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[Title] Management of type 2 diabetes mellitus associated with pituitary gigantism.

Pituitary gigantism, a condition of endogenous growth hormone (GH) hypersecretion prior to epiphyseal closure, is a rare condition.

In the adult condition of GH excess, acromegaly, the occurrence of type 2 diabetes mellitus (T2DM) and diabetic ketoacidosis (DKA) have been reported, with resolution following normalization of GH levels.

We report the case of a 16-year-old male with pituitary gigantism due to a large invasive suprasellar adenoma who presented with T2DM and DKA.

Despite surgical de-bulking, radiotherapy and medical treatment with cabergoline and pegvisomant, GH and insulin-like growth factor-I (IGF-I) levels remained elevated.

We review the pathophysiology of T2DM and DKA in growth hormone excess and available treatment options.

[MeSH-minor] Adenoma / complications. Adenoma / surgery. Adenoma / therapy. Adolescent. Antineoplastic Agents / therapeutic use. Combined Modality Therapy. Ergolines / therapeutic use. Human Growth Hormone / analogs & derivatives. Human Growth Hormone / therapeutic use. Humans. Hypoglycemic Agents / therapeutic use. Insulin / analogs & derivatives. Insulin / therapeutic use. Insulin Glargine. Insulin, Long-Acting. Male. Metformin / therapeutic use. Pituitary Neoplasms / complications. Pituitary Neoplasms / surgery. Pituitary Neoplasms / therapy. Radiotherapy

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(PMID = 17629784.001).

[ISSN] 1386-341X

[Journal-full-title] Pituitary

[ISO-abbreviation] Pituitary

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Ergolines; 0 / Hypoglycemic Agents; 0 / Insulin; 0 / Insulin, Long-Acting; 12629-01-5 / Human Growth Hormone; 2ZM8CX04RZ / Insulin Glargine; 9100L32L2N / Metformin; LL60K9J05T / cabergoline; N824AOU5XV / pegvisomant

   

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[Title] The long-term efficacy of conventional radiotherapy in patients with GH-secreting pituitary adenomas.

OBJECTIVE: To assess the long-term efficacy and safety of conventional radiotherapy (RT) in the control of acromegaly according to recent stringent criteria of cure.

PATIENTS AND METHODS: Forty-seven patients with active acromegaly were treated with conventional RT between 1982 and 1994.

All patients were first operated on and successively irradiated at a dose of 45-50 Gy in 25-28 fractions for persistent (n = 40) or recurrent (n = 7) disease.

MEASUREMENTS: Long-term GH/IGF-I secretion and local tumour control were evaluated regularly, and possible side-effects were searched for systematically, especially in terms of secondary endocrine dysfunction.

Biochemical cure of acromegaly was defined by glucose-suppressed plasma GH levels below 1 microg/l during an oral glucose tolerance test (OGTT) and normal age-corrected IGF-I values.

Suppression of GH during OGTT was seen in 9% of patients at 2 years, 29% at 5 years, 52% at 10 years, and 77% at 15 years.

Normalization of GH/IGF-I mainly depended on pre-RT levels.

CONCLUSION: Conventional RT is effective in the long-term control of GH-secreting pituitary adenomas, although with a high prevalence of progressive hypopituitarism.

[MeSH-major] Acromegaly / radiotherapy. Adenoma / radiotherapy. Adenoma / secretion. Growth Hormone / secretion. Pituitary Neoplasms / radiotherapy. Pituitary Neoplasms / secretion

[MeSH-minor] Adult. Female. Follow-Up Studies. Glucose Tolerance Test. Humans. Insulin-Like Growth Factor I / analysis. Male. Middle Aged. Retrospective Studies. Survival Rate. Treatment Outcome

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(PMID = 15670198.001).

[ISSN] 0300-0664

[Journal-full-title] Clinical endocrinology

[ISO-abbreviation] Clin. Endocrinol. (Oxf)

[Language] eng

[Publication-type] Journal Article

[Publication-country] England

[Chemical-registry-number] 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

   

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[Title] Transient MR changes and symptomatic epilepsy following gamma knife treatment of a residual GH-secreting pituitary adenoma in the cavernous sinus.

OBJECTIVE: To report a rare side effect of gamma knife treatment of pituitary macroadenoma.

CASE REPORT: In a forty-one-year old female patient acromegaly was diagnosed due to a growth hormone secreting pituitary macroadenoma.

Following transsphenoidal surgery the patient underwent gamma knife treatment for persistent uncontrolled acromegaly activity of residual tumor, infiltrating the left cavernous sinus.

CONCLUSION: Gamma knife surgery of a pituitary adenoma may cause radiation induced MR changes of the mesial temporal lobe mimicking glioma or radionecrosis and cause symptomatic epileptic seizures.

[MeSH-major] Adenoma / surgery. Brain Injuries / etiology. Epilepsy / etiology. Growth Hormone-Secreting Pituitary Adenoma / surgery. Radiation Injuries / etiology. Radiosurgery / adverse effects

[MeSH-minor] Acromegaly / etiology. Acromegaly / surgery. Adult. Cavernous Sinus / pathology. Cavernous Sinus / physiopathology. Cavernous Sinus / surgery. Female. Humans. Magnetic Resonance Imaging. Necrosis / diagnosis. Necrosis / etiology. Necrosis / physiopathology. Neoplasm Recurrence, Local / surgery. Pituitary Gland / pathology. Pituitary Gland / physiopathology. Pituitary Gland / surgery. Positron-Emission Tomography. Postoperative Complications / diagnosis. Postoperative Complications / etiology. Postoperative Complications / physiopathology. Temporal Lobe / pathology. Temporal Lobe / radiation effects. Temporal Lobe / radionuclide imaging

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(PMID = 16761113.001).

[ISSN] 0001-6268

[Journal-full-title] Acta neurochirurgica

[ISO-abbreviation] Acta Neurochir (Wien)

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] Austria

   

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[Title] [Management of acromegaly in pregnant woman].

[Transliterated title] Prise en charge de l'acromégalie évolutive au cours de la grossesse.

On the other hand, pregnancy may cause an enlargement of the adenoma or an increase of growth hormone (GH) secretion.

We report the case of a 26-year-old woman with a GH-secreting pituitary macroadenoma who was operated by transphenoidal approach.

After surgery, she had a persistent acromegaly due to an intrasellar tumour.

Lanreotide was stopped when the diagnosis of pregnancy was established.

The pituitary adenoma was not significantly enlarged during pregnancy.

Therefore, pregnancy doesn't influence acromegaly in young women well controlled by medical treatment.

[MeSH-major] Acromegaly / surgery. Adenoma / surgery. Growth Hormone-Secreting Pituitary Adenoma / surgery. Pregnancy Complications / surgery

[MeSH-minor] Adult. Anti-Inflammatory Agents / therapeutic use. Female. Human Growth Hormone / blood. Humans. Insulin-Like Growth Factor I / metabolism. Magnetic Resonance Imaging. Peptides, Cyclic / therapeutic use. Pregnancy. Pregnancy Outcome. Somatostatin / analogs & derivatives. Somatostatin / therapeutic use

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[Copyright] Copyright (c) 2009 Elsevier Masson SAS. All rights reserved.

(PMID = 19926070.001).

[ISSN] 0003-4266

[Journal-full-title] Annales d'endocrinologie

[ISO-abbreviation] Ann. Endocrinol. (Paris)

[Language] fre

[Publication-type] Case Reports; English Abstract; Journal Article

[Publication-country] France

[Chemical-registry-number] 0 / Anti-Inflammatory Agents; 0 / Peptides, Cyclic; 118992-92-0 / lanreotide; 12629-01-5 / Human Growth Hormone; 51110-01-1 / Somatostatin; 67763-96-6 / Insulin-Like Growth Factor I

   

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[Title] A prospective analysis of 151 cases of patients with acromegaly operated by one neurosurgeon: a follow-up of more than 23 years.

BACKGROUND: Transsphenoidal adenomectomy has been the accepted surgical management for treatment of growth hormone (GH)-secreting pituitary adenomas.

Although the goal of treatment might be to keep the GH level in the reference range, the actual definition of success in control of acromegaly is not yet clear.

The preoperative hormonal studies documenting the high GH and/or insulin-like growth factor were available in all the cases.

RESULTS: There were 90 patients with pure GH-secreting adenoma (59.6%) with the highest GH level of 235 mU/L.

A second group of 12 patients had normal GH level but elevated serum level of insulin-like growth factor 1 (8%).

The group with mixed secretion of GH and prolactin included 49 cases (32.4%).

Normal postoperative serum GH level could be achieved in 98 patients (94.2%) of 104 cases with full follow-up.

CONCLUSION: In the developing countries, early diagnosis and proper surgical extirpation of the GH-secreting adenoma by an experienced and dedicated pituitary surgeon is mandatory to reduce the mortality and increase the chance of cure of this rather mortal endocrionopathy.

[MeSH-major] Acromegaly / surgery. Adenoma / surgery. Growth Hormone-Secreting Pituitary Adenoma / surgery. Hypophysectomy / methods

[MeSH-minor] Adolescent. Adult. Aged. Cerebrospinal Fluid Rhinorrhea / etiology. Cerebrospinal Fluid Rhinorrhea / physiopathology. Diabetes Insipidus / etiology. Diabetes Insipidus / physiopathology. Early Diagnosis. Female. Follow-Up Studies. Growth Hormone / blood. Growth Hormone / secretion. Humans. Hypopituitarism / etiology. Hypopituitarism / physiopathology. Insulin-Like Growth Factor I / metabolism. Insulin-Like Growth Factor I / secretion. Male. Middle Aged. Pituitary Gland / physiopathology. Pituitary Gland / secretion. Pituitary Gland / surgery. Postoperative Complications / etiology. Postoperative Complications / physiopathology. Prolactin / blood. Prolactin / secretion. Prospective Studies. Sella Turcica / anatomy & histology. Sella Turcica / pathology. Sella Turcica / surgery. Sphenoid Bone / anatomy & histology. Sphenoid Bone / pathology. Sphenoid Bone / surgery. Treatment Outcome

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(PMID = 16793431.001).

[ISSN] 0090-3019

[Journal-full-title] Surgical neurology

[ISO-abbreviation] Surg Neurol

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 67763-96-6 / Insulin-Like Growth Factor I; 9002-62-4 / Prolactin; 9002-72-6 / Growth Hormone

   

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[Title] [Acromegaly-associated lesions of the nasal mucosa. Case report].

Acromegaly is a rare disease caused by a growth-hormone-secreting pituitary adenoma.

Besides these "cosmetic" symptoms, the disease is associated with hypertension and diabetes mellitus, as well as with an increased risk for adenomas and carcinomas of the colon.

The average time span from first symptom to diagnosis is well over 6 years; a single determination of insulin-like growth factor 1 in serum can confirm the disease.

The treatment of choice remains surgical resection of the adenoma in suitable patients, whereas in extensive disease with invasion of surrounding tissue, drug therapy and/or radiotherapy may be necessary.

