Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

Brazilian multicenter study on pegvisomant treatment in acromegaly

ABSTRACT Objective Investigate the therapeutic response of acromegaly patients to pegvisomant (PEGV) in a real-life, Brazilian multicenter study. Subjects and methods Characteristics of acromegaly patients treated with PEGV were reviewed at diagnosis, just before and during treatment. All patients with at least two IGF-I measurements on PEGV were included. Efficacy was defined as any normal IGF-I measurement during treatment. Safety data were reviewed. Predictors of response were determined by comparing controlled versus uncontrolled patients. Results 109 patients [61 women; median age at diagnosis 34 years; 95.3% macroadenomas] from 10 Brazilian centers were studied. Previous treatment included surgery (89%), radiotherapy (34%), somatostatin receptor ligands (99%), and cabergoline (67%). Before PEGV, median levels of GH, IGF-I and IGF-I % of upper limit of normal were 4.3 µg/L, 613 ng/mL, and 209%, respectively. Pre-diabetes/diabetes was present in 48.6% and tumor remnant in 71% of patients. Initial dose was 10 mg/day in all except 4 cases, maximum dose was 30 mg/day, and median exposure time was 30.5 months. PEGV was used as monotherapy in 11% of cases. Normal IGF-I levels was obtained in 74.1% of patients. Glycemic control improved in 56.6% of patients with pre-diabetes/diabetes. Exposure time, pre-treatment GH and IGF-I levels were predictors of response. Tumor enlargement occurred in 6.5% and elevation of liver enzymes in 9.2%. PEGV was discontinued in 6 patients and 3 deaths unrelated to the drug were reported. Conclusions In a real-life scenario, PEGV is a highly effective and safe treatment for acromegaly patients not controlled with other therapies.

Prolactinomas: evolution after menopause

ABSTRACT Objetive The aim was to assess the evolution of tumor size and prolactin (PRL) levels in patients with micro and macroprolactinomas diagnosed and treated with dopamine agonists during fertile age, and the effects of suspension of drugs after menopause. Retrospective study, 29 patients with prolactinomas, 22 microadenomas and 7 macroadenomas, diagnosed during their fertile age were studied in their menopause; treatment was stopped in this period. Age at menopause was 49 ± 3.6 years. The average time of treatment was 135 ± 79 months. The time of follow-up after treatment suspension was 4 to 192 months. Results Pre-treatment PRL levels in micro and macroadenomas were 119 ± 57 ng/mL and 258 ± 225 ng/mL, respectively. During menopause after treatment suspension, and at the latest follow-up: in microadenomas PRL levels were 23 ± 13 ng/mL and 16 ± 5.7 ng/mL, respectively; in macroadenomas, PRL levels were 20 ± 6.6 ng/mL 5t5and 25 ± 18 ng/mL, respectively. In menopause after treatment suspension, the microadenomas had disappeared in 9/22 and had decreased in 13/22. In the group of patients whose tumor had decreased, in the latest follow-up, tumors disappeared in 7/13 and remained unchanged in 6/13. In macroadenomas, after treatment suspension 3/7 had disappeared, 3/7 decreased and 1/7 remained unchanged. In the latest control in the 3 patients whose tumor decreased, disappeared in 1/3, decreased in 1/3 and there was no change in the remaining. Conclusions Normal PRL levels and sustained reduction or disappearance of adenomas were achieved in most of patients, probably due to the decrease of estrogen levels. Dopamine agonists might be stopped after menopause in patients with prolactinomas.

