2): 183-186 PubMed PMID: 17159811 Citation  Keywords:  Acetylcholinesterase:blood, Animals, Brain:drug effects, Butyrylcholinesterase:blood, Carnitine:pharmacology, Cholinesterase Inhibitors:pharmacology, Galantamine:pharmacology, Liver:drug effects, Male, Pituitary Gland:drug effects, Rats, Rats, Wistar,.   

OBJECTIVES: The alkaloid galantamine (GAL), which exhibits a combined anticholinesterase and direct parasympathomimetic mechanism of action, is employed in conjunction with therapeutic interventions in the stimulation of central cholinergic transfer in cognitive diseases. We attempted to achieve pharmacologically-induced enhancement of the parasympathomimetic activity of GAL in the key areas of rat brain, using an interactive combination of the alkaloid with the transmembrane enhancer L-carnitine (CAR).

METHODS: We investigated activities of acetylcholinesterase (AChE) in brain areas (frontal cortex, basal ganglia, septum and hippocampus) and the hypophysis, and that of butyrylcholinesterase (BuChE) in plasma and liver.

RESULTS: Following administration of the highest of the GAL doses used (2.5; 5; 10 mg/kg i.m.), AChE activity decreased mainly in the frontal cortex, hippocampus and hypophysis. In the interaction of GAL and CAR, AChE inhibition was stronger but without any statistical significance. The peripheral inhibition of BuChE was found to be dose-dependent. Premedication by CAR led to a slight change in the values of the activities monitored.

CONCLUSIONS: CAR in terms of positive modulation of GAL targeting to the central nervous system had no statistically significant effect....

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Case Reports 2006; 27(5): 569-572 PubMed PMID: 17159826 Citation  Keywords:  Adenoma:complications, Aged, Gonadotropin-Releasing Hormone:analogs & derivatives, Goserelin:therapeutic use, Humans, Male, Neoplasms, Multiple Primary:diagnosis, Pituitary Apoplexy:etiology, Pituitary Neoplasms:complications, Prostatic Neoplasms:complica.   

: LHRH analogs have become a promising modality in prostate cancer therapy as an alternative to surgical castration, and the use of these agents is generally considered to be safe. Since now, only few cases of an apoplexy of previously undiagnosed pituitary adenoma (usually gonadotropinoma) at the beginning of therapy have been described in the medical literature. We present a case of a 74 year old patient who was diagnosed of prostate cancer at the age of 68. There was no evidence of metastatic disease. Radical prostatectomy was performed and LHRH analog gosereline (Zoladex 3.6 mg s.c.) was administered. During the first day after gosereline injection the patient developed headaches that became more severe over the next 3 days. Then the patient experienced nausea and vomiting, double vision and eyelid ptosis. On the 5th day the patient temporarily lost consciousness and was admitted to hospital. Imaging (computerized tomography, magnetic resonance imaging) revealed the presence of a pituitary tumor and hemorrhage within the gland. There was no evidence of pituitary dysfunction in hormonal studies. Neurosurgical intervention was postponed for 5 days after admission. Pathological mass with signs of recent hemorrhage was removed via transsphenoidal route. The tumor had negative immunohistochemical GH, ACTH and PRL staining. Neurological impairment resolved within 9 months after the operation. As a result the patient required adrenal and thyroid replacement. During 6 years of follow-up there was no evidence of prostate cancer recurrence....

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Clinical Trial 2006; 27(4): 433-437 PubMed PMID: 16892008 Citation  Keywords:  Adult, Anxiety:physiopathology, Depression:physiopathology, Dexamethasone, Feedback, Physiological:drug effects, Follow-Up Studies, Glucocorticoids, Humans, Hydrocortisone:blood, Hypothalamo-Hypophyseal System:physiology, Immunosuppression, Male, Pituitar.   

OBJECTIVES: Higher rates of dexamethasone test (DST) nonsuppression in schizophrenia have been attributed to depressive symptoms, suicidality and negative symptoms. No study concerning first-episode schizophrenia has yet been published.

