Showing papers on "Hypophysectomy published in 2013"
TL;DR: This case suggests that in patients with Cushing’s disease who have other evidence of endocrine neoplasia, if MEN1 is excluded then MEN2 should be considered, and a diagnosis of mutation-negative MEN1, which was reviewed at regular intervals.
Abstract: We report a patient with Cushing’s disease and primary hyperparathyroidism who subsequently developed medullary thyroid carcinoma (MTC) and bilateral phaeochromocytomas. Genetic testing for multiple endocrine neoplasia type 1 (MEN1) was negative, but a characteristic multiple endocrine neoplasia type 2A (MEN2A) RET-mutation was identified. Our case suggests that in patients with Cushing’s disease who have other evidence of endocrine neoplasia, if MEN1 is excluded then MEN2 should be considered. A 68-year-old man had presented with classical Cushingoid features at the age of 48 years. Biochemical investigation was compatible with ACTH-dependent Cushing’s syndrome. Bilateral inferior petrosal sinus (BIPSS) sampling demonstrated a central source, confirming pituitary-dependent Cushing’s syndrome, Cushing’s disease. He had attempted transsphenoidal adenomectomy (TSA), and although no adenoma was confirmed on histology, his cortisol level became undetectable (serum cortisol at 09.00 h <50 nmol/l (<1.8 lg/dl), all his clinical symptoms and signs gradually disappeared; indicating remission. He then remained well for 10 years, when he was noted to have hypercalcaemia with a corresponding elevated serum PTH, indicative of primary hyperparathyroidism (PHPT). He was offered conservative management with regular monitoring of his serum calcium. In the light of the diagnoses of primary hyperparathyroidism and the past history of a pituitary tumour, Cushing’s disease, he was tested for MEN1, but no mutation was found. His parents were deceased and he had no siblings, but he had single child, a 20-year-old son who had been diagnosed with primary hyperparathyroidism: following parathyroidectomy in the son, parathyroid hyperplasia was confirmed on histology. Our patient was therefore reviewed at regular intervals with a diagnosis of mutation-negative MEN1. He was noted to be Cushingoid in appearance some 15 years after the initial surgical cure, and on BIPPS was confirmed to have a recurrence of his Cushing’s disease. He had a transsphenoidal hypophysectomy, and again while no tumour was confirmed on surgical pathology, he went into clinical and biochemical remission with a postoperative serum cortisol at 09.00 h of <50 nmol/l. He was now panhypopituitary and pituitary hormone replacement therapy was commenced including hydrocortisone, thyroxine and testosterone. At the age of 66 years, he developed osteoporosis and at this stage parathyroidectomy was offered. Ultrasound scanning of his thyroid showed a thyroid nodule: fine needle aspiration of the thyroid nodule gave rise to suspicions of a medullary thyroid carcinoma (MTC). Plasma calcitonin level was massively elevated at 27,500 ng/l (normal<15 ng/l). Radionuclide scanning with FDG-PET revealed extensive FDG-avid disease in the thyroid with additional avid uptake in the liver and bone, strongly suggestive of metastatic MTC (Fig. 1). Furthermore, the FDG-PET also showed FDG-avid adrenal uptake (Fig 1); coincident CT scanning demonstrated bilateral adrenal nodules, 2.0–2.3 cm in maximal diameter, which in retrospect had been noted many years previously and were without any interval change on serial scans. Assessment of 24-h urinary metanephrines had been normal. However, 24-h urinary metanephrines were now abnormal (urine metanephrines 5.94 lmol/24 h, reference range 0.00–1.90; normetanephrine 2.12 lmol/24-h reference range 0.00–4.50), while plasma metanephrine was also highly elevated (plasma metanephrine 2125 pmol/l, reference range 80–510 pmol/l; plasma normetanephrine 1092 pmol/l, reference range 120–1180). Further questioning failed to reveal any evidence of paroxysmal symptoms, and he was normotensive. He was therefore diagnosed as having asymptomatic bilateral phaeochromocytomas. He was started on aand then b-adrenoceptor blockade, and was assessed at a multidisciplinary team meeting. It was decided to remove his MTC in the first instance, and to operate on the phaeochromocytoma(s) at a
27 citations
TL;DR: It is concluded that hormones from each pituitary lobe affect the gastrointestinal immune responses to T. spiralis through various mechanisms.