Change in Somatostatinergic Tone of Acromegalic Patients according to the Size of Growth Hormone-Producing Pituitary Tumors

The aim of this study was to investigate the relationship between somatostatinergic tone (SST) and the size of growth hormone (GH)-producing pituitary tumors. GH levels of 29 patients with newly diagnosed acromegaly were measured using a 75-gram oral glucose tolerance test (OGTT), an insulin tolerance test (ITT), and an octreotide suppression test (OST). Differences between GH levels during the ITT and the OGTT (DeltaGH(IO)), and between the OGTT and the OST at the same time point (DeltaGH(OS)) were compared according to the size of the tumor and the response pattern to the OST. DeltaGH(IO) of macroadenomas (n=22) was non-significantly higher than those of microadenomas while DeltaGH(OS) of macroadenomas were significantly higher than those of microadenomas. According to further analyses of macroadenomas based on the response pattern to the OST, GH levels during the ITT were significantly higher in non-responders. DeltaGH(OS) showed near-significant differences between responders and non-responders. In conclusion, as the size of the pituitary tumor increases, the effect of glucose on SST appears to be attenuated. Macroadenomas that are non-responders to the OST possess a portion of GH secretion exceeding the range of regulation by SST.

Temozolomide in aggressive pituitary adenomas and carcinomas

Temozolomide is an alkylating agent used in the treatment of gliomas and, more recently, aggressive pituitary adenomas and carcinomas. Temozolomide methylates DNA and, thereby, has antitumor effects. O6-methylguanine-DNA methyltransferase, a DNA repair enzyme, removes the alkylating adducts that are induced by temozolomide, thereby counteracting its effects. A Medline search for all of the available publications regarding the use of temozolomide for the treatment of pituitary tumors was performed. To date, 46 cases of adenohypophysial tumors that were treated with temozolomide, including 30 adenomas and 16 carcinomas, have been reported. Eighteen of the 30 (60%) adenomas and 11 of the 16 (69%) carcinomas responded favorably to treatment. One patient with multiple endocrine neoplasia type 1 and an aggressive prolactin-producing adenoma was also treated and demonstrated a good response. No significant complications have been attributed to temozolomide therapy. Thus, temozolomide is an effective treatment for the majority of aggressive adenomas and carcinomas. Evidence indicates that there is an inverse correlation between levels of O6-methylguanine-DNA methyltransferase immunoexpression and therapeutic response. Alternatively, high-level O6-methylguanine-DNA methyltransferase immunoexpression correlates with an unfavorable response. Here, we review the use of temozolomide for treating pituitary neoplasms.

Clomiphene fails to revert hypogonadism in most male patients with conventionally treated nonfunctioning pituitary adenomas / Clomifeno não reverte o hipogonadismo na maioria dos homens com adenomas pituitários não funcionais tratados de forma convencional

OBJETIVE: To evaluate the effect of clomiphene in men with hypogonadism and conventionally treated nonfunctioning pituitary adenomas (NFPA). PATIENTS AND METHODS: Open label, single-arm, prospective trial. Nine hypogonadal men (testosterone < 300 ng/dL and low/normal LH) with previously treated NFPA. Clomiphene (50 mg/day orally) for 12 weeks. Testosterone, estradiol, LH, FSH, prolactin and erectile function were evaluated before and after 10 days, 4, 8 and 12 weeks of clomiphene treatment. RESULTS: After clomiphene treatment, testosterone and erectile function improved in only one patient. In the remaining eight patients, testosterone levels decreased whereas LH, FSH, and estradiol remained unchanged. Insulin sensitivity increased in unresponsive patients. CONCLUSIONS: Compared with hypogonadal men with prolactinomas under dopaminergic therapy, clomiphene treatment failed to restore normal testosterone levels in most patients with conventionally treated NFPA.

OBJETIVO: Avaliar o efeito do clomifeno em homens com hipogonadismo e adenoma hipofisário não funcionante (NFPA) previamente tratados. PACIENTES E MÉTODOS: Aberto, braço único, prospectivo. Nove homens hipogonádicos (testosterona < 300 ng/dL e LH normal/baixo) com NFPA previamente tratados. Clomifeno (50 mg/dia oral) por 12 semanas. Testosterona, estradiol, LH, FSH, prolactina e função erétil foram avaliados antes e após 10 dias, 4, 8 e 12 semanas de clomifeno. RESULTADOS: Após clomifeno, a testosterona e a função erétil melhoraram em um paciente. Em outros oito pacientes, os níveis de testosterona reduziram enquanto os níveis de LH, FSH, e estradiol permaneceram inalterados. A sensibilidade à insulina aumentou nos não respondedores. CONCLUSÕES: Em contraste com homens hipogonádicos com prolactinomas tratados com agonistas dopaminérgicos, a maioria dos hipogonádicos com NFPA falha em restaurar os níveis de testosterona durante o uso de clomifeno.

