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PubMed1980

Diminished prolactin reserve in acromegaly.

Prolactin (PRL) secretion has been evaluated in twenty acromegalic patients. All had intact LH, FSH, and cortisol levels and normal thyroid function. Five patients had persistent hyperprolactinemia. The remainder had decreased basal PRL levels with impaired PRL responses to TRH and the dopaminergic antagonist metoclopramide (MET). Despite adequate hypoglycemia and an intact cortisol response, there was no PRL rise following insulin hypoglycemia. The imparied PRL response to TRH was evident in treated and untreated patients and was independent of GH levels. Basal hyperprolactinemia may be related to PRL secretion by the tumor cells or interference with the transport of PIF by the tumor. The decreased PRL reserve noted in the majority of the patients may be related to a decrease in lactotrope cell mass or, alternatively, to enhanced dopaminergic activity.

Acromegaly↗
PubMed1982

Impaired prolactin responsiveness to dopamine antagonists in acromegaly.

Prolactin (PRL) and growth hormone (GH) secretion have been evaluated in 17 acromegalic patients following acute administration of two dopamine (DA) receptor antagonists, i.e. sulpiride (SULP) and domperidone (DOM). Six patients had persistent hyperprolactinemia. In 8 normoprolactinemic patients, i.m. injection of 100 mg SULP elicited only a slight rise iN plasma PRL, which was strikingly lower than that SULP induced in control subjects. Likewise, an i.v. bolus injection of DOM (4 mg) was barely effective to raise plasma PRL in the 11 normoprolactinemic and the 6 hyperprolactinemic patients. DOM was instead capable of inducing a clear-cut rise in plasma PRL in normoprolactinemic controls and in a group of subjects with puerperal hyperprolactinemia. Neither drug affected GH secretion in acromegalic patients. It is proposed that a defective tuberoinfundibular DA function or, alternatively, a diminished PRL reserve due to a decrease pituitary lactotroph mass may be responsible for the blunted PRL responsiveness of acromegalics. However, standing the paucity of present knowledge on the pituitary PRL secretory pool in acromegalics, neither hypothesis seems capable to account satisfactory for the reported results.

Acromegaly↗
PubMed1992

Long-term efficacy and tolerability of octreotide treatment in acromegaly.

Twenty-five acromegalic patients were studied during 6 years of treatment with octreotide, with a particular focus on the following parameters: (1) Administration schedule: in 10 patients, continuous subcutaneous (SC) octreotide infusion was compared with injections of octreotide at three dose levels (100, 250, and 1,500 micrograms/24 h) and was found to induce a greater and less-fluctuating 24-hour growth hormone (GH) suppression. (2) Carbohydrate tolerance: average 24-hour blood glucose levels were unaffected by octreotide, regardless of administration schedule. Oral carbohydrate tolerance and intravenous (IV) glucose tolerance were unaffected by continuous octreotide infusion. However, octreotide injection given shortly before the tests reduced carbohydrate tolerance. (3) Thyroid function: octreotide and somatostatin acutely reduce the response of thyroid-stimulating hormone (TSH) to thyrotropin-releasing hormone (TRH). After a few days of treatment, it was demonstrated that octreotide slightly inhibits iodothyronine deiodination and induces a transient reduction in serum triiodothyronine (T3), rapidly compensated for by a persistent slight elevation of serum TSH. (4) Fat absorption was estimated as 24-hour fecal fat content and found to be in the same high-normal range before and after octreotide treatment. Vitamin K and D absorption were unaffected by octreotide. The incidence of gallstone formation was not greater than in the general Danish population, possibly due to the schedule used for octreotide injections. (5) Foot volume was regularly estimated and found to decrease with time, on average by 12% during the first 18 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMed1992

Presurgical octreotide treatment in acromegaly.

The aim of this study was to determine the role of octreotide administration in acromegalic patients as a preparation for selective adenomectomy using transsphenoidal route. Octreotide was administered for 3 to 6 weeks before surgery in 12 patients and for 4 to 39 months in 25 patients. The clinical response was judged as excellent or good in 10 of 12 patients from group I and in 23 of 25 patients from group II. Marked reduction (ie, greater than 50% of initial values) in serum growth hormone (GH) levels was seen in all patients, with levels to less than 5 micrograms/L in 68% of patients and less than 2 micrograms/L in 27%. Insulin-like growth factor 1 (IGF-1) levels decreased to within normal limits in half the cases. During long-term treatment, an escape phenomenon could be seen. Varying degrees of tumor shrinkage were seen in more than 50% of cases. During surgery, with regard to the relative ease or difficulty in removing the tumor, the consistency of the tumor and the separation of normal from pathological tissue, no significant difference was observed between patients given octreotide and those from control series. Morphological changes in adenomatous tissue were rather small. The surgical outcome was similar in the pretreated series as in the control series, except in enclosed adenomas, which showed a tendency to a higher success rate. Since octreotide improves both the clinical condition and hormonal parameters and induces varying degrees of tumor shrinkage, it is potentially useful as an adjunct to surgery. Morphological data suggest that octreotide exercises a functional inhibitory effect on GH release.

