scholarly journals Mixed gangliocytoma-pituitary adenoma containing GH and GHRH co-secreting adenoma cells

2019 ◽  
Vol 2019 ◽  
Author(s):  
Shinichiro Teramoto ◽  
Yuichi Tange ◽  
Hisato Ishii ◽  
Hiromasa Goto ◽  
Ikuko Ogino ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Tumor ◽  
Past History ◽  
Tolerance Test ◽  
Oral Glucose ◽  
List Type ◽  
Releasing Hormone ◽  
History Of

Summary A 67-year-old woman with a past history of type 2 diabetes mellitus presented with worsening glycemic control. She had some acromegaly symptoms and magnetic resonance imaging demonstrated a pituitary tumor. Endocrinological examination found the resting growth hormone (GH) level within the normal range, but elevated insulin-like growth factor 1 level. A 75 g oral glucose tolerance test showed inadequate suppression of nadir GH levels. Acromegaly due to GH-secreting pituitary tumor was diagnosed. The patient underwent endoscopic transsphenoidal surgery resulting in gross total removal of the tumor and recovered well postoperatively. Histological examination of the tumor showed coexistence of relatively large gangliocytoma cells and pituitary adenoma cells, suggesting mixed gangliocytoma-pituitary adenoma. In addition, colocalization of GH and GH-releasing hormone (GHRH) in pituitary adenoma cells was revealed, so the adenomatous components were more likely to produce GHRH in our mixed gangliocytoma-pituitary adenoma case. Mixed gangliocytoma-pituitary adenoma is very rare, and the present unique case demonstrated only the adenomatous components associated with GHRH production. Learning points: Sellar gangliocytoma coexisting with pituitary adenoma is recognized as a mixed gangliocytoma-pituitary adenoma and is very rare. A proposed developmental mechanism of growth hormone (GH)-secreting mixed gangliocytoma-pituitary adenoma involves GH-releasing hormone (GHRH) produced by the gangliocytic components promoting the growth of tumor including GH-secreting adenomatous components. Since our present case indicated that the adenomatous components of mixed gangliocytoma-pituitary adenoma could secrete both GH and GHRH simultaneously, progression of GH-secreting mixed gangliocytoma and pituitary adenoma may involve exposure to spontaneously produced GHRH due to the adenomatous components.

Association of pituitary adenoma with neuronal christoma: A TEM study

1994 ◽  
Vol 52 ◽  
pp. 232-233
Author(s):  
Eva Horvath ◽  
Kalman Kovacs ◽  
B. W. Scheithauer ◽  
R. V. Lloyd ◽  
H. S. Smyth
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Tumor ◽  
Nervous Tissue ◽  
Alternative Explanation ◽  
Growth Hormone Releasing Hormone ◽  
Cell Hyperplasia ◽  
Releasing Hormone ◽  
Secretory Neurons

The association of a pituitary adenoma with nervous tissue consisting of neuron-like cells and neuropil is a rare abnormality. In the majority of cases, the pituitary tumor is a chromophobic adenoma, accompanied by acromegaly. Histology reveals widely variable proportions of endocrine and nervous tissue in alternating or intermingled patterns. The lesion is perceived as a composite one consisting of two histogenetically distinct parts. It has been suggested that the neuronal component, morphologically similar to secretory neurons of the hypothalamus, may initiate adenoma formation by releasing stimulatory substances. Immunoreactivity for growth hormone releasing hormone (GRH) in the neuronal component of some cases supported this view, whereas other findings such as consistent lack of growth hormone (GH) cell hyperplasia in the lesions called for alternative explanation.Fifteen tumors consisting of a pituitary adenoma and a neuronal component have been collected over a 20 yr. period. Acromegaly was present in 11 patients, was equivocal in one, and absent in 3.

scholarly journals Diagnostic challenges and management of a patient with acromegaly due to ectopic growth hormone-releasing hormone secretion from a bronchial carcinoid tumour