[MeSH-major] Acromegaly / complications. Acromegaly / surgery. Adenoma / etiology. Adenoma / surgery. Nasal Mucosa / surgery. Nose Neoplasms / etiology. Nose Neoplasms / surgery

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(PMID = 19557321.001).

[ISSN] 1433-0458

[Journal-full-title] HNO

[ISO-abbreviation] HNO

[Language] ger

[Publication-type] Case Reports; English Abstract; Journal Article

[Publication-country] Germany

   

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[Title] The evaluation of ghrelin mRNA expression in human somatotroph adenomas.

Ghrelin is one of the peptides involved into GH-release, binding to specific GHS receptors on hypothalamus and pituitary.

The ghrelin peptide and ghrelin mRNA have been detected in several regions of hypothalamus, in normal pituitary, as well as in various types of pituitary adenoma, with different levels of expression in different tumour types.

We decided to determine the expression of ghrelin in somatotroph adenomas.

Human pituitary somatotroph adenoma tissues were obtained at the time of transsphenoidal surgery from 3 acromegalic patients and studied for ghrelin mRNA expression.

We wished to determine the number of copies of ghrelin gene within the single cell.

[MeSH-major] Adenoma / metabolism. Human Growth Hormone / metabolism. Peptide Hormones / biosynthesis. Pituitary Neoplasms / metabolism

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(PMID = 16648773.001).

[ISSN] 0172-780X

[Journal-full-title] Neuro endocrinology letters

[ISO-abbreviation] Neuro Endocrinol. Lett.

[Language] eng

[Publication-type] Journal Article

[Publication-country] Sweden

[Chemical-registry-number] 0 / Actins; 0 / DNA, Complementary; 0 / Ghrelin; 0 / Peptide Hormones; 0 / RNA, Messenger; 12629-01-5 / Human Growth Hormone; EC 1.2.1.- / Glyceraldehyde-3-Phosphate Dehydrogenases

   

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[Title] Current diagnosis of acromegaly.

Acromegaly is a rare and chronic condition that is characterized by sustained unregulated hypersecretion of growth hormone (GH).

More than 99% of the cases of acromegaly are due to a pathologic proliferation of pituitary somatotrophs presenting in the form of a pituitary adenoma.

The excessive amounts of GH and its target hormone, insulin like growth factor-1 (IGF-1) cause metabolic changes and tissue enlargement that, collectively, lead to significant morbidity and a two to threefold increase in mortality.

Thus, early diagnosis has proved to be crucial to improve survival and quality of life in this condition.

The development of radioimmunoassay (RIA) in the 1960s provided clinicians with a biochemical tool to diagnose acromegaly.

Many limitations were inherent to this methodology which necessitated the development of more sensitive tools, such as immunoradiometric (IRMA) or immunoluminometric (ILMA) assays for GH and IGF-1 measurements.

The reference ranges to describe normalcy of the somatotropic axis and the biochemical criteria of "cure" of acromegaly are areas of great debate.

Nevertheless, the current international consensus agrees that the diagnosis of acromegaly should be based on both clinical presentation and biochemical data.

[MeSH-major] Acromegaly / diagnosis. Growth Hormone / blood. Insulin-Like Growth Factor I / metabolism

[MeSH-minor] Adenoma / blood. Adenoma / complications. Adenoma / pathology. Humans. Pituitary Gland / metabolism. Pituitary Gland / pathology. Pituitary Neoplasms / blood. Pituitary Neoplasms / complications. Pituitary Neoplasms / pathology

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(PMID = 18236162.001).

[ISSN] 1389-9155

[Journal-full-title] Reviews in endocrine & metabolic disorders

[ISO-abbreviation] Rev Endocr Metab Disord

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] Germany

[Chemical-registry-number] 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

[Number-of-references] 72

   

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[Title] The implication of somatotroph adenoma phenotype to somatostatin analog responsiveness in acromegaly.

CONTEXT: Persistently elevated GH and IGF-I levels are associated with increased mortality.

OBJECTIVE: The objective of this study was to examine the significance of somatotroph adenoma type on response to SSA.

PATIENTS: Forty patients with acromegaly were studied.

MAIN OUTCOME MEASURES: Normalization of IGF-I levels and GH responses were the main outcome measures.

RESULTS: Univariate analysis revealed that responders were more likely to have densely granulated somatotroph adenomas (80% vs. 43.8%; P = 0.024), to be older (51.3 vs. 38.2 yr; P < 0.003), to have smaller tumors (stage < or =3; 78.6% vs. 35.7%; P = 0.022), to have lower baseline IGF-I (453 vs. 716 microg/liter; P < 0.001) and GH levels (2.7 vs. 7.8 microg/liter; P < 0.05), and to require a lower maximum dose of SSA (24 vs. 31 mg every 4 wk; P = 0.013).

Multivariate analysis confirmed that a densely granulated adenoma was the strongest predictor of complete response [adjusted odds ratio (OR), 58.41; 95% confidence interval (CI), 1.24-1000.00; P = 0.04] compared with other covariates, including older age at time of diagnosis (OR, 1.15/yr; 95% CI, 1.01-1.31; P = 0.03), and tumor stage of 3 or less (OR, 29.77; 95% CI, 1.01-885.45; P < 0.05).

CONCLUSIONS: Somatotroph tumor type represents a strong clinical predictor of response to SSA treatment and will help to identify patients who warrant more vigilant management of their disease.

[MeSH-major] Acromegaly / drug therapy. Adenoma / drug therapy. Octreotide / therapeutic use. Pituitary Neoplasms / drug therapy

[MeSH-minor] Adult. Aged. Female. Human Growth Hormone / blood. Humans. Insulin-Like Growth Factor I / analysis. Male. Middle Aged. Multivariate Analysis. Phenotype. Retrospective Studies

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(PMID = 16118335.001).

[ISSN] 0021-972X

[Journal-full-title] The Journal of clinical endocrinology and metabolism

[ISO-abbreviation] J. Clin. Endocrinol. Metab.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 12629-01-5 / Human Growth Hormone; 67763-96-6 / Insulin-Like Growth Factor I; RWM8CCW8GP / Octreotide

   

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[Title] Pituitary adenoma and concomitant Rathke's cleft cyst.

Although pituitary adenomas and Rathke's cleft cysts have a shared ancestry, they rarely occur simultaneously.

Only 32 reports involving a pituitary adenoma and a concomitant Rathke's cleft cyst were identified upon review of the literature.

Next to growth hormone, Prolactin was the most commonly hypersecreted pituitary hormone.

Here, we report a patient with a growth hormone- secreting pituitary adenoma associated with a Rathke's cleft cyst.

When a non-enhancing cyst-like structure is demonstrated on imaging in a patient with a pituitary adenoma, the possibility of a coexisting Rathke's cleft cyst should be considered.

[MeSH-major] Adenoma / surgery. Central Nervous System Cysts / surgery. Growth Hormone-Secreting Pituitary Adenoma / surgery. Neoplasms, Multiple Primary / surgery. Pituitary Neoplasms / surgery

[MeSH-minor] Diagnosis, Differential. Female. Humans. Image Processing, Computer-Assisted. Magnetic Resonance Imaging. Middle Aged. Neuronavigation. Pituitary Gland / pathology

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(PMID = 17914599.001).

[ISSN] 0942-0940

[Journal-full-title] Acta neurochirurgica

[ISO-abbreviation] Acta Neurochir (Wien)

[Language] eng

[Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't; Review

[Publication-country] Austria

[Number-of-references] 28

   

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[Title] Pegvisomant: new preparation. A last resort in acromegaly.

(1) The first-line treatment for acromegaly is transsphenoidal surgery.

As an adjunct to surgery, and for patients with inoperable tumours, the first-line drug therapy is a somatostatin analogue (octreotide or lanreotide). (2) Pegvisomant, a growth hormone (GH) receptor antagonist, is licensed for patients who have a poor response to surgery and/or radiation therapy and in whom somatostatin analogue therapy has failed. (3) There are no published comparative trials evaluating pegvisomant as alternative for patients who have already tried a somatostatin analogue.

It showed that pegvisomant, at a dose of 10 mg to 20 mg/day subcutaneously, normalised the level of insulin-like growth factor type 1 (IGF-1) and improved some symptoms.

This trial does not provide enough evidence to support the approved indication. (4) Pegvisomant lowers the IGF-1 level but also increases the GH level.

An increase in the size of the pituitary adenoma, due to the resulting hyperfunctioning, was observed in four of the 160 patients treated in clinical trials. (5) Evaluation data on pegvisomant does not resolve the question of possible hepatic toxicity. (6) In practice, pegvisomant therapy is justified for patients with serious complications of acromegaly and who have no other treatment options.

[MeSH-major] Acromegaly / drug therapy. Human Growth Hormone / therapeutic use

[MeSH-minor] Adenoma / surgery. Drug Approval. Europe. Humans. Octreotide / administration & dosage. Octreotide / adverse effects. Octreotide / therapeutic use. Randomized Controlled Trials as Topic. Somatostatin / administration & dosage. Somatostatin / adverse effects. Somatostatin / analogs & derivatives. Somatostatin / therapeutic use

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(PMID = 15751152.001).

[ISSN] 1167-7422

[Journal-full-title] Prescrire international

[ISO-abbreviation] Prescrire Int

[Language] eng

[Publication-type] Comparative Study; Journal Article

[Publication-country] France

[Chemical-registry-number] 12629-01-5 / Human Growth Hormone; 51110-01-1 / Somatostatin; RWM8CCW8GP / Octreotide

   

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[Title] Cushing's disease due to double pituitary ACTH-secreting adenomas: the first case report.

Double pituitary adenomas are rare occurrences in autoptical, surgical and neuroradiological series and are mostly due to non-functioning pituitary adenomas, GH-secreting and prolactin-secreting adenomas.

ACTH secreting tumours are more rare and, to our knowledge, two distinct ACTH-producing adenomas within the same pituitary have never been reported.

We herewith describe a 56 year old woman with Cushing' s disease due to two clearly distinct ACTH-secreting pituitary adenomas.

She presented with signs and symptoms of hypercortisolism and hormonal testing was indicative for pituitary-dependent Cushing' s syndrome.

Sellar MRI visualized an asymmetric pituitary gland with suspect lesions in both the right and the left pituitary lobes.

Pathology confirmed the existence of two distinct adenomas located in different sites in the gland.

Our case indicates that double ACTH-secreting pituitary adenomas may occur in patients with Cushing' s disease.

[MeSH-major] ACTH-Secreting Pituitary Adenoma / pathology. Adenoma / pathology. Neoplasms, Multiple Primary / pathology. Pituitary ACTH Hypersecretion / etiology

[MeSH-minor] Cushing Syndrome / etiology. Female. Humans. Middle Aged. Pituitary Neoplasms / pathology

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(PMID = 20595779.001).

[ISSN] 1348-4540

[Journal-full-title] Endocrine journal

[ISO-abbreviation] Endocr. J.

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] Japan

   

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[Title] Somatotroph adenoma cells may populate paranasal sinus mucosa.

