ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00799.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00810.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00823.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Previous studies of Pit‐1 expression in human pituitary tumours have produced conflicting results. We have studied expression of Pit‐1 mRNA in human pituitary adenomas, as well as in normal human and rat pituitaries, and results were compared with clinical, histological, and immunohistochemical features. In addition, expression of GH, PRL, and TSH‐β mRNA was also studied and compared with Pit‐1 gene expression.MATERIAL AND METHODS The adenomas consisted of 13 GH cell adenomas, 7 PRL cell adenomas, 3 TSH cell adenomas, 4 ACTH cell adenomas, and 10 clinically non‐functioning adenomas. Expression of the Pit‐1, its isoforms, and each hormone, was studied using the reverse transcription polymerase chain reaction.RESULTS Pit‐1 mRNA was expressed not only in normal human and rat pituitaries, but also in all GH, PRL and TSH cell adenomas. There was no correlation between Pit‐1 transcripts and biological behaviour or histological findings in these three types of adenoma, suggesting that Pit‐1 is generally required for the determination of cell phenotype but is insufficient for the regulation of hormonal activity and tumour growth in these pituitary adenomas. In addition, Pit‐1 was also expressed in some ACTH cell (2/4) and non‐functioning adenomas (7/10). Although there were no GH, PRL or TSH‐β transcripts in Pit‐1 mRNA‐negative ACTH cell and non‐functioning adenomas, PRL mRNA was detected in all Pit‐1 mRNA‐positive ACTH cell adenomas and GH, PRL and/or TSH‐β mRNA were found in four of seven Pit‐1 mRNA‐positive non‐functioning adenomas. In contrast, Pit‐1 mRNA was expressed without any GH, PRL, or TSH‐β transcripts in only three non‐functioning adenomas. These data suggest that expression of Pit‐1 mRNA in these two types of adenomas can be mainly attributed to the presence of GH, PRL and/or TSH‐β mRNA expressing cells and that true Pit‐1 transcripts found in non‐functioning adenomas may be a rare event. Moreover, there were two cases which expressed Pit‐1α mRNA, but failed to show other Pit‐1 isoform mRNA. There were, however, no clinical or histological differences between these two adenomas showing only Pit‐1α mRNA and the others expressing both Pit‐1α mRNA and other Pit‐1 isoform mRNA.CONCLUSIONS Pit‐1 mRNA was expressed not only in GH, PRL and TSH cell adenomas but also in other types of adenoma. However, it is suggested that expression of Pit‐1 mRNA in most ACTH cell and non‐functioning adenomas can be attributed to GH, PRL and/or TSH‐β mRNA expressing cells. Further studies are necessary to elucidate the role of Pit‐1 tr

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00812.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Physiological changes in the pituitary gland with age have not been fully evaluated. The aim of this study was to clarify the morphological characteristics of the pituitary gland by magnetic resonance imaging(MRI) in elderly subjects and to relate them to pituitary hormone secretion.DESIGN AND PATIENTS We investigated the pituitary MRI in 59 elderly (15 males, 44 females; median 82 years) and 41 young (13 males, 28 females; median 34 years) healthy subjects.RESULTS Pituitary height, width and volume in the elderly subjects were less than those in the young subjects. Empty sella was more frequently observed in the elderly subjects (19%), especially women, than in the young ones. However, no relation was observed between the pituitary size or volume and basal levels of anterior pituitary hormones. Posterior pituitary bright signal(PBS) on T1‐weighted MRI, which is thought to reflect its storage of the neurophysin‐peptide complex, was not detected in 29% of the elderly subjects while it could be detected in all the young subjects. None of the elderly subjects showed clinical signs or symptoms of diabetes insipidus. Fasting plasma osmolarity and AVP in the elderly subjects were significantly higher than in the young subjects. Moreover, plasma AVP was significantly higher in the elderly subjects without the PBS than in those with the PBS.CONCLUSIONS It is suggested that the excessive release of AVP from the posterior pituitary as a result of persistently raised plasma osmolality in the elderly subjects may lead to depletion of the neurosecretory granules in the posterior pituitary gland and may result in disappearance of the posterior pituitary bright signal on T1‐weighted MRI. As these morphological changes might relate to the normal physiological occurrence of ageing, we should be cautious in evaluating MRI of the pituitary gland in eld

