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PubMed1991

The levels of pituitary-testicular axis hormones and SHBG in active acromegaly following bromocriptine treatment.

Pituitary and testicular hormone secretion and sex-hormone binding globulin (SHBG) level were investigated in 15 males with active acromegaly in normal and hyperprolactinemic state. Basal serum folitropin (FSH) and lutropin (LH) levels did not change before and after the administration of bromocriptine and remained in normal range compared with those in healthy men. Serum total testosterone concentration and SHBG were decreased particularly in hyperprolactinemic patients, but their levels were significantly increased to the normal limits following bromocriptine application. Although slight changes in serum concentration of free testosterone (fT) and circadian rhythm of fT in saliva was observed before and following bromocriptine treatment, the statistical differences were not significant. The results of the present study suggest that in acromegaly the alterations in peripheral metabolism of sexual steroids may exist.

Acromegaly↗
PubMed1991

Extrapituitary acromegaly.

Acromegaly may result from ectopic production of the hypothalamic peptide, growth hormone releasing hormone (GHRH), or growth hormone (GH) itself. Hypothalamic, carcinoid, and pancreatic tumors account for most of these cases. The pathogenesis, etiology, and diagnosis of acromegaly caused by these nonpituitary tumors is discussed, and an approach to their management is provided.

Acromegaly↗
PubMed1991

A case of acromegaly in the Middle Ages.

A case of acromegaly in a male individual aged about 30 years, who lived in the area of Central Balkans in the 14th or 15th century will be described here. This individual is from an archeological site named Przine near Gacko, Bosnia and Herzegovina. The diagnosis is based on pathological changes of the skull and the postcranial skeleton. By radiological analysis it could be observed that the Sella turcica does not show any change. Furthermore, the individual under study is not conspicuous by giant growth. This case of acromegaly is the oldest one found in the Balkan area.

Acromegaly↗
PubMed1991

[Results of trans-sphenoidal surgery for the treatment of acromegaly].

UNLABELLED: During the past 17 years (1972-89) 55 transsphenoidal surgery (TSS) interventions were performed in our Hospital in 53 cases of acromagaly (2 cases underwent surgery twice). RESULTS: 22 were cured (40%); 15 partial efficacy (27%) and 18 negative efficacy (33%). Mean GH values (ngr/ml) before surgery were: Cured cases 15.8 + 12.9 (p = 0.0015). Basal GH values above 40 ngr/ml obscure the prognosis of TSS in acromegaly. Cure was perfectly achieved in smaller size hypophysis adenomas (Hardy Grade land 11 in CT scan). The complications in the early post-surgery were rare and transient. Chronic sequelae due to TSS occurred in 7 cases (13.5%), as complete or partial anterior hypophysis failure. TSS is the treatment of choice of acromegaly in our environment, however a significant number of cases do not achieve cure and need to complete treatment with hypophyseal radiotherapy.

Acromegaly↗
PubMed1990

Endogenous hyperinsulinemia and release of growth hormone following a glucose load as well as in response to thyrotropin releasing hormone in acromegaly.

This study was designed to determine the relationship between endogenous hyperinsulinemia or free fatty acid (FFA) levels and the abnormal release of growth hormone (GH) during the oral glucose tolerance test (OGTT) or in response to thyrotropin releasing hormone (TRH) in acromegalic patients. Seventeen patients with acromegaly and nine healthy control subjects were studied. The 12 acromegalic patients who did not show the paradoxical response of increased GH secretion to the OGTT and/or to TRH exhibited higher insulin levels (total area under the curve during the OGTT) than patients who did. However, the FFA levels of the groups of acromegalic patients were similar. These data suggest that the endogenous hyperinsulinemia exhibited by many patients with acromegaly is associated with the absence of the paradoxical increase in GH secretion during the OGTT and/or after TRH.

Acromegaly↗
PubMedDate not supplied

Bone scintigraphy in acromegaly. Preliminary report on 10 cases.