[MeSH-major] Growth Hormone-Secreting Pituitary Adenoma / secondary. Nasal Mucosa / pathology. Neoplasm Invasiveness / pathology. Paranasal Sinus Neoplasms / secondary. Pituitary Neoplasms / pathology. Sphenoid Sinus / pathology

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(PMID = 20446098.001).

[ISSN] 0942-0940

[Journal-full-title] Acta neurochirurgica

[ISO-abbreviation] Acta Neurochir (Wien)

[Language] eng

[Publication-type] Case Reports; Letter

[Publication-country] Austria

   

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[Title] [Pharmacological treatment of acromegaly].

[Transliterated title] Tratamiento farmacológico de la acromegalia.

Acromegaly is an endocrine disorder usually due to a growth hormone (GH)-secreting pituitary adenoma.

This deforming disease is associated with several metabolic abnormalities and results in an elevated cardiovascular mortality.

Pituitary transsesphenoidal surgery has been considered the treatment of choice, however, even in the most experienced hands this procedure succeeds in curing only 50 to 60% of the patients.

Therefore, close to 50% of patients require an adjunctive form of treatment such as radiation therapy or the use of diverse medications that modulate GH secretion (somatostatin analogues) or action (GH receptor antagonists).

[MeSH-major] Acromegaly / drug therapy

[MeSH-minor] Humans. Receptors, Somatotropin / antagonists & inhibitors. Somatostatin / analogs & derivatives. Somatostatin / therapeutic use

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(PMID = 17022308.001).

[ISSN] 0016-3813

[Journal-full-title] Gaceta médica de México

[ISO-abbreviation] Gac Med Mex

[Language] spa

[Publication-type] English Abstract; Journal Article; Review

[Publication-country] Mexico

[Chemical-registry-number] 0 / Receptors, Somatotropin; 51110-01-1 / Somatostatin

[Number-of-references] 66

   

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[Title] Prognostic significance of the Ki-67 labeling index in growth hormone-secreting pituitary adenomas.

OBJECTIVE: The aim of the study was to evaluate the Ki-67 index prognostic relevance in a group of acromegalic patients who underwent transsphenoidal surgery for a GH-secreting pituitary adenoma.

The Ki-67 index was determined by immunohistochemistry on tissue samples obtained from each adenoma after surgery.

Periodical pituitary magnetic resonance imaging and hormonal evaluation were performed during the follow-up.

Pituitary magnetic resonance imaging showed residual/recurrent disease in 25 of 68 patients after 6 months.

No correlation was found between Ki-67 index and age, tumor size, GH, or IGF-I plasma levels.

We suggest routine Ki-67 evaluation in GH-secreting pituitary adenomas.

[MeSH-major] Adenoma / pathology. Growth Hormone-Secreting Pituitary Adenoma / pathology. Ki-67 Antigen / analysis

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(PMID = 18460561.001).

[ISSN] 0021-972X

[Journal-full-title] The Journal of clinical endocrinology and metabolism

[ISO-abbreviation] J. Clin. Endocrinol. Metab.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / Ki-67 Antigen; 51110-01-1 / Somatostatin

   

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[Title] Gamma knife radiosurgery for acromegaly--long-term experience.

OBJECTIVE: The Leksell gamma knife (LGK) is one of the treatment options for pituitary adenomas.

We report on our long-term experience treating acromegaly using LGK.

DESIGN: Since 1993 we have followed 96 acromegaly patients through periods of from 12 to 120 months.

Thirteen patients were irradiated twice, due to persistent activity of the adenoma or its residue.

Pituitary functions were tested at 6-month intervals, post-irradiation.

RESULTS: Fifty per cent of the patients achieved mean GH < 2.5 microg/l within 42 months, normalized their IGF-I within 54 months, and achieved GH suppression in the oral glucose tolerance test (oGTT) < 1 microg/l with normal IGF-I within 66 months.

LGK effectiveness was dependent on initial adenoma hormonal activity (GH and IGF-I serum levels), not on the size of the adenoma.

Irradiation arrested all adenoma growth, causing tumour shrinkage in 62.3% of patients.

Twenty-six developed hypopituitarism when irradiated by 15 Gy (or more) on functional peritumoral pituitary tissue.

CONCLUSIONS: In acromegaly, LGK is a useful adjunct to primary neurosurgery when treating post-surgical residues because it can limit the duration of medical therapy.

[MeSH-major] Acromegaly / surgery. Adenoma / surgery. Pituitary Neoplasms / surgery. Radiosurgery / instrumentation

[MeSH-minor] Adolescent. Adult. Aged. Blood Glucose / analysis. Combined Modality Therapy. Female. Follow-Up Studies. Growth Hormone / blood. Humans. Insulin-Like Growth Factor I / analysis. Male. Middle Aged. Neurosurgical Procedures. Statistics, Nonparametric. Treatment Outcome

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(PMID = 16649981.001).

[ISSN] 0300-0664

[Journal-full-title] Clinical endocrinology

[ISO-abbreviation] Clin. Endocrinol. (Oxf)

[Language] eng

[Publication-type] Journal Article

[Publication-country] England

[Chemical-registry-number] 0 / Blood Glucose; 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

   

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[Title] Significance of postoperative fluid diuresis in patients undergoing transsphenoidal surgery for growth hormone-secreting pituitary adenomas.

OBJECT: Following successful transsphenoidal surgery in patients with growth hormone (GH)-secreting pituitary adenomas, a characteristic fluid diuresis has been described.

In this paper the authors aimed to further analyze the degree of fluid diuresis as it relates to postoperative GH levels.

METHODS: Between 2000 and 2008, 85 patients underwent transsphenoidal surgery for a GH-secreting adenoma at the USC University Hospital.

Patients with negative fluid balances at 48 hours after surgery were more than twice as likely to have a GH level of < 1.5 ng/ml (55 vs 25%, p = 0.023).

At 48 hours after surgery, patients with a negative overall fluid balance had a significantly lower median GH level than those with a positive overall fluid balance (1.3 vs 2.4 ng/ml, p = 0.039).

By 48 hours following surgery, patients with postoperative Day 1 GH levels < 1.5 ng/ml had, on average, experienced diuresis of fluid > 1.1 L (median 1.5 L) more than patients with GH levels > 1.5 ng/ml.

CONCLUSIONS: Successful resection of GH-secreting adenomas is associated with a more pronounced fluid diuresis and negative overall fluid balance within 48 hours following transsphenoidal surgery.

Patients with a negative fluid balance by postoperative Day 2 have a higher likelihood of having significantly reduced postoperative GH levels that may correlate with long-term surgical remission.

[MeSH-major] Adenoma / surgery. Diuresis. Growth Hormone-Secreting Pituitary Adenoma / surgery. Postoperative Complications / diagnosis. Water-Electrolyte Balance

[MeSH-minor] Acromegaly / surgery. Adolescent. Adult. Aged. Female. Human Growth Hormone / secretion. Humans. Male. Middle Aged. Plasma Volume. Retrospective Studies. Sphenoid Bone / surgery. Young Adult

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(PMID = 19698049.001).

[ISSN] 1933-0693

[Journal-full-title] Journal of neurosurgery

[ISO-abbreviation] J. Neurosurg.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 12629-01-5 / Human Growth Hormone

   

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[Title] Manifestation of rheumatoid arthritis after transsphenoidal surgery in a patient with acromegaly.

Acromegalic arthropathy is one of the most frequent manifestations occurring in acromegaly patients.

In contrast, rheumatoid arthritis (RA) is a rare clinical complication in acromegaly patients.

Here, we report a 70-year-old Japanese woman with acromegaly, who complained of bilateral finger stiffness and polyarthralgia two months after transsphenoidal surgery of a growth hormone (GH)-secreting pituitary adenoma.

Postoperative levels of serum GH and insulin-like growth factor-1 (IGF-1) were markedly decreased without any secretory deficiency of other anterior pituitary hormones.

Regardless of the levels of GH and IGF-1, acromegaly patients frequently complain about joint-related symptoms even after remission.

Therefore, careful observation of bone erosive changes and immunological activity in acromegaly patients is required when joint-related symptoms persist.

[MeSH-major] Acromegaly / complications. Arthritis, Rheumatoid / etiology. Sphenoid Bone / surgery

[MeSH-minor] Adenoma / complications. Adenoma / radiography. Adenoma / surgery. Aged. Bone Marrow Diseases / complications. Bone Marrow Diseases / radiography. C-Reactive Protein / analysis. Female. Growth Hormone / blood. Growth Hormone-Secreting Pituitary Adenoma / complications. Growth Hormone-Secreting Pituitary Adenoma / radiography. Growth Hormone-Secreting Pituitary Adenoma / surgery. Hand / radiography. Humans. Synovitis / complications. Synovitis / radionuclide imaging

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(PMID = 16896264.001).

[ISSN] 0918-8959

[Journal-full-title] Endocrine journal

[ISO-abbreviation] Endocr. J.

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] Japan

[Chemical-registry-number] 9002-72-6 / Growth Hormone; 9007-41-4 / C-Reactive Protein

   

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[Title] The expression of E-cadherin in somatotroph pituitary adenomas is related to tumor size, invasiveness, and somatostatin analog response.

CONTEXT: Appropriate cell-to-cell adhesion is fundamental for the epithelial phenotype of pituitary cells.

In somatotroph adenomas, a variable and reduced expression of E-cadherin has been demonstrated.

In addition, nuclear translocation of E-cadherin was found to correlate with pituitary tumor invasion.

OBJECTIVE: The objective was to examine the protein expression of E-cadherin in somatotroph pituitary adenomas in relation to adenoma size, invasiveness, and somatostatin analog (SMS) efficacy.

Adenoma E-cadherin protein expression was analyzed by Western blot (61 patients) and immunohistochemistry (IHC) (80 patients) with antibodies directed against both extracellular and intracellular domains (IHC).

RESULTS: Membranous E-cadherin was lost in several adenomas.

The E-cadherin level correlated positively to tumor reduction after SMS treatment, and adenomas with nuclear E-cadherin staining had lower IGF-I reduction and tumor shrinkage.

Preoperatively treated adenomas had reduced E-cadherin protein levels, but the IHC expression was unaltered.

CONCLUSION: Reduced E-cadherin expression may correlate to a dedifferentiated phenotype in the somatotroph pituitary adenomas.

[MeSH-major] Cadherins / genetics. Peptide Fragments / therapeutic use. Pituitary Neoplasms / genetics. Somatostatin / therapeutic use

[MeSH-minor] Acromegaly / complications. Acromegaly / surgery. Adult. Female. Growth Hormone / blood. Humans. Immunohistochemistry. Insulin-Like Growth Factor I / metabolism. Magnetic Resonance Imaging. Male. Middle Aged. Neoplasm Invasiveness

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(PMID = 20335450.001).

[ISSN] 1945-7197

[Journal-full-title] The Journal of clinical endocrinology and metabolism

[ISO-abbreviation] J. Clin. Endocrinol. Metab.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / CTAP octapeptide; 0 / Cadherins; 0 / Peptide Fragments; 51110-01-1 / Somatostatin; 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

   

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[Title] Successful treatment of acromegaly in a diabetic cat with transsphenoidal hypophysectomy.