2017 ◽  
Vol 2017 ◽  
Author(s):  
Nikolaos Kyriakakis ◽  
Jacqueline Trouillas ◽  
Mary N Dang ◽  
Julie Lynch ◽  
Paul Belchetz ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Carcinoid Tumour ◽  
Common Finding ◽  
Diagnostic Tools ◽  
Oral Glucose ◽  
List Type ◽  
Bronchial Carcinoid ◽  
Growth Hormone Releasing Hormone ◽  
Releasing Hormone ◽  
Ectopic Acromegaly

Summary A male patient presented at the age of 30 with classic clinical features of acromegaly and was found to have elevated growth hormone levels, not suppressing during an oral glucose tolerance test. His acromegaly was originally considered to be of pituitary origin, based on a CT scan, which was interpreted as showing a pituitary macroadenoma. Despite two trans-sphenoidal surgeries, cranial radiotherapy and periods of treatment with bromocriptine and octreotide, his acromegaly remained active clinically and biochemically. A lung mass was discovered incidentally on a chest X-ray performed as part of a routine pre-assessment for spinal surgery 5 years following the initial presentation. This was confirmed to be a bronchial carcinoid tumour, which was strongly positive for growth hormone-releasing hormone (GHRH) and somatostatin receptor type 2 by immunohistochemistry. The re-examination of the pituitary specimens asserted the diagnosis of pituitary GH hyperplasia. Complete resolution of the patient’s acromegaly was achieved following right lower and middle lobectomy. Seventeen years following the successful resection of the bronchial carcinoid tumour the patient remains under annual endocrine follow-up for monitoring of the hypopituitarism he developed after the original interventions to his pituitary gland, while there has been no evidence of active acromegaly or recurrence of the carcinoid tumour. Ectopic acromegaly is extremely rare, accounting for <1% of all cases of acromegaly. Our case highlights the diagnostic challenges differentiating between ectopic acromegaly and acromegaly of pituitary origin and emphasises the importance of avoiding unnecessary pituitary surgery and radiotherapy. The role of laboratory investigations, imaging and histology as diagnostic tools is discussed. Learning points: Ectopic acromegaly is rare, accounting for less than 1% of all cases of acromegaly. Ectopic acromegaly is almost always due to extra-pituitary GHRH secretion, mainly from neuroendocrine tumours of pancreatic or bronchial origin. Differentiating between acromegaly of pituitary origin and ectopic acromegaly can cause diagnostic challenges due to similarities in clinical presentation and biochemistry. Serum GHRH can be a useful diagnostic tool to diagnose ectopic acromegaly. Pituitary imaging is crucial to differentiate between a pituitary adenoma and pituitary hyperplasia, which is a common finding in ectopic acromegaly. Diagnosing ectopic acromegaly is pivotal to avoid unnecessary interventions to the pituitary and preserve normal pituitary function.

scholarly journals Clinical polymorphism of type 2 diabetes in children — the first study in Russia

2015 ◽  
Vol 61 (6) ◽  
pp. 10-16
Author(s):  
Irina Aleksandrovna Eremina ◽  
Tamara Leonidovna Kuraeva ◽  
Lubov Iosifovna Zilberman ◽  
Alexander Yur'evich Mayorov ◽  
Ekaterina Olegovna Koksharova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance ◽  
C Peptide ◽  
History Of ◽  
Peptide Secretion

