Adenoma hipofisário (prolactinoma) proveniente da disfunção hormonal da prolactina: revisão de literatura / Pituitary adenoma (prolactinoma) from prolactin hormonal dysfunction: literature review

Os adenomas hipofisários são, geralmente, tumores benignos com características de hipersecreção ou hipersecreção hormonal, diagnosticados conforme o crescimento tumoral, síndromes de hiperprodução, deficiência da secreção dos hormônios, alterações visuais e cefaleias. A hiperprolactinemia é a produção excessiva de prolactina (PRL), apresentando níveis elevados de prolactina sérica, o que resulta no aparecimento de adenomas lactotróficos (prolactinomas), predominante em mulheres com idade fértil. O prolactinoma é um adenoma hipofisário secretor de prolactina, classificado como adenoma hipofisário microadenoma, em mulheres, e macroadenoma, em homens. Nas mulheres, o prolactinoma apresenta indícios como galactorreia, amenorreia, disfunção sexual e infertilidade. Em homens, a sintomatologia pauta-se em ganho de peso, disfunção erétil e infertilidade. Os exames laboratoriais, como dosagem de prolactina sérica, e os exames de imagem, principalmente a ressonância magnética (RM), são importantes para confirmar o diagnóstico e a escolha da terapêutica ideal. O tratamento medicamentoso inicial dá-se por drogas agonistas dopaminérgicos (AD), sendo padrão-ouro a cabergolina (CAB), em razão da eficácia e dos efeitos colaterais reduzidos. Quando agonistas dopaminérgicos não surtem efeitos, indica-se submissão a tratamento cirúrgico. Em casos de tumores agressivos ou prolactinomas malignos, indica-se radioterapia. Sendo assim, este artigo corresponde a uma revisão bibliográfica que visa relacionar o adenoma hipofisário (prolactinoma) com a produção excessiva de prolactina (PRL).

Pituitary adenomas are generally benign tumors with characteristics of hypersecretion or hormonal hypersecretion, diagnosed according to tumor growth, hyperproduction syndromes, deficiency in hormone secretion, visual changes and headaches. Hyperprolactinemia is the excessive production of prolactin (PRL), with high levels of serum prolactin, resulting in the appearance of lactotrophic adenomas (prolactinomas), predominant in women of childbearing age. Prolactinoma is a prolactin-secreting pituitary adenoma, classified as pituitary adenoma microadenoma in women and macroadenoma in men. In women, prolactinoma shows signs such as galactorrhea, amenorrhea, sexual dysfunction and infertility. In men, the symptoms are based on weight gain, erectile dysfunction and infertility. Laboratory tests, such as serum prolactin levels, and imaging tests, especially magnetic resonance imaging (MRI), are important to confirm the diagnosis and choose the ideal therapy. The initial drug treatment is done by dopaminergic agonist drugs (AD), with cabergoline (CAB) being the gold standard, due to the reduced efficacy and side effects. When dopaminergic agonists have no effect, submission to surgical treatment is indicated. In cases of aggressive tumors or malignant prolactinomas, radiotherapy is indicated. Thus, this article corresponds to a bibliographic review that aims to relate pituitary adenoma (prolactinoma) with excessive prolactin production (PRL).

Panhipopituitarismo secundario a hemorragia obstétrica profusa / Panhypopituitarism secondary to profuse obstetric haemorrhage

