scholarly journals The Therapeutic Effect of Endoscopic Tumor Resection on Acromegalic Cardiomegaly in Patients With Pituitary Adenoma

2019 ◽  
Vol 7 (1) ◽  
pp. 31-34
Author(s):  
Kaveh Ebrahimzadeh ◽  
Kurosh Mojtabavi ◽  
Sasan Mohammadi ◽  
Mehrdad Farahani ◽  
Zohreh Gholizadeh Ghozloujeh ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Soft Tissues ◽  
Tumor Resection ◽  
Clinical Manifestations ◽  
Potential Effect ◽  
Tolerance Test ◽  
Cardiovascular Complications ◽  
Oral Glucose ◽  
Cardiovascular Comorbidity ◽  
Plasma Gh

Background: Acromegaly defines as chronic elevations of insulin-like growth factor-1 (IGF-1) and growth hormone (GH), which results in enlargement of organs and soft tissues. Cardiovascular complications of acromegaly such as cardiomegaly, hypertension contributing to a high risk of cardiovascular events. This study aimed to identify the determinants of the prevalence of cardiomegaly as cardiovascular comorbidity of acromegaly and the potential effect of the curative intervention. Methods: A total of 160 patients with acromegaly due to pituitary adenoma participated in this study. Acromegaly diagnosed was based on clinical manifestations, age-adjusted plasma IGF-I, and elevated plasma GH levels, not suppressible during an oral glucose tolerance test (75 g). Electrocardiogram and chest X-ray obtained in all patients. Treatment approaches included transsphenoidal surgery and hormonal evaluation performed before and six months after surgery. Results: The GH serum level was elevated in all patients before surgery, with a mean of 33.7 ng/ mL that reached 5.7 ng/mL after surgery. Mean IGF-1 was 794.1 ng/mL that reached 395.6 ng/mL postoperatively. The prevalence of cardiomegaly was 15% that improved in 5% of patients after trans sphenoidal surgery. Conclusion: Appropriate surgical intervention in acromegaly that complicated by cardiomegaly may result in significant improvement of the cardiac structure.

scholarly journals Association between Serum Mg2+ Concentrations and Cardiovascular Organ Damage in a Cohort of Adult Subjects

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1264 ◽  
Author(s):  
Elettra Mancuso ◽  
Maria Perticone ◽  
Rosangela Spiga ◽  
Carolina Averta ◽  
Mariangela Rubino ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Intima Media Thickness ◽  
Multivariate Regression Analysis ◽  
Organ Damage ◽  
Tolerance Test ◽  
Cardiovascular Complications ◽  
Left Ventricular ◽  
Oral Glucose ◽  
Model Assessment ◽  
Increased Risk

Magnesium (Mg2+) levels are associated with insulin resistance, hypertension, atherosclerosis, and type 2 diabetes (T2DM). We evaluated the clinical utility of physiological Mg2+ in assessing subclinical cardiovascular organ damage including increased carotid artery intima- media thickness (c-IMT) and left ventricular mass index (LVMI) in a cohort of well-characterized adult non-diabetic individuals. Age- and gender-adjusted correlations between Mg2+ and metabolic parameters showed that Mg2+ circulating levels were correlated negatively with body mass index (BMI), fasting glucose, and 2h-oral glucose tolerance test (OGTT) glucose. Similarly, Mg2+ levels were significantly and negatively related to c-IMT and LVMI. A multivariate regression analysis revealed that age (β = 0.440; p < 0.0001), BMI (β = 0.225; p < 0.0001), and Mg2+ concentration (β = −0.122; p < 0.01) were independently associated with c-IMT. Age (β = 0.244; p = 0.012), Mg2+ (β = −0.177; p = 0.019), and diastolic blood pressure (β = 0.184; p = 0.038) were significantly associated with LVMI in women, while age (β = 0.211; p = 0.019), Mg2+ (β = −0.171; p = 0.038) and the homeostasis model assessment index of insulin resistance (HOMA-IR) (β = −0.211; p = 0.041) were the sole variables associated with LVMI in men. In conclusion, our data support the hypothesis that the assessment of Mg2+ as part of the initial work-up might help unravel the presence of subclinical organ damage in subjects at increased risk of cardiovascular complications.