Objective.To elucidate the specific features of diagnostics, clinical course and manifestations of type 2 diabetes mellitus (DM2) in the children of the Russian population.Material and methods.A total of 80 children presenting with DM2 were enrolled in the study including 70 available for the dynamic examination, with the follow-up period of 2.6 years (1.5; 4.5). The general clinical examination of the patients was supplemented by measuring insulin secretion, studying HLA-polymorphism of the DQ and DR-genes, and determination of type 1 diabetes (DM1) — related specific antibodies (At).Results.The median age at diagnosis of DM2 was 13 years (11.5; 15.5). 58.8% of the children had a family history of DM2 but only 26.3% of them had classical complaints of diabetes mellitus. In 65% of the children, DM2 was diagnosed when they were passing medical examination in connection with obesity (in 51.9% with the use the oral glucose tolerance test (OGTP); 48.1% of these children had the fasting blood glucose level above 7.0 mmol/l. Ketonuria at the onset of the disease was documented in 21.3% of the patients while 85% were either obese or overweight. Antibodies (ICA and IAA) were detected in 15.2% of the children at a low titer. The HLA-genotype associated with a high risk of development of DM1 was identified in 5.5% of the cases. The glycosylated hemoglobin test revealed its mean level of 7.1% (6.3; 8.5%) at the onset of diabetes; in the majority of the children, it fell down below 6.5% within the first 3 years of the disease. During this period, insulin and C-peptide secretion remained elevated. Insulin resistance was initially documented in 81.3% of the children; the dynamic observation failed to show its appreciable decrease. Insulin therapy initiated at the onset of the disease was prescribed to 30% of the patients. After 3 years, only 8% of the children retaining endogenous insulin secretion continued to use insulin.Conclusion.The asymptomatic onset of type 2 diabetes mellitus in the children and adolescents emphasizes the importance of its active diagnostics during the pubertal period in the high risk groups comprising the patients with obesity and the family history of DM2. In one third of the children, the diagnosis of DM2 was possible only with the use the oral glucose tolerance test. DM2 in the children and adolescents is characterized by clinical polymorphism in the form of acute manifestations in 21% of the cases and the absence of obesity and insulin resistance in 15 and 18% respectively. This finding suggests the necessity of differential diagnostics of such cases from DM1 and MODY. Rather high insulin and C-peptide secretion persists for 3 years after the onset of DM2 in the children. Therefore, they do not need insulin therapy during this period. The presence of ICA and IAA antibodies at low titers does not compromise diagnosis of DM2.

scholarly journals Acromegaly with empty sella syndrome

2021 ◽  
Vol 2021 ◽  
Author(s):  
Reyna Daya ◽  
Faheem Seedat ◽  
Khushica Purbhoo ◽  
Saajidah Bulbulia ◽  
Zaheer Bayat
Keyword(s):  
Growth Hormone ◽  
Past History ◽  
Sella Turcica ◽  
Primary Treatment ◽  
Empty Sella ◽  
Oral Glucose ◽  
List Type ◽  
Biochemical Tests ◽  
Ectopic Production

Summary Acromegaly is a rare, chronic progressive disorder with characteristic clinical features caused by persistent hypersecretion of growth hormone (GH), mostly from a pituitary adenoma (95%). Occasionally, ectopic production of GH or growth hormone-releasing hormone (GHRH) with resultant GH hypersecretion may lead to acromegaly. Sometimes localizing the source of GH hypersecretion may prove difficult. Rarely, acromegaly has been found in patients with an empty sella (ES) secondary to prior pituitary radiation and/or surgery. However, acromegaly in patients with primary empty sella (PES) is exceeding rarely and has only been described in a few cases. We describe a 47-year-old male who presented with overt features of acromegaly (macroglossia, prognathism, increased hand and feet size). Biochemically, both the serum GH (21.6 μg/L) and insulin-like growth factor 1 (635 μg/L) were elevated. In addition, there was a paradoxical elevation of GH following a 75 g oral glucose load. Pituitary MRI demonstrated an ES. In order to exclude an ectopic source of GH hypersecretion, further biochemical tests and imaging were done, which were unremarkable. Notably, increased uptake in the sella turcica on the 68Gallium DOTATATE PET/CT confirmed the ES as the likely source of GH secretion. As no overt lesion was noted, medical treatment (octreotide acetate) was initiated with a good clinical and biochemical response. At his 3 month follow-up, he reported an improvement in symptoms (fatigue and headache), however he still complained of low libido. Due to a persistently low testosterone level at follow-up, a long-acting testosterone was initiated. His GH level normalised, and IGF-1 has significantly reduced. Learning points The commonest cause of acromegaly is due to GH hypersecretion from pituitary adenomas (95%). Acromegaly has rarely been found in patients with ES. It is important to exclude a past history suggestive of pituitary apoplexy. Extra-pituitary source of GH such as ectopic production of GHRH with resultant GH hypersecretion needs to be excluded. In such cases, since there is no resectable mass, medical therapy is the primary treatment option.