El síndrome de Sheehan o necrosis hipofisaria posparto, constituye la causa más importante de panhipopituitarismo, que de forma ocasional se asocia a hemorragia obstétrica profusa asociada a choque hipovolémico hemorrágico, ocasionando un colapso circulatorio intenso debido a isquemia de la adenohipófisis durante el parto o después del mismo, debido a que esta glándula endócrina sufre importantes cambios anatómicos e histológicos durante el embarazo, los cuales incrementan su volumen hasta en 40%. De esta forma, se produce una secreción reducida de las hormonas que ayudan a regular el crecimiento, la reproducción y el metabolismo, evidenciando en el examen hormonal detallado insuficiencia específicamente de la hormona de crecimiento, foliculoestimulante, luteinizante, estimulante de tiroides, adrenocorticotropica y prolactina predisponiendo a la paciente a inestabilidad hemodinámica a corto plazo así como desequilibrio hormonal permanente. Por esta importancia, es que se presenta el caso de una paciente que ingresó a la Unidad de Terapia Intensiva tras cesárea iterativa debido a acretismo placentario llegando a la histerectomía total intercurriendo con choque hemorrágico, quien cursó durante su estancia en la Unidad con ausencia de recuperación neurológica total y características propias de síndrome de Sheehan, confirmándose el mismo por los niveles hormonales bajos y la ausencia de imagen en la silla turca correspondiente a la necrosis hipofisaria evidenciado por resonancia magnética, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

ABSTRACT Sheehan syndrome or postpartum pituitary necrosis is the most common cause of hypopituitarism and occurs secondary to profuse obstetric haemorrhage with subsequent hypovolemic hemorrhagic shock, with intense circulatory collapse, predisposing to pituitary ischemia during delivery or after the same, due to the hypertrophic changes that occur in this gland during pregnancy. In this syndrome exists a reduced secretion of the hormones that regulate growth, reproduction and metabolism. We present the case of a female patient admitted to the Critical Care Unit after iterative cesarean due to placenta accreta and total hysterectomy, in hypovolemic shock secondary to severe hemorrhage, being suspicious of Sheehan´s syndrome, with characteristic clinical features, low hormone levels and the absence of image in the Turkish chair corresponding to the pituitary necrosis.

A Case of Asymptomatic Multiple Endocrine Neoplasia Type I with Thymic Carcinoid

Multiple endocrine neoplasia type 1 (MEN 1) is an autosomal dominant hereditary disorder caused by germline mutation of the MEN1 gene. It is characterized by tumors of the anterior pituitary gland, parathyroid glands, and endocrine pancreas. Thymic carcinoid tumor is uncommon and associated with a high mortality, but its natural history has not been investigated yet. We report a case of asymptomatic MEN 1 with a thymic carcinoid tumor. A 37-year-old man underwent a routine medical checkup and upper gastrointestinal endoscopy revealed a duodenal neuroendocrine tumor (NET). Further studies showed the coexistence of pancreatic tumor, parathyroid hyperplasia, pituitary adenoma, and thymoma. The patient underwent duodenal endoscopic mucosal resection, distal pancreatectomy, subtotal parathyroidectomy, and thymectomy. The pathological test revealed a duodenal NET, pancreatic NET, parathyroid hyperplasia, and thymic carcinoid tumor. He was treated for MEN 1. We report this asymptomatic case of MEN 1 with a literature review.

Tumores hipofisarios, casuística de Anatomía Patológica / Pituitary tumors: anatomopathological reports

This study examines a description of pituitary tumors considering an anatomopathological casuistic. The study of the tumors of the Central Nervous System (CNS) include the pituitary gland, located in the sella turcica. The pathology of the sellar region is represented by the adenomas, tumors of slow development with or without endocrine secretion, that usually involve the population of young adults. The aim of this report, was to describe the casuistic of the " J. Fernandez Hospital" between the years 2000 through 2017. A retrospective review was performed and 234 samples of the sellar region were processed. Mean age was 42 years with a range of 17 to 77 years. Sex distribution was 57% women and 43 % men. Of these, 77% of the cases resulted adenomas. The conclusions obtained in the study are detailed.

Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of ¹⁸F-Fluorocholine PET/CT in MEN1 Syndrome / 대한핵의학회잡지

Multiple endocrine neoplasia type 1 (MEN1) syndrome is characterized by combined occurrence of tumors of endocrine glands including the parathyroid, the pancreatic islet cells, and the anterior pituitary gland. Parathyroid involvement is the most common manifestation and usually the first clinical involvement inMEN1 syndrome, followed by gastroentero-pancreatic neuroendocrine tumors (NETs). Here we present a case where the patient initially presented with metastatic gastric NET and a single parathyroid adenoma was detected incidentally on ⁶⁸Ga-DOTANOC PET/CT done as part of post ¹⁷⁷Lu-DOTATATE therapy (PRRT) follow-up. Further ¹⁸F-fluorocholine PET/CT showed four adenomas for which the patient subsequently underwent subtotal parathyroidectomy.