Plasma concentrations of growth hormone (GH) (51 microg/l, reference range 0.8-7.2 microg/l) and insulin-like growth factor 1 (IGF-1) (3871 microg/l, reference range 39-590 microg/l) were highly elevated, whereas those of alpha-melanocyte-stimulating hormone, adrenocorticotropic hormone and cortisol were normal.

Computed tomography revealed a thick palatum molle and an enlarged pituitary gland, indicating a pituitary neoplasm.

Microsurgical transsphenoidal hypophysectomy was performed and microscopic examination of the surgical specimen revealed an acidophilic, infiltrative pituitary adenoma that showed positive immunostaining for GH.

One year after hypophysectomy the plasma concentrations of GH and IGF-1 were 2.4 microg/l and 113 microg/l, respectively.

PRACTICAL RELEVANCE: This is the first report detailing transsphenoidal hypophysectomy as a feasible and effective treatment for feline acromegaly due to a pituitary somatotroph adenoma.

The surgery is discussed in the context of human and other feline therapies for acromegaly.

[MeSH-major] Acromegaly / veterinary. Adenocarcinoma / veterinary. Cat Diseases / surgery. Hypophysectomy / veterinary

[MeSH-minor] Adrenocortical Hyperfunction / blood. Adrenocortical Hyperfunction / complications. Adrenocortical Hyperfunction / surgery. Adrenocortical Hyperfunction / veterinary. Animals. Blood Glucose / metabolism. Cats. Diabetes Mellitus / blood. Diabetes Mellitus / surgery. Diabetes Mellitus / veterinary. Growth Hormone / blood. Insulin-Like Growth Factor I / metabolism. Male. Sphenoid Bone. Treatment Outcome

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[Copyright] Copyright 2010 Elsevier Ltd. All rights reserved.

(PMID = 20417901.001).

[ISSN] 1532-2750

[Journal-full-title] Journal of feline medicine and surgery

[ISO-abbreviation] J. Feline Med. Surg.

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] England

[Chemical-registry-number] 0 / Blood Glucose; 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

   

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[Title] Elevation of growth hormone secretagogue receptor type 1a mRNA expression in human growth hormone-secreting pituitary adenoma harboring G protein alpha subunit mutation.

OBJECTIVE: The purpose of this study was to investigate the relationship between the ghrelin or GHSR-1a mRNA levels and clinical characteristics and to confirm the effect of gsp mutations on ghrelin/GHSR-1a system in human GH-secreting pituitary adenomas.

The gsp mutations in 43 cases of human GH-secreting pituitary adenomas were detected using PCR-DNA direct sequencing analysis.

Clinical data were obtained from the medical records of 43 acromegalic patients who had GH and IGF-1 assays in the same laboratory.

The expression level of GHSR-1a mRNA was significantly higher in gsp positive adenomas than in negative adenomas (p<0.05).

Whereas, there was no significant difference in the expression of ghrelin mRNA between gsp mutation-positive and -negative adenomas (p>0.05).

Additionally there was a significant positve correlation between the ghrelin and GHSR-1a mRNA expression levels in gsp-positive (R=0.553, p=0.040) or -negative adenomas (R=0.489, p=0.007).

Gsp mutations may upregulate the expression of GHSR-1a mRNA and have no effect on ghrelin mRNA levels in human GH-secreting pituitary adenomas.

[MeSH-major] Adenoma / genetics. GTP-Binding Protein alpha Subunits / genetics. Growth Hormone-Secreting Pituitary Adenoma / genetics. Mutation. Receptors, Ghrelin / genetics

[MeSH-minor] Acromegaly / etiology. Acromegaly / genetics. Adult. Female. Ghrelin / genetics. Ghrelin / metabolism. Humans. Male. Middle Aged. RNA, Messenger / metabolism. Retrospective Studies. Tumor Burden. Up-Regulation. Young Adult

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(PMID = 20150876.001).

[ISSN] 0172-780X

[Journal-full-title] Neuro endocrinology letters

[ISO-abbreviation] Neuro Endocrinol. Lett.

[Language] eng

[Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] Sweden

[Chemical-registry-number] 0 / GTP-Binding Protein alpha Subunits; 0 / Ghrelin; 0 / RNA, Messenger; 0 / Receptors, Ghrelin

   

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[MeSH-major] Acromegaly / etiology. Acromegaly / therapy. Adenoma / surgery. Human Growth Hormone / metabolism. Neurosurgical Procedures / methods. Pituitary Neoplasms / surgery

[MeSH-minor] Adult. Aged. Connective Tissue / pathology. Connective Tissue / surgery. Female. Humans. Immunohistochemistry. Male. Microsurgery. Middle Aged. Neoplasm Recurrence, Local. Pituitary Hormones / deficiency

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(PMID = 15739069.001).

[ISSN] 0344-5607

[Journal-full-title] Neurosurgical review

[ISO-abbreviation] Neurosurg Rev

[Language] eng

[Publication-type] Journal Article

[Publication-country] Germany

[Chemical-registry-number] 0 / Pituitary Hormones; 12629-01-5 / Human Growth Hormone

   

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[Title] The choice of therapy in acromegaly: results of treatment at a tertiary care hospital.

Demographic, hormonal, visual and imaging data at diagnosis and during follow-up were recorded, as well as the treatments applied.

RESULTS: In 73.0% of the patients, acromegaly was due to a pituitary macroadenoma.

Considering normal age and sex-matched concentrations of IGF-I as a control criteria, surgery resulted in disease control in 10% of the patients who had surgery, while medical treatment controlled the disease in 76.9% (P <0.05).

CONCLUSIONS: Not all centres obtain the results reported in the literature in terms of disease control and morbidity after surgical treatment of growth hormone-secreting tumours.

[MeSH-major] Acromegaly / therapy. Adenoma / complications. Insulin-Like Growth Factor I / analysis. Pituitary Neoplasms / complications. Somatostatin / therapeutic use

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(PMID = 19112390.001).

[ISSN] 0172-780X

[Journal-full-title] Neuro endocrinology letters

[ISO-abbreviation] Neuro Endocrinol. Lett.

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] Sweden

[Chemical-registry-number] 51110-01-1 / Somatostatin; 67763-96-6 / Insulin-Like Growth Factor I

   

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[Title] Rapid progression of amyotrophic lateral sclerosis in an acromegalic patient after surgical resection of a growth hormone-producing pituitary adenoma.

INTRODUCTION: Insulin-like growth factor-1 (IGF-1) promotes the survival of neurons, mediates neuritic growth, and in 1 clinical trial human recombinant IGF-1 delayed the progression of functional impairment and decline of health-related quality of life in patients with amyotrophic lateral sclerosis (ALS).

CASE REPORT: We describe a case of a 65-year-old woman with a 2-year history of symptoms and signs of acromegaly because of a pituitary microadenoma.

The patient posed a challenging diagnostic dilemma because of the presence of dysarthria, which was initially considered as the consequence of acromegaly.

After octreotide long-acting release (LAR) treatment, the patient underwent uneventful pituitary surgery.

Although postoperative evaluation indicated a cure of acromegaly, progressive bulbar symptoms developed, which were followed by upper limb weakness and muscle atrophy.

Neurologic investigations confirmed the diagnosis of ALS and riluzole therapy was given.

One year after surgery growth-hormone deficiency was diagnosed, but a trial with human recombinant growth hormone failed to produce any significant improvement.

Histopathologic examination of the brain and spinal cord confirmed the diagnosis of ALS.

CONCLUSIONS: This is the first report showing a rapid progression of ALS after a surgical cure of coexisting acromegaly presumably because of cessation of high endogenous IGF-I levels.

[MeSH-major] Acromegaly. Amyotrophic Lateral Sclerosis. Disease Progression. Growth Hormone-Secreting Pituitary Adenoma. Pituitary Neoplasms

[MeSH-minor] Aged. Antineoplastic Agents, Hormonal / therapeutic use. Fatal Outcome. Female. Human Growth Hormone / deficiency. Human Growth Hormone / therapeutic use. Humans. Insulin-Like Growth Factor I / metabolism. Octreotide / therapeutic use

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(PMID = 20827122.001).

[ISSN] 2331-2637

[Journal-full-title] The neurologist

[ISO-abbreviation] Neurologist

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 12629-01-5 / Human Growth Hormone; 67763-96-6 / Insulin-Like Growth Factor I; RWM8CCW8GP / Octreotide

   

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[Title] Clinical indicators of biochemical remission in acromegaly: does incomplete disease control always mean therapeutic failure?

OBJECTIVE: Correction of GH and IGF-I levels are associated with improvements in insulin secretion, cardiac performance and body composition in patients with acromegaly, but whether these parallel post-treatment levels of GH-IGF-I axis activity is undefined.

We investigate whether various biochemical outcomes after transsphenoidal pituitary surgery (TSS) in these patients are associated with clinically relevant differences in cardiac performance, insulin resistance and body composition.

DESIGN: Cross-sectional study of consecutive patients with acromegaly admitted to the hospital between 2001 and 2002.

PATIENTS AND METHODS: Forty-one patients after TSS for somatotroph pituitary adenoma and 23 patients with naive acromegaly serving as positive controls were enrolled in the study.

Mean daily GH levels (mGH), IGF-I, leptin and lipid levels, glucose, insulin and GH concentrations during oral glucose tolerance test (oGTT) were measured in all study participants.

RESULTS: We found no difference in cardiac indices, insulin resistance, body composition and leptin levels between patients with complete biochemical remission and those with inadequately controlled disease (P > 0.05 for all) after TSS.

A similar decrease in LVM(i) was observed in controlled (108.4 +/- 30.0 g/m(2); P = 0.015) and inadequately controlled disease (108.8 +/- 30.7 g/m(2); P = 0.03) in comparison with naive disease (160.3 +/- 80.6 g/m(2)).

In controlled and inadequately controlled disease, R(HOMA) index was lower (2.2 +/- 1.4; P = 0.001 and 3.1 +/- 2.0; P = 0.05 vs. 5.1 +/- 3.1) while leptin concentration was higher (14.9 +/- 8.7 microg/l, P = 0.004 and 12.8 +/- 7.8 microg/l, P = 0.05 vs. 7.4 +/- 3.8 microg/l) than in naive disease.

Similar results were obtained if the definition of cure included both normal IGF-I levels and the ability to achieve GH nadir < 1 microg/l during oGTT.

CONCLUSION: This study shows that cardiac indices, insulin resistance and body composition were not different between patients with complete biochemical remission and those with discordant GH and IGF-I levels.

It appears that even incomplete disease control after TSS can result in improvement of these clinical markers.

[MeSH-major] Acromegaly / surgery

[MeSH-minor] Absorptiometry, Photon. Adenoma / blood. Adenoma / complications. Adenoma / surgery. Adult. Aged. Area Under Curve. Biomarkers / blood. Blood Glucose / analysis. Body Composition. Echocardiography. Female. Growth Hormone / blood. Humans. Insulin / blood. Insulin-Like Growth Factor I / analysis. Leptin / blood. Lipids / blood. Logistic Models. Male. Middle Aged. Pituitary Neoplasms / blood. Pituitary Neoplasms / complications. Pituitary Neoplasms / surgery. Remission Induction. Treatment Failure

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(PMID = 15807870.001).