The present study investigates if bone scintigraphy could be used as a diagnostic and prognostic tool in acromegaly. Bone scintigraphy (99m Tc-diphosphonate) was performed in 10 acromegalic (7 active and 3 inactive acromegaly) vs 12 control patients. Isotope uptake (in counts/cell) was assessed in the area of interest 3-4 hours after diphosphonate administration. Three views were chosen: cranium lateral (I)/frontal (II), and the hands (III). Between the acromegalic and control patients there were significant differences (x = p less than 0.001; xx = p less than 0.05) for the following areas: I-parietal: 66.5 vs 24.82x; I-occipital: 58.4 vs 23x; I-mediosphenoidal temporal: 55.2 vs 21.36x: I-nasal: 55.9 vs 38.73 xx; II-frontal: 46.8 vs 16.64 x; II-nasal: 59.8 vs 40.27 xx; III-left metacarpal: 21.67 vs 15.36 xx; III-right metacarpal: 21.78 vs 16.18 xx. Surprisingly, bone isotope uptake at the mandibular level, both in lateral and frontal view, showed no significant differences between acromegalic and control patients (55.2 vs 45 and 59.8 vs 44.5). Between the active and nonactive acromegalic patients there were no significant differences in any area. Bone scintigraphy, therefore, does not represent a useful index for disease activity. However, the results gave rise to two interesting problems: the acromegalic bone seems to have the same metabolic activity irrespective of the disease status; why is bone isotope uptake the same in acromegalics with pronounced prognathism as in the controls with normal mandible?

Acromegaly↗
PubMed1990

[Studies on the abnormal response of pituitary somatotropin to dopaminergic drugs in patients with acromegaly].

This article studies the effects of dopaminergic drugs on the pituitary GH secreting adenoma. The secretion of GH was enhanced and suppressed in 6 normal adults and 5 acromegalic patients respectively after intravenous infusion of dopamine and oral ingestion of L-dopa. Simultaneous administration of L-dopa and carbidopa (a drug that inhibits the conversion of L-dopa to dopamine in peripheral tissue) showed no suppressive or stimulatory effect on the secretion of GH in acromegaly. This result indicates that an abnormality in the GH secreting cell may be the cause of the different responses of GH to dopaminergic drugs in acromegaly.

Acromegaly↗
PubMedDate not supplied

[Analgesic effect of Sandostatin (SMS 201-995) in acromegaly headache].

Somatostatin analogue (Sandostatin; SMS 201-995) is utilized as a therapy in acromegaly because of its efficiency in inhibiting GH secretion; it induces some clinical improvements, such as headache remission in acromegalic patient, which seem to be unrelated to Gh normalization. We have examined 8 acromegalic patients, suffering from headache, after injection of saline solution and subsequently of SMS 201-995 (100 y), in order to study the mechanism of analgesic effect induced by Sandostatin administration. Headache, by autovaluation test, heart rate frequency, PAO, sistolic and diastolic blood velocity in medial cerebral artery, by utilizing Transcranial Doppler Sonography (SDSV), have been measured before and after saline and after SMS 201-995. GH and beta-endorphin have been also assayed in plasma samples. All patients have shown a rapid and complete improvement in headache after Sandostatin administration. At the same time we have observed an increase in SDSV and a parallel slight increase in PAO values, more evident in the diastolic phase. Plasma beta-endorphin assay has shown rather conflicting results after SMS 201-995 administration. Our results confirm an important and rapid analgesis effect of Sandostatin on acromegaly headache unrelated to GH normalization. The cerebral emodinamic changes suggest their involvement in Sandostatin induced analgesia.

Acromegaly↗
PubMed1990

[Treatment of acromegaly. Results in 56 patients].

The results of the treatment of acromegaly in 56 patients have been reviewed. Transsphenoidal pituitary adenomectomy (TPA) represented the most effective therapy, as it resulted in a cure rate of 64.7%, with 8.8% of complications and 14.7% of endocrine insufficiencies secondary to surgery. When radiotherapy was administered after surgery (when the latter had not been curative), the overall rate of cure increased to 73.5%. By contrast, the patients treated only with radiotherapy had a markedly lower cure rate (44.4%), with a higher rate of endocrine insufficiency (55%). The occurrence of extrasellar extension shown in preoperative pituitary computed tomography did not correlate with a worse postoperative cure rate; by contrast, the invasive character of the adenoma represented a reduction in the postoperative cure rate. It was concluded that TPA is the treatment of choice in acromegaly, independently of the tumor size.

Acromegaly↗
PubMed1990

Acromegaly and proximal femoral fracture in an aged person: bone histomorphometry, vitamin D metabolites and parathormone.

Osteoporosis and fractures are rare in acromegaly. An 84-year-old acromegalic woman sustained a fractured neck of femur in a fall. Histomorphometric analysis of an iliac crest biopsy showed marked osteoporosis and augmented resorption parameters. Cortical plates were very thin and bone volume was 8.5%; 12.5% is the reference value for women at this age. The total resorption surfaces were 23.7% compared with the reference value of 8%. We conjecture that postmenopausal and involutional osteoporosis were far advanced before the development of acromegaly, explaining the coexistence of the two conditions. Parathormone (65 pmol/l) and 24,25-dihydroxyvitamin D (1.34 ng/ml) levels were within normal limits, but those of 25-hydroxyvitamin D (5.6 ng/ml) and 1,25-dihydroxyvitamin D (15 pg/ml) were markedly decreased.

