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Immunohistochemical detection of dopamine D2 receptors in human pituitary adenomas.  [cached]
Marek Pawlikowski
Folia Histochemica et Cytobiologica , 2010, DOI: 10.5603/4203
Abstract: Thirty one pituitary adenomas and 3 samples of peritumoral anterior pituitary tissue were immunostained with an antibody raised against dopamine D2 receptor protein. The positive reactions were found in cell cytoplasm, a subpopulation of cell nuclei and the intratumoral blood vessels walls. As expected, the positive immunostaining was shown in cytoplasm and/or cell nuclei of all examined prolactinomas (7/7). In acromegaly the positive D2 staining occurred in 5/7 samples, in gonadotropinomas in 6/8 and in plurihormonal adenomas 2/4. The lowest expression was observed in corticotropinomas (1/5). These findings corroborate with the well known efficacy of D2 agonists in the treatment of prolactinomas and somatotropinomas, and support the rationale of the therapeutic trials with these compounds in gonadotropinomas. Moreover, the presence of D2 receptors in intratumoral blood vessels walls constitutes the possibility of the anti-angiogenic action of D2 agonists in pituitary adenomas.
Tratamiento de los prolactinomas y tumores secretores de hormona de crecimiento
Mangupli,Ruth;
Revista Venezolana de Endocrinología y Metabolismo , 2005,
Abstract: pituitary adenomas represent 10% of all the diagnosed intracraneal tumors, and 25% of the surgically treated brain tumors. the goals of treatment in a patient with a pituitary adenoma include elimination of the mass effect, lowering excessive hormone production, restoration of normal pituitary function, and prevention of recurrence. the primary therapy for all prolactinomas is a dopamine agonist. bromocriptine and cabergoline are both effective in reducing the size of the tumor and restoring gonadal funtion. surgery should be recommended only when medical therapy have failed. growth hormone secreting pituitary tumors are usually treated first with surgical resection by a transphenoidal adenomectomy, but strict normalization of hc and igf-1 values occur in less than half of patients with a macroadenoma, therefore a substantial number of acromegalic patients require aditional therapy. somatostatin analogs are at present the most widely used drugs for control of acromegaly with excellent results. in selected patients combined treatment with dopamine agonist and somatostatin seems to suppress hc levels better than either drug given separately. pegvisomant is a hc receptor antagonist that promises a very high hc rate of normalization of igf-1 in patients with acromegaly.
Guías para el diagnóstico y tratamiento de acromegalia, prolactinomas y enfermedad de Cushing
Chih Hao,Chen-Ku;
Acta Médica Costarricense , 2004,
Abstract: the most frequent functioning pituitary adenomas are those who that produce prolactin (prolactinomas), growth hormone (acromegaly) and acth (cushing?s disease). there are different opinions about the diagnosis and treatment of these diseases. we present here the guidelines for diagnosis and treatment of these tumors made by the costa rican association of endocrinology, diabetes and nutrition. the main cause of acromegaly is a pituitary tumor that produces growth hormone. the diagnosis is usually made several years after the disease has started because the physical changes occur very slowly. the initial treatment should be surgery and when it fails, medical therapy with octreotide is the main choice. radiotherapy can be used although it is limited by the long time it takes to start its effect. if there is hyperprolactinemia, other causes of prolactin elevation should be ruled out. if a prolactinoma is identified, the treatment almost always will be with dopamine agonists. surgery should be performed only in macroprolactinomas with visual field changes that do not shrink with medical treatment. the first choice for medical treatment will be bromocriptine although there are other agents like cabergoline and quinagolide. in cushing′s disease, there are different tests for screening for hypercortisolism, after which a confirmatory test should be performed. initial treatment should be surgery followed by radiotherapy. in these cases, medical treatment is less effective than in other pituitary tumors.
