Endocrine Abstracts (2009) 19 S1

Per ardua ad pituita: not just phlegm

J Wass

OCDEM, Oxford, UK.

By Galen the pituitary was thought to be the ‘exhaust pipe’ of the brain producing phlegm. More recently it was the conductor of the endocrine orchestra but we now know that for the most part the pituitary itself is conducted by the hypothalamus, the hormones of which gave some of their discoverers the Nobel Prize (1977).

Pituitary disease is much commoner than was thought previously. In Oxford, we have the good fortune to have large numbers of patients with pituitary disease and we concentrated on contributions to the literature which are practical and hopefully useful in the field of acromegaly, non functioning pituitary tumours, Cushing’s disease, pituitary apoplexy, silent ACTH tumours, craniopharyngiomas and in other areas. Thus we know we can predict somatostatin responses in acromegaly with an acute somatostatin test, that debulking pituitary surgery in macroadenomas causing acromegaly increases responsiveness to somatostatin analogues in acromegaly and that post operative glucose tolerance testing can obviate the need for post operative day curves in the assessment of these patients at this time. In the field of non functioning tumours, we know that microadenomas virtually never progress in size but that macroadenomas significantly do. Eighty-five percent of recurrences of non functioning adenomas occur in the first 5 years after operation and in the differentiation of non functioning pituitary tumour from prolactinoma, prolactin levels in the former are very rarely more than 2000 mU/l. In the field of prolactinoma, we know that CSF rhinorrhea is statistically commoner in men and those patients with resistant prolactinomas. Why this is, is uncertain. We also know that recovery of pituitary function as prolactinomas decreases in size is very uncommon. In the field of pituitary apoplexy, we know that operating within 8 days in patients with neurological deficit increases the frequency of neurological recovery.

However there remain important questions for the future. Answers to some of these will require collaborative efforts because of the rarity of some of these tumours.

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