Acromegaly↗
PubMed1989

Effect of extracellular fluid volume contraction and expansion on plasma atrial natriuretic peptide (ANP) concentration in patients with acromegaly.

Atrial natriuretic peptide (ANP) is a hormone release into the circulation by atrial cardiocytes (Gutkowska et al. 1984). Extracellular fluid volume expansion acts as a powerful stimulus for ANP secretion and results in the augmentation of its plasma concentration (Lang et al. 1985). Patients with active acromegaly demonstrate the increased extracellular fluid volume (Falkheden et al. 1964), while a successful treatment of the disease results in the disappearance of hypervolemia (Strauch et al. 1977). We have recently demonstrated that in patients with active acromegaly the increased total body plasma volumes are accompanied by the elevated plasma ANP concentrations, whereas, in the successfully treated patients, both: total plasma volumes and plasma ANP levels do not differ significantly from these in healthy subjects (Czekalski et al. 1988b).

Acromegaly↗
PubMed1989

[Effectiveness of lysenyl-forte treatment in acromegaly and hyperprolactinemia syndrome].

Lysenyl-forte, a derivative of polysynthetic ergot alkaloids, producing a dopaminergic and antiserotoninergic action was employed to treat acromegaly and prolactin hypersecretion in 11 and 71 patients, respectively. Clinical effect was established basing on a complex of clinical, x-ray, neuro-ophthalmologic and hormonal evidence. Acromegaly treatment proved efficient: 7 patients (63%) showed partial relief of clinical signs, reduced STH blood level. Out of 48 patients with prolactinemia a response was registered in 34 (71%): a more than 50% decrease in prolactin concentration, normal levels of the hormone in 35% of the patients. A menstrual cycle recovered, galactorrhea diminished, 2 women got pregnant. A positive effect was noticed in management of 13 sterile men with prolactin hypersecretion, in 6 patients with idiopathic prolactin hypersecretion, in 4 women with primary hypothyrosis and galactorrhea. Compared to parlodel, lysenyl was not superior in the frequency of side effects, though was inferior in clinical effectiveness. The drug is recommended for wide-scale use.

Acromegaly↗
PubMed1987

The somatostatin analogue SMS 201-995 in acromegaly: prolonged, preferential suppression of growth hormone but not pancreatic hormones.

The treatment of acromegaly is not optimal at present, since many patients have continued growth hormone hypersecretion. We report the acute effects of a cyclic octapeptide analogue of somatostatin, SMS 201-995 (Sandoz) in 9 nondiabetic, acromegalic patients between the ages of 30 and 74. We report potent and prolonged dose-dependent effects to suppress growth hormone secretion. A single 50 micrograms dose of SMS 201-995 inhibited growth hormone concentration rapidly within 15 minutes, with maximal effect in 75 minutes. Maximal inhibition was of the order of 80%, with absolute concentrations under 2 micrograms/L for about 6 hours in 5 of 7 patients. Growth hormone concentrations remained significantly suppressed below placebo control for up to 24 hours after a single dose of SMS 201-995, but the inhibitory effects on insulin and C-peptide concentrations were limited to 2 hours. The effects on glucagon secretion were minimal, and also evident for only 2 hours. Mild transient postprandial elevations of plasma glucose and FFA were documented. No adverse effects were noted; routine hematology, biochemistry, and vital signs were not altered. Thus SMS 201-995, with preferential effects at the pituitary somatotroph, holds considerable promise as an attractive and viable alternative for treatment of acromegaly.

Acromegaly↗
PubMed1987

Long-term treatment of acromegaly with Sandostatin (SMS 201-995). Normalization of most anomalous growth hormone responses.

Twelve patients with active acromegaly were treated with the long-acting somatostatin analogue SMS 201-995 (SMS), at a dose of 50 micrograms sc twice daily in the first 2 weeks of treatment and 100 micrograms sc thereafter. Four h after the first injection of SMS, GH levels became normal in 8 of the 12 patients. Basal glucose levels were significantly lower at the 28th day of treatment. This glucose lowering effect was stronger in the diabetic than in the nondiabetic patients. The postprandial rise of insulin levels was reversed by SMS, leading to a more pronounced postprandial rise of glucose, whereas the postprandial secretion of glucagon was also reversed by SMS. The rise of glucose levels during oral glucose loading was similar before and during SMS, despite a strong inhibitory effect of the drug on the insulin rise after glucose loading. Basal TSH levels were not influenced by SMS, the TRH-induced TSH response, however, was significantly blunted. Although the basal PRL levels were significantly reduced by SMS, the TRH-induced PRL rise was similar before and during administration of the analogue. Paradoxical GH responses to TRH disappeared in 7 out of 8 patients during SMS. Paradoxical GH responses to GnRH, however, persisted in 4 out of 4 patients. Paradoxical responses of GH after glucose loading disappeared in 2 out of 2 patients. The GH response after GHRH administration was strongly suppressed by SMS. During long-term treatment (up to 2 years), the GH level obtained within 5 h after the last injection of SMS remained normal in the patients whose GH levels normalized at the first day of treatment. There was a good response of the disease to this treatment, and no serious adverse reactions were observed. We conclude that SMS normalizes most anomalous growth hormone kinetics in acromegaly. The drug offers a new tool in the treatment of this disease.

