- A rare case of necrotizing hypophysitis (NH) in a 52-year-old man presenting with pituitary apoplexy and sterile meningitis is described. This case indicates that the diagnosis of NH could be made ...without biopsy, based on concomitant presence of diabetes insipidus, hypopituitarism and radiologic features of ischemic pituitary apoplexy. Conservative management of pituitary apoplexy should be advised in NH. Additionally, this is the first report of a case of sterile meningitis caused by ischemic pituitary apoplexy.
Purpose. In low-income countries, prolactinomas are difficult to manage with dopamine agonists (DA). We compared the effectiveness of DA in microprolactinomas as a first line treatment and as ...adjuvant therapy for residual macroprolactinomas treated surgically. Methods. Our retrospective study analyzed 78 patients, 38 with microprolactinomas and 40 with macroprolactinomas. Microprolactinomas were treated with DA. Macroprolactinomas were treated with microsurgical or endoscopic adenomectomies and adjuvant DA. Surgical remission was defined as normoprolactinemia three months postoperatively, and long-term remission as normoprolactinemia at the last control. Results. Surgical remission was achieved in 9 patients (23%). Postsurgical tumor mass was reduced by 50% (34–68). Residual macroprolactinoma size was greater than microprolactinoma size prior to treatment (10 mm versus 4 mm, P < 0.001 ). Both groups received similar doses of DA. Long-term remission occurred in 68% of microprolactinomas and 43% of macroprolactinomas ( P = 0.102 ). Prolactin (PRL) levels at the last control were similar in both groups (23.1 versus 32.9 mcg/L, P = 0.347 ). Conclusion. Comparable remission rates and PRL levels were reached in microprolactinomas and macroprolactinomas using similar doses of DA. Although complete tumor resection is the goal of surgery, our study suggests that even partial surgical removal has a role in treatment of prolactinomas since it may enhance the response to DA.
Prema brojnim istraživanjima adenomi hipofize vrlo su česte neoplazme, a među njima
su najčešći prolaktinomi. Suvremene epidemiološke studije pokazuju da su adenomi hipofize
3 do 5 puta učestaliji ...nego što se mislilo. Razvojem i dostupnošću modernih neuroradioloških
metoda, kao i pouzdanim mjerenjem koncentracije hormona u plazmi bolesnika,
dijagnoza adenoma hipofize postala je jednostavnija i pouzdanija. Sve češće susrećemo tzv. incidentalome,
tzv. slučajno nađene tumore hipofize, kod potpuno asimptomatskih bolesnika,
bez biokemijskih ili neuroloških promjena.
Adenomi hipofize najčešće se dijagnosticiraju u mladih žena u reproduktivnoj dobi. Kod muškaraca
i starijih osoba su rjeđi, a obično se dijagnosticiraju u uznapredovanoj fazi kao nefunkcionalni
adenomi ili makroprolaktinomi s dominacijom neuroloških ispada u kliničkoj slici. U
djetinjstvu su rijetki, a mogu se javiti i u obliku nasljednih adenoma hipofize. Atipični invazivni
adenomi javljaju se u 15 % makroadenoma hipofize, a maligna alteracija izuzetno je rijetka.
Cijena njihovog liječenja je visoka. Poznavanje epidemioloških podataka omogućuje kvalitetnije
planiranje kliničke obrade u zdravstvenom sustavu uz smanjenje nepotrebnog morbiditeta,
kao i troškova liječenja.
U današnje doba živimo u gustom moru polja elektromagnetskog zraèenja, za koje se
procjenjuje da je 100 do 200 puta jaèe nego što je bilo prije sto godina. Dalekovodi, radari
odašiljaèi, elektrièni ...vodovi, mobilni telefoni, televizori, digitalni satovi, CD/radioplejeri,
raèunala i bežièni internet stvaraju elektromagnetska polja, a problem elektromagnetskog
“zagaðenja” pogoršava upravo eksplozija bežiènih tehnologija. Tijekom rada, spomenuti ureðaji
emitiraju elektromagnetsko zraèenje koje utjeèe na žive sustave. S obzirom na to da mobilne
telefone za vrijeme razgovora prislanjamo na uho, dio njihovog zraèenja apsorbiraju tkiva
glave, te postoji opravdana zabrinutost da njihovo korištenje utjeèe na razvoj tumora
mozga i drugih fizioloških poremeæaja.