Long term treatment of a thyrotropin-secreting microadenoma with somatostatin analogues / Tratamento de longa duração com análogos da somatostatina de um microadenoma tirotrofinoma

Thyrotropin (TSH) secreting pituitary adenomas (TSH-omas) account for < 1 percent of all pituitary adenomas and are a rare cause of hyperthyroidism. The diagnosis is often made at the stage of macroadenoma because of the aggressive nature of the tumor and due to the fact that patients are mistakenly treated for more common primary hyperthyroidism for a long time. First line therapy is transsphenoidal resection of the tumor, which can cure one-third of the patients completely. However, if surgery is not possible or curative, pituitary radiotherapy and/or somatostatin analogs (SSA) can be useful. We report the case of a 54-year-old woman treated 20 years earlier for a mistakenly suspected primary hyperthyroidism. Given the persistence of symptoms she was studied further and was diagnosed with a thyrotropinoma. Despite the delay in diagnosis and prior thyroid ablation, a microadenoma was found. As transsphenoidal surgery was not considered effective, medical therapy with a somatostatin analogue was initiated. Currently, at four years of follow-up, the patient continues on this treatment and remains euthyroid and asymptomatic. We report a case of successful long-term treatment with SSA, after unsuccessful surgery.

Tirotrofinomas (TSH-omas) representam < 1 por cento dos adenomas hipofisários. Eles são uma causa muito rara de hipertireoidismo. O diagnóstico é frequentemente feito na fase de macroadenoma em consequência da natureza agressiva do tumor e do feito de que os doentes são tratados inicialmente por engano e por um longo tempo para hipertireoidismo primário. A terapêutica de primeira linha é a ressecção transesfenoidal do tumor, que cura um terço dos pacientes completamente. Contudo, se a cirurgia não for possível ou curativa, a radioterapia da pituitária e/ou o tratamento com análogos da somatostatina (SSA) podem ser úteis. Relatou-se o caso de uma mulher de 54 anos, tratada há 20 anos por uma suspeita equivocada de hipertireoidismo primário. Dada a persistência dos sintomas, foram realizados mais exames e a paciente foi diagnosticada com TSH-oma. Apesar do diagnóstico tardio e da ablação prévia com iodo radioativo, encontrou-se um microadenoma. Como a cirurgia transesfenoidal não foi considerada eficaz, iniciou-se o tratamento da paciente com SSA. Atualmente, após quatro anos de acompanhamento, a paciente continua com o tratamento e permanece eutireoidea e assintomática. Neste artigo, relatou-se a eficácia da terapia medicamentosa com SSA em longo prazo, após cirurgia não eficaz.

Somatostatin receptors subtypes 2 and 5, dopamine receptor type 2 expression and gsp status as predictors of octreotide LAR® responsiveness in acromegaly / Expressão dos receptores da somatostatina subtipos 2 e 5 e do receptor da dopamina tipo 2 e gsp status como preditores de resposta ao octreotide LAR® na acromegalia

We present two acromegalic patients in which clinical and molecular data are discussed in regard to their ability to predict long term octreotide LAR® therapy response. Case reports: Patient 1: female, 36 years old at diagnosis. Basal GH and IGF-I at diagnosis were 133 ng/mL and 181 percent above the upper limit of reference values (ULRV), respectively. Growth hormone during acute test with subcutaneous octreotide decreased from 133 to 13 ng/mL. Patient started on primary octreotide LAR® therapy (20mg q28 days) and achieved biochemical parameters of disease control after 6 months. Molecular analysis of tumor fragments: gsp +; quantitative analysis of SSTR (somatostatin receptor) and DR (dopamine receptor) mRNA - SSTR2 23954; SSTR5 2407; DR2 total 17016 copies. Patient 2: male, 38 years old at diagnosis. Basal GH and IGF-I at diagnosis were 120 ng/mL and 114 percent ULRV, respectively. Patient underwent non-curative trans-sphenoidal surgery. Post-operative GH and IGF-I were 112 ng/mL and 137 percent ULRV, respectively. Growth hormone during acute test with subcutaneous octreotide decreased from 112 to 7 ng/mL. Octreotide LAR® therapy (20 mg q28 days) was then initiated. After 6 months of treatment, patient did not attain biochemical control of disease and displayed increased tumor volume. Molecular analysis of tumor fragments: gsp not done; quantitative analysis of SSTR and DR mRNA - SSTR2 416; SSTR5 3767; DR2 total 3439 copies. In conclusion, these two cases illustrate how laboratory data can be conflicting as predictors of octreotide LAR® responsiveness and how molecular analysis of tumor fragments can help explain different behaviors in clinically similar patients.

Apresentamos dois pacientes acromegálicos nos quais dados clínicos e moleculares são discutidos quanto à sua capacidade de predizer a resposta a longo prazo ao tratamento com octreotide LAR®. Relato dos casos: Paciente 1: Feminina, 36 anos de idade ao diagnóstico. GH e IGF-I ao diagnóstico 133 ng/mL e 181 por cento acima do limite superior do valor de referência (LSVR), respectivamente. GH durante o teste agudo com octreotide subcutâneo diminuiu de 133 para 13 ng/mL. Foi iniciado tratamento primário com octreotide LAR® (20 mg q28 dias) e a paciente alcançou os parâmetros bioquímicos de controle de doença depois de seis meses. Análise molecular do tumor: gsp +; análise quantitativa do mRNA de SSTR (receptores de somatostatina) e DR (receptor de dopamina) - SSTR2 23.954; SSTR5 2.407; DR2 total 17.016 cópias. Paciente 2: Masculino, 38 anos de idade ao diagnóstico. GH e IGF-I ao diagnóstico 120 ng/mL e 114 por cento LSVR, respectivamente. Paciente foi submetido à cirurgia trans-esfenoidal não-curativa. GH e IGF-I pós-operatórios 112 ng/mL e 137 por cento LSVR, respectivamente. GH durante o teste agudo diminuiu de 112 para 7 ng/mL. Foi iniciado tratamento com octreotide LAR® (20 mg q28 dias). Após seis meses o paciente não alcançou controle bioquímico e apresentou aumento do volume tumoral. Análise molecular do tumor: gsp não estudado; análise quantitativa do mRNA de SSTR e DR - SSTR2 416; SSTR5 3.767; DR2 total 3.439 cópias. Em conclusão, estes dois casos ilustram como dados laboratoriais podem ser conflitantes enquanto preditores de resposta ao tratamento com octreotide LAR® e como a análise molecular de fragmentos do tumor pode ajudar a explicar comportamentos diferentes em pacientes clinicamente semelhantes.

Rational use of glucocorticoid during pituitary surgery--a pilot study.