scholarly journals Reduced Birth Weight, Decreased Early-Phase Insulin Secretion, and Increased Glucose Concentrations after Oral Glucose Tolerance Test in Japanese Women Aged 20 Years with Family History of Type 2 Diabetes

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Mari Honda ◽  
Ayaka Tsuboi ◽  
Satomi Minato-Inokawa ◽  
Kaori Kitaoka ◽  
Mika Takeuchi ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Insulin Secretion ◽  
Birth Weight ◽  
Early Phase ◽  
Tolerance Test ◽  
Japanese Women ◽  
Oral Glucose ◽  
Model Assessment ◽  
History Of

Introduction. We tested the hypothesis that family history of type 2 diabetes (FHD) is associated with reduced birth weight and reduced insulin secretion later in life. Materials and Methods. Birth weight, body composition by whole-body dual-energy X-ray absorptiometry, and homeostasis model assessment-insulin resistance were compared between Japanese women aged 20 years with positive ( n = 73 ) and negative ( n = 258 ) FHD. A subsample of 153 women (57 with positive FHD) underwent a 75 g oral glucose tolerance test. Multivariate logistic regression analyses were used to identify the most important determinants of FHD. Results. Women with positive as compared with negative FHD had lower birth weight ( 3132 ± 364 vs. 3238 ± 418   g , p = 0.04 ). However, the current fat mass index and trunk/leg fat ratio, sophisticated measures of general and abdominal fat accumulation, respectively, did not differ. Women with positive FHD had a lower insulinogenic index ( 2.4 ± 7.3 vs. 6.2 ± 16 , p = 0.007 ) and higher area under the glucose curve ( 217 ± 47 vs. 198 ± 36   mg /dL/2 h, p = 0.006 ). However, fasting and postload insulinemia, homeostasis model assessment-insulin resistance, and Matsuda index did not differ. In multivariate logistic regression analysis, birth weight was marginally associated with FHD (odds ratio, 0.999; 95% confidential interval, 0.98-1.00000; p = 0.0509 ). Conclusions. FHD was associated not only with reduced birth weight but also with decreased early-phase insulin secretion and increased postload glucose concentrations in Japanese women aged 20 years. These findings may be in keeping with the fetal insulin hypothesis and provide some evidence that FHD can alter size at birth, probably through genetic and shared environmental components, which consequently resulted in decreased early-phase insulin secretion and increased glucose excursion in the early twenties. FHD was not related to sophisticated measures of general and abdominal adiposity and insulin resistance/sensitivity.

THE EFFECT OF THE PROGESTOGEN ETHYNODIOL DIACETATE ON GLUCOSE, INSULIN, AND GROWTH HORMONE AFTER SIX MONTHS TREATMENT

1972 ◽  
Vol 70 (2) ◽  
pp. 373-384 ◽  
Author(s):  
W. N. Spellacy ◽  
W. C. Buhi ◽  
S. A. Birk
Keyword(s):  
Growth Hormone ◽  
Blood Glucose ◽  
Plasma Insulin ◽  
Tolerance Test ◽  
Metabolic Effects ◽  
Oral Glucose ◽  
Hormone Levels ◽  
Glucose Levels ◽  
Ethynodiol Diacetate ◽  
Tolerance Curve

ABSTRACT Seventy-one women were treated with a daily dose of 0.25 mg of the progestogen ethynodiol diacetate. They were all tested with a three-hour oral glucose tolerance test before beginning the steroid and then again during the sixth month of use. Measurements were made of blood glucose and plasma insulin and growth hormone levels. There was a significant elevation of the blood glucose levels after steroid treatment as well as a deterioration in the tolerance curve in 12.9% of the women. The plasma insulin values were also elevated after drug treatment whereas the fasting ambulatory growth hormone levels did not significantly change. There was a significant association between the changes in glucose and insulin levels and the subject's age, control weight, or weight gain during treatment. The importance of considering the metabolic effects of the progestogen component of oral contraceptives is stressed.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

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