DESIGN: In patients hospitalised for the first time with first-episode schizophrenia the DST has been performed before, at the end of the acute treatment and after one year. At the same time the clinical evaluation with PANSS was performed. A cortisol value >5 microgram/dl in either of the postdexamethasone samples indicated nonsuppression of cortisol.

RESULTS: A total of 56 males were included. 18% of pts were DST nonsuppressors at medication-free baseline, 5% and 16% after acute treatment and after one year respectively. After 1 year 42/56 of patients fulfilled the criteria of remission. The rate of nonsuppression was 21.4%, 5% and 16.4% in remitters and 7%, 7% and 14.3% in nonremitters. Significant differences in the whole group were found between postdexamethasone cortisolemia at discharge on the one hand and on admission and at the one-year follow-up on the other. Significant correlations were observed between postdexamethasone cortisolemia and negative symptoms at the end of acute treatment.

MAIN FINDINGS: In first-episode schizophrenia the short-term treatment led to a decrease in cortisolemia and rates of nonsuppression and an increase at a one-year follow-up.

CONCLUSIONS: Rates of DST nonsuppression in schizophrenia including first-episode schizophrenia are influenced by the stage of illness and medication status. The impairment of feedback regulation of cortisol secretion may be related to different biopathogenetic mechanisms depending on the phase of the illness....

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Journal Article 2006; 27(4): 501-505 PubMed PMID: 16891994 Citation  Keywords:  Animals, Cerebral Decortication, Corpus Callosum:cytology, Denervation, Frontal Lobe:cytology, Functional Laterality, Luteinizing Hormone:blood, Male, Neural Pathways, Occipital Lobe:cytology, Pituitary Gland, Anterior:metabolism, Rats, Rats, Wistar, Test.   

OBJECTIVES: In addition to being regulated by the hypothalamo-hypophyseal system, testosterone (T) secretion is influenced by a number of less understood mechanisms. The aim of the present study was to examine whether defined areas of the right cerebral cortex could modulate T production.

METHODS: In adult male Wistar rats right frontal or occipital decortication, anterior or posterior callosotomy and corresponding sham-operations were performed. After 7-day survival time, T secretion in vitro, serum T and LH concentrations were measured by RIA.

RESULTS: Right occipital decortication and posterior callosotomy resulted in an increase in T secretion in vitro when compared to the corresponding sham-operated controls. In contrast, right frontal decortication or anterior callosotomy did not interfere with steroidogenesis. Serum LH concentration was not altered by any interventions.

CONCLUSION: The right occipital but not the right frontal cortex is involved in the control of T secretion. The caudal part of the corpus callosum accommodating the fibers originating from the occipital cortex might have a similar function. The fact that LH remained unchanged in all experimental groups suggests that the right occipital cortex and the caudal part of the corpus callosum influence testicular steroidogenesis by a pituitary-independent mechanism....

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Case Reports 2006; 27(1-2): 89-92 PubMed PMID: 16648816 Citation  Keywords:  Adenoma:metabolism, Adrenocorticotropic Hormone:biosynthesis, Adult, Cell Proliferation, Female, Humans, Immunohistochemistry, Intermediate Filament Proteins:biosynthesis, Ki-67 Antigen:metabolism, Pituitary Hormones:chemistry, Pituitary Neoplasms:metabol.   

: Herein, we report the case of a 28-year old woman clinically presenting with unclear weight gain over the last years. The patient displayed facial and neck edema in combination with unobtrusive striae distensae. Endocrinological examinations led to the diagnosis of Cushing's disease. Neuroradiological examination revealed an intrasellar tumor mass of 7 mm in diameter. Subsequently, transsphenoidal tumor resection was performed. Histological and immunohistochemical investigations revealed a pituitary gland adenoma showing a biphasic tumor growth pattern with two morphologically different tumor areas producing ACTH and prolactin respectively. Co-expression of ACTH and prolactin is exceedingly rare in pituitary adenoma. To our surprise, both tumor areas exhibited features of atypia consisting in elevated MIB-1 proliferation index in the ACTH-producing portion as well as p53 expression selectively in the prolactin-producing tumor parts. To our knowledge, this is the first case of an ACTH- and prolactin-producing pituitary gland adenoma exhibiting biphasic features of atypia....

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