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1. Kunishio K, Okada M, Matsumoto Y, Nagao S, Nishiyama Y: Technetium-99m sestamibi single photon emission computed tomography findings correlated with P-glycoprotein expression in pituitary adenoma. J Med Invest; 2006 Aug;53(3-4):285-91
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  • [Title] Technetium-99m sestamibi single photon emission computed tomography findings correlated with P-glycoprotein expression in pituitary adenoma.
  • The aim of this study is to evaluate whether the technetium-99m sestamibi ((99m)Tc-MIBI) single photon emission computed tomography (SPECT) characteristics of pituitary adenomas might be correlated with cavernous sinus invasion, proliferative potential or the multidrug-resistance (MDR-1) gene product P-glycoprotein (Pgp) expression in pituitary adenomas.
  • Fifteen patients with pituitary adenomas, including 10 nonfunctioning adenomas, two prolactinomas, two GH producing adenomas, and one ACTH producing adenomas was investigated for this study.
  • The tumor-to-normal brain ratio was calculated both early (ER) and delayed (DR) images.
  • The pituitary adenomas specimens were examined by immunohistochemistry using anti-Pgp and MIB-1 monoclonal antibodies.(99m)Tc-MIBI SPECT findings were not related to MIB-1 labeling index or cavernous sinus invasion. (99m)Tc-MIBI SPECT RI (-38.55+/-20.77) of the Pgp-positive group was significantly lower than that (-15.78+/-19.40) of Pgp-negative group (p=0.0494).
  • Our study suggests that although (99m)Tc-MIBI SPECT is not useful to evaluate the proliferative potential or cavernous sinus invasion of pituitary adenomas. (99m)Tc-MIBI SPECT could predict anti-cancer drug resistance related to the expression of Pgp in pituitary adenomas.
  • [MeSH-major] P-Glycoprotein / metabolism. Pituitary Neoplasms / metabolism. Pituitary Neoplasms / radionuclide imaging
  • [MeSH-minor] Adult. Aged. Cavernous Sinus / pathology. Cell Proliferation. Female. Gene Expression Regulation, Neoplastic. Genes, MDR. Humans. Immunohistochemistry. Male. Middle Aged. Neoplasm Invasiveness. RNA, Messenger / genetics. RNA, Messenger / metabolism. Technetium Tc 99m Sestamibi. Tomography, Emission-Computed, Single-Photon

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  • (PMID = 16953066.001).
  • [ISSN] 1343-1420
  • [Journal-full-title] The journal of medical investigation : JMI
  • [ISO-abbreviation] J. Med. Invest.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / P-Glycoprotein; 0 / RNA, Messenger; 971Z4W1S09 / Technetium Tc 99m Sestamibi
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2. Páez-Pereda M, Kovalovsky D, Hopfner U, Theodoropoulou M, Pagotto U, Uhl E, Losa M, Stalla J, Grübler Y, Missale C, Arzt E, Stalla GK: Retinoic acid prevents experimental Cushing syndrome. J Clin Invest; 2001 Oct;108(8):1123-31
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  • Cushing syndrome is caused by an excess of adrenocorticotropic hormone (ACTH) production by neuroendocrine tumors, which subsequently results in chronic glucocorticoid excess.
  • We found that retinoic acid inhibits the transcriptional activity of AP-1 and the orphan receptors Nur77 and Nurr1 in ACTH-secreting tumor cells.
  • Retinoic acid treatment resulted in reduced pro-opiomelanocortin transcription and ACTH production.
  • ACTH inhibition was also observed in human pituitary ACTH-secreting tumor cells and a small-cell lung cancer cell line, but not in normal cells.
  • This correlated with the expression of the orphan receptor COUP-TFI, which was found in normal corticotrophs but not in pituitary Cushing tumors.
  • COUP-TFI expression in ACTH-secreting tumor cells blocked retinoic acid action.
