scholarly journals Long-term management in five cases of TSH-secreting pituitary adenomas: a single center study and review of the literature

2007 ◽  
Vol 157 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Tina Kienitz ◽  
Marcus Quinkler ◽  
Christian J Strasburger ◽  
Manfred Ventz
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumor ◽  
Somatostatin Analogs ◽  
Pituitary Tumors ◽  
Term Treatment ◽  
Dopaminergic Agonists ◽  
Pituitary Mass ◽  
Long Term Treatment ◽  
Age Range

Objective: TSH-secreting pituitary tumors (TSH-omas) are a rare cause of hyperthyroidism and account for <1% of all pituitary adenomas. Failure to recognize the presence of a TSH-oma may result in dramatic consequences such as thyroid ablation that may cause further growth in pituitary tumor. The primary goal of the treatment of TSH-omas is to remove the pituitary tumor. Medical treatment includes dopaminergic agonists or somatostatin analogs. Methods and results: We report five cases of TSH-oma diagnosed between 1997 and 2006 and review the literature. All the patients are females with an age range from 54 to 65 years at diagnosis. Four of the five patients had at least one event of thyroid surgery due to goiter or nodule of unknown dignity. Three of the five patients had a stroke before the diagnosis of TSH-oma, probably due to hypertension, or smoking and contraceptive treatment. One patient with invasive tumor growth received stereotactic radiotherapy (and developed panhypopituitarism after operation), another patient received somatostatin analogs preoperatively and successfully underwent transsphenoidal operation. Three of the five patients received dopaminergic agonists (bromocriptine 5 mg daily or cabergoline 0.5–0.75 mg per week), because they refused surgical therapy or the tumor was stable under dopaminergic therapy. All patients have been followed-up for 2.5–8 years. A normalization of circulating thyroid hormone levels was achieved in all patients. The patient who underwent operation shows no recurrence of the disease. The other patients have a stable pituitary mass without signs of growth. Conclusion: We report the successful long-term treatment of TSH-omas with different therapies.

scholarly journals Long term treatment of a thyrotropin-secreting microadenoma with somatostatin analogues

2010 ◽  
Vol 54 (5) ◽  
pp. 502-506 ◽  
Author(s):  
Alma Prieto-Tenreiro ◽  
Patricia Díaz-Guardiola
Keyword(s):  
Pituitary Adenomas ◽  
Somatostatin Analogs ◽  
Somatostatin Analogues ◽  
Term Treatment ◽  
Somatostatin Analogue ◽  
Delay In Diagnosis ◽  
First Line Therapy ◽  
Long Term Treatment ◽  
Primary Hyperthyroidism

Thyrotropin (TSH) secreting pituitary adenomas (TSH-omas) account for < 1% of all pituitary adenomas and are a rare cause of hyperthyroidism. The diagnosis is often made at the stage of macroadenoma because of the aggressive nature of the tumor and due to the fact that patients are mistakenly treated for more common primary hyperthyroidism for a long time. First line therapy is transsphenoidal resection of the tumor, which can cure one-third of the patients completely. However, if surgery is not possible or curative, pituitary radiotherapy and/or somatostatin analogs (SSA) can be useful. We report the case of a 54-year-old woman treated 20 years earlier for a mistakenly suspected primary hyperthyroidism. Given the persistence of symptoms she was studied further and was diagnosed with a thyrotropinoma. Despite the delay in diagnosis and prior thyroid ablation, a microadenoma was found. As transsphenoidal surgery was not considered effective, medical therapy with a somatostatin analogue was initiated. Currently, at four years of follow-up, the patient continues on this treatment and remains euthyroid and asymptomatic. We report a case of successful long-term treatment with SSA, after unsuccessful surgery.