[ISSN] 0300-0664

[Journal-full-title] Clinical endocrinology

[ISO-abbreviation] Clin. Endocrinol. (Oxf)

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] England

[Chemical-registry-number] 0 / Biomarkers; 0 / Blood Glucose; 0 / Insulin; 0 / Leptin; 0 / Lipids; 67763-96-6 / Insulin-Like Growth Factor I; 9002-72-6 / Growth Hormone

   

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[Title] AIP Mutations are not identified in patients with sporadic pituitary adenomas.

The pathogenesis of pituitary adenomas remains a subject of interest.

Recently, mutations in the aryl hydrocarbon receptor-interacting protein (AIP) were identified as germline events leading to pituitary tumor predisposition in Finnish and Italian families with familial growth hormone-secreting pituitary adenomas and acromegaly.

We examined the frequency of AIP mutations in pituitary tumors and blood of Canadian patients with sporadic pituitary somatotroph adenomas and sporadic pituitary adenomas of other types.

Genomic DNA was extracted from pituitary tumors and white blood cells obtained from peripheral blood.

AIP mutations were not detected as germline events in blood or as somatic alterations in tumors of 66 patients with pituitary adenomas.

These included 50 acromegalics and 16 patients with other types of pituitary tumor.

Our results indicate that mutations in AIP are not identified in sporadic pituitary adenomas of Canadian patients.

This rare mechanism of pituitary tumorigenesis appears to be unique to the initial Finnish and Italian families described.

[MeSH-major] Adenoma / metabolism. Pituitary Neoplasms / metabolism. Proteins / metabolism

[MeSH-minor] Acromegaly / etiology. Canada / epidemiology. Cohort Studies. DNA / biosynthesis. DNA / genetics. DNA, Neoplasm / genetics. Exons / genetics. Gene Frequency. Germ-Line Mutation. Humans. Intracellular Signaling Peptides and Proteins

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(PMID = 17916996.001).

[ISSN] 1046-3976

[Journal-full-title] Endocrine pathology

[ISO-abbreviation] Endocr. Pathol.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / DNA, Neoplasm; 0 / Intracellular Signaling Peptides and Proteins; 0 / Proteins; 0 / aryl hydrocarbon receptor-interacting protein; 9007-49-2 / DNA

   

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[Title] Signalling pathway alterations in pituitary adenomas: involvement of Gsalpha, cAMP and mitogen-activated protein kinases.

Despite extensive research on sporadic pituitary adenomas, it is not yet possible to assign one protein alteration to one specific type of pituitary adenomas.

Nevertheless, alterations of the cAMP pathway appear to be molecular hallmarks of most growth hormone (GH)-secreting adenomas.

In this review, we summarise the literature regarding signalling alterations observed in GH-secreting adenomas.

In the light of results obtained on human somatotroph adenoma cells in primary culture and on models of murine somatotroph cell lines, we postulate a crucial role for ERK1/2 in GH-secreting adenomas downstream of cAMP pathway alterations that might impact the tumoural phenotype.

[MeSH-major] Adenoma / metabolism. Cyclic AMP / metabolism. GTP-Binding Protein alpha Subunits, Gs / metabolism. Mitogen-Activated Protein Kinases / metabolism. Pituitary Neoplasms / metabolism. Signal Transduction

[MeSH-minor] Growth Hormone / secretion. Humans

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(PMID = 19732293.001).

[ISSN] 1365-2826

[Journal-full-title] Journal of neuroendocrinology

[ISO-abbreviation] J. Neuroendocrinol.

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review

[Publication-country] England

[Chemical-registry-number] 9002-72-6 / Growth Hormone; E0399OZS9N / Cyclic AMP; EC 2.7.11.24 / Mitogen-Activated Protein Kinases; EC 3.6.5.1 / GTP-Binding Protein alpha Subunits, Gs

[Number-of-references] 95

   

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Acromegaly is a chronic, invalidating disease due in over 95% of cases to a growth hormone (GH) secreting pituitary adenoma.

Its clinical manifestations are associated to local complications related to the tumor growth and/or to the metabolic consequences of GH excess.

In only 14.0% of acromegalics drug therapy with dopaminergic agents was effective in controlling the disease.

In summary, multimodal therapy of acromegaly can lead to a global safe control of the disease in 55.2% of the cases.

[MeSH-major] Acromegaly / therapy

[MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Female. Human Growth Hormone / metabolism. Humans. Male. Middle Aged. Retrospective Studies. Young Adult

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(PMID = 20679052.001).

[ISSN] 0025-7680

[Journal-full-title] Medicina

[ISO-abbreviation] Medicina (B Aires)

[Language] spa

[Publication-type] English Abstract; Journal Article

[Publication-country] Argentina

[Chemical-registry-number] 12629-01-5 / Human Growth Hormone

   

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[Title] [Gastrointestinal tract polyps in acromegaly patients].

Acromegaly is a rare, chronic disease due to hypersecretion of growth hormone (GH) by pituitary adenoma arising from somatotrophs.

The course of the disease is related to long-term organ and systemic complications and malignancies.

Colon polyps seem to constitute the most frequent tumours in acromegaly apart from thyroid nodules.

The aim of this study was to evaluate the prevalence of colon polyps in patients with acromegaly.

Thirty one acromegaly patients, 22 females and 9 males (mean age 46.3 +/- 11.9 yrs), were enrolled to the study.

Polyps were histopatologically verified as tubular adenoma with low-grade dysplasia (10 patients, 76.9%) and hyperplastic polyps (3 patients, 23.1%).

The prevalence of colon polyps was significantly related to the duration of uncontrolled acromegaly (p < 0.01).

Median duration of uncontrolled acromegaly in patients with and without colon polyps were 10.0 (IQR = 2.0) yrs and 6.5 (IQR = 5.0) yrs, respectively.

IGF-1, GH basic and in 120 min of OGTT serum concentrations on diagnosis were not significantly related to the prevalence of colon polyps.

Our study indicates that duration of uncontrolled acromegaly, contrary to IGF-1, GH basic and in OGTT serum concentrations at diagnosis are essential for the colon polyps development.

Colonoscopy is considered to be routine in patients with acromegaly.

[MeSH-major] Acromegaly / epidemiology. Colonic Polyps / epidemiology

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(PMID = 21591351.001).

[ISSN] 0033-2240

[Journal-full-title] Przegla̧d lekarski

[ISO-abbreviation] Prz. Lek.

[Language] pol

[Publication-type] English Abstract; Journal Article

[Publication-country] Poland

   

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[Title] Elevation of growth hormone-releasing hormone receptor messenger ribonucleic acid expression in growth hormone-secreting pituitary adenoma with Gsalpha protein mutation.

Growth hormone-releasing hormone (GHRH) stimulates not only the synthesis and secretion of GH but also the proliferation of normal somatotrophs.

The expression of GHRH receptor (GHRHR) is regulated by GHRH, both of which are known to be expressed in human GH-secreting pituitary adenoma cells.

Somatic mutations in the subunit of Gsalpha protein (gsp), lead to the constitutive activation of adenylyl cyclase in pituitary adenomas that secrete GH.

It has not been examined how gsp mutations influence GHRHR expression in GH-secreting adenomas.

We therefore analyzed the expression levels of GHRHR messenger ribonucleic acid (mRNA) in GH-secreting pituitary adenomas focusing on a gsp mutation.

Furthermore, we investigated the effect of GHRH on the expression of GHRHR mRNA in primary cultures of GH-secreting pituitary adenoma cells.

GHRHR mRNA expression levels were significantly elevated in gsp mutation-positive GH-secreting adenomas compared with those in gsp mutation-negative ones.

In primary-cultured GH-secreting adenoma cells, the increase of GH secretion in response to GHRH was shown in both gsp mutation-positive and -negative adenoma cells with a significantly higher response in the latter adenoma cells.

GHRH increased GHRHR mRNA expression level in gsp mutation-negative adenoma cells while it was not influenced by GHRH in gsp mutation-positive adenoma cells.

These results suggest that gsp mutations up-regulate GHRHR mRNA expression in GH-secreting pituitary adenoma cells, and that gsp mutations desensitize the adenoma cells to GHRH in terms of their GHRHR mRNA expression probably because of their saturation of GHRH signaling.

[MeSH-major] Adenoma / genetics. GTP-Binding Protein alpha Subunits, Gs / genetics. Growth Hormone-Releasing Hormone / secretion. Mutation, Missense. Neoplasm Proteins / genetics. Nerve Tissue Proteins / genetics. Pituitary Neoplasms / genetics. Point Mutation. RNA, Messenger / biosynthesis. RNA, Neoplasm / biosynthesis. Receptors, Neuropeptide / genetics. Receptors, Pituitary Hormone-Regulating Hormone / genetics

[MeSH-minor] Acromegaly / etiology. Acromegaly / surgery. Adult. Amino Acid Substitution. Cell Line, Tumor / drug effects. Cell Line, Tumor / metabolism. Cell Line, Tumor / secretion. Female. Gene Expression Regulation, Neoplastic. Humans. Male. Middle Aged

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(PMID = 19029774.001).

[ISSN] 1349-8029

[Journal-full-title] Neurologia medico-chirurgica

[ISO-abbreviation] Neurol. Med. Chir. (Tokyo)

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] Japan

[Chemical-registry-number] 0 / Neoplasm Proteins; 0 / Nerve Tissue Proteins; 0 / RNA, Messenger; 0 / RNA, Neoplasm; 0 / Receptors, Neuropeptide; 0 / Receptors, Pituitary Hormone-Regulating Hormone; 0 / somatotropin releasing hormone receptor; 9034-39-3 / Growth Hormone-Releasing Hormone; EC 3.6.5.1 / GTP-Binding Protein alpha Subunits, Gs

   

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[Title] Immunohistochemical analysis of 11-beta-hydroxysteroid dehydrogenase type 2 and glucocorticoid receptor in subclinical Cushing's disease due to pituitary macroadenoma.

Subclinical Cushing's disease (SCD) is characterized by lack of clinically evident Cushingoid features, despite abnormal hypersecretion of ACTH.

Impaired glucocorticoid (GC) action may be correlated with the proliferation and development of pituitary macroadenomas causing SCD.

In this study, immunohistochemical analysis of the resected tumors were performed to evaluate the expression of 11beta-hydroxysteroid dehydrogenase type 2 (11betaHSD2) and glucocorticoid receptor (GR) in pituitary tissues obtained from two SCD (macroadenomas), eight Cushing's disease (CD) (microadenomas), nine acromegaly, and nine normal pituitary (NP).