BACKGROUND & OBJECTIVE: The conventionally used perioperative glucocorticoid replacement protocol in patients with pituitary tumours is far from optimal. In this study we evaluated the validity of a modified protocol for perioperative glucocorticoid replacement in non-functioning pituitary macroadenomas. METHODS: A total of 24 consecutive patients with non functioning pituitary macroadenomas were included in this interventional study. Patients with a pre-operative 0800 h cortisol of > or = 350 nmol/l (> or = 12.6 microg/dl) did not receive glucocorticoid replacement during perioperative (d(0)-d-(2)) period, while those with < or = 100 nmol/l (< or = 3.6 microg/dl) received glucocorticoid replacement. Those patients with 0800 h cortisol value between > 100-349 nmol/l (> 3.6-12.6 microg/dl) required them to undergo an insulin induced hypoglycaemia (IIH). In response to IIH, patients with a peak cortisol of < 550 nmol/l (< 19.8 microg/dl) received glucocorticoid replacement. Post-operatively, patients on day 3 with 0800 h cortisol of < or = 100 nmol/l (< or = 3.6 microg/dl) received hydrocortisone 10 mg/m(2) per day; those between > 100-449 nmol/l (> 3.6-16 microg/dl) received hydrocortisone replacement only if they had symptoms of adrenal insufficiency (AI) or during stress; while patients with > or = 450 nmol/l (> or = 16.0 microg/dl) did not receive any glucocorticoid replacement. Retesting was done at 12 wk in 23 subjects based on the algorithm. RESULTS: Pre-operatively, 8 (35%) patients were hypocortisolic and received glucocorticoid supplementation, thereby sparing 15 (65%) subjects from glucocorticoid replacement. On d(3) of surgery, 13 (57%) patients were hypocortisolic, but only 6 with serum cortisol of < or = 100 nmol/l (< or = 3.6 microg/dl), had symptoms and were substituted with glucocorticoid. Remaining seven patients, with serum cortisol between >100-349 nmol/l (> 3.6-12.6 microg/dl), were asymptomatic and advised glucocorticoid support only during stress but none required. Overall, 17 (74%) patients were spared from unnecessary glucocorticoid support. At 12 wk, 13 (57%) patients were hypocortisolic and only 6 either with serum cortisol level of < or = 100 nmol/l (< or = 3.6 microg/dl) or symptomatic for AI received glucocorticoids. Post-operative complications including diabetes insipidus and CSF leak remarkably decreased. INTERPRETATION & CONCLUSION: The protocol used was safe and spared unnecessary use of glucocorticoids peri- and post-operatively. However, more number of patients are to be studied to substantiate the validity of this protocol.

Contribuição da analise de textura do nucleo celular para o diagnostico diferencial de lesões foliculares da tireoide: comparação com marcadores imunoistoquimicos / Contribution of the cellular nucleus texture analyses for the differential diagnosis of follicular thyroid lesions: comparison with imunohistochemical

O diagnóstico diferencial entre algumas lesões da tireóide é, muitas vezes, difícil de ser determinado, mesmo diante de diversas amostras de tecido. O propósito deste estudo foi o de investigar até que ponto a análise de textura da cromatina em cortes histológicos de rotina contribui para o diagnóstico diferencial entre lesões foliculares da glândula tireóide. Entraram no estudo cortes histológicos corados com hematoxilina-eosina de 12 nódulos adenomatosos hiperplásicos (NA), 18 adenomas foliculares (AF), 24 carcinomas foliculares mínimamente invasores (CFMI) e 22 variantes foliculares do carcinoma papilífero (VFCP). As amostras de tecido utilizadas foram analisadas morfologicamente por meio de estudo histológico e estudo imunoistoquímico pela expressão de diferentes proteínas ou marcadores. Os marcadores utilizados foram HBME-1, CK-19 e galectina-3. Em cada caso 100 núcleos foram aleatoriamente escolhidos, digitalizados e segmentados. A estrutura dos núcleos foi descrita por morfometria, densitometria e por variáveis derivadas da matriz de co-ocorrência. Sexo, idade do paciente e metástases foram informações pesquisadas. Os resultados da análise de imagem computadorizada foram comparados com aqueles obtidos por meio de estudo imunoistoquímico, na distinção das lesões foliculares benignas e malignas da tireóide. Os dados foram comparados por análise de variância (nível de significância p<0,05). As amostras sugerem...