Non-pituitary actions of somatostatin. A review on the therapeutic role of SMS 201-995 (sandostatin)

1986 ◽  
Vol 113 (2_Suppla) ◽  
pp. S41-S55 ◽  
Author(s):  
Steven W. J. Lamberts
Keyword(s):  
Half Life ◽  
Potential Role ◽  
Somatostatin Analogs ◽  
Subcutaneous Administration ◽  
Term Treatment ◽  
Acute Administration ◽  
Intestinal Function ◽  
Long Term Treatment

Abstract. Natural Somatostatin has a short half-life (3 min), is only active after intravenous administration and causes a rebound hypersecretion of hormones after discontinuation of administration. Recently a longacting powerful Somatostatin analog was developed (SMS 201-995; Sandostatin) which has a half-life of 113 min after subcutaneous administration. After administration of this analog no rebound hypersecretion of hormones was observed. In the present review the effects of the acute administration and of long-term treatment with SMS 201-995 in acromegalic patients is discussed. In addition the potential role of therapy with Somatostatin analogs and the preliminary effects of Somatostatin and/or SMS 201-995 are discussed in disorders of gastro-intestinal function (haemorrhages, diarrhoea, pancreatitis and endocrine pancreatic tumours), diabetes mellitus, central nervous system disturbances and oncology. Finally, several aspects of the tolerance, tachyphylaxis and side effects of SMS 201-995 are discussed.

Effects of long-term treatment with the gonadotropin-releasing hormone analog nafarelin in patients with non-functioning pituitary adenomas

1994 ◽  
Vol 130 (4) ◽  
pp. 339-345 ◽  
Author(s):  
Paolo Colombo ◽  
Bruno Ambrosi ◽  
Katia Saccomanno ◽  
Monique Bassetti ◽  
Donatella Cortelazzi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Term Treatment ◽  
Gonadotropin Releasing Hormone ◽  
Gnrh Analog ◽  
Hormonal Responses ◽  
Releasing Hormone ◽  
Hormone Analog ◽  
Long Term Treatment ◽  
Non Functioning Pituitary Adenomas

Colombo P, Ambrosi B, Saccomanno K, Bassetti M, Cortelazzi D, Faglia G. Effects of long-term treatment with the gonadotropin-releasing hormone analog nafarelin in patients with non-functioning pituitary adenomas. Eur J Endocrinol 1994;130:339–45. ISSN 0804–4643 The supposed origin of non-functioning pituitary adenomas (NFPA) from gonadotrophs prompted us to investigate the effects of the gonadotropin-releasing hormone (GnRH) analog nafarelin on hormonal and tumoral parameters in eight patients with NFPA, previously unsuccessfully operated and all hypogonadal. Nafarelin was administered intranasally for 1 year to all patients. Four patients received a dose of 1200 μg/day; the remaining four received 800 μg/day for 3 months, which was subsequently increased to 1200 μg/day. Basal gonadotropin and α-subunit (αSU) levels were low–normal. In four patients (nos. 1,2,3,5) nafarelin significantly lowered luteinizing hormone (LH) levels, and also folliclestimulating hormone (FSH) in three of them (nos. 1,2,3). Persistent FSH stimulation occurred in three patients (nos. 6,7,8), with a transient slight LH increase only in patient no. 8. In one patient (no. 7), αSU levels were persistently stimulated. Hormonal responses to an acute GnRH test during nafarelin administration were generally blunted when compared to the pretreatment responses. Immunofluorescence results, obtained before treatment in five adenomas (nos. 2,3,4,6,7), had been as follows: positive for FSH-β in all; negative for LH-β in all, except a few positive cells in case no. 4; positive for αSU in three (nos. 2,3,7). No changes of visual field and tumor size occurred in any patient during treatment. However, one patient who showed a persistent increase in FSH levels exhibited left palpebral ptosis after 12 months of therapy and underwent a second transsphenoidal surgery. In conclusion: NFPA behave heterogeneously in terms of hormonal responses to GnRH analog therapy; long-term nafarelin treatment was unsuccessful in reducing the size of NFPA; and stimulation rather than inhibition of gonadotropin levels may suggest discontinuance of GnRH analog therapy in NFPA. Paolo Colombo, Istituto di Scienze Endocrine, Ospedale Maggiore IRCCS-Pad, Granelli, via F. Sforza 35, 20122 Milano, Italy

Long-term Effect of Aromatase Inhibition in Aromatase Excess Syndrome

2021 ◽  
Author(s):  
Gerhard Binder ◽  
Akie Nakamura ◽  
Roland Schweizer ◽  
Tsutomu Ogata ◽  
Maki Fukami ◽  
...  
Keyword(s):  
Tandem Duplication ◽  
Low Dose ◽  
Adult Height ◽  
Standard Deviation Score ◽  
Bone Age ◽  
Term Treatment ◽  
Long Term Effect ◽  
Long Term Treatment ◽  
Age Range

Abstract Context Aromatase excess syndrome (AEXS) is a very rare disorder characterized by prepubertal gynecomastia, bone age acceleration, and early growth arrest. Heterozygote submicroscopic rearrangements within the promotor of CYP19A1 result in overexpression of aromatase and enhanced aromatization of androgens. Objective The objective was to study long-term treatment effects of an aromatase inhibitor. Methods Data from 7 boys with AEXS were retrospectively collected. Genetic analysis revealed upstream of CYP19A1 a 165 901 bp deletion in 4 German cousins, a 198 662 bp deletion in 2 Japanese brothers, and a 387 622 bp tandem duplication in a Japanese boy. Results All boys developed prepubertal gynecomastia, at median 9.0 years of age (range: 7.0-11.0). Height was +1.20 standard deviation score (SDS) (–0.24 to +1.98); predicted adult height was -1.29 SDS (-3.29 to +1.09). Four boys were treated with 1.0 mg of anastrozole daily, while 3 reached adult height untreated. Treatment with anastrozole was stopped after 5.6 years (4.0-6.8). Three treated boys exceeded their prognosis by 2.4, 6.9, and 8.1 cm, while 1 untreated boy fell below the prognosis by 8.6 cm. One treated with a low dose and 2 untreated reached their prognosis. Adult heights were –0.91 SDS with anastrozole (–2.86 to –0.29) and –0.15 SDS without (–2.31 to –0.03). Distance to target height was –0.22 SDS with anastrozole (–1.72 to +0.52) and +0.54 SDS without (+0.23 to +1.30). Conclusion Spontaneous growth in AEXS varied, even in the same family. Our data suggest that early started, long-term inhibition by anastrozole promotes adult height in boys with AEXS.

scholarly journals Treatment with GH receptor antagonist in acromegaly: effect on cardiac arrhythmias

2013 ◽  
Vol 168 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Renata S Auriemma ◽  
Rosario Pivonello ◽  
Maria Cristina De Martino ◽  
Giuseppe Cudemo ◽  
Ludovica F S Grasso ◽  
...  
Keyword(s):  
Somatostatin Analogs ◽  
Complete Recovery ◽  
Term Treatment ◽  
Left Ventricular ◽  
High Dose ◽  
Short Term Treatment ◽  
Conduction Disturbances ◽  
Long Term Treatment ◽  
Gh Receptor Antagonist

ObjectiveTo evaluate the effects of short- and long-term treatment with pegvisomant (PEG) on arrhythmias in acromegalic patients resistant to long-term, high-dose therapy with somatostatin analogs (SA).Materials and methodsThirteen patients entered the study. All patients started PEG at initial dose of 10 mg daily and then titrated to 5 mg every 6 weeks on the basis of IGF1. A standard 24-h electrocardiography registration was performed in all patients at baseline and after 6 and 18 months of PEG to evaluate: mean (HR), maximum (MHR), and minimum (mHR) heart rate; pauses number (P) and duration (PD); supraventricular episodes (SEs) number and duration (SED); and ventricular ectopic beats (EB) number and duration (EBD). Left ventricular mass (LVM) was also evaluated by standard echocardiography.ResultsA slight but not significant decrease in HR, MHR, and mHR was observed after 6-month PEG, whereas a significant decrease in HR (P=0.03), MHR (P=0.05), and mHR (P=0.05) was found after 18-month PEG compared with baseline. LVM significantly (P=0.05) correlated with MRH (r=−0.50) after short-term treatment, and with HR (r=−0.54) and mHR (r=−0.55) after long-term treatment. Long-term PEG induced the complete recovery of arrhythmias recorded at baseline in one patient and the improvement of rhythm disorders developed after 6-month therapy in another patient. The prevalence of conduction disturbances passed from 15 to 7.7% after long-term PEG.ConclusionsLong-term treatment with PEG reduces HR, MHR, and mHR and improves rhythm abnormalities in acromegaly.

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