[MeSH-major] 11-beta-Hydroxysteroid Dehydrogenase Type 2 / metabolism. ACTH-Secreting Pituitary Adenoma / metabolism. Adenoma / metabolism. Pituitary ACTH Hypersecretion / metabolism. Receptors, Glucocorticoid / metabolism

[MeSH-minor] Acromegaly / metabolism. Acromegaly / pathology. Adolescent. Adrenocorticotropic Hormone / metabolism. Adult. Aged. Female. Humans. Immunohistochemistry / methods. Male. Middle Aged. Pituitary Gland / metabolism. Pituitary Gland / pathology. Young Adult

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(PMID = 19048413.001).

[ISSN] 1046-3976

[Journal-full-title] Endocrine pathology

[ISO-abbreviation] Endocr. Pathol.

[Language] eng

[Publication-type] Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / Receptors, Glucocorticoid; 9002-60-2 / Adrenocorticotropic Hormone; EC 1.1.1.146 / 11-beta-Hydroxysteroid Dehydrogenase Type 2

   

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[Title] Are there alternative tests for diagnosis of acromegaly?

In acromegaly, clinical features are of the utmost importance, and biochemical confirmation is rarely difficult.

However, some clinically manifest acromegalics have subtle abnormalities in GH secretion resulting in post-glucose GH nadir in the designated "normal" range with high IGF-I levels.

Clinical decision may be based on the probability of the disease and elevated IGF-I levels.

The TRH test or the frequent GH sampling test may help confirm acromegaly but on their own have no diagnostic advantage.

A TRH-GH response is not specific to acromegaly, while frequent sampling is not practical.

Post-treatment assessment of the disease activity and definition of acromegaly cure, by measuring GH secretion, remain problematic.

IGF-I levels seem to differentiate normality less clearly and discordance of GH and IGF-I results is frequent.

Post-treatment probability for residual disease activity should include more clinical parameters such as insulin sensitivity, leptin and echocardiography.

Furthermore, with efforts to achieve tight biochemical control of the disease it is foreseeable that a proportion of patients may be rendered GH deficient, requiring stimulatory testing.

Acromegaly is a disfiguring and disabling illness, in which by definition, the disorder is caused by a pituitary GH-secreting adenoma resulting in high circulating levels of GH and IGF-I.

The clinical features of acromegaly include those of GH and IGF-I on tissues and the effects of the pituitary tumor itself.

There is no single cut-off value for GH with perfect discrimination between acromegaly and normality.

The recommended post-glucose GH nadir value of 1 microg/l is now considered to be inappropriately high, and measurement of IGF-I levels although extremely valuable has its limitations.

Furthermore, some acromegalics may have subtle abnormalities in GH secretion, resulting in post-glucose GH nadir in the designated "normal" range with elevated IGF-I levels.

[MeSH-major] Acromegaly / diagnosis

[MeSH-minor] Glucose Tolerance Test. Human Growth Hormone / blood. Human Growth Hormone / secretion. Humans. Insulin-Like Growth Factor I / analysis. Pituitary Neoplasms. Thyrotropin-Releasing Hormone

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(PMID = 16625850.001).

[ISSN] 0391-4097

[Journal-full-title] Journal of endocrinological investigation

[ISO-abbreviation] J. Endocrinol. Invest.

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] Italy

[Chemical-registry-number] 12629-01-5 / Human Growth Hormone; 5Y5F15120W / Thyrotropin-Releasing Hormone; 67763-96-6 / Insulin-Like Growth Factor I

[Number-of-references] 11

   

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[Title] Medical therapy of acromegaly: efficacy and safety of somatostatin analogues.

Acromegaly is a chronic disease with signs and symptoms due to growth hormone (GH) excess.

The most frequent cause of acromegaly is a GH-producing pituitary adenoma.

Chronic GH excess is accompanied by long-term complications of the locomotor (arthrosis) and cardiovascular (atherosclerosis, cardiomyopathy) systems and is, when untreated, associated with an increased mortality.

The aim of treatment of acromegaly is to improve symptoms, to achieve local tumour mass control, and to decrease morbidity and mortality.

Primary medical therapy has been increasingly applied in recent years, especially when a priori chances of surgical cure are low (because of adenoma size and localization) and in patients with advanced age and/or serious co-morbidity.

In addition, preoperative primary medical therapy may result in tumour shrinkage, facilitating tumour resection, and may reduce perioperative complications due to GH excess.

Treatment with somatostatin analogues results in GH control in approximately 60% of patients.

The currently available somatostatin analogues, octreotide and lanreotide, seem to be equally effective; however, this should still be evaluated in prospective, randomized trials evaluating efficacy with respect to GH control and tumour shrinkage.

In patients with an insufficient clinical and biochemical response to somatostatin analogues, combination therapy with dopamine receptor agonists or the GH receptor antagonist pegvisomant usually leads to disease control.

New developments in the medical therapy of acromegaly include the universal somatostatin receptor agonist pasireotide, which has a broader affinity for all somatostatin receptor (sst) subtypes compared with the currently available somatostatin analogues with preferential affinity for the sst2 receptor, and chimeric compounds that interact with both somatostatin and dopamine receptors with synergizing effects on GH secretion.

[MeSH-major] Acromegaly / drug therapy. Receptors, Somatostatin / drug effects. Somatostatin / analogs & derivatives

[MeSH-minor] Adenoma / complications. Antineoplastic Agents / adverse effects. Antineoplastic Agents / pharmacology. Antineoplastic Agents / therapeutic use. Female. Growth Hormone-Secreting Pituitary Adenoma / complications. Human Growth Hormone / metabolism. Human Growth Hormone / secretion. Humans. Male. Octreotide / adverse effects. Octreotide / pharmacology. Octreotide / therapeutic use. Peptides, Cyclic / adverse effects. Peptides, Cyclic / pharmacology. Peptides, Cyclic / therapeutic use

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(PMID = 19852525.001).

[ISSN] 1179-1950

[Journal-full-title] Drugs

[ISO-abbreviation] Drugs

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] New Zealand

[Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Peptides, Cyclic; 0 / Receptors, Somatostatin; 0G3DE8943Y / lanreotide; 12629-01-5 / Human Growth Hormone; 51110-01-1 / Somatostatin; RWM8CCW8GP / Octreotide

[Number-of-references] 130

   

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[Title] GSPalpha mutations in Mexican patients with acromegaly: potential impact on long term prognosis.

OBJECTIVE: The frequency of activating mutations of the GSPalpha gene as the etiology of GH-secreting pituitary adenomas has been the subject of important ethnogenetic variability.

Whereas up to 40% of Caucasian patients with acromegaly have tumors which harbor these somatic mutations, their prevalence among Asian populations is much lower.

In the present study, we investigated the prevalence of GSPalpha mutations in GH-secreting tumors obtained from a genetically homogenous population of Mexican patients with acromegaly.

We also sought to establish whether or not the presence of these mutations correlates in any way with the clinical or biochemical characteristics of the disease.

STUDY DESIGN AND METHODS: Fifty eight GH-secreting pituitary adenomas were examined for the presence of point mutations in either codon 201 or 227 of the GSPalpha gene, using PCR and direct sequencing of DNA extracted from either fresh or paraffin-embedded tissues.

Patients were prospectively followed clinically and biochemically for up to nine years after pituitary surgery.

The frequency and severity of the different clinical features of acromegaly did not differ between patients with and without GSPalpha mutations.

Patients with and without mutations had pre-operative GH and IGF-I elevations of similar magnitude, and although microadenomas appeared to be more frequent among patients with GSPalpha mutations, this did not reach statistical significance.

Upon short-term follow-up, biochemical cure (normal age- and gender-adjusted IGF-I and post-glucose GH below 1 ng/mL) was similarly achieved in both groups.

After 3-9 years of post-operative follow up however, a significantly greater proportion of patients with the mutation achieved a "safe" basal GH value (100% vs 33%, p=0.001) as well a lower nadir post-glucose GH (0.53+/-0.5 vs 2.9+/-6.2 ng/mL, p=0.04) although the rate of IGF-1 normalization did not differ between the 2 groups.

CONCLUSIONS: Our results show that the prevalence of GSPalpha mutations in Mexican patients with acromegaly is intermediate between that found in Asian and Caucasian populations.

In this well-defined genetic population the presence of codon 201 mutations appeared to be associated with a greater probability of achieving a "safe" GH value upon long-term follow-up.

[MeSH-major] Acromegaly / genetics. Adenoma / genetics. GTP-Binding Protein alpha Subunits, Gs / genetics. GTP-Binding Protein alpha Subunits, Gs / physiology. Mutation. Pituitary Neoplasms / genetics

[MeSH-minor] Adult. Codon. DNA Primers / chemistry. Exons. Female. Growth Hormone / metabolism. Heterozygote. Humans. Male. Mexico. Middle Aged. Point Mutation. Sex Factors. Time Factors. Treatment Outcome

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(PMID = 15701569.001).

[ISSN] 1096-6374

[Journal-full-title] Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society

[ISO-abbreviation] Growth Horm. IGF Res.

[Language] eng

[Publication-type] Journal Article

[Publication-country] Scotland

[Chemical-registry-number] 0 / Codon; 0 / DNA Primers; 9002-72-6 / Growth Hormone; EC 3.6.1.- / GNAS protein, human; EC 3.6.5.1 / GTP-Binding Protein alpha Subunits, Gs

   

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[Title] Analyses of factors influencing the acute effect of octreotide in growth hormone-secreting adenomas.

Somatostatin analogues such as octreotide are used to treat active acromegalic patients by reducing serum growth hormone (GH) levels.

However, the acute effect of octreotide on GH secretion differs among patients.

To elucidate factors influencing the acute effect of octreotide, we collected data from 56 patients with somatotroph adenoma from two institutions.

Monovariate analysis revealed a statistically significant inverse relation of Ki-67 SI with the reduction of GH by octreotide.

Post-test revealed that the plasma membrane-dominant staining pattern of SSTR 2A was significantly related to the reduction of GH by octreotide.

[MeSH-major] Growth Hormone-Secreting Pituitary Adenoma / secretion. Human Growth Hormone / secretion. Octreotide / therapeutic use. Pituitary Neoplasms / secretion

[MeSH-minor] Adult. Aged. Cell Membrane / metabolism. Female. Humans. Ki-67 Antigen / metabolism. Male. Middle Aged. Receptors, Somatostatin / metabolism. Regression Analysis

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(PMID = 19164866.001).

[ISSN] 1348-4540

[Journal-full-title] Endocrine journal

[ISO-abbreviation] Endocr. J.

[Language] eng

[Publication-type] Journal Article

[Publication-country] Japan

[Chemical-registry-number] 0 / Ki-67 Antigen; 0 / Receptors, Somatostatin; 0 / somatostatin receptor 2; 12629-01-5 / Human Growth Hormone; RWM8CCW8GP / Octreotide

   

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[Title] Effect of preoperative use of long-acting octreotide on growth hormone secreting pituitary adenoma and transsphenoidal surgery.

OBJECTIVE: To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery.

METHODS: Seventeen previously untreated active acromegalic patients with pituitary adenomas were treated with LAR (30 mg intramuscular injection every 28 days) for 3 months prior to transsphenoidal surgery.

Clinical reaction, mean GH secretion, and tumor volume were measured under basal conditions and after LAR treatment.

