Endocrine Abstracts

Introduction: Acromegalia is frequently associated to a glucidic metabolic disorders. Hyperinsulinemia and insulin resistance play an important part in the cardiovascular risk and the surmortality of this pathology.Aim: Study of changes in carbohydrate disorders after cure of acromegalia.Materials and Methods: This is a retrospective study of 36 patients (16 men and 12 women) hospitalized between 1985 and 2013. Pituitary macro aden...

Introduction: The purpose of this study was to characterize management and outcomes of patients with acromegaly seen in single centre in Lithuania.Methods: The study involved retrospective data collection from charts of 44 patients who were admitted to the centre between 2007 and 2012.Results: All cases except one were caused by pituitary adenomas (61.4% macroadenomas, and 29.5% microadenomas). The most common co-morbidities were n...

Thyrotropin-secreting pituitary tumors are <1% of pituitary adenomas. Clinical manifestations are similar to other forms of hyperthyroidism. Most of them are diagnosed as macroadenoma (microadenomas <10%).Case 1: A 48 years old woman with menopause presented 6 years ago, consulting in 2009 for weight loss and palpitations. She had elastic goiter and distal tremor. Blood test: TSH 8.66 μUI/ml (0.2–4.2), FT4 4.7 ng/dl (0.7&#150...

TSH-secreting pituitary tumors (TSH-omas) are a rare cause of hyperthyroidism and account for < 1% of all pituitary adenomas. They are usually benign adenomas arising from a monoclonal expansion of neoplastic thyrotropes.We report two patients’ cases with thyrotropinoma.The first case is a 73-year-old woman, who presents a TSH-secreting pituitary adenoma in the setting of multiple endocrine neoplasia syndrome type 1 (TSH-o...

Background: Acromegaly is a relatively rare endocrine disorder which may result in morbidity and mortality. In this study, we report the demographical and clinical characteristics of 62 acromegalic patients who were followed-up at our Department of Endocrinology Clinic.Methods and results: In this retro-prospective study, medical files of the patients who were followed-up from 1984 to 2013 were examined. Data was obtained for age at the time of diagnosis...

Background: Transsphenoidal surgery of pituitary adenoma is often first-line therapy for patients with acromegaly. Pharmacotherapy and/or radiotherapy are applied when surgery fails to achieve good disease control, or when surgery is impossible or contraindicated. In this study, we report the results of therapies, rates of cure and hypophyseal insufficiency in our acromegalic patients.Methods and results: Medical files of the 62 patients who were followe...

AcroQoL is a very well-authenticated survey questionnaire capable of evaluating the quality of life (QoL) in acromegalic patients. This study was designed to investigate how AcroQoL of acromegalic patients in Korea would change after medical treatment with octreotide LAR. A total of 58 drug-naïve patients from 11 tertiary centers in Korea were included; all of them were prescribed with octreotide LAR 20 mg at the time of enrollment, and their QoL were evaluated with AcroQ...

Introduction: Gonadotrophin-producing pituitary adenomas are usually non-functioning masses, and are not associated with elevated serum gonadotrophins. Functioning LH-producing gonadotroph pituitary adenomas are exceedingly rare in males, causing elevation of serum testosterone.Case report: We present an adult male who has been admitted to the emergency department a comatose state. Brain MRI revealed a large, lobulated mass of 6 cm caudal and 7.8 cm late...

Introduction: Non-functioning pituitary adenomas (NFPA) accounts for about 40% of all pituitary tumors. One or more anteropituitary deficiencies are present at diagnosis in 60–80% of NFPA. Hypopituitarism classically appears with the following order: GH→FSH/LH→TSH→ACTH. Aim of the study was to evaluate the incidence and the order of appearance of pituitary deficiencies in patients with NFPA.Materials and methods: We retrospectively...

Introduction: Giant prolactinomas are rare pituitary tumours. They can present with visual field defect, intracranial pressure symptoms and even temporal lobe epilepsy. Impairment of higher cognitive functions has been reported postoperatively after trans-cranial surgery and following radiotherapy. Reversible cognitive disturbances have been previously reported in patients with surgically decompressed arachnoid cysts but not after medical treatment of giant prolactinoma. We pr...

Background: TSH secreting pituitary adenomas represent small proportion of functional pituitary tumours presenting as hyperthyroidism with elevated thyroid hormone levels and inappropriately normal or increased TSH concentration. They are ≥1 cm in size and quite aggressive with tendency to relapse following transphenoidal adenomectomy (TSA). Surgical resection remains gold standard in their definitive treatment while pharmacotherapy with long-acting somatostatin analogue...

Background: Hyponatraemia is the most commonly observed electrolyte abnormality in hospitalised patients. The many causes of hyponatraemia may be classified either by volume status or aetiology. Thorough history taking, clinical examination and investigation are necessary in order to accurately determine the cause of hyponatremia and so formulate the most appropriate management plan.Methods: Patients with serum sodium <131 mM were identified by daily...

Objective: To provide a latent class regression model predictive of surgical outcome in patients with non-functioning macroadenomas (NFMA) of the pituitary gland.Patients and methods: Seventy-five patients with surgically treated NFMA of the pituitary gland were analyzed retrospectively. Thirty-two patients were male. Median age at the time of surgery was 58 years (range: 16–84 years). Median follow-up time was 90 months (range: 14–208 months)....

Aim: Empty sella is usually an incidental finding. The term primary empty sella (PES) makes reference to the herniation of the subarachnoid space within the sella turcica in patients with no history of pituitary tumor, surgery or radiotherapy. The aim of this study was to evaluate hormonal abnormalities associated with empty sella.Materials and methods: Twenty-three primary empty sella patient were retrospectively analyzed. Hormonal evaluation including ...

