Recurrent acromegaly resulting from ectopic growth hormone gene expression by a metastatic pancreatic tumor.

Background: Acromegaly is usually the result of a pituitary growth hormone (GH)-cell adenoma or is more rarely due to ectopic secretion of GH-releasing hormone (GHRH). The authors previously described a more unusual form of acromegaly secondary to ectopic GH synthesis by a pancreatic islet cell tumor.

Methods: One year after tumor resection and transient disease remission, multiple abdominal metastases were identified with accompanying elevated levels of circulating GH and insulin-like growth factor-1 (IGF-1).

Sustained pulsatile insulin secretion from adenomatous human beta-cells. Synchronous cycling of insulin, C-peptide, and proinsulin.

The endocrine pancreas secretes insulin in a pulsatile fashion. This rhythm is generated at a site within the pancreas, although its precise location has not been determined. With an in vitro system, we tested the possibility that beta-cells might generate spontaneous pulsatile insulin secretion in the absence of any external influence.

Metastatic carcinoma to pituitary adenomas: a report of two cases.

Two cases of carcinoma metastatic to pituitary adenomas are reported. One patient had a prostatic adenocarcinoma, giving rise to metastases in an adenoma found incidentally at autopsy; clinically and immunohistochemically, the adenoma showed lack of endocrine activity. The second patient had symptoms of cortisol excess.

Rhabdomyosarcoma in the region of the sella turcica.

Intracranial extension of rhabdomyosarcoma from the face, nasopharynx or middle ear is rare. A 16-year-old boy presented with deterioration of vision and headache. CT scan revealed a soft tissue mass occupying the sphenoid and ethmoid sinuses, extending to the suprasellar fossa and impinging on the optic chiasm.

Effects of caloric restriction and exercise on insulin receptors in obesity: association with changes in membrane lipids.

We have studied the effects of supervised caloric restriction and exercise on mononuclear leukocyte lipid composition, membrane fluidity, and insulin receptors in ten nondiabetic obese adults, (175 +/- 9.3% of ideal body weight) and ten normal adult subjects. In a second study, we examined the effects of caloric restriction alone using a very low calorie liquid diet in the treatment of another ten obese adults.

Human fetal adenohypophysis. Histologic and immunocytochemical analysis.

One hundred and forty human fetal pituitary glands were removed from fetuses at 7-40 weeks of gestation and studied by light microscopy and immunocytochemistry to localize adenohypophysial hormones. For immunocytology, the avidin-biotin-peroxidase complex technique was more sensitive and identified hormones in younger fetuses than did the immunoperoxidase method. Adrenocorticotrophin, beta-endorphin, and growth hormone were the first hormones detected; they were identified by intense cytoplasmic immunopositivity at 8 weeks of gestation.

Sellar glomangioma.

A glomangioma (glomus tumor) arising in the pituitary region is described. The histologic and ultrastructural features were characteristic. The tumor was composed of epithelioid cells arranged in an organoid fashion around vascular channels and contained scattered mast cells.

Mammosomatotroph cell adenoma of the human pituitary: a morphologic entity.

Nine cases of a hitherto undescribed morphologic entity, termed mammosomatotroph cell adenoma of the human pituitary, are reported. These tumors, occurring mostly in men, are invariably associated with acromegaly (or gigantism) and high-normal or slightly elevated blood prolactin levels, and it cannot be distinguished clinically from well-differentiated growth hormone cell or mixed growth hormone cell-prolactin cell adenomas. They show a slow growth rate and usually exhibit a diffuse pattern and intense cytoplasmic acidophilia by histology.

Pathophysiology of acromegaly.

This review discusses the pathophysiology of acromegaly. Acromegaly has been classified in this paper into distinct entities based on etiology, ultrastructural features of the pituitary, and cytogenesis. This classification has been proposed based on clinical signs, immunoperoxidase techniques, transmission electromicroscopy and immunoelectron microscopy.

Prolactin cells in the human pituitary. A quantitative immunocytochemical analysis.

Sixty adult human pituitary glands taken at autopsy were stained for prolactin using the immunoperoxidase technique, and percentages of prolactin-bearing cells were assessed. There was no difference between the percentages of prolactin cells seen in the adenohypophyses of adult men and nulliparous women; they averaged 16.9%, with an average of from 8.

Adenoma of the human pituitary producing growth hormone and thyrotropin. A histologic, immunocytologic and fine-structural study.

A pituitary adenoma removed by surgery from a 22-year-old man was studied by histology, immunocytology, transmission electron microscopy and immunoelectron microscopy. Clinically, the patient had acromegaly and euthyroidism with elevated blood GH concentrations. Blood TSH and T4 levels were within the normal range.

Thyrotroph cell adenoma of the human pituitary gland associated with primary hypothyroidism: clinical and morphological features.

The morphological features of a pituitary adenoma resected from a 39-year-old woman with hypothyroidism have been investigated. Hypothyroidism followed radioactive iodine treatment of pre-existing hyperthyroidism, presumably Graves' disease. Blood TSH was low during a euthyroid interval and was elevated above normal with the onset of hypothyroidism.

The effect of pregnancy on suspected pituitary adenomas after conservative management of ovulation defects associated with galactorrhea.

Thirty infertile patients with ovulation defects and galactorrhea conceived after medical therapy: four after clomiphene stimulation (with or without hCG) and 26 after receiving CB-154 (2-Br-alpha-ergocryptine or bromergocryptine). Pregnancies were followed closely; sellar tomography and perimetry were repeated at 36 weeks' and 8 weeks' post partum. One patient required transsphenoidal adenectomy because of acute pituitary enlargement.