Caracterización de familia hondureña afectada por neoplasia endócrina múltiple (NEM-2A), Instituto Nacional Cardiopulmonar, Tegucigalpa, Honduras / Characterization of Honduran family affected by Multiple Endocrine Neoplasia (MEN-2A), Instituto Nacional Cardio-Pulmonar, Tegucigalpa, Honduras

RESUMEN. Introducción . Las Neoplasias Endocrinas Múltiples (NEM) son síndromes clínicos autosómico-dominantes. Se maniies - tan por tumores benignos y malignos que involucran órganos endócrinos y no endócrinos. Incidencia de 1/30,000 personas. Objetivo : Caracterizar una familia hondureña cuyos miembros presentan tumores endócrinos, Instituto Nacional Cardio-Pulmonar (INCP), Tegu - cigalpa, 2017. Métodos . Estudio descriptivo longitudinal. Análisis de información clínica, epidemiológica y de laboratorio, consignada en expedientes clínicos (INCP) y brindada por pacientes, previo consentimiento informado. Conirmación de dos casos mediante estudios genéticos. Resultados . Familia de 9 hijos, procedente de Olancho. Madre falleció por Adenocarcinoma Pancreático; padre sin información. Hija3, caso índice, se le realizó Tiroidectomía Total por Cáncer Medular de Tiroides (CMT). Hijo2 no evaluado. Hija4 portadora asintomática de la mutación del proto-oncogén RET. Hija1 se realizó Tiroidectomía Proiláctica por Hiperplasia Folicular de Tiroides e Hiperplasia Linfática Benigna en nódulo post-auricular derecho. Hija7 se practicó Parotidectomía izquierda por Adenoma Pleomórico Benigno. Hijo5 fue diagnosticado con CMT multifocal. Hija9 se le hizo Tiroidectomía Total con linfadenectomía por CMT multifocal. Hijos 6 y 8, residentes en Estados Unidos de América, se les realizó Adrenalectomía por Feocromocitoma y Tiroidectomía Total por CMT multifocal, respectivamente. Además, se les realizaron pruebas genéticas y moleculares, cuyos resultados conirmaron la mutación en los exones 10, 11, 13, 14, 15 y 16 del proto-oncogén RET, del codón 634 con la sustitución del amino ácido cisteína por triptófano (Cys634Trp), conirmatorio de NEM-2A. Discusión . Constituye el primer trabajo publicado de esta patología en Honduras. Sugerimos la búsqueda epidemiológica de NEM en todo paciente diagnosticado con CMT.

Delayed diagnosis of pituitary stalk interruption syndrome with severe recurrent hyponatremia caused by adrenal insufficiency

Pituitary stalk interruption syndrome (PSIS) involves the occurrence of a thin or absent pituitary stalk, hypoplasia of the adenohypophysis, and ectopic neurohypophysis. Diagnosis is confirmed using magnetic resonance imaging. Patients with PSIS have a variable degree of pituitary hormone deficiency and a wide spectrum of clinical manifestations. The clinical course of the disease in our patient is similar to that of a syndrome of inappropriate antidiuretic hormone secretion. This is thought to be caused by failure in the suppression of vasopressin secretion due to hypocortisolism. To the best of our knowledge, there is no case report of a patient with PSIS presenting with hyponatremia as the first symptom in Korean children. Herein, we report a patient with PSIS presenting severe recurrent hyponatremia as the first symptom, during adolescence and explain the pathophysiology of hyponatremia with secondary adrenal insufficiency.