Acromegaly↗
PubMed1989

Postoperative prognostic indicators of control of acromegaly.

Changes in growth hormone basal levels and growth hormone dynamic tests such as thyrotropin-releasing hormone and luteinizing hormone-releasing hormone tests, and the glucose tolerance test were evaluated during a follow-up period of 1-17 years in 17 acromegalic patients. In these cases, mean growth hormone basal levels obtained 1-2 months after surgery had dropped to levels below 5 ng/mL. In 11 of the patients, the 1-2 months postoperative mean growth hormone basal levels were reduced to less than 3 ng/mL. In these patients, abnormal growth hormone responses to these dynamic tests were not present and mean growth hormone basal levels remained below 3.0 ng/mL during the follow-up period of 1-6 years. In contrast, the six other patients' 1-2 months postoperative mean growth hormone basal levels were between 3 and 5 ng/mL. Of these, four presented abnormal responses in at least one of these three dynamic tests 1-2 months postoperatively, and three exhibited a rise in growth hormone basal levels after intervals of 1-3.5 years after surgery. It is concluded that the restoration of normal growth hormone response to the dynamic tests is better related to the value of the mean growth hormone basal levels obtained 1-2 months postoperatively being less than 3 ng/mL rather than it is to the conventional criterion of the growth hormone basal levels being less than 5 ng/mL.

Acromegaly↗
PubMed1984

Myocardial involvement in acromegaly.

We recently encountered a case of an acromegalic patient with congestive heart failure and secondary cardiomyopathy. Cardiac biopsies were available in addition to autopsy material. This enabled us to perform electron microscopical studies which have hitherto not been reported. This may help to clarify the relationship between these two conditions and reveal specific characteristics.

Acromegaly↗
PubMed2007

Acromegaly.

Explore the source record for details and available documents.

Acromegaly↗
PubMed2004

Familial acromegaly.

Most pituitary tumors are sporadic, though a few occur with a familial aggregation. Three distinct syndromes have been recognized to date: multiple endocrine neoplasia, type I (MEN-1), Carney complex (CNC), and isolated familial somatotropinomas (IFS). Pituitary tumor types in MEN-1 are similar to those occurring sporadically. The largest percentage are prolactin-secreting or non-functioning and only about 10% are growth hormone (GH)-secreting (somatotropinomas). In contrast, tumors types in CNC and IFS are invariably somatotropinomas, though there are differences in both clinical and histological features. Each of the familial syndromes is associated with a tumor-suppressor gene that was initially recognized by an observed loss of heterozygosity on chromosome 11q13 in MEN-1 and IFS and on chromosome 17q in CNC. The MEN-1 gene, which codes for the nuclear protein, menin, has been identified and a large number of inactivating mutations have been recognized. The gene associated with CNC codes for the protein kinase A regulatory subunit 1, inactivation of which leads to enhanced activity of the GH-releasing hormone-induced signal transduction pathway. This pathway exerts proliferative effects in somatotropes. The gene associated with IFS is distinct from the MEN-1 gene, though it is located in close proximity, and is contained in a candidate region of approximately 10 Mb. Identification of the IFS gene should provide new insight into the pathogenesis of somatotropinomas, not only in IFS but also in sporadic tumors, where there is an up to 40% allelic loss on chromosome 11q13.

Acromegaly↗
PubMed2001

A rare association between acromegaly and pheochromocytoma.

The occurrence of multiple endocrine tumors is rare; however, they may be found with hereditary diseases such as multiple endocrine neoplasia (MEN). The endocrine tumors involved with these diseases are well documented. We present a case of a patient with a pheochromocytoma and a growth hormone (GH) secreting pituitary adenoma. This association is not described with any of the known MEN syndromes. The association may be a cross-over MEN syndrome or a secondarily induced GH-secreting pituitary adenoma from a pheochromocytoma producing growth hormone releasing hormone (GHRH) instead of catecholamines.

Acromegaly↗