Successful treatment of pituitary gigantism

2021 ◽  
Vol 14 (12) ◽  
pp. e247989
Author(s):  
Clara Cunha ◽  
Catarina Saraiva ◽  
Conceição Canas Marques ◽  
João Sequeira Duarte
Keyword(s):  
Transsphenoidal Surgery ◽  
Glucose Tolerance Test ◽  
Tanner Stage ◽  
Treatment Delay ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Residual Tumour ◽  
Oral Glucose Tolerance ◽  
Excessive Secretion

Pituitary gigantism is extremely rare, resulting from excessive secretion of growth hormone (GH) before fusion of epiphysial growth plates. We report a case of a 13-year-old boy, who presented with increased statural growth and headaches since the age of 10 years. On physical examination, his height was 180.7 cm (+3.3 SD) and Tanner stage V. Investigation revealed increased levels of serum age-adjusted and sex-adjusted insulin-like growth factor 1 (IGF-1) and failure of GH suppression during an oral glucose tolerance test (OGTT). MRI of the sellar region revealed a pituitary macroadenoma. He underwent transsphenoidal surgery and histopathological evaluation revealed mammosomatotropic adenoma. Three months after surgery, IGF-1 normalised, nadir GH during OGTT was less than 1 ng/mL and no residual tumour was found on the MRI. Genetic testing identified a mutation in the AIP gene. This case emphasises the importance of early diagnosis of gigantism, as treatment delay increases long-term morbidity.

Surgical outcome after repeated transsphenoidal surgery in acromegaly

1996 ◽  
Vol 85 (2) ◽  
pp. 239-247 ◽  
Author(s):  
Hélène Long ◽  
Hugues Beauregard ◽  
Maurice Somma ◽  
Ronald Comtois ◽  
Omar Serri ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Transsphenoidal Surgery ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Content Type ◽  
Fine Print

✓ Transsphenoidal selective adenomectomy is the most efficient primary treatment for acromegaly. However, management of persistent or recurrent disease remains controversial. The objective of the present study was to evaluate the early and long-term efficacy and safety of a second transsphenoidal surgery performed in those cases. The results of a retrospective study of 16 patients undergoing reoperation by the senior author (J.H.) between 1970 and 1991 are reported. Reoperation was performed for persistent or progressive acromegaly in 11 patients, visual impairment in four, and disease recurrence in one. Normalization of growth hormone (GH) was defined as a basal GH level of less than 5µg/L and suppression to less than 2 µg/L during the oral glucose tolerance test. Long-term follow-up data were available in 15 patients. The second transsphenoidal surgery induced a greater than 50% decrease of GH level in 11 patients. Three (19%) of 16 patients were cured according to the authors' criteria and remained so after 2, 7, and 20 years. Two more patients had a postoperative basal GH level of less than 5 µg/L but incomplete suppression during the oral glucose tolerance test. Thus, a total of five patients (31%) achieved a basal GH of less than 5 µg/L. One other patient who had no initial improvement after the second transsphenoidal surgery had spontaneous normalization of his GH level after 13 years. The following complications of the second surgery occurred in three patients: one subarachnoid hemorrhage, two new visual field defects, one cranial nerve palsy, and one meningitis. Moreover, 10 patients (62.5%) developed one or more new pituitary hormone deficiencies. In conclusion, reoperation for persistent or recurrent acromegaly has low success and high complication rates. According to the authors' experience, this procedure should be reserved for patients unresponsive to other forms of therapy or with progressive visual impairment despite medical therapy.

scholarly journals Predicting long-term type 2 diabetes with support vector machine using oral glucose tolerance test

PLoS ONE ◽  
2019 ◽  
Vol 14 (12) ◽  
pp. e0219636 ◽  
Author(s):  
Hasan T. Abbas ◽  
Lejla Alic ◽  
Madhav Erraguntla ◽  
Jim X. Ji ◽  
Muhammad Abdul-Ghani ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Support Vector Machine ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Support Vector ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Term Type

scholarly journals Reduced Glucose Tolerance and Skeletal Muscle GLUT4 and IRS1 Content in Cyclists Habituated to a Long-Term Low-Carbohydrate, High-Fat Diet

2020 ◽  
Vol 30 (3) ◽  
pp. 210-217
Author(s):  
Christopher C. Webster ◽  
Kathryn M. van Boom ◽  
Nur Armino ◽  
Kate Larmuth ◽  
Timothy D. Noakes ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Glucose Tolerance ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Mixed Diet ◽  
Oral Glucose Tolerance ◽  
High Fat ◽  
Low Carbohydrate

Very little is known about how long-term (>6 months) adaptation to a low-carbohydrate, high-fat (LCHF) diet affects insulin signaling in healthy, well-trained individuals. This study compared glucose tolerance; skeletal muscle glucose transporter 4 (GLUT4) and insulin receptor substrate 1 (IRS1) content; and muscle enzyme activities representative of the main energy pathways (3-hydroxyacetyl-CoA dehydrogenase, creatine kinase, citrate synthase, lactate dehydrogenase, phosphofructokinase, phosphorylase) in trained cyclists who followed either a long-term LCHF or a mixed-macronutrient (Mixed) diet. On separate days, a 2-hr oral glucose tolerance test was conducted, and muscle samples were obtained from the vastus lateralis of fasted participants. The LCHF group had reduced glucose tolerance compared with the Mixed group, as plasma glucose concentrations were significantly higher throughout the oral glucose tolerance test and serum insulin concentrations peaked later (LCHF, 60 min; Mixed, 30 min). Whole-body insulin sensitivity was not statistically significantly different between groups (Matsuda index: LCHF, 8.7 ± 3.4 vs. Mixed, 12.9 ± 4.6; p = .08). GLUT4 (LCHF: 1.13 ± 0.24; Mixed: 1.44 ± 0.16; p = .026) and IRS1 (LCHF: 0.25 ± 0.13; Mixed: 0.46 ± 0.09; p = .016) protein content was lower in LCHF muscle, but enzyme activities were not different. We conclude that well-trained cyclists habituated to an LCHF diet had reduced glucose tolerance compared with matched controls on a mixed diet. Lower skeletal muscle GLUT4 and IRS1 contents may partially explain this finding. This could possibly reflect an adaptation to reduced habitual glucose availability rather than the development of a pathological insulin resistance.

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