Growth Hormone Deficiency and Replacement in Patients with Treated Cushing’s Disease, Prolactinomas and Non-Functioning Pituitary Adenomas: Effects on Body Composition, Glucose Metabolism, Lipid Status and Bone Mineral Density
Arthur ColsonAntonia BrookeDavid WalkerG. M. BesserShern L. ChewA. GrossmanP JenkinsWM DrakeJohn P. Monson
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<i>Background/Aims:</i> This study was designed to determine whether previous Cushing’s disease (CD) or prolactinoma (PRL) could exert adverse effects additional to those of growth hormone (GH) deficiency as a consequence of variable degrees of prior hypogonadism or hypercatabolism. We report the effects of 5 years GH treatment in 124 GH deficiency adults; 42 patients with non-functioning pituitary adenomas (NFPA), 43 with treated PRL and 39 with treated CD. <i>Methods:</i> Fasting plasma glucose, HbA<sub>1c</sub>, lipoprotein profile, anthropometry and bone mineral density (BMD) were measured at baseline, 6 months and annually up to 5 years. <i>Results:</i> Mean body mass index remained unchanged in the PRL group and tended to increase in the NFPA group. In contrast, body mass index decreased in the CD group. Decreases in waist and waist/hip ratio were seen in all groups at 6 months. Decreases in total cholesterol and low-density lipoprotein cholesterol were seen in all groups and remained sustained at 5 years. Plasma glucose and HbA<sub>1c</sub> increased at 6 months. Subsequently, plasma glucose returned to baseline values at 5 years; in contrast, HbA<sub>1c </sub>remained unchanged at the end of the study. Baseline lumbar spine and hip BMD were lower in the PRL and CD groups than in the NFPA group, decreased over 1 year in all groups and subsequently increased by 2 years in NFPA with a subsequent increase in lumbar spine BMD in PRL and CD groups delayed to 3–5 years. <i>Conclusions:</i> Baseline characteristics and response to GH replacement are qualitatively similar in NFPA, PRL and CD patients. Because improvements in BMD occur later in PRL and CD patients, an extended trial of GH therapy may be indicated in those patients who were commenced on GH therapy as an additional treatment for reduced BMD.Keywords:
Prolactinoma
Objective To study the mechanism of estrogen in inducing rat prolactinoma.Methods Adult Wistar rats were divided into two groups at random.Rat in control group(n=5)were subscutaneously implanted with a blank implant.Rats in prolactinoma group(n=5) were implanted with estrogen-containing implants.After 8 weeks,all the animals were sacrificed.Each pituitary gland was weighed and collected for histopathological and immunocytochemical study.Serum prolactin(PRL) levels were measured by RIA.c-fos mRNA levels in pituitary tissue were measured by RT-PCR.Results Pituitary weights,PRL levels and PRL(+)cell counts in prolactinoma group were higher than those in control group(P0.1).Prolactinoma models were developed successfully according to serum PRL level,pituitary weight and immunocytochemical profile.The expression levels of c-fos mRNA in prolactinoma group were obviously higher than those in control group(P0.01).Conclusion Estrogen stimulates c-fos gene expression,which plays an important role in induction of rat prolactinoma.
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The prolactinoma is the most frequent pituitary tumor; the clinical presentation in women is characterized by menstrual disorders, amenorrhea, galactorrhea and/or sterility; neurological symptoms are present only when the tumor exceeds the sella turcica which is exceptional. Prolactin levels over 100 ng/mL are usually diagnostic of prolactinoma, as long as there are no pregnancy and/or hypothyroidism. The first therapeutical option is dopamine agonist drugs, thus surgery has been practically eliminated. Dopaminergic drugs suppress both synthesis and prolactin secretion, which in turn restores the ovarian function and induces tumor shrinkage. In conclusion, dopamine agonists constitute the prolactinoma treatment; in addition drug withdrawal is followed by remission of prolactinoma activity. In men, the size of the prolactinoma is larger, macroprolactinoma which usually presents extrasellar extension accompanied of neurological and visual symptoms; however the prolactinoma exhibits a favorable response with dopaminergic drugs.