  • Retinoic acid also inhibited cell proliferation and, after prolonged treatment, increased caspase-3 activity and induced cell death in ACTH-secreting cells.
  • The antiproliferative action and the inhibition of ACTH and corticosterone produced by retinoic acid were confirmed in vivo in experimental ACTH-secreting tumors in nude mice.
  • [MeSH-minor] Adrenocorticotropic Hormone / biosynthesis. Animals. COUP Transcription Factor I. Carcinoma, Non-Small-Cell Lung / complications. Carcinoma, Non-Small-Cell Lung / drug therapy. Carcinoma, Non-Small-Cell Lung / metabolism. DNA-Binding Proteins / metabolism. Humans. Lung Neoplasms / complications. Lung Neoplasms / drug therapy. Lung Neoplasms / metabolism. Mice. Mice, Nude. Neoplasm Transplantation. Neuroendocrine Tumors / complications. Neuroendocrine Tumors / drug therapy. Neuroendocrine Tumors / metabolism. Pituitary Neoplasms / complications. Pituitary Neoplasms / drug therapy. Pituitary Neoplasms / metabolism. Pro-Opiomelanocortin / genetics. Transcription Factors / metabolism. Transcription, Genetic / drug effects. Transplantation, Heterologous. Tumor Cells, Cultured

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  • (PMID = 11602619.001).
  • [ISSN] 0021-9738
  • [Journal-full-title] The Journal of clinical investigation
  • [ISO-abbreviation] J. Clin. Invest.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / COUP Transcription Factor I; 0 / DNA-Binding Proteins; 0 / NR2F1 protein, human; 0 / Nr2f1 protein, mouse; 0 / Transcription Factors; 5688UTC01R / Tretinoin; 66796-54-1 / Pro-Opiomelanocortin; 9002-60-2 / Adrenocorticotropic Hormone
  • [Other-IDs] NLM/ PMC209498
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3. Vidal S, Kovacs K, Horvath E, Rotondo F, Kuroki T, Lloyd RV, Scheithauer BW: Topoisomerase IIalpha expression in pituitary adenomas and carcinomas: relationship to tumor behavior. Mod Pathol; 2002 Nov;15(11):1205-12
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  • [Title] Topoisomerase IIalpha expression in pituitary adenomas and carcinomas: relationship to tumor behavior.
  • DNA topoisomerase IIalpha (Topo IIalpha) is a molecular and immunohistochemical marker that indicates proliferation rate and is the target for several antineoplastic agents.
  • The present immunohistochemical study of a large series of surgically removed pituitary tumors was designed to assess the prognostic significance of Topo IIalpha expression relative to patient age, gender, tumor type and size, invasiveness, metastasis, MIB-1-labeling index and angiogenesis.
  • Topo IIalpha immunopositivity was detected only in the nuclei of tumor cells.
  • Gonadotroph adenomas, null cell adenomas, and ACTH-producing adenomas had the lowest Topo IIalpha indices, whereas primary pituitary carcinomas and silent type 3 adenomas presented the highest counts.
  • Although Topo IIalpha and MIB-1 indices were similar in most tumor types, no significant correlation between Topo IIalpha and MIB-1-labeling indices (r =.16, P =.09) was found.
  • Our results demonstrated a significant decrease in Topo IIalpha index in octreotide-treated, GH-producing adenomas, compared with untreated tumors, but no significant changes were observed in bromocriptine-treated, PRL-producing adenomas.
  • The present study showed no significant advantage of Topo IIalpha over MIB-1 as a prognostic marker; however, Topo IIalpha may provide crucial information regarding selection of adenohypophyseal tumors responsive to antineoplastic therapy, such as invasive pituitary adenomas and pituitary carcinomas, which exhibit a high Topo IIalpha index.