Two novel heterozygous missense variations within the GLI2 gene in two unrelated argentine patients / Two novel heterozygous missense variations within the GLI2 gene in two unrelated Argentine patients

Several heterozygous GLI2 gene mutations have been reported in patients with isolated GH deficiency (IGHD) or multiple pituitary hormone deficiency (MPHD) with or without other malformations. The primary aim of this study was to analyze the presence of GLI2 gene alterations in a cohort of patients with IGHD or MPHD and ectopic/absent posterior pituitary. The coding sequence and flanking intronic regions of GLI2 gene were amplified and directly sequenced from gDNA of 18 affected subjects and relatives. In silico tools were applied to identify the functional impact of newly found variants (Polyphen2, SIFT, Mutation Taster). We identified two novel heterozygous missense variations in two unrelated patients, p.Arg231Gln and p.Arg226Leu, located in the repressor domain of the protein. Both variations affect highly conserved amino acids of the Gli2 protein and were not found in the available databases. In silico tools suggest that these variations might be disease causing. Our study suggests that the GLI2 gene may be one of the candidate genes to analyze when an association of pituitary hormone deficiency and developmental defects in posterior pituitary gland. The highly variable phenotype found suggests the presence of additional unknown factors that could contribute to the phenotype observed in these patients.

Mutaciones heterocigotas en el gen GLI2 fueron previamente comunicadas como causa de déficit aislado de hormona de crecimiento (IGHD) o déficit múltiple de hormonas hipofisarias (MPHD), con o sin otras malformaciones. El objetivo del estudio fue analizar la presencia de alteraciones en el gen GLI2 en un grupo de pacientes con IGHD o MPHD acompañado de neurohipófisis ectópica o ausente. La secuencia codificante y las regiones intrónicas flanqueantes del gen GLI2 fueron amplificadas y secuenciadas de manera directa a partir de ADN genómico extraído de sangre periférica proveniente de 18 sujetos afectados y sus familiares. Se utilizaron herramientas informáticas para predecir el impacto funcional de las nuevas variantes encontradas (Polyphen2, SIFT, Mutation Taster). Identificamos dos nuevas variantes heterocigotas con pérdida de sentido en dos pacientes no relacionados, p.Arg231Gln y p.Arg226Leu, localizadas en el dominio represor de la proteína. Estas variantes afectan aminoácidos altamente conservados en la secuencia proteica de GLI2 y no se encuentran informadas en las bases de datos disponibles. Las herramientas informáticas utilizadas sugieren que estas variantes pueden ser la causa del desarrollo de la enfermedad. Nuestro resultados indican que el gen GLI2 es uno de los genes candidatos a estudiar cuando existe una asociación entre déficit de hormonas hipofisarias y alteraciones en el desarrollo de la neurohipófisis. Se sugiere la existencia de otros factores adicionales que podrían contribuir a la variabilidad del fenotipo observado.

Clinical, hormonal and radiological features of partial Sheehan's syndrome: an Indian experience

ABSTRACT Objective The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan’s syndrome. Subjects and methods This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion To conclude some of the pituitary functions can be preserved in Sheehan’s syndrome and this has important implications from the treatment and long term morbidity point of view.

Effect of Bushen Tiaojing Recipe and Xiaoyao Pill on adenohypophysis and ovary in androgen-induced sterile rats: a comparative study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Bushen Tiaojing Recipe (BTR) and Xiaoyao Pill (XYP) on the morphology and sex hormones secretion of adenohypophysis and ovaries in androgen-induced sterile rats (ASR).</p><p><b>METHODS</b>Fifty 9-day old SD female rats randomly recruited from total 60 rats were subcutaneously injected with testosterone propionate to establish the ASR model. And the rest 10 rats were recruited as the normal group. Thirty successfully modeled rats were recruited and randomly divided into the model group, the BTR group (administered with BTR suspension), and the XYP group (administered with XYP suspension), 10 in each group. Five weeks later, rats were decapitated in the proestrus. Serum levels of estradiol (E2), progesterone (P), testosterone (T), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were detected by radioimmunoassay. The morphologies of adenohypophysis and ovary were observed after HE staining.</p><p><b>RESULTS</b>Compared with the normal group, serum E2 and T levels increased, while FSH and LH levels decreased in the model group (all P < 0.01). The morphology of adenohypophysis and ovary was abnormal in the model group. Compared with the model group, serum E2 and T levels decreased, while FSH and LH levels increased in the BTR group and the XYP group (P < 0.05, P < 0.01). Besides, E2 and T levels in the BTR group and FSH levels in the XYP group restored to normal (all P > 0.05). The damaged structure of adenohypophysis and ovary got restored to different degrees.</p><p><b>CONCLUSION</b>BTR and XYP both could improve ovulation failure.</p>

histological and immunohistochemical study of the effects of leptin on the pars distalis of the pituitary gland in female albino rats