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目的将学习 prolactinoma 的诊断、治疗学的特征。有 prolactinoma 的 124 个病人在临床的表明被学习的方法，病理学， endocrinological， X 光线照相术、治疗学的特征。结果男病人的平均年龄是 41.6 年， 32.3 年女性。在男性的主要临床的表明是性、视觉的机能变常。在女性，机能变常行经并且乳漏。平均浆液催乳激素在男性是 1875.22，在女性的 376.6 ng/mL。肿瘤的平均直径是在男性的 38.05 公里，并且 83.3% 肿瘤是侵略的，在女性是 15.25 公里并且 49% 。在外科以后，平均浆液催乳激素减少了到 385.84 ng/mL (P < 0.05 ) ， 15 个病人中的 13 个在性功能改善了， 82.6% 病人在视力和视觉地改善了。在女性，催乳激素减少了到 23.93 ng/mL (P < 0.05 ) ，并且有 microprolactinoma 的 81.25% 不孕得到了怀孕，比药治疗的控制高(P < 0.05 ) 。在男性的结论，肿瘤通常更大、更侵略，并且浆液催乳激素层次更高。病人是年长的。但是在女性，比男性年轻得多，大多数肿瘤是微腺瘤，并且在操作以后，通常，到正常的减少铺平的催乳激素和更多怀孕碰巧。单个治疗的结果与更少的满足，我们在操作附近倡导综合治疗。
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Pituitary prolactin has been quantified by radioimmunoassay in whole milk obtained from cattle, goats, sheep and rats. Prolactin concentrations in milk samples obtained following the completion of lactogenesis approximate concentrations of the hormone in blood plasma or serum. However, concentrations of prolactin in prepartum mammary secretions were much higher than plasma prolactin in prepartum dairy cows. This observation was consistent with the hypothesis that during mammary lactogenesis, endogenous milk prolactin in the alveolar lumen may be an additional source of biologically active prolactin. The value of milk prolactin to neonatal animals remains unknown. Experiments with milk-fed calves and suckling rats failed to demonstrate absorption of the intact molecule into the neonate's blood. Further research is needed to determine the role, if any, that maternal prolactin consumed in milk plays in neonatal physiology. Measurements of milk prolactin seem to be highly predictive of the average blood prolactin concentration. Milk prolactin can probably be used in lactating females to predict average plasma prolactin in a manner that is relatively independent of stress- or milking-induced increases in pituitary release of the hormone.
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In a previous study we demonstrated that hyperprolactinemia causes increased ADP stimulation of platelets both in vitro and in vivo (1). Moreover, we showed a higher incidence of venous thrombembolism (VTE) in prolactinoma compared to the general population. In attempt to analyse the association between pituitary tumors especially prolactinoma and VTE we investigated 311 patients undergoing pituitary surgery. The diagnosis was based on immunohistochemistry and hormonal findings. Hormone active adenomas (n=27 GH- and n=75 PRL- secreting) and hormone inactive pituitary tumors (n=209) were analysed. In patients with hormone inactive tumors we detected 6 (2.9%) prae- and 1 (0.5%) postoperative VTE, whereas GH-adenoma showed 1 VTE (3.7%) praeoperative. However, patients with prolactinoma showed a significant (p<0.001) higher incidence of prae- n=5 (6.7%) and postoperative n=5 (6.7%) VTE than hormone inactive or GH- adenoma and as estimated in the general population. Therefore, our study indicate that patients with pituitary tumors especially those with prolactinoma seems to have an increased risk for VTE. One of the reasons of this increased risk might be the thrombogenic effect of hyperprolactinemia mediated through enhanced platelet reactivity.
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It was studied 40 patients (6 men and 34 women) with prolactinoma. It was conducted a quan-titative and qualitative analysis of complaints at the time of disease manifestation and examination.The main specific clinical manifestations of pathological hyperprolactinemia in women and men haveimpaired of sexual function. Severity of complaints of a general nature for men concealed clinicalsymptoms of hyperprolactinemia and complicates timely diagnosis of prolactinoma. The frequency ofneurological and neuro-ophthalmic complaints in patients with prolactinoma depends on the size ofthe hypophysis adenoma. In 15 % of patients prolactinomas characterized by a long asymptomaticand are diagnosed at a stage invasive macroadenomas.
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Prolactinoma
Galactorrhea
Pituitary Tumors
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Objective To study the effect of the Chinese medicine,Jiangrusan,on the expression of Pit-1 in rat prolactinoma.Methods To establish prolactinoma model in rats.The Prolactinoma-bearing rats were divided into 2 groups at random.Jiangrusan was orally administered to rats in the Jiangrusan group,and water was administered to rats in the placebo group.After 4 weeks of treatment,all animals were sacrificed and the pituitary gland was taken out and weighed.Serum prolactin(PRL) levels were measured by RIA method.Pit-1 mRNA levels in pituitary tissue were measured by RT-PCR.Results The weight of pituitary gland and PRL level in rats of Jiangrusan group were significantly lower than those in the placebo group(P0.001,respectively).The expression level of Pit-1 mRNA in rats of Jiangrusan group was significantly lower than that in placebo group(P0.001).Conclusion Jiangrusan has a potential preventive effect on estrogen-induced rat prolactinoma.The decrease of Pit-1 mRNA level may be involved in the mechanism of anti-prolactinoma effect of Jiangrusan.
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Abstract Objective: We report an extremely rare case of a giant invasive prolactinoma presenting as a nasopharyngeal tumour. Method: Case report and literature review regarding giant prolactinoma. Results: Giant prolactinoma is a rare form of prolactinoma which accounts for 0.5–4.4 per cent of all pituitary tumours. It is more common in men and generally presents with symptoms of endocrine disturbance or neurological deficit. Conclusion: To our knowledge, this is the first report of giant prolactinoma presenting with symptoms of sinusitis and nasopharyngeal tumour.
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