  • [MeSH-major] Adenoma / pathology. DNA Topoisomerases, Type II / biosynthesis. Pituitary Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Antigens, CD34 / analysis. Antigens, Neoplasm. Antineoplastic Agents, Hormonal / therapeutic use. Blood Vessels / chemistry. Blood Vessels / pathology. Child. DNA-Binding Proteins. Female. Humans. Immunohistochemistry. Ki-67 Antigen / analysis. Male. Middle Aged. Neoplasm Invasiveness. Octreotide / therapeutic use. Prognosis

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  • (PMID = 12429800.001).
  • [ISSN] 0893-3952
  • [Journal-full-title] Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc
  • [ISO-abbreviation] Mod. Pathol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antigens, CD34; 0 / Antigens, Neoplasm; 0 / Antineoplastic Agents, Hormonal; 0 / DNA-Binding Proteins; 0 / Ki-67 Antigen; EC 5.99.1.3 / DNA Topoisomerases, Type II; EC 5.99.1.3 / DNA topoisomerase II alpha; RWM8CCW8GP / Octreotide
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4. Pimentel-Filho FR, Silva ME, Nogueira KC, Berger K, Cukiert A, Liberman B: Pituitary-adrenal dynamics after ACTH-secreting pituitary tumor resection in patients receiving no steroids post-operatively. J Endocrinol Invest; 2005 Jun;28(6):502-8
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  • [Title] Pituitary-adrenal dynamics after ACTH-secreting pituitary tumor resection in patients receiving no steroids post-operatively.
  • We compared the dynamics of ACTH and cortisol from a group of CD patients (cured and not cured), receiving no steroids post-operatively, with a control group of acromegalic patients who presented normal hypothalamic-pituitary-adrenal (HPA) axis.
  • Blood samples for ACTH and cortisol determination were obtained immediately before, at the end of surgery and at 4, 8, 12, 16, 24, 48 and 72 h after surgery, in 8 cured CD patients (Group I), 9 not cured CD patients (Group II) and in 7 subjects with acromegaly (Group III) who presented normal HPA axis (control group).
  • The mean ACTH level in Group I was significantly lower than in Group III from 4 to 12 h and lower than in Group II from 8 to 12 h post-operatively.
  • [MeSH-major] Adrenal Glands / physiopathology. Adrenocorticotropic Hormone / secretion. Glucocorticoids / administration & dosage. Pituitary Gland / physiopathology. Pituitary Neoplasms / secretion. Pituitary Neoplasms / surgery
  • [MeSH-minor] Adenoma / physiopathology. Adenoma / secretion. Adenoma / surgery. Adrenal Insufficiency / drug therapy. Adrenal Insufficiency / etiology. Adult. Female. Humans. Hydrocortisone / blood. Male. Pituitary ACTH Hypersecretion / physiopathology. Pituitary ACTH Hypersecretion / surgery. Postoperative Care. Postoperative Complications. Time Factors

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  • (PMID = 16117190.001).
  • [ISSN] 0391-4097
  • [Journal-full-title] Journal of endocrinological investigation
  • [ISO-abbreviation] J. Endocrinol. Invest.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Italy
  • [Chemical-registry-number] 0 / Glucocorticoids; 9002-60-2 / Adrenocorticotropic Hormone; WI4X0X7BPJ / Hydrocortisone
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5. Illouz F, Dubois-Ginouves S, Laboureau S, Rohmer V, Rodien P: [Use of cabergoline in persisting Cushing's disease]. Ann Endocrinol (Paris); 2006 Sep;67(4):353-6
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  • [Transliterated title] Utilisation de la cabergoline dans la maladie de Cushing non contrôlée.
  • Cabergoline is a dopaminergic agonist with demonstrated efficiency of for the treatment of prolactin-secreting pituitary tumors.
  • We describe the use of cabergoline in three patients with Cushing's disease, one of them presenting a silent ACTH-secreting pituitary tumor.
  • We describe a decrease or a normalization in hypercortisolism; for one of the subjects, tumor growth seemed to be stopped.
  • While cabergoline can induce a suppression of cortisol secretion or a corticotroph tumor shrinkage, the sites of action remain unclear.