Controle hormonal dos adenomas hipofisários pela cirurgia transesfenoidal: evolu??o dos resultados nos primeiros cinco anos de experiência
Barbosa, Erika Ribeiro;Zymberg, Samuel Tau;Santos, Rodrigo de Paula;Machado, Helio Rubens;Abucham, Julio;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2011, DOI: 10.1590/S0004-27302011000100003
Abstract: objective: to evaluate the initial results of a surgical team in the hormonal control of secreting pituitary adenomas. materials and methods: in five years 51 functioning adenomas were operated (31 gh-secreting, 14 acth-secreting, 5 prl-secreting and 1 tsh-secreting). hormonal control was defined as gh < 2,5 ng/ml, normal free-urinary cortisol, lower prolactin and normal t3 and ft4. results: control rates were 36% in acromegaly, and 57% in cushing's disease. two prolactinomas normalized prolactin levels. thyroid hormone levels were normalized in the tsh-secreting adenoma. control of hypercortisolism was positively correlated with years of experience (p = 0.01). conclusion: our results, although restricted to the beginning of our experience, lie below the reported range of other surgical series with much longer experience. during these years, there was a significant improvement in initial post surgery urinary cortisol levels in cushing's disease as a function of surgical experience.
Tratamento medicamentoso dos tumores hipofisários. Parte I: prolactinomas e adenomas secretores de GH
Vilar, Lucio;Naves, Luciana;Freitas, Maria da Concei??o;Oliveira Jr, Sebasti?o;Leite, Ver?nica;Canadas, Viviane;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2000, DOI: 10.1590/S0004-27302000000500003
Abstract: the recent development of new drugs, particularly the somatostatin analogues (srifa), represents a great advance in the therapy of pituitary tumours. srifas are very effective in normalizing gh and igf-1 levels in acromegaly and may be an effective alternative to transsphenoidal surgery. however, their usefulness as primary therapy for acromegaly is limited due to the small effect on tumour size. according to early data from clinical trials, pegvisomant, a gh receptor antagonist, seems to be a promising therapeutic tool in the management of acromegalic patients. this drug induces significant clinical improvement and normalization of igf-1 levels in nearly all patients. however, it does not induce tumor shrinkage. dopamine agonists (da) are the preferred therapy for both symptomatic microprolactinomas and macroprolactinomas; their use result in normalization of prolactin levels and tumor shrinkage in most treated patients. they also may be useful in acromegaly, mainly in patients whose adenoma co-secrete prolactin and those with mild elevation of gh and igf-1 levels. due to its greater effectiveness and better tolerability, cabergoline represents the da of choice for the management of prolactinomas and acromegaly.
Prolactinomas: Aspectos neurocirúrgicos
Tella Jr, Oswaldo Inácio;Herculano, Marco Antonio;Delcello, Rosana;Aguiar, Paulo Henrique;
Arquivos de Neuro-Psiquiatria , 2002, DOI: 10.1590/S0004-282X2002000100019
Abstract: we report our experience with 38 cases of prolactin secreting pituitary adenomas. the adenomas were divided in three different groups. the adenomas producing only prolactin tend to be microadenoma and they show the typical alterations of this type of tumor. the gh-prl, gh-alpha subunit, the other combinations, and the pluri hormonal adenomas tend to present with visual symptoms. the treatment of the prolactinomas is initially clinical and the surgical indication for this type of adenomas is related to intolerance to the medication or to visual alterations. surgical result with total resection of the tumor was possible in 50% of the cases.
Acromegaly
Philippe Chanson, Sylvie Salenave
Orphanet Journal of Rare Diseases , 2008, DOI: 10.1186/1750-1172-3-17
Abstract: Acromegaly (derived from the Greek words "akros", extremities, and "megas", big). This term was proposed by Pierre Marie, a famous French neurologist working in La Salpetrière Hospital, in Paris, who published the first description of the disease and its pathology in 1886. It is used when the disease begins in adulthood.Gigantism: when the disease begins during childhood.Prosopectasia (derived from the Greek words "prosopon", face, and "ektasis", stretching): used by Verga, an Italian anatomist, in 1864.Acromegaly is characterized by an acquired progressive somatic disfigurement, mainly involving the face and extremities, but also many other organs, that is associated with systemic manifestations. The disease is related to the excessive production of growth hormone (GH). This GH hypersecretion originates from a monoclonal benign pituitary tumor (adenoma) in more than 