Positron emission combined with computed tomography using 18F-deoxy-glucose (FDG–PET/CT) is increasingly used in the staging and detection of malignant disease. Normal pituitary is not visualized by routine FDG–PET/CT and its radiological evaluation relies predominantly on magnetic resonance imaging (MRI). The role of FDG–PET/CT in differential diagnosis of sellar mass, in patients investigated for malignant disease, will be discussed.<p class="ab...

Introduction: Lymphocytic hypophysitis (LH) is a rare condition that has been increasingly recognised. We studied the natural history and current management of patients with lymphocytic hypophysitis.Methods: We performed a multi-centre retrospective review of all patients that either had histologically proven disease or a strong clinical suspicion for its presence, diagnosed from 2000 onwards. Cases of secondary hypophysitis or granulomatous or xanthomat...

Introduction: Hypothalamic–pituitary anomalies are well proven in Prader–Willi syndrome (PWS). In this context, it has been previously reported that central adrenal insufficiency (CAI) may be part of the PWS phenotype. However, the diagnostics of CAI is critical and debated, due to the lack of fully reliable tests. Several studies have looked at the clinical usefulness of the low dose (1 μg) short Synacthen test (LDSST) compared to the conventional dose (250 &#9...

Aim: Isolated male hypogonadotropic hypogonadism can be congenital or acquired. Mean platelet volume (MPV), which is a determinant of platelet function, is an independent risk factor for cardiovascular disease. The aim of this study is to evaluate MPV values in untreated, normosmic, isolated, male, idiopatic hypogonadotropic hypogonadism (IHH) patients, and the relationships among MPV, low testosterone levels, metabolic syndrome, impaired fasting glucose (IFG) and cardiovascul...

Introduction and objective: Cardiovascular mortality is high in acromegaly. Our aim in this study was to determine the levels of the new cardiovascular marker in active acromegaly patients, the mean platelet volume (MPV) values before and after octreotide acetate long-acting repeatable treatment.Material and methods: Thirty-six patients with active acromegaly who presented at the Endocrinology Department (mean age 46.0±14.0 years and mean BMI: 30.4&...

Introduction: Appropriate replacement therapy of not only gonadotrophins, but other deficient pituitary hormones is important in patients with hypopituitarism for a successful pregnancy. Data regarding GH replacement therapy during pregnancy is limited. We would like to present a case with panhypopituitarism including severe GH deficiency due to Sheehan’s syndrome, who achieved successful pregnancy with GH replacement therapy in the first half of pregnancy.<p class="a...

An empty sella (ES) develops when cerebrospinal fluid (CSF) compresses pituitary tissue until it lines the sellar floor and walls and lead to shrinkage of pituitary gland. Primary ES occurs when CSF enters the sella from the subarachnoid space that may or may not be associated with increased intracranial pressure. Secondary ES is a result of an injury to the pituitary itself (e.g. pituitary apoplexy) or the consequence of surgical or radiation treatment. Primary ES is most com...

Introduction: Hypophysitis is an inflammatory disease of the pituitary that may mimic tumors. Primary hypophysitis has been classified as lymphocytic (LH), granulomatous (GH), and xanthomatous (XH). It has been recently proposed to be an IgG4-related autoimmune disease (serum IgG4 concentration: 135 mg/dl), proven by tissue IgG4 immunostaining.Case description: A 23-year-old men suffered from typical cluster type headache. Two years after the first sympt...

Introduction: Growth failure is the most frequent endocrine abnormality observed in patients with sickle-cell disease SCD. Decreased synthesis of IGF1 might be secondary to a disturbed GH–IGF1 axis and defective GH secretion has been reported in some patients. Infarction, atrophy, and hemorrhage may occur in the pituitary gland in SCD during or following the vaso-occlusive crisis.Objective: To define the possible abnormalities of pituitary gland in ...

Background: Acromegaly is frequently associated with impaired glucose tolerance (IGT) or diabetes and treatment has also differential effects on glucose metabolism depending on specific type of medication.Objective: To study in 57 acromegalic patients evolution of glucose metabolism according to disease activity and treatment.Methods: IGF1 measurement, oral glucose tolerance test (OGTT) and HOMA test to evaluate insulin sensitivity...

Introduction: Hyperprolactinemia is a frequent endocrine disorder with well known harmful effects on the reproductive system and bone metabolism. Besides prolactinomas several drugs and disorders such as renal failure and hypothyroidism have been shown to cause hyperprolactinemia. Based on former studies liver cirrhosis has also been suggested to cause hyperprolactinemia while mechanisms have not been identified yet. In this study we set out to investigate the prevalence and p...

Introduction: The majority of secreted hormones influence the whole body, its weigh and constitution as the results of ongoing metabolism. Scientific studies have reported the existence of relationship between the TSH and selected anthropometric parameters such as BMI or body weight.Aim: The aim of the study was to assess the relationship between the value of TSH and selected anthropometric parameters in the group of endocrine patients.<p class="abst...

Acromegaly is usually caused by a GH-secreting pituitary adenoma. Although fertility is frequently impaired, pregnancy can be possible due to improvement in diagnosis and treatment modalities. Tumour enlargement and nontumoral lactotroph enlargement related with pregnancy can compress the optic chiasm and cause visual impairment. Optimal management of acromegaly during pregnancy is not well established. In this paper our experience about the clinical, laboratory, radiologic da...