  • [MeSH-major] Adrenocortical Hyperfunction / drug therapy. Ergolines / therapeutic use. Pituitary ACTH Hypersecretion / diagnosis

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  • (PMID = 17072242.001).
  • [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 / Dopamine Agonists; 0 / Ergolines; LL60K9J05T / cabergoline; WI4X0X7BPJ / Hydrocortisone
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6. Wolfsberger S, Wunderer J, Zachenhofer I, Czech T, Böcher-Schwarz HG, Hainfellner J, Knosp E: Expression of cell proliferation markers in pituitary adenomas--correlation and clinical relevance of MIB-1 and anti-topoisomerase-IIalpha. Acta Neurochir (Wien); 2004 Aug;146(8):831-9
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  • [Title] Expression of cell proliferation markers in pituitary adenomas--correlation and clinical relevance of MIB-1 and anti-topoisomerase-IIalpha.
  • Pituitary adenomas represent an inhomogeneous tumor entity in terms of growth rate, invasiveness and recurrence.
  • To improve understanding of their different biological behaviour, tumor cell proliferation markers are applied.
  • Further, we correlated the two markers, and defined the clinical value of Topo-IIalpha in pituitary adenomas as compared to MIB-1.
  • We analyzed tumor cell proliferation rates using MIB-1 and Topo-IIalpha antibodies on samples of 260 primary pituitary adenomas.
  • We excluded recurrent cases and cases with drug pretreatment.
  • Tumor size and invasiveness were noted from surgical and/or radio logical reports in 95% of cases.
  • Silent ACTH-cell and PRL-producing adenomas had the highest, null-cell adenomas and gonadotropinomas the lowest proliferation values, respectively.
  • Our data show a strong correlation between MIB-1 and Topo-IIalpha indices in pituitary adenomas.
  • [MeSH-major] Adenoma / pathology. Antibodies, Antinuclear / blood. Antibodies, Monoclonal / blood. Biomarkers, Tumor / blood. DNA Topoisomerases, Type II / blood. Pituitary Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Antigens, Neoplasm. Cell Division. DNA-Binding Proteins. Female. Humans. Male. Middle Aged. Neoplasm Invasiveness. Reproducibility of Results

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  • (PMID = 15254805.001).
  • [ISSN] 0001-6268
  • [Journal-full-title] Acta neurochirurgica
  • [ISO-abbreviation] Acta Neurochir (Wien)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Austria
  • [Chemical-registry-number] 0 / Antibodies, Antinuclear; 0 / Antibodies, Monoclonal; 0 / Antigens, Neoplasm; 0 / Biomarkers, Tumor; 0 / DNA-Binding Proteins; 0 / MIB-1 antibody; EC 5.99.1.3 / DNA Topoisomerases, Type II; EC 5.99.1.3 / DNA topoisomerase II alpha
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7. Sasaki M, Funayama H, Asano T, Kasono K, Namai K, Tamemoto H, Ueno S, Ota M, Kawakami M, Shinoda S, Ishikawa SE: Full-blown Cushing's disease after an episode of pituitary apoplexy. Endocr J; 2003 Oct;50(5):501-6
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  • [Title] Full-blown Cushing's disease after an episode of pituitary apoplexy.
  • The present study reports a rare case of full-blown Cushing's disease several years after an episode of pituitary apoplexy.
  • Ten years ago she had an episode of pituitary apoplexy.
  • Diabetes mellitus was diagnosed at age 56, and thereafter she had been controlled her plasma glucose with diet therapy and oral hypoglycemic agents.
  • Both plasma ACTH and serum cortisol levels were elevated to 170 pg/ml and 19.6 microg/dl, respectively.
  • Dexamethasone suppression test showed that a large dose of 8 mg dexamethasone, but not a small dose of 2 mg, suppressed the pituitary-adrenocortical axis.
  • CRH and methyrapone caused increases in plasma ACTH and serum cortisol levels.