The differential diagnosis between some thyroid lesions is often difficult to determine, even with permanent sections. The purpose of this study was to find out if chromatin texture analysis contributes to the differential diagnosis of thyroid follicular lesions. We selected slides stained with H-E (hematoxilin-eosin) of 12 hyperplastic adenomatous nodules (AN), 18 follicular adenomas (FA), 24 minimally invasive follicular carcinomas (MIFC) and 22 follicular variants of papillary carcinomas (FVPC). A total of 100 nuclei of each case were digitalized and segmented. The utility of a combination of immunostaining including galectin-3, HBME-1 and CK-19 in the routine differentiation of the histologies of thyroid malignancies was evaluated. The nuclei structure was described by morfometry, densitometry and by variables derived by co-occurrence matrix. Sex, age of the patient and metastasis were clinical and morphologic parameters searched in this study. These data, described as prognostic factors for follicular malignant tumors, were compared by variance analysis (significance value p<0,05) and did not differentiate significantly among the groups. The best marker, in terms of sensitivity and specificity, was HBME-1. The combination CK-19, HBME-1 and galectin-3, in a panel, may be useful in specific cases, for example, for differentiate folicullar lesions, with special reference for folicullar variant of papillary carcinoma. Morphometric variables did not show significant discriminant value...

Tratamento medicamentoso dos tumores hipofisários. Parte II: adenomas secretores de ACTH, TSH e adenomas clinicamente näo funcionantes / Drug therapy of hypophyseal tumors. Part II: ACTH and TSH secreting adenomas and functionless clinically adenomas

Este artigo revisa o potencial papel do tratamento medicamentoso para os adenomas hipofisários secretores de ACTH, TSH e aqueles clinicamente näo-funcionantes (ACNF). Metirapona, mitotano e cetoconazol (preferível por causar menos efeitos colaterais) säo as drogas mais eficazes no controle do hipercortisolismo, mas nenhuma delas supera a eficácia da cirurgia transesfeinodal (TSA). O tratamento medicamentoso da doença de Cushing está, portanto, melhor indicado para pacientes aguardando o efeito pleno da radioterapia ou, como alternativa para esta última, em casos de hipercortisolismo persistente após TSA, e para pacientes com rejeiçäo ou limitaçöes clínicaspara a cirurgia. Outra indicaçäo potencial seria em idosos com microadenomas ou pequenos macroadenomas, ou em casos associados a sela vazia. No que se refere aos adenomas secretores de TSH, os análogos somatostatínicos (SRIFa) proporcionam normalizaçäo dos hormônios tireoidianos em até 95 por cento dos casos. Assim, eles podem se mostrar úteis em casos de insucesso da cirurgia ou como terapia primária de casos selecionados. Ocasonalmente, agonistas dopaminérgicos (DA), sobretudo a cabergolina, também podem ser eficazes. Em contraste, DA e SRIFa raramente induzem uma significante reduçäo das dimensöes dos ACNFs. Por isso, em pacientes com tais tumores, essas drogas devem ser principlamente consideradas diante de contra-indicaçöes ou limitaçöes clínicas para a cirurgia ou quando a cirurgia e a radioterapia tenham sido mal-sucedidas.

Tratamento medicamentoso dos tumores hipofisários: parte I: prolactinomas e adenomas secretores de GH / Drug therapy of hypophyseal tumors: part I: prolactinomas and GH secretory adenomas

O recente desenvolvimento de novas drogas, particularmente os análogos da somatostatina (SRIFa), representou um grande processo na terapia dos tumores hipofisários. Os SRIFa mostram-se bastante eficazes na normalizaçäo dos níveis de GH e IGH- 1 em acromegálicos e podem ser uma alternativa para a cirurgia transesfeinodal, mas seu uso como terapia primária da acromegalia fica limitado pelo pequeno efeito dessas drogas na reduçäo das dimensöes do tumor. Os resultados preliminares com os antagonistas do receptor de GH, como o pegvisomant, säo bastante animadores. Tais drogas permitem a normalizaçäo do IGF-1 e melhora clínica em mais de 80 por cento dos casos; entretanto, nao causam reduçäo tumoral. Agonistas dopaminérgicos (DA) represemtam a terapia de escolha para microprolactinonas sintomáticos e macroprolactinomas, permitindo normalizaçäo dos níveis da prolactina e reduçäo do volume do adenoma na maioria dos pacientes . Podem também ser eventualmente eficazes em acromegálicos, sobretudo naqueles com adenomas co-secretores de prolactina e níveis näo muito elevados de GH e IGF-1. Devido a sua maior eficácia e maior tolerabilidade, a carbegolina representa o DA de escolha para o manuseio dos prolactinomas e da acromegalia.