Introduction: Lymphocytic hypophysitis is an uncommon disease of the pituitary gland mimicking pituitary macroadenoma on magnetic resonance imaging (MRI).Case: A 37-year-old female admitted to our clinic with headache, amenorrhea, polyuria and history of pituitary microadenoma. On laboratory examinations, prolactin level was mildly elevated (42 ng/ml) and FSH–LH levels were normal (2.4–4.04 mIU/ml) despite the low estrogen level (<20 pg/ml)...

Generously supported by IPSEN)-->Hyperprolactinemia is reportedly associated with impaired metabolic profile, particularly in patients with concomitant hypogonadism. The current study aimed at investigating the effects of 12 and 24 month-continuous cabergoline (CAB) treatment on metabolic profile in male hyperprolactinemic patients. Thirty-two men with prolactinomas, including 22 with testosterone < 8 nmol/l (HG, 69%) and 10 with...

Introduction: Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary adrenal insufficiency with low levels of serum cortisol, decreased production of ACTH, adequate secretion of other pituitary hormones and normal pituitary structure on radioimaging. Due to the rarity of its occurrence the prevalence of IAD as a cause of secondary adrenal insufficiency has not been determined. To our knowledge 200 cases are described in the literature. Impairment of GH secr...

Introduction: Pituitary abscess is rare. The incidence is difficult to estimate but two papers indicated numbers <1 and 0.6% of all cases of pituitary disease. We present a patient with panhypopituitarism without diabetes insipidus sharing a cystic mass in the pituitary gland.Case history: A man aged 47 was referred with symptoms of intense, frontal headache since a few months, fatigue and erectile dysfunction with decreased sexual desire. There was ...

Introduction: Acromegaly is an endocrinopathy that affects many different organ systems and leads to multiple comorbidities. Data on morphologic pathology of kidneys in acromegaly is scarce.Methods: We investigated 19 acromegalic patients (11 male, mean age 57.8±12.1 years) presenting in our outpatient clinic. We evaluated each patient’s kidneys by ultrasound, measuring organ dimensions and volume as well as noting any pathologic findings.<...

Introduction: Acromegaloidism is characterized by features of acromegaly without excessive GH secretion.Case report: A 24-year-old male presented with acral enlargement and bilateral non-inflammatory wrist and ankle pain. He had coarse facial features, prominent clubbing, enlarged hands and feet. BMI was 21.3 kg/m2. He did not have a relevant personal and family history. He was not on any medication. Due to his acromegaloid appearance he was r...

Background: Metastases to the pituitary gland are rare events and usually indicate widespread malignant disease. Most common symptoms of pituitary metastases are diabetes insipidus and visual disturbances. The lung and breast are the most common sites of primary tumors that metastasize to the pituitary gland. Pituitary metastasis of gastrointestinal tractus is extremely rare.Case presentation: A 53-year-old woman was given chemotherapy for colon cancer w...

İntroduction: CNS involvement is rare in acute monocytic leukemia cases. Pituitary involvement seems much more rarely with unknown frequency. Here, we present a case of AML- M5 (FAB classification) patient with pituitary involvement.Case presentation: A 29 years old, male patient, admitted to hematology clinic with visual disturbance and poor performance status. Allogeneic hematopoietic stem cell transplantation was performed in 2010 after chemothe...

Introduction: It’s well known that any form of diabetes insipidus (DI) can be exacerbated or first become appearent during pregnancy, since increased catabolism of ADH by plasental vasopressinas enzyme. Postpartum DI cases mostly presenting as a part of Sheean syndrome and began after postpartum first days. There was no any published case of isolated DI that began in the 6th month after deliveration in current literature.Case: A 37...

Introduction: Abnormalities of midline (AML) can be isolated or to be associated to secretory pituitary abnormalities that reflect a developmental defect of the hypothalamic pituitary (HP) region.Aim: Find AML in GH deficiency (GHD) and see their relationship with the appearance of the HP region and the severity of hypopituitarism (I P).Population and methodology: 160 children (141 ♂, ♀ 19) (IGH) underwent a clinical ex...

Context: Acromegaly associated to schizophrenia was firstly reported ~60 years ago and, so far it is unclear whether this association is causal or not.Objective: We report on three new cases and discuss the potential pathophysiological mechanisms of this association.Results: We report two males and one female diagnosed with schizophrenia and treated for several years with antipsychotics who developed acromegaly due to a GH-secretin...

Context: Following the recent evolution in therapeutic strategies for GH-secreting pituitary adenomas, determining optimal individualized patient management is now crucial.Objective: To determine whether pre-surgical medical treatment (PSMT) in patients with acromegaly improves surgical outcome and to specify thresholds for such a strategy.Methods and design: This retrospective study included 110 newly diagnosed acromegalic patient...

Objective: Early postoperative results for the Preoperative Octreotide Treatment of Acromegaly (POTA) study has been published, and like later randomized studies we demonstrated a beneficial effect of presurgical treatment with somatostatin analogues (SSA) in GH-secreting macroadenomas when evaluated 3–4 months postoperatively. However, concerns about a potential lingering effect of SSA and thereby potential false positive results have been raised. The objective of this s...

Macroprolactinemia is reportedly 10–25% in patients with hyperprolactinemia (1). Prolactin plays a major role in breast development (2). Macromastia, gigantomastia, breast hypertrophy are used interchangeably (3). Most authors conclude that gigantomastia cannot be treated medically and only resolves with surgical manoeuvres (4). We report a case with gigantomastia diagnosed with macroprolactinemia and treated with cabergolin.Case: A 44-year-old woma...

