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PubMed1980

Morphofunctional study of pituitary adenomas with acromegaly by immunoperoxidase technique and electron microscopy.

In attempting to establish a functional classification of acidophilic adenomas of the pituitary gland, immunoperoxidase staining techniques specific for growth hormone (GH), prolactin (PRL), and luteinizing hormone (LH) were carried out. Surgically removed specimens from 24 acromegalic patients were studied. The pathologic observations were then compared with the basal plasma levels of each of the hormones. The existence of GH was demonstrated in all patients. Immunohistologically, GH-secreting adenomas could be subdivided into three types: Type I had the highest plasma-GH level (average 121 ng/ml), while the average plasma-GH levels of types II and III were 103 ng/ml and 73 ng/ml, respectively. This result suggested that the serum-GH level may correlate with the GH cell population in a tumor. In 13 of the acromegalic patients, immunoenzyme methods were utilized in order to identify prolactin cells. No clear correlation between serum-PRL levels and the distribution of PRL cells could be demonstrated. A few immunoreactive LH cells were found in 13 patients. These LH cells may be a mixture of normal cells, based on our clinical finding.

Acromegaly↗
PubMed1976

Ultrastructure of tubular inclusions in endothelial cells of pituitary tumors associated with acromegaly.

Tubular inclusions were present in 13 out of 43 pituitary adenomas of acromegalic patients and in a single chromophobe pituitary adenoma. There were none in 76 other pituitary adenomas with differing endocrinological symptomatology. The arrays were usually located in the perinuclear cistern of capillary endothelial cells. The tubule diameter in osmium fixed material measured 19-26 nm and the light core averaged 6-11 nm. A longitudinal period of about 4.5 nm could be demonstrated with PTA block staining. Fixation with glutaraldehyde and block staining with ethidium bromide as well as permanganate fixation followed by RNAse treatment showed only the core of the tubules consisting of globular subunits. Several histochemical reactions (perchloric acid extraction, methenamine-silver staining, trypsin and DNAse digestion of frozen sections) suggested that the particles consist of a core of DNA coated with protein. No virus multiplication could be detected in cell cultures or in mice innoculated with fresh tumor material. No significant antibody titers against several virus antigens could be demonstrated.

Acromegaly↗
PubMed1991

Long-term treatment with SMS 201-995 in resistant acromegaly: effectiveness of high doses and continuous subcutaneous infusion.

Seventeen patients (8 women and 9 men) resistant to all other forms of therapy were treated with the somatostatin analogue SMS 201-995 (octreotide, Sandostatin). The duration of treatment ranged from 1 to 5 years. Mean GH levels of only 4 patients were suppressed under 5 micrograms/L during an 8 h serum profile with the standard dose of 0.1 mg 2 or 3 times daily. This standard dose suppressed mean GH levels in 10 other patients more than 50% of baseline, but for optimal effect higher doses up to 1.5 mg, 4 daily injections or continuous subcutaneous infusion (CSI) were needed. Octreotide had no influence on GH secretion in 3 patients. Suppression of mean GH levels under 5 micrograms/L was achieved in 10 patients. Normalization of insulin-like growth factor I (IGF-I) occurred in only 5 patients. Altogether, therapy with SMS 201-995 reduced GH levels from 23.8 +/- 32.2 micrograms/L (mean +/- SD) to 6.7 +/- 5.0 micrograms/L by 71.8% and IGF-I levels from 7.9 +/- 3.1 U/ml to 3.2 +/- 1.6 U/ml by 59.5%. We conclude that 1) treatment with SMS 201-995 in patients resistant to other forms of therapy may be less successful than previously reported for heterogenous groups of patients; 2) the dose regimen must be adapted to the individual patient for optimal effect and most of our patients needed higher doses than 300 micrograms daily; 3) 4 or maybe more daily injections or CSI seem to be most effective; and 4) in a minority of patients SMS has no influence on GH-secretion.

Acromegaly↗
PubMed2002

Intrasellar gangliocytomas associated with acromegaly.

The present study was designed to investigate the immunohistochemical characteristics of gangliocytomas associated with growth hormone (GH)-secreting pituitary adenomas. In our surgical collection of 476 GH-secreting adenoma cases, we examined tumor tissue from 6 patients (1.3%). All 6 patients were women, ranging from 29 to 52 years (mean, 40.3 +/- 9.5 SD) of age. Among 470 patients with GH-secreting adenomas without gangliocytoma, there were 255 female and 215 male patients. The preponderance of female patients with gangliocytomas was striking. Histological examination of the resected specimens showed areas of ganglion cells and adenomatous cells. Ganglion cell lesions were stained positively for synaptophysin (4 of 4; 100%) and neurofilament (4 of 4; 100%) as well as GH-releasing hormone (5 of 6; 83.3%). Subtypes of GH cell adenomas included 4 cases of sparsely granulated type and 2 cases of mixed GH and prolactin (PRL) cell adenomas. Based on these findings, we hypothesized that the intrasellar gangliocytoma promoted the growth of the pituitary adenoma by chronic overstimulation from excess GH-releasing hormone.

Acromegaly↗