  • Brain T(1)-weighted magnetic resonance imaging depicted a low signal of pituitary tumor, which was not enhanced by gadolinium.
  • The pituitary tumor was removed by transsphenoidal adenomectomy, and immunohistochemistry revealed an ACTH-producing adenoma.
  • The evidence suggested the possibility that the two pituitary tumors with dormant period of several years were a recurrence of ACTH-producing tumors in the present patient.
  • [MeSH-major] Cushing Syndrome / etiology. Pituitary Apoplexy / complications
  • [MeSH-minor] Adenoma / complications. Adenoma / diagnosis. Adenoma / secretion. Adenoma / surgery. Administration, Oral. Adrenocorticotropic Hormone / secretion. Diabetes Complications. Diabetes Mellitus / diet therapy. Diabetes Mellitus / drug therapy. Female. Humans. Hypoglycemic Agents / administration & dosage. Magnetic Resonance Imaging. Middle Aged. Neoplasm Recurrence, Local. Obesity / complications. Pituitary Neoplasms / complications. Pituitary Neoplasms / diagnosis. Pituitary Neoplasms / secretion. Pituitary Neoplasms / surgery

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  • (PMID = 14614205.001).
  • [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] 0 / Hypoglycemic Agents; 9002-60-2 / Adrenocorticotropic Hormone
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8. Castillo V, Giacomini D, Páez-Pereda M, Stalla J, Labeur M, Theodoropoulou M, Holsboer F, Grossman AB, Stalla GK, Arzt E: Retinoic acid as a novel medical therapy for Cushing's disease in dogs. Endocrinology; 2006 Sep;147(9):4438-44
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  • Cushing's disease is almost always caused by an ACTH-secreting pituitary tumor, but effective medical therapy is currently limited.
  • A randomized treatment with retinoic acid (n = 22) vs. ketoconazole (n = 20) in dogs with Cushing's disease was assigned for a period of 180 d.
  • Clinical signs, plasma ACTH and alpha-MSH, the cortisol/creatinine urine ratio, and pituitary magnetic resonance imaging were assessed and compared at different time points.
  • We recorded a significant reduction in plasma ACTH and alpha-MSH, and also in the cortisol/creatinine urine ratio, of the dogs treated with retinoic acid.
  • Pituitary adenoma size was also significantly reduced at the end of retinoic acid treatment.
  • No adverse events or signs of hepatotoxicity were observed, suggesting that the drug is not only effective but also safe.
  • Retinoic acid treatment controls ACTH and cortisol hyperactivity and tumor size in dogs with ACTH-secreting tumors, leading to resolution of the clinical phenotype.
  • This study highlights the possibility of using retinoic acid as a novel therapy in the treatment of ACTH-secreting tumors in humans with Cushing's disease.
  • [MeSH-major] Dog Diseases / drug therapy. Pituitary ACTH Hypersecretion / veterinary. Tretinoin / therapeutic use
  • [MeSH-minor] Adenoma / pathology. Adrenocorticotropic Hormone / blood. Animals. Body Weight. Creatinine / urine. Dogs. Female. Hydrocortisone / urine. Ketoconazole / therapeutic use. Magnetic Resonance Imaging / veterinary. Male. Pituitary Gland / pathology. Pituitary Neoplasms / pathology. Survival Rate. alpha-MSH / blood

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  • (PMID = 16740975.001).
  • [ISSN] 0013-7227
  • [Journal-full-title] Endocrinology
  • [ISO-abbreviation] Endocrinology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 5688UTC01R / Tretinoin; 581-05-5 / alpha-MSH; 9002-60-2 / Adrenocorticotropic Hormone; AYI8EX34EU / Creatinine; R9400W927I / Ketoconazole; WI4X0X7BPJ / Hydrocortisone
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9. Suri D, Weiss RE: Effect of pioglitazone on adrenocorticotropic hormone and cortisol secretion in Cushing's disease. J Clin Endocrinol Metab; 2005 Mar;90(3):1340-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Peroxisomal proliferator-activated receptors (PPAR)-gamma are abundantly expressed in ACTH-secreting pituitary tumors.