Introduction: We aimed to determine changes in geriatric assessment of cases with acromegaly.Methods: 26 elderly cases with acromegaly (controlled/uncontrolled: 15/11, F/M: 17/9) were included. 20 age, gender and BMI matched cases without acromegaly composed control group (CG) (F/M: 10/10). Presence of concomitant diseases and educational level were not different between the groups. Cognitive functions were evaluated with Mini Mental State Exam (MMSE), a...

Objective: To report the unusual presentation of a thyrotropinoma in a patient with: i) accelerated bone turnover, evident as osteopenia and increased serum alkaline phosphatase level, and ii) a pericardial effusion, years before diagnosis, that resolved completely following surgery and somatostatin analogue treatment.Case report: A 38-year-old man had been treated for years for presumed hypothyroidism with thyroxine supplementation based on elevated TSH...

Introduction: Previously, impaired health-related quality of life (HRQoL) was reported in patients with functional pituitary adenomas (FPA) and/or hypopituitarism. Our aim was to assess HRQoL in a cohort of FPA patients who underwent transsphenoidal surgery as primary treatment at our University Central Hospital between years 2000 and 2010.Design: A cross-sectional study including an age- and gender-standardized sample of the general population.<p cl...

Objective: The aim was to compare the effectiveness of the bromocriptine and cabergoline treatment of the women with microprolactinomas.Materials and methods: 82 women with microprolactinomas were included in this study (51 patients received bromocriptine (Group 1) and 31 – cabergoline (Group 2)) with MRI-control after the first year of treatment (11 women from Group 1; 7 – from Group 2), the second (27 women from Group 1; 15 – from Group ...

Pregnancy in active acromegaly at reproductive age is very rare occurrence due to hyperprolactinemia, hypogonadism and side effects of treatment of acromegaly. Only a few reports were described in medical literature by now.We report a 31-year-old woman ongoing active acromegaly despite who received Octeatide LAR 30 mg treatment monthly for the control of GH and IGF1 excess until realized her pregnancy. A GH secreting pituitary macroadenoma (tumor size 2 ...

Acromegaly is usually diagnosed after several years of duration. The multimodal therapy – surgery, radiotherpy, pharmacotherapy – is necessary in the majority of patients. Register of sellar tumors (RESET) collecting data of patients from eight tertiary centers in the Czech and Slovak Republics since the year 2000 was established in 2008.Aim of analysis: Evaluation of diagnostics of acromegaly and effectiveness of its treatment in a daily pract...

Background: Dopamine and somatostatin receptors on corticotroph pituitary adenomas are targets for medical treatment of Cushing’s disease (CD). Data indicate synergistic effects between pasireotide and cabergoline in improving biochemical control rates and clinical features in patients with CD.Objective: To evaluate safety and efficacy of pasireotide alone or with cabergoline in patients with CD.Methods: Patients: adults with ...

The association of acromegaly and end stage renal disease was not reported before. Here, we present a case of 57 years old male patient who had been followed with the diagnosis of 13 years of acromegaly and 18 years of type 2 diabetes at another center until 2005 when he was admitted to our outpatient clinic. He had been operated for a pituitary macroadenoma 13 years ago and followed without treatment for acromegaly. He was treated with long acting insulin and he was metabolic...

Introduction: Male prolactinomas are very rare pituitary tumors as they account for 1/10 among pituitary tumors secreting prolactin. They are usually larger and more aggressive than female ones. The gonadal deficit due to multi factorial mechanism is well known, but other deficiencies are diversely appreciated. Our aim was to analyze anterior and posterior pituitary functions in a large series of male prolactinomas.Subjects and methods: 117 male prolacti...

We investigated 49 patients with non-functioning pituitary macroadenomas: 11 males, 38 females, age 31–78 y.o. (median 61). Extrasellar tumor expansion was observed in 46 (93.9%) patients: suprasellar – 41 (83.7%), laterosellar 27 (55.1%), and infrasellar 18 (36.7%) patients; combined types of extrasellar expansion – 36 (73.5%) patients.Prolactin levels (PRL) varied from 115 to 1495 mU/l, hyperprolactinemia was found in 27 (55.1%) patients...

Introduction: Arthropathy affects the majority of acromegalic patients and is a major cause of morbidity, absenteeism and impaired quality of life. GH excess and increased levels of circulating IGFI result initially in a marked thickening of the soft tissues and cartilage. Along with disease progression, there’s subperiostal bone neoapposition, cartilage regressive phenomena and bone structural changes. We aimed to investigate prevalence, clinical presentation, treatment ...

Purpose: The pathogenesis of idiopathic GH deficiency (GHD) in children, including possible cerebral metabolic alterations, remains unclear. The aim of the study was to evaluate the metabolic changes within the normal appearing brain in children with GHD using MR spectroscopy (MRS) and to correlate MRS measurements with hormonal concentrations.Materials and methods: 71 children with GHD (mean age 6.9 years) and 11 healthy controls (mean age 8.4 years) we...

Introduction: The pituitary non-secreting microadenomas (or incidentalomas) are frequently diagnosed over the last decades thanks to imagery scan progresses and access. The gonadal dysfunction, as well as other pituitary deficiency is related to common genetic backup (+/− other pituitary dysfunctions) or may be incidental.Aim: We analyzed the endocrine profile in pituitary incidentalomas (microadenomas).Material and method: A...

Introduction: The pituitary tumors which are considered pituitary incidentalomas are accidentally discovered at pituitary scan and they associate a lack of pituitary hyper-secretion. Opposite to what generally are considered for adrenal incidentalomas, the pituitary incidentalomas are more frequent with years of life.Aim: We analyzed the incidentaloma sizes related to decades of age.Material and method: This is a retrospective stud...

Background: Postpartum hypopituitarism, known as Sheehan’s syndrome, occurs during a complicated childbirth, due to severe hemorrhage and hpovolemic shock that lead to ischemic necrosis of the pituitary gland.The aim of the study is to point out the clinical features in postpartum pituitary necrosis, so that the disease could be recognize rapidly, to present a laboratory work-up for a postive diagnosis, and also to describe the com...

Background: Prolactin secreting pituitary adenomas (prolactinomas) is the most common pituitary adenoma. The magnitude of prolactin secretion in prolactinomas is usually proportionate to the tumor’s size. Invasive giant prolactinoma is a large prolactinoma (>4 cm in dimension) presenting with serum prolactin levels of >1000 ng/ml and mass related clinical symptoms. Giant prolactinoma is rare and usually presents in men.Case report: A 52-year...

Introduction: Immunocytochemistry methods have demonstrated that most of the ‘clinically non functional’ adenomas are actually gonadotrophin secreting adenomas or gonadotroph adenomas. Gonadotroph adenomas are discovered in patients presenting with visual field disorder. Pituitary imaging almost always demonastrates macroadenoma. Anterior pituitary insufficiency is much more frequent than gonad hyperstimulation. Herein, we present six cases of FSH and/or LH positive ...

Objective: The aim of this single centre prospective open trial was to evaluate the long-term efficacy of octreotide LAR in acromegaly patients and possibility of withdrawal of this therapy.Methods: In total 17 patients with acromegaly diagnosed at Endocrinology Clinic in Sarajevo, somatostatin sensitive (ten females and six males, age range 37–65 years, six patients with microadenoma and ten patients with macroadenoma) were treated with octreotide....

A 77-year-old female had a loss of appetite, severe fatigue and hyponatremia (127–135 mmol/l) for 2 months. She was diagnosed as depression, and was psychiatrically hospitalized. After admission, she was beginning to take antidepressants, but they did not work at all. To examine hyponatremia, endocrinological examination was done, then low plasma ACTH (2.0 pg/ml) and cortisol (1.3 μg/dl) was found. Brain MRI examination showed no remarkable findings in pituitary. We ...

Introduction: The optimal treatment duration for prolactinomas to minimize reccurences is not clear. 2011 Endocrine Society Guidelines suggested that cabergoline withdrawal may be safely undertaken after 2 years in patients achieving normoprolactinemia and tumor volume reduction.Materials and methods: We analyzed 74 patients (mean age=46.9±14.4, M/F=19/56, macro/micro=18/56) bearing a prolactinoma. Patients were divided in 3 groups: Group A (23) tre...

Introduction: Langerhans cell histiocytosis is a rare disease with clonal proliferation of Langerhans histiocytes or their precursors. It is characterized by the infiltration of lipid-laden histiocytic cells or foam cells in skin, viscera, and bone.Case report: We report a case with gradual onset of polyuria and polydipsia when she was 18 years old. Central diabetes insipidus was diagnosed. Pituitary magnetic resonance imaging (MRI) revealed mild promine...

Introduction: The most common cause of diabetes insipidus is idiopathic. However, it may be also seen after metastasis to hypothalamic–pituitary region.Case: Fifty year old female patient with breast cancer was referred to our clinic with complaints of polyuria and polydipsia. Two years ago, she had diagnosed and after surgery, she has taken three cycles of cyclophosphamide+adriamycin+5-flurourasil than three cycles dosetaxel and finally seventeen c...

Introduction: Pharmacological treatments are still not ideal in ACTH-microadenomas and transnasal-trans-sphenoidal surgery (TSS) is first choice in the treatment of Cushing’s disease (CD). The question is how can a nearly 100% remission rate be achieved with minimally invasive diagnostic testing and TSS. In the discussion of the main lecture from an expert from the USA in ECE13, it became clear that in many European centres, like ours, the procedures are less invasive. Th...

Hypothesis and aim: Acromegaly is frequently associated with impaired glucose tolerance and diabetes, and concomitant hyperprolactinaemia was suggested to add to this effect. We hypothesized that pituitary prolactin (PRL) histopathology and plasma hyperprolactinaemia has a prognostic value in predicting the risk of glucose metabolic disturbances in acromegalic patients. The aim of this study was to examine glucose metabolic outcomes in acromegalic patients with and without his...

Introduction: Effective surgical treatment of Cushing’s disease (CD) is associated with a rapid decrease in the serum cortisol concentration, which requires the introduction of the hydrocortisone replacement treatment. However, the time of restoration of adrenal function is difficult to predict. The aim of the study was to evaluate the dynamics of serum cortisol concentrations after successful transsphenoidal surgery and to determine the time to restore the function of th...

Introduction: Macroforms of prolactin (PRL), the most often macroprolactin (MaPRL), may be the cause of about 25% cases of laboratory diagnosed hyperprolactinaemia. Macroprolactin is usually quantified by polyethylene glycol precipitation, however, the cut-off value (that means the calculated recovery ratio of monomeric PRL) has not been precisely determined and has rather unsatisfactory diagnostic specificity. Therefore, it is suggested that the evaluation of hyperprolactinae...

Background: The PAOLA study assessed the efficacy/safety of pasireotide LAR vs continued treatment with octreotide LAR/lanreotide Autogel in patients with inadequately controlled acromegaly. An exploratory objective was to measure changes in various associated biomarkers, including IGF1 and IGFBP2 (released from white fat cells and known to prevent insulin resistance), glucose and HbA1c.Methods: Adult patients (GH >2.5 μg/l and IGF1 >1.3&#21...

Context: Acromegaly is chronic insidious disease caused by excessive GH secretion by pituitary adenoma. This leads to overproduction of IGF1 and serious disseminated concequences.Material: 14 acromegalic subjects with diagnosed insulin dependent diabetes on stable octreotide LAR) treatment. Patients did not meet recent criteria of biochemical controlled disease (mean GH 4.6 ng/ml, mean IGF1 2.2-fold upper normal limit).Methods: Pat...

Background: Some patients with acromegaly do not achieve biochemical control despite receiving maximum-approved doses of currently available somatostatin analogues. This 24-week, randomized study assessed the multireceptor-targeted somatostatin analogue pasireotide LAR vs octreotide LAR/lanreotide Autogel in patients with inadequately controlled acromegaly.Methods: Eligible patients: ≥18 years with mean GH levels ≥2.5 μg/l and IGF1 level...

Background: Experimental studies have demonstrated that prolactin is a potent immunomodulator influencing both humoral and cell-mediated responses. In accordance with these data, our retrospective studies revealed higher prevalence of autoimmune thyroid diseases in prolactinoma patients compared to general population.Design: A prospective cross-sectional case–control study was carried out in a single tertiary referral centre.A...

Introduction: Craniopharyngiomas are benign epitelial tumors located in the suprasellar region and they are associated to several comorbidities. Our aim is to describe hormonal deficiency and complications after surgery.Design: Descriptive study of patients that underwent surgery of craniopharyngioma. Data collected included hormonal levels, clinical data and mortality. Quantitative variables with normal distribution are shown as mean and standard deviat...

Introduction: PRIMARYS provided evidence for TVR with monthly LAN-ATG 120 mg in treatment-naïve acromegalic patients (63% achieved TVR ≥20% with a favourable safety profile). To help clinicians with therapeutic management of acromegaly, tumour responsive over time needs to be further explored.Methods: PRIMARYS was an international, multicentre, open-label, single-arm study of 90 treatment-naïve acromegalic patients with pituitary macroade...

Introduction: The PRIMARYS study demonstrated primary treatment with lanreotide Autogel 120 mg could achieve favourable tumour and hormone response rates in a large cohort of acromegalic patients. Here, we further interrogate the PRIMARYS database on the relationship between the tumour volume responsiveness and hormonal control.Methods: PRIMARYS was an international, multicentre, open-label, single-arm study of 90 treatment-naïve acromegalic patient...

Introduction: EDIs with LAN-ATG therapy may help improve the burden associated with long-term acromegaly management. The LEAD study evaluated the efficacy and safety of this approach by switching from OCT-LAR conventional dosing to LAN-ATG EDI.Methods: LEAD was a multinational, multicentre, open-label, non-comparative study. Acromegalic patients with normal IGF1 after OCT-LAR 10 or 20 mg injections every 4 weeks for ≧6 months were switched to LAN-...

The aim of the study was a detailed analysis and a comparison of hypothalamic–pituitary–adrenal axis tests and cortisol metabolites analysis during these tests. This procedure might enable to design new diagnosis algorithms of hypocorticalism and normal levels for salivary cortisol estimation for early diagnostic of patients with hypothalamic–pituitary–adrenal axis disorder as well as to give us a possibility to reveal adrenal disorder in patients on estrog...

Background: Octreotide is the most widely used somatostatin analogue; however, the LAR formulation must be reconstituted prior to intramuscular injection. This Phase I study compared the pharmacokinetics and pharmacodynamics of octreotide Fluid Crystal (FC), a ready-to-use depot formulation for s.c. administration, vs octreotide LAR.Methods: After a single dose of octreotide s.c. 200 μg, healthy adult male/female volunteers were randomized 1 week la...

Introduction: The silent corticotropinomas (SC) account for 1.1–6% of surgically removed pituitary adenomas and 17–22% of ACTH-immunoreactive tumours. They do not cause prominent clinical features of hypercortisolism, nor biochemically evident, but show positive immunostaining for ACTH similar to functional corticotropinomas, They usually present as non-functioning adenomas (NFPA) with local mass effects and/or visual impairment.Aim: To describ...

Case: A 63-year-old acromegalic woman admitted hospital for lassitude and dizziness. She has been diagnosed acromegaly 10 years ago and had two transsphenoidal operations. Remission wasn’t achieved. Then she started to use lanreotide (somatostatin analogue) and for 7 years she has been treated with it. In laboratory examination, basal plasma GH 1.21 ng/ml (NR:0–5); nadir GH level after glucose tolerance test, 1.2 ng/ml (NR: less than 1); IGF1, 129.1 ng/ml (NR: for ag...

Background and Aim: Prolactinoma is the most common type of functional pituitary tumor in adults. Giant prolactinomas are defined as tumors achieve a diameter >4 cm and often have very high serum prolactin level. In our previous study showed that endoscopic endonasal pituitary surgery is a very convenient procedure for the patient due to low morbidity and high efficiency. In this study we evaluated endoscopic endonasal pituitary surgery series in patients with prolactinoma...

Introduction: A recent 12-month randomized, double-blind study showed that pasireotide LAR was superior to octreotide LAR at providing biochemical control (GH and IGF1) in medically naïve patients with acromegaly. This analysis evaluates the PK/PD of pasireotide and octreotide in these patients.Methods: Patients received pasireotide LAR 40 mg/28 day (n=176) or octreotide LAR 20 mg/28 day (n=182) for 12 m. The relationship between p...

Introduction: Copeptin is a proposed new diagnostic marker in differential diagnosis of diabetes insipidus as it is secreted in equimolar concentrations with vasopressin. Thus our aim was to assess diagnostic value of copeptin evaluation in patients with polydipsic-polyuric disorders.Materials and Methods: We’ve evaluated the copeptin (BRAHMS CT-proAVP Kryptor), sodium levels and blood/urine osmolality in 26 healthy volunteers (1M/25F, mean age 24.7...

A 35-year old female presented with a 5 day history of headache, diplopia and reduced visual acuity preceded by 6 months of lethargy and weight gain. Visual field testing revealed left temporal hemianopia. Magnetic resonance imaging (MRI) showed a benign pituitary adenoma with intra-tumoural haemorrhage compressing the optic chiasm. Neurosurgical opinion advised on transphenoidal surgery. However, in view of spontaneous resolution of diplopia and recovery of peripheral vision,...

Background: Acromegaly is associated with increased prevalence of thyroid diseases, particularly of differentiated thyroid carcinoma.Aim: To assess prevalence of thyroid diseases and thyroid cancer in patients with acromegaly.Patients and methods: Forty (10 M/30 F) acromegalic patients, 14 residents in iodine deficient areas, aged 47±12.8 years, were retrospectively reviewed. Mean duration of acromegaly was 7.6±9.5 years ...

Introduction: Growth of the tongue and mandible and dental pathologies are recognized consequences of untreated growth hormone excess in acromegaly. However, data on the frequency of the individual oro-dental pathologies are sparse. We, therefore, developed a self-report questionnaire on typical oro-dental changes, therapeutic measures, costs for prosthetic treatment and the role of dental professionals in the diagnostic process of acromegaly.Methods: Th...

It is well known that heart failure is associated with oxidative stress (OS). Reactive oxygen species in fact influence sarcolemmal and mitochondrial ione channels, which are responsible for cardiomyocyte excitability and are important in myocardial remodeling after a myocardial infarction. The decrease of anabolic axes can have a role in the progression of the illness.In order to evaluate the relationship between growth hormone deficiency (GHD) and inde...

Introduction: Growth Hormone deficiency (GHD) is frequent in patients with human immunodeficiency virus 1 (HIV-1), undergoing highly active antiretroviral therapy. GHD seems to depend on HIV-related lipodystrophy and to be less frequent in women.Aim of the study: To investigate the association of gender, body composition and GH/IGF1 axis, and to clarify whether GHD in HIV-infected patients is functional or a clinical entity.Methods...

Introduction: Pituitary apoplexy is a life-threatening entity developing as a result of ischemia or hemorrhage into pre-existing pituitary tumor. Clinical course is characteristic and commonly consists of severe headache accompanied by nausea, emesis, impaired consciousness, visual field impairment as well as eyeballs movement restriction. Symptoms are typically accompanied by secondary adrenal insufficiency. Corticosteroids are drugs of choice regarding coexisting adrenal ins...

Objectives: The rarity of pituitary apoplexy renders it a difficult subject for audit; hence there are no evidence-based standards of optimum care for such patients. The main controversy in management relates to the role of acute surgical intervention. Recently, a more conservative management has been adopted towards patients presenting with this condition. Therefore, it is important to evaluate the differences in outcome between patients submitted to surgical and conservative...

Histiocytosis is a disease caused by growth of histiocytes within one or more organs. Symptomatology may be very different: from isolated skin or bone lesions, by diabetes insipidus after life-threatening multisystem form. Diabetes insipidus as a symptom of pituitary can be observed many years before visibility of the changes in magnetic resonance imaging.A case of 59-year-old woman who has experienced diabetes insipidus with no other symptoms of hypopit...

Background: Cranial diabetes inspidus (DI) may be familial or acquired. Traumatic brain injury is an important cause of acquired cranial DI, occurring in up to 22% of patients with moderate or severe head injuries1.Case 1: A 20-year-old male was admitted following a road traffic accident (RTA) with polytrauma including several skull fractures, subdural haematoma, and pneumocephalus. The following day, he developed polyuria and polydipsia. Bioc...

Abstract: Generously supported by IPSEN)-->Pituitary adenomas (PA) may occur in association with malignancies. Although an increased risk of cancer has been reported in acromegalics, this has been poorly studied in patients with other phenotypes. We wished to evaluate the prevalence of recognized malignancies in PA.Material and Methods: A series of 422 consecutive PA patients followed at the Neuromed Institute ...

Objective: The cross-sectional study was designed to assess the psychosocial profiles of patients with acromegaly and with non-functioning adenomas in correlation with the severity of the diseases.Methods: Forty-one patients with acromegaly and thirty-one with non-functioning adenomas underwent a cross-sectional assessment regarding their socio-demographic and medical profiles, including the quality of life, psychiatric morbidity, and acceptance of illne...

Introduction: Congenital multiple pituitary hormone deficiency (MPHD) may result from defects of transcription factors that govern the early pituitary development. The most prevalent are two mutation of PROP1 gene: the c.296delGA and c.150delA.Methods: Seventy-five Lithuanian MPHD patients were tested for PROP1 defects. Perinatal and postnatal data were obtained from medical records. Hormonal investigations, pituitary imaging and GH the...

Prolactinomas are the most common hormonally active tumours of the pituitary. The treatment of choice is pharmacological. They are treated with cabergolin, which decreases the level of prolactin as well as the size of the tumour. Rarely, dangerous complications can arise after a quick reduction of the tumour’s size.Case presentation: Two men with macroprolactinomas were initially treated with cabergoline (Dostinex®) in a dose of 1 mg per week w...

A 64-year-old Sri Lankan female was admitted with a 1 week history of vomiting and poor oral intake. She had an episode of pneumonia 4 months previously and reported headaches, weight loss and dizziness since then.On admission, her blood tests showed marked hyponatraemia with a sodium of 118 mmol/l and low serum osmolality of 243 mOsm/kg. A short synacthen test confirmed adrenal insufficiency and thyroid function tests showed secondary hypothyroidism des...

Introduction: The Russian Registry of patients with tumors of the hypothalamic–pituitary region (OGGO) is a national registry founded in 2004 by Russian society for Endocrinology and Endocrinology Research Centre as a patient registry for acromegaly, in 2006 it was expanded to collect information on all lesions of the hypothalamic–pituitary region, in 2010 the first fully electronic version and in 2013 a new upgraded electronic online version were implemented. At thi...

Introduction: Thyroid diseases are frequent in acromegalic patients. We aimed to investigate thyroid function and morphology in a population of patients with de novo acromegaly.Materials and methods: We evaluated 32 patients newly diagnosed with acromegaly in a single medical center. We collected data on patient’s age, sex, duration of acromegaly symptoms, history of thyroid disease, laboratory tests results (serum GH, IGF1, TSH, fT4, fT3, ...

Introduction: Chronic somatotropin (ST) hypersecretion has systemic effects. It can cause important structural and functional cardiovascular (CV) changes, which can result in increased morbidity and mortality.Case report: A 48-year-old, male. followed by cardiology since 2005 for dilated cardiomyopathy (DCM) (Ecocardiography: moderately dilated left ventricle with globular appearance. Severely impaired global systolic function - LVEF 25%. Right cavities ...

The IGF1 response to recombinant human growth hormone (rhGH) showed some individual variability and the responsible factors for this behavior remain unknown. Some studies have emphasized the possible role of isoforms of the GH receptor (GHR), showing conflicting results.Therefore, we investigated the possible influence of the isoforms of the GHR to the diagnosis of GHD and in determining adult hormone replacement therapy responsiveness.<p class="abst...

Introduction: In the search for markers of invasiveness of pituitary adenomas, we studied the expression of Ki-67 antigen, TOPO 2A (topoisomerase 2 alpha), AIP (Aryl Hydrocarbon Receptor-Interacting Protein), and VEGF (Vascular Endothelial Growth Factor) in somatotropinomas.Material and methods: We studied retrospectively a group of 31 patients (20 female, 11 male) of mean age 43.3±14.3 years who underwent pituitary tumour surgery. Expression of Ki-...

Metabolic abnormalities in adult GH deficiency (AGHD) determine its significance as a disease associated with increased cardiovascular risk. However, recent contradictory data about the long-term beneficial effects of GH replacement, especially on cardiovascular risk, provoked some further analysis of its contributory factors.Aim of the study: To identify the individual risk factors of metabolic syndrome (MS) in AGHD and to compare the prevalence and the...

Background: Cortisol excess in Cushing’s disease (CD) leads to metabolic complications, thromboembolic events, and increased cardiovascular risk. The aim of this study was to assess the reversibility of glucose homeostasis alterations and dynamics of inflammatory and coagulation parameters following the successful transsphenoidal surgery.Methods: The group consisted of 14 patients with CD (11 females; age: 41.5±14.5) operated on according to th...

Introduction: Patients with untreated acromegaly have a reduced survival, mostly due to vascular disease. Recent studies claim an improvement of survival in the last years.Aims: To assess mortality ratio and to identify prognostic factors associated with reduced survival in acromegaly.Methods: Three hundred and twenty-seven patients (207 F/110 M, mean age 48.1±0.7 years, (range 18–81.42)) with acromegaly admitted in a sin...

Nelson’s syndrome (NS) is a rare clinical syndrome of an enlarging, aggresive corticotroph pituitary adenoma that can occur following bilateral adrenalectomy performed in the treatment of CD.The aim of this work is the evaluation of the early and long-term results of the microsurgery in a single surgeon’s series of patients with NSDuring the period from January 2000 to December 2005 - ten patients with NS have been operat...

Background: The Cushing’s disease (CD) is associated with comorbidities that have a significant impact on patients’ quality of life. However, it is not known the true impact of the disease remission on these comorbidities.Objectives: To assess the evolution of comorbidities associated with CD, after its remission.Methods: It was done an observational, analytical and retrospective study of patients with CD in remission, fo...

Introduction: The metabolic consequences of hyperprolactinemia and the repercussions of its treatment with dopaminergic agonists are not yet fully understood. This study aims to evaluate the metabolic profile of patients with prolactinomas (prevalence of diabetes mellitus, dyslipidaemia and obesity) and identify the potential variations after treatment with bromocriptine.Methods: Retrospective study of patients followed between 1962 and 2013. Included 17...

Introduction: Cushing’s Disease results of corticotrophin (ACTH) hypersecretion from pituitary which increases cortisol production. WHO classified pituitary tumors as typical adenoma, atypical adenoma and carcinoma. Diagnostic criteria for an atypical adenoma include invasive growth, elevated mitotic index, Ki-67 labeling index greater than 3% and extensive p53 immunoreactivity.Case Report: Sixty-eight years-old man presented to our consult with his...