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00555.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Magnetic resonance imaging (MRI) without contrast medium is unable to give detailed information on the hypothalamic‐pituitary structures. MRI using gadopentetate dimeglumine (Gd‐DTPA), and dynamic MRI, were performed in patients with hypopituitarism previously diagnosed as having anterior pituitary hypoplasia, ectopic posterior pituitary and unidentified pituitary stalk (1) to determine whether Gd‐DTPA improves the delineation of hypothalamic‐pituitary structures; (2) to verify whether, if so, such improvement can be correlated with residual pituitary function in patients subjected to long‐term follow‐up; and (3) to identify the hypothalamic‐pituitary vascular network in such cases.PATIENTS Eighteen patients (13 males, 5 females) aged 10–26.4 years with unidentified pituitary stalk at first MRI study were evaluated. Eight had isolated GH deficiency (IGHD), and 10 had multiple pituitary hormone defect (MPHD) with the progression to complete anterior pituitary deficits seen by the age of 15 years in 8 patients (1 had GH and FSH–LH deficiency and 1 had GH, TSH and FSH–LH deficiency).RESULTS The MRI revealed a very thin pituitary stalk in 7 patients (38.8%), 6 with IGHD (75%) and 1 (10%) with MPHD (GH and FSH‐LH deficiency), after Gd‐DTPA administration. Reassessment of anterior pituitary function showed that the thyroid, adrenal and gonadal functions were intact in the 6 patients with IGHD and pituitary stalk identified by Gd‐DTPA as well as in one IGHD patient with no evidence of pituitary stalk. In one 10‐year‐old with IGHD at the time of presentation (6 years) and no pituitary stalk seen after Gd‐DTPA, subclinical hypothalamic hypothyroidism and suspected hypogonadotropic hypogonadism were documented. Partial ACTH deficiency was recorded In the patient with TSH and FSH–LH deficiency with no pituitary stalk. After Gd‐DTPA, patients with absent pituitary stalk had a risk of developing MPHD 27 times greater than had those with an identified pituitary stalk (relative riskr=27, 95% confidence interval 1.9–368.4, Fisher’s exact testP=0.009). Dynamic MR images obtained every 4.6 s revealed rapid enhancement of hypothalamic‐pituitary structures and allowed the determination of the times to initial enhancement of ectopic posterior pituitary and hypoplastic anterior pituitary which ranged between 9.2 and 18.4 s, and that of complete anterior pituitary (32.2–41.4 s). The time to maximum enhancement of anterior pituitary was significantly longer than in controls (35.5±3.8 svs25.2±1.6 s,P<0.0001).CONCLUSIONS MRI with Gd‐DTPA proved more sensitive in identifying the vascular component of pituitary stalk and added new information about the partial preservation of hypothalamo‐hypophyseal portal vessels. The vascular pituitary stalk is easily recognized after Gd‐DTPA in most IGHD patients, but exceptionally in MPHD; this sheds light on the possible normal course of affected patients. The neural component of the pituitary stalk is lacking regardless of whether patients have IGHD or MPHD, indicating that the termcongenital agenesis of the neural pituitary stalkis more appropriate thanpituitary stalk interruption. The times to enhancement of ectopic posterior pituitary and residual anterior pituitary obtained by the fast‐framing MRI technique disclose dynamic changes in regional blood supply w

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00789.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE Sixty‐one of 83 patients with acromegaly treated between 1969 and 1993 were analysed retrospectively to clarify which early postoperative factors were significant predictors of a successful long‐term outcome and which preoperative factors significantly influenced the early postoperative results.PATIENTS Of the 61 patients, 30 were operated on before 1987 and 31 afterwards. A successful long‐term surgical outcome was defined as a long‐term mean basal GH level<6 mU/l (comparable to<3 μg/l), a normal IGF‐I level, and normal GH dynamics.RESULTS Overall, 59% of patients (37% before 1987 and 81% after) had an early postoperative mean basal GH level<6 mU/l, and 56% (29% before 1987 and 77% after) met all three of the specified criteria for a successful long‐term surgical outcome. Statistical analysis confirmed that GH dynamics and postoperative mean basal GH level<6 mU/l were significant predictors of the long‐term surgical outcome, whereas the postoperative IGF‐I level alone was not. On the other hand, abnormal preoperative GH dynamics were normalized in all patients with a postoperative mean basal level<6 mU/l. In addition, there were no patients showing an unsuccessful long‐term outcome in those associated with both the early postoperative mean basal GH level<6 mU/l and normalization of the IGF‐I level. Therefore, measurement of the early postoperative mean basal GH level and the IGF‐I level may be an economical and simple guide to predict the long‐term surgical outcome. Moreover, multivariate analysis indicated that cavernous sinus invasion was an independent significant factor influencing the early postoperative outcome.CONCLUSIONS Successful long‐term surgical outcome may be predicted if early postoperative mean basal GH level is reduced to<6 mU/l (<3 μg/l) and IGF‐I level becomes normal. This study also confirms that early diagnosis and treatment by an experienced endocrinologist and neurosurgeon can improve the operativ