RESULTS: Presurgical treatment improved acromegaly symptoms and induced a significant reduction of GH under the 5 ng/mL limit in microadenoma (P < 0.05), while only 18.2% (2/11) in macroadenoma.

During operation, adenoma was soft in 15 cases, with the exception of 2 cases in which the soft tumor was divided by fibrous septa, but all tumor removal was smooth.

CONCLUSIONS: A short term administration of preoperative LAR may induce a significant decrease in GH-secretion level and adenoma volume.

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(PMID = 15844307.001).

[ISSN] 1001-9294

[Journal-full-title] Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih

[ISO-abbreviation] Chin. Med. Sci. J.

[Language] ENG

[Publication-type] Journal Article

[Publication-country] China

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Delayed-Action Preparations; 12629-01-5 / Human Growth Hormone; RWM8CCW8GP / Octreotide

   

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[Title] Radiation therapy in the treatment of pituitary tumors.

The treatment of pituitary tumors has progressed into a multidisciplinary approach that involves neurosurgeons, radiation oncologists, and endocrinologists.

This has allowed improved outcomes in treatment of pituitary tumors due to a combination of surgical, medical, and radiation therapies.

In this study, the authors review the role of radiation therapy in the treatment of pituitary adenomas.

[MeSH-major] Adenoma / radiotherapy. Cranial Irradiation. Pituitary Neoplasms / radiotherapy

[MeSH-minor] Acromegaly / drug therapy. Acromegaly / etiology. Acromegaly / radiotherapy. Acromegaly / surgery. Brain / radiation effects. Combined Modality Therapy. Cushing Syndrome / etiology. Cushing Syndrome / radiotherapy. Cushing Syndrome / surgery. Humans. Hypophysectomy / methods. Hypopituitarism / etiology. Nelson Syndrome / radiotherapy. Nelson Syndrome / surgery. Postoperative Complications / etiology. Radiation Injuries / etiology. Radiation Injuries / prevention & control. Radiosurgery / adverse effects. Radiotherapy, Adjuvant / adverse effects. Radiotherapy, Computer-Assisted / methods. Treatment Outcome

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(PMID = 18447747.001).

[ISSN] 1092-0684

[Journal-full-title] Neurosurgical focus

[ISO-abbreviation] Neurosurg Focus

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] United States

[Number-of-references] 54

   

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[Title] McCune-Albright syndrome and acromegaly: hormonal control with use of cabergoline and long-acting somatostatin--case report.

OBJECTIVES: The use of drug therapy based on cabergoline, octreotide and long-acting release (LAR) octreotide has presented varying results in the treatment of GH excessive production in patients with McCune-Albright Syndrome.

METHODS: We report the case of a 29 year-old female patient presenting McCune-Albright Syndrome and complaint of excessive bone growth.

RESULTS: The patient presented a pituitary adenoma involving the right internal carotid artery and excessive secretion of growth hormone (no GH suppression was observed after the oral glucose tolerance test).

At the one year follow-up, GH and IGF-1 levels were normal and no adverse effects were present.

CONCLUSION: The use of drug therapy based on the association of cabergoline and octreotide is safe and able to achieve complete hormonal control in the treatment of acromegaly for McCune-Albright patients.

[MeSH-major] Acromegaly / drug therapy. Ergolines / therapeutic use. Facial Bones / drug effects. Fibrous Dysplasia, Polyostotic / drug therapy. Octreotide / therapeutic use

[MeSH-minor] Adenoma / complications. Adult. Antineoplastic Agents, Hormonal / therapeutic use. Female. Human Growth Hormone / analysis. Human Growth Hormone / secretion. Humans. Insulin-Like Growth Factor I / analysis. Pituitary Neoplasms / complications. Skull / drug effects

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(PMID = 19347192.001).

[ISSN] 1677-9487

[Journal-full-title] Arquivos brasileiros de endocrinologia e metabologia

[ISO-abbreviation] Arq Bras Endocrinol Metabol

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] Brazil

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Ergolines; 12629-01-5 / Human Growth Hormone; 67763-96-6 / Insulin-Like Growth Factor I; LL60K9J05T / cabergoline; RWM8CCW8GP / Octreotide

   

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[Title] Acromegaly accompanied by Turner syndrome with 47,XXX/45,X/46,XX mosaicism.

A pituitary adenoma with elevated serum levels of growth hormone (GH) and insulin-like growth factor-I (IGF-I) was detected, indicating acromegaly caused by GH-secreting pituitary adenoma.

Transsphenoidal resection of the tumor decreased serum GH and IGF-I levels, but the edema was not improved.

This case may indicate the important relationships between GH/IGF-I and Turner syndrome.

[MeSH-major] Acromegaly / genetics. Chromosomes, Human, X / genetics. Mosaicism. Turner Syndrome / genetics

[MeSH-minor] Adenoma / blood. Adenoma / complications. Adenoma / diagnosis. Adult. Diagnosis, Differential. Female. Growth Hormone / blood. Humans. In Situ Hybridization, Fluorescence. Magnetic Resonance Imaging. Pituitary Neoplasms / blood. Pituitary Neoplasms / complications. Pituitary Neoplasms / diagnosis

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(PMID = 19293545.001).

[ISSN] 1349-7235

[Journal-full-title] Internal medicine (Tokyo, Japan)

[ISO-abbreviation] Intern. Med.

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] Japan

[Chemical-registry-number] 9002-72-6 / Growth Hormone

   

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[Title] Novel medical therapies for pituitary tumors.

Despite considerable progress, there is still no medical treatment available for some kinds of pituitary tumors, in particular hormone inactive adenomas and corticotroph pituitary tumors.

Moreover, treatment resistance is present in a considerable proportion of patients bearing pituitary tumors, for which medical treatment regimens are already available (prolactinomas, somatotroph adenomas).

Here, we summarize preclinical and clinical findings about the hormone and growth-suppressive action of various drugs, which will probably lead to novel future medical treatment concepts for pituitary tumors.

[MeSH-major] Pituitary Neoplasms / drug therapy

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[Copyright] Copyright (c) 2010 S. Karger AG, Basel.

(PMID = 20616507.001).

[ISSN] 0301-3073

[Journal-full-title] Frontiers of hormone research

[ISO-abbreviation] Front Horm Res

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] Switzerland

[Chemical-registry-number] 0 / BIM 23A760; 0 / Dopamine Agonists; 51110-01-1 / Somatostatin; 5688UTC01R / Tretinoin; 82115-62-6 / Interferon-gamma; 98H1T17066 / pasireotide; VTD58H1Z2X / Dopamine

[Number-of-references] 32

   

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[Title] [New medical treatments in pituitary adenomas].

Currently, the role of dopaminergic and somatostatinergic agonists in the treatment of pituitary adenomas is quite well established.

Nevertheless, a clearer understanding of the expression of dopaminergic and somatostatinergic receptors at the cellular level of pituitary adenomas as well as the development of newer analogues compounds may drastically change current therapeutic modalities.

In the midst of GH-secreting pituitary adenomas, a positive correlation exists between the expression of Sst2 mRNA and the inhibition of GH release by somatostatin analogues.

The involvement of Sst5 subtype in adenomas resistant to preferential Sst2 agonists has recently been proved.

SOM-230 could therefore allow for much more effective methods in treating patients suffering from acromegaly.

Besides, the use of a chimeric molecule presenting a binding affinity to both Sst2 and D2 subtypes (BIM-23A287) inhibits the secretion of GH in ways similar to the Sst2 or D2 agonists used alone or concurrently but however in a concentration 50 times lower than that of the latter.

The discovery of Sst5 and D2 subtypes at the level of corticotropic adenomas reveals newer therapeutic perspectives with promising preliminary results with the use of SOM-230 ; these finding lead to a rise in interest in cabergoline.

In the midst of non-functioning pituitary adenomas, the expression of Sst2, Sst3 and D2 receptors will perhaps allow the use of combined therapies associating the new somatostatin analogues to the dopaminergic agonists or even use dopastatin (BIM-23A760, chimeric molecule Sst2-Sst5-D2).

Nevertheless, it seems that adenomas resistant to dopaminergic agonist due to a lack of expression of D2 receptor fail to express Sst5 receptors as well.

On the other hand, dopastatin appears to be more efficient than cabergoline in the management of this type of adenomas.

Therefore, the growing awareness concerning the mechanisms involved in the control of pituitary secretions as well as cellular proliferation will perhaps allow physicians to treat the pathology of pituitary adenomas, macroadenomas in particular, using solely pharmacological means instead of invasive surgical procedures and/or radiotherapy.

[MeSH-major] Adenoma / drug therapy. Pituitary Neoplasms / drug therapy

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(PMID = 18954854.001).

[ISSN] 0003-4266

[Journal-full-title] Annales d'endocrinologie

[ISO-abbreviation] Ann. Endocrinol. (Paris)

[Language] fre

[Publication-type] English Abstract; Journal Article; Review

[Publication-country] France

[Chemical-registry-number] 0 / Dopamine Agonists; 0 / Peptides, Cyclic; 0 / Receptors, Dopamine; 0 / Receptors, Somatostatin; 118992-92-0 / lanreotide; 51110-01-1 / Somatostatin; RWM8CCW8GP / Octreotide

[Number-of-references] 49

   

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[Title] Does the response of GH-secreting pituitary adenomas to octreotide depend on the cellular localization of the somatostatin receptor subtypes SSTR2 and SSTR5?

INTRODUCTION: The immunohistochemical examination of somatostatin receptor (SSTR) subtypes expression in different endocrine tumours, including pituitary adenomas, revealed membranous or cytoplasmic distribution of SSTR1-5.

In an earlier study a positive correlation between the summarized score of SSTR2A + SSTR2B expressions and growth hormone (GH) response to octreotide administration was found, independently of receptor distribution within the cell.

In this study we searched for the relationship between the GH inhibitory response to acute octreotide administration and SSTR2A, SSTR2B, and SSTR5 cellular localization.

The drop in GH was defined as the percentage of the basal value.

The pituitary adenomas from these patients were immunostained to determine the hormonal phenotype and expression of SSTR subtypes.

The drop in GH after octreotide administration varied between 57.1-96.7% (mean 82.1%).

Among the patients with the cytoplasmic localization of SSTR5, the decrease in GH was significantly higher (92.0 +/- 7.0%).

CONCLUSIONS: It seems that cytoplasmic localization of SSTR5, SSTR2A, and SSTR2B is connected with enhanced GH inhibition after octreotide administration.

As a consequence, the SSTR-immunopositivity in cell cytoplasm is increased.

[MeSH-major] Adenoma / drug therapy. Adenoma / pathology. Octreotide / pharmacology. Pituitary Neoplasms / drug therapy. Pituitary Neoplasms / pathology. Receptors, Somatostatin / analysis

[MeSH-minor] Adult. Aged. Antineoplastic Agents, Hormonal / pharmacology. Chemotherapy, Adjuvant. Cytoplasm / pathology. Female. Growth Hormone / secretion. Humans. Immunohistochemistry. Male. Middle Aged. Tissue Distribution

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(PMID = 20464704.001).