  • Treatment with PPARgamma agonists inhibits ACTH-secreting pituitary tumor growth, proliferation, and ACTH secretion in vitro in human and murine models and in vivo in murine corticotroph tumors.
  • It was hypothesized that treatment with the PPARgamma agonist pioglitazone would normalize the hypothalamic-pituitary-adrenal axis of patients with CD.
  • We evaluated the hypothalamic pituitary adrenal axis in five patients with CD in whom we measured:.
  • 2) the 24-h profile of serum cortisol and plasma ACTH; and 3) the ACTH and cortisol response to CRH stimulation.
  • At baseline, before low-dose dexamethasone, all five patients had elevated 24-h urine free cortisol, elevated 24-h serum cortisol and plasma ACTH levels, and robust responses to CRH, consistent with their diagnosis of CD.
  • Furthermore, there was no significant difference in the number of cortisol or ACTH spikes or in their diurnal rhythms.
  • In summary, pioglitazone treatment (45 mg daily for 30 d) of patients with CD was not found to be effective at attenuating either ACTH or cortisol levels and does not appear to be an alternative to surgical therapy.
  • [MeSH-major] Adrenocorticotropic Hormone / blood. Hydrocortisone / blood. Hypoglycemic Agents / administration & dosage. Pituitary ACTH Hypersecretion / drug therapy. Pituitary ACTH Hypersecretion / metabolism. Thiazolidinediones / administration & dosage
  • [MeSH-minor] Adult. Circadian Rhythm. Female. Humans. Hypothalamo-Hypophyseal System / drug effects. Male. Middle Aged. PPAR gamma / metabolism. Pituitary-Adrenal System / drug effects. Treatment Failure

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  • (PMID = 15585550.001).
  • [ISSN] 0021-972X
  • [Journal-full-title] The Journal of clinical endocrinology and metabolism
  • [ISO-abbreviation] J. Clin. Endocrinol. Metab.
  • [Language] eng
  • [Grant] United States / NIDDK NIH HHS / DK / DK 58258; United States / NIDDK NIH HHS / DK / DK07011; United States / NIDDK NIH HHS / DK / DK17050; United States / NIDDK NIH HHS / DK / DK58258; United States / NCRR NIH HHS / RR / RR00055; United States / NCRR NIH HHS / RR / RR18372
  • [Publication-type] Clinical Trial; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Hypoglycemic Agents; 0 / PPAR gamma; 0 / Thiazolidinediones; 9002-60-2 / Adrenocorticotropic Hormone; WI4X0X7BPJ / Hydrocortisone; X4OV71U42S / pioglitazone
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10. Kobayashi T, Mori Y, Uchiyama Y, Kida Y, Fujitani S: Long-term results of gamma knife surgery for growth hormone-producing pituitary adenoma: is the disease difficult to cure? J Neurosurg; 2005 Jan;102 Suppl:119-23
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Long-term results of gamma knife surgery for growth hormone-producing pituitary adenoma: is the disease difficult to cure?
  • OBJECT: The authors conducted a study to determine the long-term results of gamma knife surgery for residual or recurrent growth hormine (GH)-producing pituitary adenomas and to compare the results with those after treatment of other pituitary adenomas.
  • The mean tumor diameter was 19.2 mm and volume was 5.4 cm3.
  • The tumor resolution rate was 2%, the response rate 68.3%, and the control rate 100%.
  • Gamma knife radiosurgery is thus indicated for small tumors after surgery or medication therapy when a relatively high-dose radiation is required.