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.8080817.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

AIM To determine the frequency with which hyperprolactinaemic illnes tends to resolve with time.STUDY DESIGN A retrospective case‐notes review from a specialist endocrine unit in a provincial teaching hospital and tertiary referral centre.PATIENTS Seventy women with hyperprolactinaemia referred to the unit in the 15 year period between May 1979 and May 1994. All those with a non‐pituitary cause or with macroadenoma had been excluded, as were those who did not have high‐resolution imaging, or who were on treatment at the time of referral.INTERVENTION Intermittent course of treatment with dopamine receptor agonists according to individual need.ENDPOINTS Latest serum PRL concentration in those who had discontinued treatment, and whether serum PRL tended to be lower in any particular groupRESULTS There was a significant fall in median PRL concentration from 2000 (714–8000) to 1000 mU/l (220–5600) in the 31 women who had discontinued therapy (P<0.0005), and serum PRL was normal (<700 mU/l) in 11 of them. Serum PRL also fell to normal in three of ten women who had no treatment at all. Final PRL concentration was normal in 35% of women who had had at least one pregnancy during the period of follow‐up compared to 14% who had not (P<0.05).CONCLUSIONS These data confirm the findings of others that hyperprolactinaemia will prove self‐limiting in up to one‐third of women, and that pregnancy may be one factor which tr

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00824.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE The long‐term cardiovascular effects of GH administration in adults are of major clinical importance, given the increasing use of such treatment. We have evaluated long‐term cardiovascular effects of recombinant human GH (rhGH) substitution in GH deficient men.DESIGN S.c. rhGH 0.5 U/kg/week or placebo was administered in a 6‐month double‐blind, cross‐over study, followed (after a year without substitution) by a 42‐month period of open GH substitution.PATIENTS We evaluated 7 GH‐deficient men serially and compared the results with 21 men matched in terms of age and height.MEASUREMENTS Investigations included exercise tests and Doppler‐echocardiography to determine exercise capacity and cardiovascular performance.RESULTS Heart rate and systolic blood pressure at rest increased with GH substitution to the level of the controls, as did diastolic blood pressure after an initial reduction. Age‐adjusted exercise capacity increased during the study and we found no evidence of ischaemic heart disease on exercise ECG. Stroke volume increased with GH substitution, thereby normalizing the initially reduced cardiac index. There was no significant change in left atrial or ventricular internal dimensions, systolic function as measured by fractional shortening, or diastolic function as measured by isovolumic relaxation time and left ventricular filling (A/E ratio). However, a lower atrial emptying index than that seen among controls might indicate some diastolic disturbance and there was a definite increase in left ventricular wall thickness compared with controls (to 25.1±1.5vs19.7±0.4 mm,P<0.001).CONCLUSIONS We found that GH substitution in GH‐deficient adults had a beneficial effect on physical performance and cardiac output. The concomitant increase in left ventricular mass index might be an eff

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.00820.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

OBJECTIVE The interrelationships between maternal hormone levels and placental dysfunction in mothers bearing children with intrauterine growth retardation remain unclear. We have examined some endocrinological aspects of intrauterine growth retardation and, in particular, tested whether low levels of GH and IGF‐ I in maternal serum are associated with direct evidence of placental dysfunction.DESIGN Prospective, descriptive and comparative.PATIENTS Women with singleton pregnancies: 48 with a small for gestation fetus (SGA) (estimated fetal weight less than −1.5 standard deviation scores) and 28 with an appropriate for gestation fetus (AGA).MEASUREMENTS Maternal serum GH, IGF‐I, IGFBP‐1 and 3 were determined, and fetal weight and umbilical artery pulsatility index (PI) was estimated by ultrasonography and Doppler ultrasound at 33 weeks gestational age.RESULTS Serum IGF‐I was lower in the SGA group (246 vs297 μg/l,P = 0.03) but GH and IGFBP‐1 and ‐3 did not differ between the groups. In the 16 SGA pregnancies with increased PI, IGF‐I concentration was low (218 μg/l, quartiles 149–265), whereas in the 32 with normal PI, IGF‐I was 269 μg/l, quartiles 219–382. Serum IGFBP‐1 was increased in the high PI group compared to the normal PI group (161 μg/lvs113,P = 0.05).CONCLUSION M aternal serum IGF‐I concentration was lower in small for gestational age pregnancieswith increased pulsatility of the umbilical artery blood flow, compared to small for gestational age pregnancies with normal umbilical blood flow, which in turn was close to the IGF‐I concentration in appropriate for gestational age pregnancies.

ISSN:0300-0664    

DOI:10.1046/j.1365-2265.1996.553812.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY