Adrenocorticotropin-secreting pituitary adenomas originate from the anterior or the intermediate lobe in Cushing's disease: differences in the regulation of hormone secretion.
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Biomedical subjects
Publications and source records attributed to S A de Lange.
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A discussion on the clinical value of telemetric measurements of intracranial pressure is presented. The technical improvements of an earlier described implantable epidural transducer are reported. Furthermore, the results are given of an in vivo study in dogs of the relation between epidural pressure as measured by this device and ventricular fluid pressure for variable physiologic conditions. An evaluation of the implantation technique is included and a justification for the selection of the constituting materials is given. Clinical results obtained in a patient are illustrated.
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A patient with Cushing's disease is described who underwent transsphenoidal adenomectomy of a basophilic microadenoma with a diameter of 3 mm. In a piece of surrounding normal pituitary tissue removed at operation, multiple small nests of adenomatous basophilic cells were found both in the adeno- and neurohypophysis. No clinical improvement was observed. Cortisol secretory rate, plasma ACTH, the absent response of plasma cortisol to insulin-induced hypoglycemia, and the responses of plasma cortisol to lysine vasopressin and TRH remained unchanged. The observations in this patient point to the presence of multiple ACTH-secreting adenomatous cell nests and microadenomas throughout pituitary gland and bring back into view the concept of primary stimulation of hypothalamic corticotropin-releasing factor as the primary derangement in some patients with Cushing's disease.
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Results of measurements in vivo of intracranial pressure obtained with a new telemetric epidural pressure transducer are described. The relations of epidural pressure to ventricular fluid pressure are studied in acute experiments and found to be linear, but variable. The functioning of 18 transducers was studied over many months of implantation.
The course of pregnancy achieved after bromocriptine therapy is described in nine patients with radiologically evident prolactin-secreting pituitary tumors. In six patients no complications occurred. No changes in sellar size or secondary endocrine deficiencies developed. In three patients, however, complications developed between the 22nd and 24th weeks of pregnancy. Despite prior external pituitary irradiation, one patient developed transient bitemporal hemianopsia and one patient had apoplexy of the pituitary tumor with transient paresis of the left abducens nerve. A third patient developed parasellar expansion of the pituitary tumor with bone destruction and paresis of the right abducens and oculomotor nerves. After transsphenoidal surgery the paresis of both nerves disappeared. Microscopically, the tissue removed at surgery was a chromophobe adenoma with focal fibrosis and calcifications without recent hemorrhages. In the course of more than 100 pregnancies achieved in The Netherlands after bromocriptine therapy, five patients reportedly developed complications of the pituitary tumor. At present, patients in whom complications can be expected cannot be predicted by the size or configuration of the sella turicica or the magnitude of elevation of the plasma prolactin level. In two patients external pituitary irradiation did not prevent complications during pregnancy.
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The influence of Trimetaphan induced hypotension was studied on the development of increased ventricular fluid pressure after induction of cold injuries of the brain in cats. Hypotension was induced in two series of animals: in one immediately after freezing and in another series after a delay of three quarters of an hour. In the animals not treated with hypotension ventricular fluid pressure increased considerably according to three types of response. In both series treated with hypotension the ventricular fluid pressure and elastance were significantly lower than in the animals not treated; also brain stem herniation tended to occur less frequently in the animals treated. No deleterious effect of the hypotension was seen on cerebral metabolism as measured by the lactate content in the cerebrospinal fluid.
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