scholarly journals Reduced epinephrine reserve in response to insulin-induced hypoglycemia in patients with pituitary adenoma

2007 ◽  
Vol 157 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Shinya Morita ◽  
Michio Otsuki ◽  
Maki Izumi ◽  
Nobuyuki Asanuma ◽  
Shuichi Izumoto ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Adrenal Insufficiency ◽  
Serum Cortisol ◽  
Tolerance Test ◽  
Secondary Adrenal Insufficiency ◽  
Counterregulatory Hormones ◽  
Insulin Tolerance ◽  
Secondary Hypothyroidism ◽  
Severe Impairment ◽  
Plasma Gh

Objective: Hypoglycemia induces rapid secretion of counterregulatory hormones such as catecholamine, glucagon, cortisol, and GH. Insulin-induced hypoglycemia is used for evaluating GH–IGF-I and ACTH–adrenal axes in patients with pituitary disorders. The aim of this study was to determine whether the response of catecholamine secretion to hypoglycemia is disrupted in patients with pituitary adenoma. Methods: The study population comprised 23 patients with pituitary adenoma (non-functioning adenoma or prolactinoma). An insulin tolerance test was performed and serum catecholamines as well as plasma GH and serum cortisol were measured. Results: The study patients showed diminished response of plasma epinephrine to insulin-induced hypoglycemia. With the cutoff level of peak epinephrine for defining severe impairment set at 400 pg/ml, more patients with secondary adrenal insufficiency showed severe impairment of the epinephrine response than did those without it. Peak epinephrine levels to insulin-induced hypoglycemia were significantly correlated with peak cortisol levels. In patients with secondary hypothyroidism, secondary hypogonadism, GH deficiency, or diabetes insipidus, the prevalence of severe impairment of the epinephrine response was similar to that in patients without these deficiencies. Conclusions: Impaired epinephrine secretion in response to insulin-induced hypoglycemia was frequently observed in patients with pituitary adenoma. This disorder was especially severe in patients with secondary adrenal insufficiency.

Evaluation of treated acromegalic patients with normal growth hormone levels during oral glucose load

1984 ◽  
Vol 107 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Max Rieu ◽  
Jean-Marc Kuhn ◽  
Henri Bricaire ◽  
Jean-Pierre Luton
Keyword(s):  
Glucose Tolerance Test ◽  
Binding Assay ◽  
Serum Insulin ◽  
Normal Growth ◽  
Tolerance Test ◽  
Urinary Calcium ◽  
Oral Glucose ◽  
Calcium Excretion ◽  
Competitive Binding Assay ◽  
Plasma Gh

Abstract. Twenty-one treated acromegalics with plasma GH levels ≤ 5 ng/ml were evaluated during an oral glucose tolerance test (OGTT). Serum insulin-like growth factor (IGF) levels, measured by a competitive binding assay, were high in 10, normal in 8 and low in 3 patients. Urinary calcium excretion (Ca U), measured over 24 h, was elevated in 9 of the 10 patients whose IGF levels were high, whereas only 1 of the patients with normal or low IGF levels was hypercalciuric. A paradoxical rise in GH following TRH injection was observed in 5 of the 10 patients whose IGF levels were high, whereas all patients with normal or low IGF levels showed no GH response to TRH. GH levels ≥ 10 ng/ml occurred during ornithine (ORN) administration in 6 of the 18 patients with normal or high IGF levels. The remaining 12 patients with no GH rise during ORN included 2 cases in which IGF levels were high and GH rose following TRH, and 2 cases in which IGF levels were normal and GH levels were ≥ 10 ng/ml during insulin-induced hypoglycaemia (IIH), thus excluding a GH deficiency. These results show that acromegaly is not cured in certain treated patients with normal GH levels during OGTT. It seems that IGF and Ca U determinations are valuable indices of activity, in contrast to GH response to ORN. The GH response to TRH is also relatively useful.

scholarly journals Clinical characteristics and management of growth hormone excess in patients with McCune–Albright syndrome

2017 ◽  
Vol 176 (3) ◽  
pp. 295-303 ◽  
Author(s):  
Yong Yao ◽  
Yang Liu ◽  
Linjie Wang ◽  
Kan Deng ◽  
Hongbo Yang ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Complete Remission ◽  
Clinical Manifestations ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Somatostatin Analogue ◽  
Preoperative Treatment ◽  
Retrospective Clinical Study ◽  
Albright Syndrome ◽  
Gh Excess

Objective McCune–Albright syndrome (MAS) is a sporadic, postzygotic disease presenting with fibrous dysplasia, cafe-au-lait spots and multiple endocrinopathies. Growth hormone (GH) excess is an uncommon but potentially severe complication of MAS. This study aims to describe the clinical manifestations of GH excess in the context of MAS and analyze the responses of these patients to treatments. Design Retrospective clinical study. Methods Clinical data from 52 MAS patients were analyzed. Serum GH and IGF1 levels, as well as nadir GH levels after an oral glucose tolerance test and alkaline phosphatase (ALP) levels were determined before and after the treatment. Results In total, 13 MAS patients (25%) had the complication of GH excess, including 10 males (76.9%). Among them, all had FD, and 6 patients had sphenoidal bone involvement. Visual deficits were present in 8 patients, and hearing deficits were present in 5. Olfactory dysfunction was observed in 3 patients. Evident pituitary adenomas were confirmed in 9 patients by MRI. These patients underwent surgery with or without pretreatment of long-acting somatostatin analogue octreotide, and 6 achieved complete remission. The serum ALP levels decreased significantly after treatment for GH excess. Conclusions MAS with GH excess is more common in male patients. GH excess can lead to more severe skeletal lesions in MAS patients involving more of the craniofacial bones. Complete trans-sphenoidal complete tumor excision with neuronavigational guidance is effective and could lower ALP levels. LAR is recommended as a preoperative treatment and when patients fail to achieve complete remission after surgery.

HYPOTHALMIC-PITUITARY ADRENAL RESPONSIVENESS TO DEXAMETHASONE-INSULIN TOLERANCE TEST IN ACROMEGALIC PATIENTS BEFORE AND DURING TREATMENT WITH BROMOCRIPTINE

1978 ◽  
Vol 88 (1) ◽  
pp. 18-22 ◽  
Author(s):  
A. D. B. Harrower ◽  
N. McD. Davidson ◽  
P. L. Yap ◽  
I. M. Nairn ◽  
J. A. Fyffe ◽  
...  
Keyword(s):  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
Plasma Growth Hormone ◽  
Insulin Tolerance ◽  
Basal Plasma ◽  
The Mean ◽  
Plasma Gh

ABSTRACT Insulin tolerance tests were carried out in 10 acromegalic patients after 1 mg dexamethasone had been given the previous evening (DEX-ITT). Nine patients showed a rise in plasma 11-OHCS and four patients showed a rise in plasma growth hormone (GH) levels. These responses were unaltered after treatment with bromocriptine 10 mg daily for two months. Basal plasma GH levels fell in 6 of the patients and the mean plasma GH levels of the 10 patients during an oral glucose tolerance test (OGTT) fell from 63.2 ± 25.5 ng/ml before treatment to 53.0 ± 27.1 ng/ml (mean ± sem; P < 0.05). These data fail to confirm a previous report of abnormal hypothalmic-pituitary-adrenal suppressibility during a DEX-ITT in acromegalic patients. They also indicate that bromocriptine does not alter the responses of plasma 11-OHCS and plasma GH to the DEX-ITT despite lowering plasma GH levels.

scholarly journals SUN-291 Presence of Aberrant Adrenocorticotropic Hormone Precursors in Two Cases of McCune- Albright Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Satoshi Yamagata ◽  
Shinobu Takayasu ◽  
Koshi Makita ◽  
Kazunori Kageyama ◽  
Yuta Okawa ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Low Dose ◽  
Elevated Serum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Mccune Albright Syndrome ◽  
Free Cortisol ◽  
Albright Syndrome ◽  
Gh Excess ◽  
Mccune Albright

Abstract Background: McCune-Albright syndrome (MAS) is a rare disorder. MAS is caused by an activating postzygotic somatic mutation in the GNAS, and, is classically defined by the occurrence of fibrous dysplasia (FD), café-au-lait skin macules, and precocious puberty. Autonomous GH and/or PRL production in MAS has been reported. However, there have been no reports of ACTH excess in MAS. Method: Plasma ACTH and serum cortisol (F) levels were assessed using electrochemiluminescence immunoassays (Eclusys ACTHTM and Eclusys Cortisol IITM, respectively; Roche Diagnostics K.K., Tokyo, Japan).Clinical Cases: Case1; 42-year-old man showed craniofacial deformities and suffered from multiple bone fractures. He was diagnosed with FD at the age of 23 years. Café-au-lait macules were found on his back. He had slightly acromegaloid features. He showed no cushingoid features. Pituitary adenoma or hyperplasia was not detected by MRI. The diagnosis of GH excess was confirmed by no suppression of serum GH levels by a 75-g oral glucose tolerance test (nadir GH: 2.34 ng/mL) and an elevated serum IGF-I level (307 ng/mL; normal range: 92-257 ng/mL). The patient was treated with monthly subcutaneous lanreotide injection and then GH excess was well controlled. Basal ACTH and F levels in blood were 40.6-63.4 pg/mL and 8.0-10.5 μg/dL, respectively. The urinary free cortisol (UFC) level was 53 μg/day. Autonomous F excess was excluded by the level of midnight F (1.2 μg/dL) and the level of F (0.2 μg/dL) after a low-dose (1 mg) dexamethasone suppression test (DST). Case2; A 32-year-old man was diagnosed with MAS and gigantism at the Pediatrics Department at the age of 5 years. Treatment of GH excess was well controlled by monthly octreotide depot. He had no acromegaloid features and no cushingoid features. Café-au-lait macules were observed from the left flank to the back. Pituitary adenoma or hyperplasia was not detected by MRI. Basal ACTH and F levels in blood were 35.5-73.1 pg/mL and 7.0-11.7 μg/dL, respectively. The UFC level was 61 μg/day. Autonomous F excess was excluded by the level of F (&lt;0.2 μg/dL) after a low-dose (0.5 mg) DST.Possibility of primary adrenal insufficiency was excluded by ACTH stimulation test and/or insulin tolerance test in both cases. The involvement of 11β-HSD1 by GH excess and PC1/3 deficiency were also excluded. Gel exclusion chromatography was then performed. POMC and pro-ACTH were detected and the aberrant ACTH/normal ACTH ratio was 42% in both cases. Conclusion: This is the first report of the presence of aberrant ACTH precursors, particularly POMC, in MAS. A high ratio of circulating ACTH to F may suggest secretion of inactive ACTH precursors in MAS. Further investigations are required to determine whether GNAS mutations or other mechanisms are involved in the presence of aberrant ACTH precursors in MAS.

scholarly journals The Coexistence of an Intrasellar Adenoma, Lymphocytic Hypophysitis, and Primary Pituitary Lymphoma in a Patient with Acromegaly

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Jose Hernan Martinez ◽  
Mariel Davila Martinez ◽  
Marcos Mercado de Gorgola ◽  
Luis F. Montalvo ◽  
Jaime E. Tome
Keyword(s):  
Pituitary Adenoma ◽  
B Cell Lymphoma ◽  
Tolerance Test ◽  
Lymphocytic Hypophysitis ◽  
Laboratory Evaluation ◽  
Oral Glucose ◽  
Sellar Mass ◽  
Presumptive Diagnosis ◽  
Pituitary Lymphoma ◽  
Visual Disturbances

The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.

scholarly journals Postoperative Management in Patients with Pheochromocytoma and Paraganglioma

Cancers ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 936 ◽  
Author(s):  
Divya Mamilla ◽  
Katherine Araque ◽  
Alessandra Brofferio ◽  
Melissa Gonzales ◽  
James Sullivan ◽  
...  
Keyword(s):  
Ganglion Cells ◽  
Tumor Resection ◽  
Clinical Manifestations ◽  
Perioperative Period ◽  
Cardiovascular Complications ◽  
Postoperative Management ◽  
Sudden Increase ◽  
Safe Patient Care ◽  
Precise Diagnosis ◽  
Catecholamine Levels

Pheochromocytomas and paragangliomas (PPGLs) are rare catecholamine-secreting neuroendocrine tumors of the adrenal medulla and sympathetic/parasympathetic ganglion cells, respectively. Excessive release of catecholamines leads to episodic symptoms and signs of PPGL, which include hypertension, headache, palpitations, and diaphoresis. Intraoperatively, large amounts of catecholamines are released into the bloodstream through handling and manipulation of the tumor(s). In contrast, there could also be an abrupt decline in catecholamine levels after tumor resection. Because of such binary manifestations of PPGL, patients may develop perplexing and substantially devastating cardiovascular complications during the perioperative period. These complications include hypertension, hypotension, arrhythmias, myocardial infarction, heart failure, and cerebrovascular accident. Other complications seen in the postoperative period include fever, hypoglycemia, cortisol deficiency, urinary retention, etc. In the interest of safe patient care, such emergencies require precise diagnosis and treatment. Surgeons, anesthesiologists, and intensivists must be aware of the clinical manifestations and complications associated with a sudden increase or decrease in catecholamine levels and should work closely together to be able to provide appropriate management to minimize morbidity and mortality associated with PPGLs.

Long-term follow-up of five untreated acromegalic patients

1984 ◽  
Vol 106 (4) ◽  
pp. 437-442 ◽  
Author(s):  
J.W. R. Nortier ◽  
R.J. M. Croughs ◽  
J. H. H. Thijssen ◽  
F. Schwarz
Keyword(s):  
Tolerance Test ◽  
Clinical Activity ◽  
Oral Glucose ◽  
List Type ◽  
Treatment Protocols ◽  
Gh Secretion ◽  
Spontaneous Course ◽  
Long Term Follow Up ◽  
Plasma Gh

Abstract. The present study describes the clinical, biochemical and radiological follow-up of 5 patients with acromegaly, selected from a group of 53 patients, who did not receive treatment during a follow-up period of 5–16 years. The characteristics of these patients included: 1) older age (4 cases), 2) a long history of mild symptoms and signs (4 cases), 3) absence of diabetes mellitus (5 cases), 4) relatively low plasma GH levels (3 cases). The following observations were made during follow-up: clinical activity remained constant in 3 patients and lessonned in 2 patients, the lateral fossa area as calculated from a plain lateral X-ray of the skull remained constant and plasma GH levels measured during an oral glucose tolerance test remained constant in 3 cases, decreased substantially in one case and reached low levels in another case. In this last patient a reproducible increase of plasma GH was found after oral administration of a single dose of 2.5 mg bromocriptine, suggesting complete normality of GH secretion. It is concluded that acromegaly not necessarily progresses in all patients. The results re-emphasize the importance of taking the spontaneous course of pituitary adenomas into account when assessing the effect of various treatment protocols.

scholarly journals Clinical Manifestations and Diagnosis of Acromegaly

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Gloria Lugo ◽  
Lara Pena ◽  
Fernando Cordido
Keyword(s):  
Diabetes Mellitus ◽  
Respiratory Failure ◽  
Pituitary Adenoma ◽  
Joint Pain ◽  
Clinical Manifestations ◽  
Oral Glucose ◽  
Glucose Loading ◽  
Delay In Diagnosis ◽  
Igf I ◽  
Degree Of Control

Acromegaly and gigantism are due to excess GH production, usually as a result of a pituitary adenoma. The incidence of acromegaly is 5 cases per million per year and the prevalence is 60 cases per million. Clinical manifestations in each patient depend on the levels of GH and IGF-I, age, tumor size, and the delay in diagnosis. Manifestations of acromegaly are varied and include acral and soft tissue overgrowth, joint pain, diabetes mellitus, hypertension, and heart and respiratory failure. Acromegaly is a disabling disease that is associated with increased morbidity and reduced life expectancy. The diagnosis is based primarily on clinical features and confirmed by measuring GH levels after oral glucose loading and the estimation of IGF-I. It has been suggested that the rate of mortality in patients with acromegaly is correlated with the degree of control of GH. Adequately treated, the relative mortality risk can be markedly reduced towards normal.

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