Leptin is an adipocyte-derived hormone. The plasma level of leptin is elevated in obesity and decreased in emaciation. It is involved in the neuroendocrine regulation of pituitary gland function. The present work was carried out to study the histological changes in the pars distalis of the pituitary gland after an injection of leptin in female albino rats. Thirty just-weaned immature female albino rats [22 days] were divided into two groups: group I included 10 animals and served as a control group and group II included 20 animals that received a daily subcutaneous injection of 5 micro g leptin up to the end of the experiment. The females were subjected daily to vaginal smear. After the maturation was established, rats from each group were again subdivided into groups a and b, which were sacrificed 4 and 20 days after puberty, respectively. The pituitary glands were dissected and specimens were prepared for electron microscopic and immunohistochemical assessment. Leptin injection induced various changes in the pars distalis of the pituitary gland. Some cells had deeply stained nuclei and vacuolated cytoplasm. There was a statistically significant increase in the number of positive p53 antibody immunostained cells in the leptin-treated group, especially after 4 days of leptin injection. The most affected cells were somatotrophs, thyrotrophs, and gonadotrophs. They showed features of hyperactivity, with the appearance of some apoptotic cells. Later, necrotic changes such as pyknotic nuclei, ballooned mitochondria with destroyed cristae, and dilated rough endoplasmic reticulum were observed. Prepubertal increase in leptin led to histological changes in some cells of the pars distalis. It is recommended to avoid increase in body weight, especially at a young age

Effect of malathion on pars distalis of the pituitary gland and the possible protective role of vitamin C in adult female albino rats: a histological, immunohistochemical, and ultrastructural study

Malathion is one of the organophosphorus insecticides that are widely used in agriculture and have been reported to cause multiple organ damage. Vitamin C has been proposed as an antioxidant because it reduces oxidative stress. This work aimed to study the possible histological, immunohistochemical, and ultrastructural changes of gonadotrophs and somatotrophs of the pars distalis of the anterior pituitary gland associated with chronic sublethal malathion administration and assess the possible beneficial role of vitamin C in ameliorating these possible changes. Forty adult female albino rats were divided into four groups. Group I served as the control group. Group II received vitamin C at a dose of 20 mg/100 g/day. Group III animals were treated with malathion at a dose of 100 mg/kg/day. Groups IV animals received vitamin C and then malathion after 2 h at the previous doses. The treatments were given orally to the rats for 2 months. The rats were then sacrificed and specimens from the anterior pituitary gland were taken for light and electron microscopic examination. Light microscopic examination of rats treated with malathion revealed that gonadotrophs exhibited vacuolated degranulated cytoplasm and pyknotic nuclei, whereas somatotrophs appeared shrunken with dense nuclei. Immunohistochemically, there was a decrease in the immunoreactivity of follicle stimulating hormone, luteinizing hormone, and growth hormone-secreting cells. Ultrastructurally, gonadotrophs and somatotrophs showed disintegration of cellular organelles and apoptosis of the nuclei. Coadministration of malathion with vitamin C showed a slight improvement in some gonadotrophs and somatotrophs that looked normal in both light microscopic and electron microscopic examination; however, still others were markedly affected, showing signs of degeneration and apoptosis. The results showed that malathion in chronic doses induces histological, immunohistochemical, and ultrastructural changes in gonadotrophs and somatotrophs because of oxidative stress, and the use of vitamin C partially improves the malathion-induced toxicity

Incidencia de adenomas hipofisiarios en pacientes ingresados al servicio de neurocirugía del Hospital Roosevelt. Guatemala, enero 2010 a diciembre 2011 / Incidence of pituitary adenomas in patients admitted to the neurosurgery department of Roosevelt Hospital. Guatemala, January 2010 to December 2011