[ISSN] 0423-104X

[Journal-full-title] Endokrynologia Polska

[ISO-abbreviation] Endokrynol Pol

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] Poland

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Receptors, Somatostatin; 0 / somatostatin receptor 2; 0 / somatostatin receptor 5; 9002-72-6 / Growth Hormone; RWM8CCW8GP / Octreotide

   

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[Title] Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register.

BACKGROUND: Data on surgical and medical treatment outcomes in acromegaly mostly originate from specialized centers.

We retrospectively analyzed the data on surgery, primary somatostatin analog (SSA) therapy, surgery preceded by SSA, and SSA preceded by surgery in 1485 patients from the German Acromegaly Register.

GH and IGF1 normalized in 54.3 and 67.2%.

Partial or total pituitary insufficiency occurred in 28.6% initially and 41.2% post-surgery.

GH and IGF1 normalized in 36.3 and 30.5%, increasing to 40.8 and 41.5% with longer SSA (>or=360 days) in 54 patients.

Pituitary function did not change.

Post-surgery GH and IGF1 was normalized in 62.9 and 68.4%.

GH improvement was slightly, but significantly better after SSA pretreatment.

GH and IGF1 normalized during SSA in 24.1 and 45.5%.

Relative GH decrease was significantly larger compared with primary SSA.

CONCLUSIONS: Pituitary surgery was more effective to lower GH and IGF1 concentrations than primary SSA.

Debulking surgery may result in better final outcome in patients with a high GH concentration and a large tumor.

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(PMID = 18755874.001).

[ISSN] 1479-683X

[Journal-full-title] European journal of endocrinology

[ISO-abbreviation] Eur. J. Endocrinol.

[Language] ENG

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] England

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; RWM8CCW8GP / Octreotide

[Investigator] Allolio B; Badenhoop K; Bender G; Biering H; Blossey HC; Blum H; Bogner U; Brabant G; Buchfelder M; Caspar-Bell G; Demtröder F; Diederich S; Droste M; Engelbach M; Faust M; Finke R; Fölsch UR; Gain T; Gräf KJ; Gerbert B; Grussendorf M; Hampel R; Happ J; Heckmann C; Hehrmann R; Heike M; Herrmann BL; Höffken K; Hüfner M; Jacobeit J; Jaursch-Hancke C; Jockenhövel F; Knippert A; Koch C; Kornely E; Krone W; Lehnert H; Levasseur S; Lössner C; Mann K; Matern S; Meuser J; Meyer A; Minnemann T; Mönig Hl; Müller OA; Paschke R; Petersenn S; Pfeiffer A; Plöckinger U; Raue F; Reincke M; Reschke K; Rudorff KH; Rühle H; Santen R; Schöfl C; Schopohl J; Schories M; Schröder F; Schröder HE; Schröder U; Schulte HM; Stamm B; Steinmetz M; Strasburger CJ; Sturmvoll M; Tharandt L; Tuschy U; von Werder K; Weber MM; Wiedenmann B; Wiesner TD; Würl K; Zeuzem S

   

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[Title] Insulin-like growth factor-1 is essential to the increased mortality caused by excess growth hormone: a case of thyroid cancer and non-Hodgkin's lymphoma in a patient with pituitary acromegaly.

The effects of growth hormone are mediated in part by stimulating the production of insulin-like growth factor-1.

Insulin-like growth factor-1 has significant effects on cell proliferation and differentiation, it is a potent mitogen, and it is a powerful inhibitor of programmed cell death (apoptosis).

Insulin-like growth factor-1 also has a well-established role in the transformation of normal cells to malignant cells.

Case reports on a possible association between elevated growth hormone and cancer risk in a variety of patient groups have been published.

Here, we describe clinical and laboratory findings for a patient with acromegaly who first developed thyroid cancer, and then, in the follow up period, probably due to poorly controlled insulin-like growth factor-1 levels, developed a large cell non-Hodgkin's lymphoma.

[MeSH-major] Acromegaly. Adenoma / metabolism. Insulin-Like Growth Factor I / metabolism. Lymphoma, Non-Hodgkin / metabolism. Neoplasms, Multiple Primary. Thyroid Neoplasms / metabolism

[MeSH-minor] Aged. Antineoplastic Agents, Hormonal / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cyclophosphamide / therapeutic use. Ergolines / therapeutic use. Human Growth Hormone / analogs & derivatives. Human Growth Hormone / secretion. Human Growth Hormone / therapeutic use. Humans. Male. Octreotide / therapeutic use. Prednisone / therapeutic use. Thyroidectomy. Thyroxine / therapeutic use. Vincristine / therapeutic use

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(PMID = 18663612.001).

[ISSN] 1357-0560

[Journal-full-title] Medical oncology (Northwood, London, England)

[ISO-abbreviation] Med. Oncol.

[Language] eng

[Publication-type] Case Reports; Journal Article

[Publication-country] United States

[Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Ergolines; 12629-01-5 / Human Growth Hormone; 5J49Q6B70F / Vincristine; 67763-96-6 / Insulin-Like Growth Factor I; 8N3DW7272P / Cyclophosphamide; LL60K9J05T / cabergoline; N824AOU5XV / pegvisomant; Q51BO43MG4 / Thyroxine; RWM8CCW8GP / Octreotide; VB0R961HZT / Prednisone; COP protocol 2

   

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[Title] Dopamine receptor subtype 2 and somatostatin receptor subtype 5 expression influences somatostatin analogs effects on human somatotroph pituitary adenomas in vitro.

Dopamine (DA) and somatostatin (SRIF) receptor agonists inhibit growth hormone (GH) secretion by pituitary adenomas.

We investigated DA subtype 2 receptor (DR2) and SRIF receptor (sst) subtypes 2 and 5 expression in 25 GH-secreting pituitary adenomas and tested in primary culture the effects on GH and prolactin (PRL) secretion of sst agonists selectively interacting with sst2 (BIM-23120), sst5 (BIM-23206), and sst2 and sst5 (BIM-23244).

All adenomas expressed sst2; eight adenomas expressed both sst5 and DR2, eight sst5 but not DR2, and eight DR2 but not sst5.

GH secretion was inhibited by BIM-23120 in all samples, while it was reduced by BIM-23206 only in adenomas not expressing DR2.

BIM-23120's inhibitory effects correlated with sst2 and DR2 expression, whereas DR2 expression correlated inversely with BIM-23206 inhibitory effects on GH secretion.

In seven mixed GH-/PRL-secreting pituitary adenomas, PRL secretion was inhibited in sst5-expressing tumors by BIM-23206, but not by BIM-23120.

BIM-23244 reduced PRL secretion only in adenomas expressing sst2, sst5 and DR2. sst5 and DR2 expression correlated directly with BIM23206 inhibitory effects on PRL secretion.

Our results suggest that adenomas expressing DR2 are less likely to respond to clinically available SRIF analogs in terms of GH secretion inhibition.

Therefore, drugs interacting also with DR2 might better control secretion of pituitary adenomas.

[MeSH-major] Growth Hormone-Secreting Pituitary Adenoma / metabolism. Protein Isoforms / metabolism. Receptors, Dopamine / metabolism. Receptors, Somatostatin / metabolism. Somatostatin / analogs & derivatives

[MeSH-minor] Acromegaly / metabolism. Adult. Aged, 80 and over. Dopamine Agonists. Female. Human Growth Hormone / secretion. Humans. Male. Middle Aged. Prolactin / secretion. RNA, Messenger / metabolism

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(PMID = 16216913.001).

[ISSN] 0952-5041

[Journal-full-title] Journal of molecular endocrinology

[ISO-abbreviation] J. Mol. Endocrinol.

[Language] eng

[Publication-type] Journal Article; Research Support, Non-U.S. Gov't

[Publication-country] England

[Chemical-registry-number] 0 / Dopamine Agonists; 0 / Protein Isoforms; 0 / RNA, Messenger; 0 / Receptors, Dopamine; 0 / Receptors, Somatostatin; 0 / somatostatin receptor 2; 0 / somatostatin receptor 5; 12629-01-5 / Human Growth Hormone; 51110-01-1 / Somatostatin; 9002-62-4 / Prolactin

   

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[Title] A possible new syndrome with growth-hormone secreting pituitary adenoma, colonic polyposis, lipomatosis, lentigines and renal carcinoma in association with familial testicular germ cell malignancy: A case report.

BACKGROUND: Germ-cell testicular cancer has not been definitively linked to any known hereditary cancer susceptibility disorder.

His evaluation as part of an etiologic study of familial testicular cancer revealed multiple colon polyps (adenomatous, hyperplastic, and hamartomatous) first found in his 50 s, multiple lipomas, multiple hyperpigmented skin lesions, left kidney cancer diagnosed at age 64, and a growth-hormone producing pituitary adenoma with associated acromegaly diagnosed at age 64.

Alternatively, this family's phenotype might represent a novel neoplasm susceptibility disorder.

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(PMID = 17411461.001).

[Journal-full-title] Journal of medical case reports

[ISO-abbreviation] J Med Case Rep

[Language] ENG

[Grant] United States / NCI NIH HHS / CP / N02CP11019

[Publication-type] Journal Article

[Publication-country] England

[Other-IDs] NLM/ PMC1847830

   

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[Title] Recent clinical and pathophysiological advances in non-functioning pituitary adenomas.

Pituitary adenomas are being recognized and diagnosed with increasing frequency.

One of the most common forms of pituitary lesion is the clinically non-functioning pituitary adenoma (NFPA), which is often diagnosed incidentally.

The vast majority of pituitary adenomas are sporadic, but familial adenomas can occur in the multiple pituitary adenoma type 1 syndrome, in Carney complex or in familial isolated pituitary adenoma.

NFPA often show hormone synthesis on tissue immunostaining without causing clinical symptoms.

Most often these are silent gonadotroph adenomas, with silent corticotroph or somatotroph adenomas occurring less frequently.

It is unclear why these silent adenomas do not release hormones at a clinically recognizable level, although it is probable that there is a continuum between fully functional and completely silent adenomas.

Temozolomide has been successfully used for the treatment of a few aggressive pituitary adenomas, and the response to this drug could be influenced by the expression of the DNA repair enzyme O-6-methylguanine DNA methyltransferase.

The early diagnosis, prediction of long-term outcome and treatment of NFPAs remain a challenge for endocrinologists.

[MeSH-major] Growth Hormone-Secreting Pituitary Adenoma. Prolactinoma

[MeSH-minor] ACTH-Secreting Pituitary Adenoma / diagnosis. ACTH-Secreting Pituitary Adenoma / metabolism. ACTH-Secreting Pituitary Adenoma / pathology. ACTH-Secreting Pituitary Adenoma / therapy. Female. Humans. Male

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[Copyright] Copyright 2009 S. Karger AG, Basel.

(PMID = 19407508.001).

[ISSN] 1423-0046

[Journal-full-title] Hormone research

[ISO-abbreviation] Horm. Res.

[Language] eng

[Publication-type] Journal Article; Review

[Publication-country] Switzerland

[Number-of-references] 58