Abstract: The influence of anterior pituitary hormones on the gastrointestinal tract of humans and animals has been previously reported. Hypophysectomy (HYPOX) in the rat causes atrophy of the intestinal mucosa, and reduction of gastric secretion and intestinal absorption, as well as increased susceptibility to bacterial and viral infections. However, to our knowledge, no findings have been published concerning the immune response following HYPOX during worm infection, particularly that which is caused by the nematode Trichinella spiralis. The aim of this work was to analyze the effects of total or partial HYPOX on colonization of T. spiralis in the intestinal lumen, together with duodenal and splenic cytokine expression. Our results indicate that 5 days post infection, only neurointermediate pituitary lobectomy (NIL) reduces the number of intestinally recovered T. spiralis larvae. Using semiquantitative inmunofluorescent laser confocal microscopy, we observed that the mean intensity of all tested Th1 cytokines was markedly diminished, even in the duodenum of infected controls. In contrast, a high level of expression of these cytokines was noted in the NIL infected hamsters. Likewise, a significant decrease in the fluorescence intensity of Th2 cytokines (with the exception of IL-4) was apparent in the duodenum of control and sham infected hamsters, compared to animals with NIL surgeries, which showed an increase in the expression of IL-5 and IL-13. Histology of duodenal mucosa from NIL hamsters showed an exacerbated inflammatory infiltrate located along the lamina propria, which was related to the presence of the parasite. We conclude that hormones from each pituitary lobe affect the gastrointestinal immune responses to T. spiralis through various mechanisms.
6 citations
25 Oct 2013
TL;DR: Cushing’s disease is an uncommon endocrine disorder resulting from an adrenocorticotrophin-producing pituitary adenoma and its clinical features and subsequent comorbidities are the consequence of hypercortisolism and may be life-threatening if untreated.
Abstract: SUMMARY Cushing’s disease (CD) is an uncommon endocrine disorder resulting from an adrenocorticotrophin-producing pituitary adenoma. Its clinical features and subsequent comorbidities are the consequence of hypercortisolism and may be life-threatening if untreated. Trans-sphenoidal selective adenomectomy or hypophysectomy remain recommended first-line treatments for CD and may be repeated if unsuccessful or following recurrence of the tumor. Pituitary radiotherapy, either conventional fractionated external beam or in the form of radiosurgery, is a second-line treatment option, but its effects are delayed for several years. Bilateral adrenalectomy is a valuable treatment option for acutely unwell patients or for those who are unable to take or tolerate medical therapy. Steroidogenesis inhibitors such as metyrapone, ketoconazole, etomidate and mitotane have their place at many stages in the management of CD and are usually very effective. Pituitary tumor-targeted agents, such as cabergoline or pasireotide, ...
4 citations
Journal Article•
TL;DR: The function of acupuncture regulating HPA axis is regulated by CRH secretion in the hypothalamic paraventricular nucleus, regulate secretion of CORT.
Abstract: Object:To find the relationship between acupuncture effect in CRH,ACTH and CORT secretion and pituitary,spinal cord.Methods:There are testing CRH,ACTH and CORT level in the spinal cord injury model and the hypophysectomy model by enzyme linked immunosorbent assay.Results:Acupuncture canup-regulation CRH level and down-regulation CORT levels in the spinal cord injury model;down-regulation CRH and CORT levels in the Hypophysectomy model.Conclusion:The function of acupuncture regulating HPA axis is regulated by CRH secretion in the hypothalamic paraventricular nucleus,regulate secretion of CORT.
1 citations
TL;DR: A marked hypertrophy of ependymal tanycytes adjacent to the nucleus preopticus (NPO) was seen during the 1st month after hypophysectomy, but they gradually tend to regain their normal structure by the end of the 3rd month.
Abstract: SUMMARY A marked hypertrophy of ependymal tanycytes adjacent to the nucleus preopticus (NPO) was seen during the 1st month after hypophysectomy. After the 30th day they exhibited signs of exhaustion and atrophy marked by a reduction in size. However, they gradually tend to regain their normal structure by the end of the 3rd month. Initially depletion of neurosecretory material (NSM) was noticed in 80–90% of the NPO after hypophysectomy. A few exhibited hypertrophic changes whereas others became pyknotic. Due to the degeneration of some neurons the viable ones look as if they are sparsely distributed.
TL;DR: It was found that the most pronounced changes in the morphology of the thymus occurred after neonatal hypophysectomy, and the anterior pituitary peptide had more pronounced effect on the recovery of thymic structure than posterior pituitarian peptide.
Abstract: Investigations were carried out on chicks of different age. It was found that the most pronounced changes in the morphology of the thymus occurred after neonatal hypophysectomy. These changes are least pronounced in old chicks. Peptides Lys-Glu-Asp-Gly and Ala-Glu-Asp-Gly synthesized on the basis of amino acid composition of peptide complexes of the anterior and posterior pituitary lobes administered to hypophysectomized birds regardless of age promoted recovery of the morphological structures of the thymus. The anterior pituitary peptide (Lys-Glu-Asp-Gly) had more pronounced effect on the recovery of thymic structure than posterior pituitary peptide (Ala-Glu-Asp-Gly).