Acromegaly↗
PubMed1987

[Indications and results of pituitary radiotherapy after microsurgery in acromegaly. 15 cases].

The present treatment of acromegaly consists of selective adenomectomy followed, when unsuccessful, by pituitary gland irradiation. Fifteen acromegalic patients were evaluated after adenomectomy, then radiotherapy. Growth hormone assays were performed after carbohydrate load and administration of thyroid stimulating hormone. Somatomedins were measured by radiocompetition using the vector protein. Cure was obtained with adenomectomy alone in 3 of the 15 patients (mean follow-up 39 months). The remaining 12 patients were all cured by subsequent irradiation at the cost of pituitary insufficiency in one-third of them. Post-surgical cure of acromegaly can only be asserted from range of strict criteria. The best indicators of persisting activity are high levels of growth hormone and/or somatomedins. A solitary somatotropic dysregulation does not necessarily herald a relapse.

Acromegaly↗
PubMed1986

[Acromegaly. Physiopathological aspects and description of a clinical case].

Recent physiopathological studies suggest that hypersecretion of GH in acromegaly is not necessarily the result of a primary alteration to the GH-secreting pituitary cells. Some suggest that an alteration in the hypothalamic control of the hormone secretion may also be involved. After a general introduction, a clinical case of acromegaly is reported.

Acromegaly↗
PubMed1986

[New aspects of the pathogenesis of acromegaly-somatoliberinomas].

According to modern knowledge, acromegaly can develop in at least three ways. A pituitary adenoma with growth hormone overproduction is the most frequent. Much rarer is ectopic growth hormone secretion by extra-hypophyseal tumors. A further possibility is the production of growth hormone releasing factor (GRF) by hypothalamic or ectopic tumors. This involves the secretion of a substance which selectively stimulates the GH producing cells of the pituitary. Special features of the clinical and morphological picture of this condition are described, based on the authors own observations. Two patients developed acromegaly: one had a retroperitoneal paraganglioma and the other a bronchial carcinoid. Ectopic GRF secretion could be confirmed radioimmunologically and immunohistologically in both cases. As a result of the on-going, tumor related GRF stimulation the patients developed nodular or diffuse GH-cell hyperplasia in the adenohypophysis. Since ectopic GH secretion does not cause hyperplasia of the adenohypophyseal cells, morphologic examination of the hypophysis can contribute to the differential diagnosis in such cases.

Acromegaly↗
PubMed1987

Value of growth hormone dynamics and somatomedin C (insulin-like growth factor I) levels in predicting the long-term benefit after transsphenoidal surgery for acromegaly.

Transsphenoidal microsurgery has been shown to be effective in the management of human growth hormone (hGH)-secreting pituitary adenomas. We have previously demonstrated the usefulness of hGH dynamic testing (oral glucose tolerance, insulin hypoglycemia, and thyrotropin-releasing hormone stimulation test) in evaluating the completeness of removal of the adenomas. In patients with acromegaly, serum insulin-like growth factor I (IGF-I) levels are known to correlate with the activity of the disease. We studied the dynamics of hGH secretion in 43 patients with hGH-secreting adenomas 2 to 3 months after surgery. In addition, serum IGF-I levels were recently measured in frozen sera obtained from these patients at the time of dynamic testing. Of the 43 patients undergoing surgery, 19 had normal basal hGH levels as well as dynamics (group I). Two additional patients had low or undetectable hGH levels and were hypopituitary (group II). These 21 patients were considered cured and had no evidence for recurrence of their disease during a mean follow-up period of 97 months. Serum IGF-I levels were normal in 19 (group I) and low in the remaining two patients (group II). Nine additional patients had normal basal hGH levels but abnormal dynamics of secretion (group III). Serum IGF-I levels were normal postoperatively in seven of eight patients tested in this group. During the follow-up period in these nine patients (group III), biochemical and clinical recurrence of acromegaly developed in five. The remaining 13 patients had persistent elevation of basal hGH levels, and all samples tested (n = 8) had elevated IGF-I levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