U svijetu se progresivno poveæava broj korisnika i uèestalost korištenja mobilnih telefona, stoga
je ovo pitanje od velikog javnozdravstvenog znaèaja. Mnogobrojne studije pokušale su
ustanoviti utjeèe li korištenje mobilnih telefona na nastanak tumora mozga. Ovaj èlanak prikazuje
problematiku vezanu uz štetne zdravstvene utjecaje uzrokovane korištenjem mobilnih telefona
te komentira rezultate znaèajnijih studija iz tog podruèja.a
The dilemma of whether to apply surgical or drug treatment to prolactinomas has been ongoing for the past 30 years. The aim of this study is to compare the early postoperative values of prolactin ...(PRL) in two groups of patients with prolactinomas: those who underwent primary surgical-treatment, and those who underwent surgery after a dopamine agonist (DA) therapy. We present the results of surgical treatment on a series of 161 patients with prolactinomas. Surgery was the primary treatment in 65 patients, while 96 patients had surgery following a long-term treatment with a DA. All surgically treated prolactinomas were operated in the standard transsphenoidal, microsurgical approach. The criteria for hyperprolactinemia remission was a PRL level under 25 ng/ml. Early normalization of PRL was achieved in 92% of those patients who underwent primary surgical-treatment, yet it was achieved in only 42% of patients who were operated on after receiving a long-term drug treatment with a DA. The highest prevalence of postoperative normalization of PRL was achieved in a group of patients with microadenomas who were primarily operated on (98%). The worst results in postoperative normalization of PRL were found in the group of patients with macroadenomas who received a long-term drug treatment with a DA first. These results show our surgical experience in treating prolactinomas. Using surgical treatment, the best clinical outcome was achieved with microprolactinomas and intrasellar, well-confined macroprolactinomas. Nevertheless, we stress the need of an individualized approach and recommend treatment in multidisciplinary centres for pituitary diseases.
The insulin tolerance test (ITT) is the gold standard for diagnosing adrenal insufficiency (AI) after pituitary surgery. The ITT is unpleasant for patients, requires close medical supervision and is ...contraindicated in several comorbidities. The aim of this study was to analyze whether tumor size, remission rate, preoperative, and early postoperative baseline hormone concentrations could serve as predictors of AI in order to increase the diagnostic accuracy of morning serum cortisol. This prospective study enrolled 70 consecutive patients with newly diagnosed pituitary adenomas. Thirty-seven patients had nonfunctioning pituitary adenomas (NPA), 28 had prolactinomas and 5 had somatotropinomas. Thyroxin (T4), thyrotropin (TSH), prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and insulin-like growth factor 1 (IGF-I) were measured preoperatively and on the sixth postoperative day. Serum morning cortisol was measured on the third postoperative day (CORT3) as well as the sixth postoperative day (CORT6). Tumor mass was measured preoperatively and remission was assessed 3 months after surgery. An ITT was performed 3 to 6 months postoperatively. Remission was achieved in 48% of patients and AI occurred in 51%. Remission rates and tumor type were not associated with AI. CORT3 had the best predictive value for AI (area under the curve (AUC) 0.868, sensitivity 82.4%, specificity 83.3%). Tumor size, preoperative T4, postoperative T4, and TSH were also associated with AI in a multivariate regression model. A combination of all preoperative and postoperative variables (excluding serum cortisol) had a sensitivity of 75.0% and specificity of 77.8%. The predictive power of CORT3 substantially improved by adding those variables into the model (AUC 0.921, sensitivity 94.1%, specificity 78.3%, PPV 81.9%, NPV of 92.7%). In a subgroup analysis that included only female patients with NPA, LH had exactly the same predictive value as CORT3. The addition of baseline LH to CORT3, increased sensitivity to 100.0%, specificity to 88.9%, PPV to 90.4%, and NPV to 100.0%. Besides CORT3, tumor size, thyroid hormones, and gonadotropins can serve as predictors of AI. LH in postmenopausal female patients with NPA has similar diagnostic accuracy as CORT3. Further studies are needed in order to validate the scoring system proposed by this study.
To analyze the expression and the prognostic value of CD44s and variant v5 and v6 isoforms in a large series of conventional renal cell carcinomas.
The expression of CD44 isoforms was ...immunohistochemically evaluated in 173 conventional renal cell carcinomas, and was compared with the usual clinicopathological parameters such as tumor size, histological grade, pathological stage, and Ki-67 proliferative index. The relationship of the CD44 expression to the cancer-specific survival was evaluated by log rank test.
While normal renal tissue was negative for CD44s protein, it was upregulated in 70 (40.5%) out of 173 carcinomas, and its expression significantly correlated with histological grade (p<0.001), pathological stage (p=0.023), and Ki-67 proliferative index (p<0.001). Moreover, the expression of CD44s protein was an adverse prognostic parameter in univariate survival analysis for patients with tumors expressing high levels of CD44s protein (p=0.003). CD44v5 and v6 isoforms were expressed in 11 (6.4%) and 28 (16.2%) tumors, respectively. Their expression was significantly higher in tumors with higher histological grade (p=0.001 and p=0.001, respectively). Also, the expression of v6 isoform was higher in tumors with high proliferation activity (p=0.001).
CD44s molecule may play a role in the progression of conventional renal cell carcinoma, and may be used in the evaluation of disease outcome.
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