90% of cases.Acromegaly is a rare disease, with a prevalence of 40 to 70 cases per million inhabitants and an annual incidence of 3 to 4 new cases per million inhabitants [1]. However, a recent study performed in Belgium suggests that pituitary adenomas may be more prevalent than previously thought, and thus the prevalence of acromegaly would be around 100–130 cases per million inhabitants [2]. A very recent epidemiological study (conducted in Germany [3] where screening of acromegaly was performed by means of systematic insulin-like growth factor-I (IGF-I) measurement in primary care patients of the general population on a given day) found a prevalence of biochemical acromegaly even higher (1,043 per million). Such high figures need to be confirmed. Owing to its insidious onset, acromegaly is often diagnosed late (4 to more than 10 years after onset), at an average age of about 40 years. The disease affects both men and women equally [4-6].The extremities (hands and feet) are broadened, the fingers are widened, thickened and stubby, and the soft tissue is thickened (Figure 1). The patient may have had
Tratamiento de los prolactinomas y tumores secretores de hormona de crecimiento
Ruth Mangupli
Revista Venezolana de Endocrinología y Metabolismo , 2005,
Abstract: Los adenomas hipofisarios representan el 10% de todos los tumores intracraneales diagnosticados y 25% de los tumores cerebrales que son intervenidos quirúrgicamente. Los objetivos del tratamiento de un paciente con un adenoma de la pituitaria son: eliminar el efecto de la masa tumoral (compresión sobre estructuras vecinas) disminuir la producción excesiva de hormonas, restaurar la función normal de la pituitaria y evitar la recurrencia. El tratamiento de elección para todos los prolactinomas es con un agonista de la dopamina. La bromocriptina y la cabergolina son efectivas para reducir el tama o del tumor y para restaurar la función gonadal. El tratamiento quirúrgico debe recomendarse sólo cuando falla el tratamiento médico. Los tumores de la pituitaria productores de hormona de crecimiento son tratados preferentemente mediante adenomectomía transesfenoidal, pero la normalización de los niveles de HC y de IGF-1 ocurre en menos de la mitad de los pacientes con macroadenomas; por lo tanto, un importante número de pacientes acromegálicos requiere un tratamiento adicional. Los análogos de la somatostatina son en la actualidad los medicamentos que más usados para el control de la acromegalia. En grupos especiales de pacientes, el tratamiento con agonistas de la dopamina y somatostatina parece que suprimen mejor los niveles de HC que cuando se administran esos fármacos en forma separada. El Pegvisomant, un antagonista del receptor de la HC promete lograr un alto porcentaje de normalización de la IGF-1 en pacientes con acromegalia. Pituitary adenomas represent 10% of all the diagnosed intracraneal tumors, and 25% of the surgically treated brain tumors. The goals of treatment in a patient with a pituitary adenoma include elimination of the mass effect, lowering excessive hormone production, restoration of normal pituitary function, and prevention of recurrence. The primary therapy for all prolactinomas is a dopamine agonist. Bromocriptine and cabergoline are both effective in reducing the size of the tumor and restoring gonadal funtion. Surgery should be recommended only when medical therapy have failed. Growth hormone secreting pituitary tumors are usually treated first with surgical resection by a transphenoidal adenomectomy, but strict normalization of HC and IGF-1 values occur in less than half of patients with a macroadenoma, therefore a substantial number of acromegalic patients require aditional therapy. Somatostatin analogs are at present the most widely used drugs for control of acromegaly with excellent results. In selected patients combined treatment
Guías para el diagnóstico y tratamiento de acromegalia, prolactinomas y enfermedad de Cushing  [cached]
Chen-Ku Chih Hao
Acta Médica Costarricense , 2004,
Abstract: Los tumores hipofisiarios funcionantes más frecuentes son los productores de prolactina (prolactinomas), hormona de crecimiento (acromegalia) y ACTH (síndrome de Cushing). Existe mucha controversia con respecto al diagnóstico y manejo de estas patologías. Este artículo presenta una guía para el diagnóstico y tratamiento de tales tumores hipofisiarios, y ha sido elaborado por la Asociación Costarricense de Endocrinología, Diabetes y Nutrición. La causa más frecuente de acromegalia son los tumores hipofisiarios productores de hormona de crecimiento. El diagnóstico usualmente se retarda varios a os luego de haberse iniciado los cambios, por lo lento que se producen las manifestaciones clínicas. El tratamiento inicial