Les adenomes hypophsaires thyreotropes a Yaounde [Cameron] analyse de deux cas observes: amelioration par lianalogue de la samatostatine [SMS 201-995]

We carried out treatment of 2 patients with thyrotropin, adenoma related hyperthyroidism using SMS 201-995, which lead to remarkable clinical and biological improvement. We conclude that SMS 201-995 is an efficient and simple means of treatment of thyrectropin adenoma related hyperthyroidism especially, when surgical possibilities are lacking as in Black Africa

Problems in the management of large prolactin-secreting pituitary adenomas

To determine current problems in the management of large prolactin-secreting pituitary adenomas. Retrospective study of consecutive patients with prolactin-secreting adenomas over a 10 years period. Neurosurgical division of King Khalid University Hospital, Riyadh, Saudi Arabia. Thirty-one patients four with microadenomas and 27 with macroprolactinomas. Tumour resection was performed in 22 patients: transsphenoidal in 16 and transcranial in six patients were treated conservatively [dopamine agonist alone in five cases, and combined with radiotherapy in one]. Three patients refused surgery and were excluded. Surgical morbidity and mortality, postoperative basal prolactin level. Six patients [27%] became normoprolactinaemic directly after surgery; 14 patients required additional postoperative treatment. The overall rate of return of serum prolactin level to normal at last follow up was 71%. Hyperprolactinaemia was significantly reduced in a further 21% of the patients while the remaining 8% were unchanged. One patients died 40 days after transcranial surgery. Two patients developed tumour recurrences and hyperprolactinaemia relapsed in a third patient with no evidence of tumour regrowth. The failure rate of monotherapy in large prolactin-secreting adenomas is high. At present, the combination of transsphenoidal surgery and dopamine agonist therapy provides the highest control rates of the tumour and the associated hyperprolactinaemia

Tratamiento médico del prolactinoma en mujeres: análisis de una serie de 40 casos / Medical treatment of prolactinoma in women: analysis of 40 cases

Se presenta la evolución clínica de 40 mujeres portadoras de prolactinoma (33 microadenomas y 7 macroadenomas), sometidas a tratamiento médico con bromocriptina. El motivo principal de consulta fue la alteración menstrual, presente en 97,5% de los casos. El tratamiento con bromocriptina redujo los niveles de prolactina en todas las pacientes. Al finalizar este estudio se alcanzó normalización de prolactina en el 87,4%, la que se asoció a normalización de las reglas en el 79,5%. Hubo 13 embarazos durante el tratamiento; en 11 se suspendió la bromocriptina en el primer trimestre. Los embarazos evolucionaron normalmente y los recién nacidos fueron de término y sanos. No hubo evidencias de crecimiento tumoral durante el tratamiento y la droga fue bien tolerada en 39 de las 40 pacientes. En conclusión, el tratamiento de prolactinoma con bromocriptina es exitoso y lo recomendamos como terapia de elección en el microadenoma

Destino final del fenol I 131 en el tratamiento por inyección intratumoral del adenona prostático / Final destination of 131 I phenol in the treatment of prostatic adenoma by intratumoral injection

Se realizó una evaluación sobre el destino final del producto inyectado dentro del adenoma prostático, como método terapéutico. Se evaluó la difusión del fenol inyectado en el tumor, empleando el método de radioiodación del fenol con I 131. Se realizaron mediciones cuantitativas en orina y sangre y semicuantitativas por recuento de tipos externos. Se confeccionaron los gráficos de acuerdo con los resultados de las lecturas y cinta de registro. De los resultados obtenidos se hicieron las conclusiones