Introducción: Los adenomas de hipófisis sonneoplasias benignas que afectan más a adultosde sexo femenino. No se cuenta con tasa deincidencia anual de adenomas hipofisarios anivel nacional. Se realizó un estudio descriptivocon el fin de determinar la incidencia local deadenomas hipofisarios. Metodología: Se realizóun estudio descriptivo transversal en pacientesque ingresaron al Departamento de Neurocirugíadel Hospital Roosevelt para intervención quirúrgicadurante enero 2010 a diciembre 2011. Lasvariables estudiadas fueron edad, sexo, tipo deadenoma hipofisario, síntomas y signos clínicos,complicaciones postoperatorias tempranas,estancia en cuidados críticos y mortalidad. El plande análisis estadístico incluyó la recolección de lainformación, el ordenamiento de datos y uso delprograma Epi Info 3.5.6 para el análisis estadísticode medidas de frecuencia y proporciones. Se utilizóMicrosoft Excell para la elaboración de tablas ygráficas. Resultados: La tasa de incidencia deadenomas hipofisarios fue de 15 casos por cada 100tumores. El predominio del tumor fue en pacientesfemeninas y en edades comprendidas entre los 31-65 años. La disminución de la agudeza visual y lacefalea fueron los signos y síntomas más frecuentes(81% y 77% respectivamente). La complicaciónpostoperatoria inmediata más frecuente fue ladiabetes insípida (4/10 casos). El 54% de los casospermaneció en cuidados intensivos por un periodoentre uno y tres días. Para este estudio la tasa demortalidad fue cero...

Introduction: Pituitary adenomas are benignneoplasms affecting more female adults. Thereis no annual incidence of pituitary adenomasnationwide. A descriptive study was conducted todetermine the local incidence of pituitary adenomas.Methodology: A descriptive cross-sectional studyin patients admitted to the Department of Neurosurgeryat Roosevelt Hospital for surgery injanuary 2010 to december 2011. The variablesstudied were age, sex, type of pituitary adenoma,clinical signs and symptoms, early postoperativecomplications, hospital stay and mortality in criticalcare. The statistical analysis plan included collectinginformation , the ordering of data and use of Epi Info3.5.6 program for statistical analysis of frequencymeasurements and proportions. Microsoft Excelwas used to produce tables and graphs. Results:The incidence of pituitary adenomas was 15 casesper 100 tumors. The prevalence of the tumor was infemale patients and aged 31-65 years. Decreasedvisual acuity and headache were the most commonsigns and symptoms (81% and 77% respectively).The most common immediate postoperative complicationwas diabetes insipidus (4 /10 cases) 54%of the cases remained in intensive care for a periodof one to three days. For this study, the mortality ratewas zero...

Immunohistochemical determination of effects of Withania Somnifera root extract on noise stress induced adenohypophysis in albino rats

To access the ameliorating role of Withania somnifera root extract on noise stress effected Adenohypophysis morphology in albino rats by immuno-histochemical method. Experimental and observational study. This study was carried out at Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical center Karachi from January 2008 to December 2011. 90 adult male albino rats were divided into 3 groups A, B, C each group was divided into 2 subgroups A1-A2, B1-B2 and C1-C2 [24 hrs and 30 days] obtaining15 animals each. Group A served as control, group B were exposed to 100dBA noise for 24 hrs and 6hrs/day for 30 days as experimental design and group C was protected with Withania somnifera root extract along with noise stress. The animals were sacrificed at the end of experimental period of each subgroup and blood samples were collected for hormonal assay of the plasma ACTH and plasma Corticosterone concentration. Pituitary gland was removed from each animal and prepared for microscopic examination by immunohistochemical method. Immunohistochemical study reveals that, the black brown pigments deposited more in group B2 animals and reduced in group C animals Adenohypophysis indicated by ACTH monoclonal antibody Clone-56. The ACTH level was highly significantly increased after 24hrs and 30 days. The Corticosterone level was highly significantly decreased after 24hrs and not as much decreased after 30 days. It was restored insignificantly in protected groups after 24hrs and 30 days. Withania somnifera root extract has preventive efficacy against noise stress, immunohistochemistry confirmed that, less extent of black brown pigment deposition was the amount of corticotropes