Predicted ovulatory response to 2-brom-alpha-ergocryptine (CB-154) in amenorrhea-galactorrhea syndromes.

Adenohypophyseal function was evaluated in 20 consecutive patients with hyperprolactinemic amenorrhea-galactorrhea in an attempt to predict ovulatory response with 2-brom-alpha-ergocryptine (CB-154) therapy. Pituitary fossa tomography and response to insulin, thyrotropin-releasing hormone, and luteinizing hormone--releasing hormone were correlated with the return of ovulatory cycles. Fourteen of 15 patients demonstrating normal pretreatment sellar volume ovulated, compared with 0 of 5 showing increased volume.

Null cell adenoma of the human pituitary.

Among 343 surgically-removed pituitary adenomas, 56 tumors were unassociated clinically or biochemically with increased hormone secretion and contained no adenohypophysial hormones by the immunoperoxidase technique, except for 10 cases in which a few scattered cells showed positive immunostaining for beta-TSH or beta-FSH, beta-LH, prolactin and/or alpha-subunit. These tumors were chromophobic adenomas with no PAS, lead hematoxylin or carmoisine positivity and electron microscopy failed to reveal their morphogenesis. The term null cell adenoma of the pituitary is proposed to designate this tumor type.

Correlative ultrastructural morphometry of human prolactin-producing adenomas.

Ultrastructural morphometry was applied to 24 surgically removed human sparsely granulated prolactin cell adenomas in an attempt to correlate the measurements with blood prolactin levels, size of tumour, and age and sex of patient. No correlation was apparent. However, further evaluation revealed that correlation existed between size of tumour and blood prolactin levels, indicating that tumour mass, and not subcellular morphology, was related to the amount of prolactin released.

The effects of estrogen on prolactin cells of the male rat pituitary. An immunocytologic and autoradiographic study.

Both immunoperoxidase staining (to identify specifically prolactin cells) and autoradiography after labelling with 3H-thylmidine (to demonstrate those cells which actively produce DNA) were performed on the same sections from normal male rat pituitaries and on those from rats treated with 17 beta-estradiol. In normal pituitaries, 3.3% of prolactin cells appeared to take up 3H-thymidine.

Gonadotroph cell adenoma of the pituitary in a women with long-standing hypogonadism.

A 57-year-old woman, with long-standing hypogonadism secondary to irradiation of the ovaries, was found to have a pituitary tumor which was removed and investigated by histology, immunocytology and electron microscopy. Histologically, the tumor corresponded to a chromophobe, slightly PAS positive adenoma and the immunoperoxidase stain revealed the presence of both FSH and LH in the cytoplasm of the adenoma cells. The structural features of the adenoma cells resembled those of FSH cells in the nontumorous adenohypophysis.

Pituitary adenomas in old age.

Pituitaries obtained at unselected autopsies of 152 men and women over 80 years of age, dying of different diseases, have been investigated histologically by using various staining procedures, including the immunoperoxidase technique. In 20 pituitaries, 22 adenomas were found providing evidence that these tumors are common in aging subjects. In 9 adenomas out of 17 cases, the immunoperoxidase technique revealed the presence of prolactin, indicating that prolactin-producing adenomas constitute the most frequently occurring pituitary tumor type in old age.

Cushing's syndrome and autoimmunity.

Is Cushing's syndrome ever caused by adrenal stimulating autoantibodies? Specific antiadrenal antibodies were found in the serum of three of seven patients with Cushing's syndrome. The immunologic techniques that showed positive results were complement fixation, tanned RBC hemagglutination, and immunofluorescence. Lymphocytic infiltration of the adrenal was present in two cases, in one of which nodular hyperplasia seemed to be of primary adrenal origin with autoimmunity as a possible cause.

Regression of pituitary tumors, a possible effect of bromergocryptine.

With the advent of the prolactin radioimmunoassay and more sensitive methods of roentgenologic examination, prolactin-secreting pituitary tumors are now being diagnosed with much greater frequency. Definitive treatment has been considered to involve transphenoidal hypophysectomy. The symptoms of hyperprolactinemia including amenorrhea, galactorrhea and infertility can usually be controlled without difficulty by bromergocryptine therapy, but little is known regarding continued tumor growth.

Thyrotrophs in old age. An immunocytologic study of human pituitary glands.

In order to reveal whether thyrotroph cells of the human pituitary are affected by aging, a histologic and immunocytologic study was undertaken on the pituitaries of patients over 80 years of age (10 men, 10 women), dying of various acute illnesses and the findings compared with those of a younger age group (10 men, 10 women), dying of various acute illnesses between the age of 20-56 years. The incidence, distribution, granulation, cytoplasmic vacuolization, as well as immunoreactivity of TSH cells, showed no major differences related to age and sex. Lack of involution of thyrotroph cells in old subjects indicates that the pituitary is capable of producing TSH with advancing age.

Prolactin cell adenomas of the human pituitary. Morphologic features of prolactin cells in the nontumorous portions of the anterior lobe.

Twenty pituitary glands, harbouring prolactin cell adenomas, obtained from autopsy of male and female patients of various ages and dying of different diseases have been investigated by the immunoperoxidase technique in order to reveal the morphologic changes of prolactin cells in the nontumorous protions of the anterior lobes. For comparison, 40 nontumorous pituitary glands and 20 pituitaries lodging adenomas not consisting of prolactin cells have also been studied. In all four prolactin cell adenoma cases, the anterior lobes contained numberous prolactin cells outside the tumors, indicating a lack of involution of prolactin cells in the nontumorous portions of the pituitary glands.