  • [MeSH-major] Adenoma / secretion. Adenoma / surgery. Human Growth Hormone / secretion. Pituitary Neoplasms / secretion. Pituitary Neoplasms / surgery. Radiosurgery / instrumentation
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Follow-Up Studies. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Neoplasm Recurrence, Local. Outcome Assessment (Health Care). Pituitary ACTH Hypersecretion / pathology. Pituitary ACTH Hypersecretion / surgery. Prolactinoma / pathology. Prolactinoma / surgery

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  • (PMID = 15662793.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 12629-01-5 / Human Growth Hormone
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11. Gross BA, Mindea SA, Pick AJ, Chandler JP, Batjer HH: Medical management of Cushing disease. Neurosurg Focus; 2007;23(3):E10
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Although transsphenoidal excision of the adrenocorticotropic hormone (ACTH)-producing neoplasm is often the treatment of choice in patients with Cushing disease, medical management is itself a useful preoperative temporizing measure, an option for long-term management in nonsurgical candidates, and an option for patients in whom surgery and/or radiotherapy have failed.
  • Three pathophysiologically based approaches exist in the research literature--neuro-modulation to limit ACTH levels, adrenal enzyme inhibition, and glucocorticoid receptor antagonism.
  • Unfortunately, the neuromodulatory approach involving agents such as bromocriptine, cyproheptadine, octreotide, and valproate has yielded only suboptimal results.
  • Glucocorticoid receptor antagonism remains in its infancy but may overall be limited by side effects and a resultant increase in ACTH and cortisol levels.
  • If success is still not achieved, the potent adrenolytic agent often used for adrenocortical carcinomas, mitotane, is another alternative.
  • [MeSH-major] Antineoplastic Agents, Hormonal / therapeutic use. Hormone Antagonists / therapeutic use. Neurotransmitter Agents / therapeutic use. Pituitary ACTH Hypersecretion / drug therapy. Receptors, Glucocorticoid / antagonists & inhibitors

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  • (PMID = 17961023.001).
  • [ISSN] 1092-0684
  • [Journal-full-title] Neurosurgical focus
  • [ISO-abbreviation] Neurosurg Focus
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal; 0 / Hormone Antagonists; 0 / Neurotransmitter Agents; 0 / Receptors, Glucocorticoid
  • [Number-of-references] 32
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12. Nieman LK: Medical therapy of Cushing's disease. Pituitary; 2002;5(2):77-82
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Surgical excision of an ACTH-producing pituitary tumor is the optimal therapy for Cushing's disease.
  • However, medical therapy may have either a primary or adjunctive role if the patient cannot safely undergo surgery, if surgery fails, or if the tumor recurs.
  • When medication is the only therapy, a major disadvantage is the need for lifelong therapy; in general, recurrence follows discontinuation of treatment.
  • "Neuromodulatory" compounds modulate corticotropin (ACTH) release from a pituitary tumor, steroidogenesis inhibitors reduce cortisol levels by adrenolytic activity and/or direct enzymatic inhibition and glucocorticoid antagonists block cortisol action at its receptor.
  • In general, neuromodulatory compounds (bromocriptine, cyproheptidine, somatostatin and valproic acid) are not very effective agents for Cushing's disease.
  • Steroidogenesis inhibitors, including mitotane, metyrapone, ketoconazole, and aminoglutethimide, are the agents of choice for medical therapy of Cushing's disease.
  • In general, ketoconazole is the best tolerated of these agents and is effective as monotherapy in about 70% of patients.
  • Mitotane and metyrapone may be effective as single agents, while aminoglutethimide generally must be given in combination.
  • The intravenously-administered etomidate may used when patients cannot take medications by mouth.
  • [MeSH-major] Adrenocorticotropic Hormone / antagonists & inhibitors. Cushing Syndrome / drug therapy. Hydrocortisone / antagonists & inhibitors. Steroids / antagonists & inhibitors

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  • (PMID = 12675504.001).
  • [ISSN] 1386-341X
  • [Journal-full-title] Pituitary
  • [ISO-abbreviation] Pituitary
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Steroids; 9002-60-2 / Adrenocorticotropic Hormone; WI4X0X7BPJ / Hydrocortisone
  • [Number-of-references] 59
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