Deficiencia de hormona del crecimiento en el adulto / Growth hormone deficiency in adults

La hormona del crecimiento tiene funciones más allá de la que su nombre implica. En el adultoes una hormona importante en el metabolismo de lípidos y carbohidratos, cumple funciones vitales en estados de ayuno y juega un papel preponderante en el equilibrio energético del organismo. La deficiencia de hormona del crecimiento es una entidad bien reconocida en la edad pediátrica, con consecuencias bien establecidas y fácilmente identificables; en contraste, su deficiencia en la edad adulta es más difícil de establecer y puede obedecer a causas congénitas o adquiridas durante la infancia o a causas adquiridas en la edad adulta. En años recientes, se aisló y sintetizó una forma recombinantede la hormona del crecimiento humana, lo cual abrió la posibilidad de tratamiento para aquellas personas con deficiencia de dicha hormona. Sin embargo, hay muchos interrogantes con respecto a la deficiencia de hormona del crecimiento en el adulto, entre ellos, el diagnóstico adecuado y los verdaderosbeneficios y la seguridad del tratamiento con hormona del crecimiento humana recombinante. En este módulo se realiza un estado del arte acerca de la deficiencia de hormona del crecimiento en los adultos.

Growth hormone has other functions besides those that are implied by its name. During adulthood, it is for lipid and carbohydrate metabolism, it has vital function in non-fasting states and it has a pivotal role in maintaining the energy balance of the body. Growth hormone deficiency is a well-known disease in childhood, with established and easily recognizable manifestations. In contrast, adult growth hormone deficiency is more difficult to establish and it can result from either genetic or acquired causes during childhood, or acquired causes during adulthood. In recent years, the isolation and synthesis of recombinant human growth hormone was achieved, and this made it possible to treat affected patients. However, many questions remain regarding adult growth hormone deficiency, including questions about the criteria for an adequate diagnosis, and questions with regards to the real benefits and safety of treatment with human growth hormone. This article reviews the current state of the art regarding practices for the diagnosis and management of adult growth hormone deficiency.

Hypothalamic Hypopituitarism Caused by Pituitary Stalk Dysgenesis / 대한내과학회지

Functional defects of the pituitary gland are a rare cause of pubertal delay. The pituitary stalk is an important structure that connects the hypothalamus and pituitary gland. A defect in fusion of the pituitary stalk and anterior pituitary gland will block the function of the anterior pituitary gland. A 28-year-old man was referred to our clinic with poorly developed secondary sexual characteristics. He had undeveloped facial, axillary, and pubic hair and was Tanner stage I. Laboratory tests gave random serum testosterone < 0.025 ng/mL, luteinizing hormone (LH) < 0.1 mIU/mL, follicle-stimulating hormone (FSH) 0.626 mIU/mL, thyroid-stimulating hormone (TSH) 6.85 microIU/mL, and fT4 6.96 pmol/L. Sella magnetic resonance imaging (MRI) showed no pituitary stalk enhancement. The response in the combined pituitary function test revealed multiple hormonal defects, while the TSH response to thyrotropin-releasing hormone (TRH) was exaggerated and delayed. Therefore, we concluded that pituitary stalk dysgenesis had led to hypothalamic-type panhypopituitarism.