de elección consiste en la cirugía, reservándose tratamiento médico con análogos de somatostatina como primera elección, para casos donde ha fallado el tratamiento quirúrgico. Otra posibilidad de tratamiento consiste en la radioterapia, cuya eficacia se ve limitada por el tiempo necesario para hacer efecto. Con respecto a las hiperprolactinemias, se deben descartar otras causas que produzcan elevación de prolactina. Si se identifica un prolactinoma, el tratamiento va a ser médico en la mayoría de los casos, reservándose la cirugía para aquellos macroprolactinomas con compromiso visual que no han reducido de tama o con el tratamiento médico. El tratamiento de elección consistió en agonistas dopaminérgicos, y en Costa Rica la elección será bromocriptina, aunque hay otras opciones como cabergolina y quinagolide. En la enfermedad de Cushing existen diferentes pruebas de diagnóstico, tanto para tamizaje como para diagnóstico confirmatorio. El tratamiento inicial debe ser cirugía, seguida por radioterapia. En este caso el tratamiento médico es mucho menos eficaz que en las otras dos entidades. The most frequent functioning pituitary adenomas are those who that produce prolactin (prolactinomas), growth hormone (acromegaly) and ACTH (Cushing’s disease). There are different opinions about the diagnosis and treatment of these diseases. We present here the guidelines for diagnosis and treatment of these tumors made by the Costa Rican Association of Endocrinology, Diabetes and Nutrition. The main cause of acromegaly is a pituitary tumor that produces growth hormone. The diagnosis is usually made several years after the disease has started because the physical changes occur very slowly. The initial treatment should be surgery and when it fails, medical therapy with octreotide is the main choice. Radiotherapy can be used although it is limited by the long t
Cirugia transeptoesfenoidal en adenomas hipofisarios productores de prolactina Transsphenoidal approach to prolactinomas  [cached]
O. López-Arbolay,O. Morales-Sabina,J.L. González-González,N. Valdés-Lorenzo
Neurocirugía , 2006,
Abstract: Introducción. Para un gran número de tumores pituitarios, la cirugía es el tratamiento de primera línea y el abordaje transesfenoidal microquirúrgico el proceder más utilizado. El tratamiento actual de los prolactinomas es bastante controversial, por los buenos resultados alcanzados con los nuevos agonistas dopaminérgicos; no obstante la adenomectomía selectiva se incluye entre las modalidades de tratamiento para aquellos prolactinomas que no respondan a dicho tratamiento dopaminérgico. Objetivo. Evaluar los resultados del tratamiento microquirúrgico por vía transeptoesfenoidal de los adenomas productores de prolactina en el Servicio de Neurocirugía del Hospital "Hermanos Ameijeiras". Material y método. Presentamos un estudio retrospectivo y descriptivo de 63 pacientes intervenidos por vía sublabial transeptoesfenoidal microquirúrgica, portadores de este tipo de adenomas, y tratados en nuestro servicio desde 1996 hasta el 2003. Se analizan edad, sexo, cuadro clínico, tama o de las lesiones, niveles hormonales, complicaciones y evolución postoperatoria. Resultados. Se encontró un franco predominio del sexo femenino, 86% (54 pacientes). Se operaron 31 pacientes con macroadenomas y 32 con microadenomas. La complicación más común en el postoperatorio fue la diabetes insípida transitoria (11 enfermos), siendo de poca trascendencia. Se logró reducir las cifras iniciales de prolactina a valores no tumorales en el 90.6% de lo microadenomas (29 casos) y en el 67.7% de los macroadenomas (21 casos). Los síntomas más frecuentes que aquejaban a nuestros pacientes mejoraron, sobre todo la cefalea en el 82% (36 casos) y los trastornos visuales en el 69% (18 casos). Conclusiones. Se concluye que la adenomectomía transeptoesfenoidal es un proceder seguro y eficaz como opción de tratamiento para pacientes con adenomas secretores de prolactina que tengan indicación quirúrgica. Introduction. Transeptal transsphenoidal surgery for pituitary tumors is a well established surgical technique. In particular the use of medical treatment in patient with prolactinomas has induced the control of hiperprolactinemia and the shrinkage of the tumor in the great majority of the patients, for that reason the treatment of the prolactinomas is controversial. Objective. We evaluate the results of trassphenoidal microsurgical treatment of prolactin secreting adenomas at our Unit. Methods. We made a retrospective analysis of 63 patients operated on via transsphenoidal microsurgical technique for prolactin secreting adenomas between 1996 and 2003. Age, sex, symptoms, tumor size, hormonal levels
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