Evaluation of anterior pituitary function following traumatic brain injury

Neuroendocrine dysfunction following traumatic brain injury [TBI] is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI. From June to December 2009, over a period of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, [61 males and 9 females mean age 30 years] included in the study, 39 patients had moderate [GCS; 9 - 12] and 31 cases had severe [GCS < 8] TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status. Forty-one patients [58.6%] were found to be suffering from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins [LH, FSH], 12.9%, corticotrophin [ACTH], 12.9%, somatotropin [GH], 4.3%, and prolactin [PRL], 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases [31.5%]. The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patients' health

A Case of a Calcitonin-Secreting Pancreatic Endocrine Tumor in a Pateint with Multiple Endocrine Neoplasia Type 1 / 대한내과학회지

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant hereditary disorder characterized by the combined occurrence of tumors of the parathyroid gland, exocrine pancreas, and anterior pituitary gland. Calcitonin-secreting pancreatic endocrine tumors are rare, and calcitonin-secreting pancreatic endocrine tumors with MEN1 have not been reported in Korea. A 46-year-old woman was admitted for a right breast cancer operation. Abnormal blood chemistry findings were hypercalcemia and elevated calcitonin. The patient was diagnosed with a calcitonin-secreting pancreatic endocrine tumor, left thyroid papillary carcinoma, right breast invasive ductal carcinoma, a thymic carcinoid tumor, left adrenal adenoma, uterine myoma, and adenomyosis by computed tomography scan, and with pituitary macroadenoma by brain magnetic resonance imaging. We present this case with a review of the literature, because it is the first reported calcitonin-secreting pancreatic endocrine tumor with MEN 1 in Korea.

Hormonal and Histomorphologic Effects of Azadirachta indica leaf Extract on the Pars Anterior of Wistar Rats / Efectos Hormonales e Histomorfológicosdel Extracto de la Hoja de Azadirachta indica en la Pars Anterior de Ratas Wistar

Azadirachta indica is a tree whose medicinal value is unquantifiable. Any part of the tree can be used in the treatment of malarial infection. Reports have indicated its antifertility effects, and this necessitated this study on the effects of the methanol leaf extract on serum luteinizing (LH) and follicle stimulating hormones (FSH) levels and the histomorphology of the pars anterior of Wistar rats. Thirty adult male Wistar rats were equally divided into 3 groups of A, B and C. Group A was the control and the animals received distilled water orally, while groups B and C were treated with 200mg/kg and 400mg/kg respectively of the leaf extract by oral gavage for fourteen days. On day fifteen, the animals were sacrificed by chloroform anaesthesia. Blood was obtained from their hearts, while the skull was opened to assess the hypophysis. Hormonal assay showed that luteinizing (LH) and follicle stimulating (FSH) hormone levels in the serum were lower in groups B and C treated with 200mg/kg and 400mg/kg respectively of the leaf extract, while that of LH were significant (P<0.001). Histomorphologic sections of the pars anterior revealed reduced acidophil and basophil populations, with prominent degranulated chromophobes which were larger in the group treated with 400mg/kg of A. indica leaf extract. This group also presented hypertrophy of the basophils compared to the control. In conclusion, methanol leaf extract of A. indica decreases serum LH and FSH and caused histomorphologic changes in the pars anterior of adult male Wistar rats.

Azadirachta indica es un árbol cuyo valor medicinal es invaluable. Cualquier parte del árbol se puede utilizar en el tratamiento de la infección por malaria. Reportes han indicado su efecto antifertilidad, lo que requirió estudiar los efectos del extracto metanólico de la hoja sobre los niveles séricos de las hormonas luteinizante (LH) y folículo estimulante (FSH) y la histomorfología de la pars anterior de ratas Wistar. Treinta ratas Wistar adultas fueron divididas en tres grupos. El grupo A fue utilizado como control y los animales recibieron agua destilada por vía oral, mientras que los grupos B y C fueron tratados con 200 mg/kg y 400 mg/kg respectivamente, con extracto de hoja mediante una sonda nasogástrica durante catorce días. A los quince días, los animales fueron sacrificados por anestesia con cloroformo. Se obtuvo sangre desde sus corazones, mientras que el cráneo fue abierto para evaluar la hipófisis. Los ensayos hormonales mostraron que los niveles en suero de la LH y FSH se redujeron en los grupos B y C, tratados con 200 mg/kg y 400 mg/kg respectivamente, siendo la reducción de LH significativa (p<0,001). Secciones histomorfológicos de la pars anterior revelaron una reducción de las poblaciones acidófilas y basófilas, con prominentes cromófobos degranulados que fueron mayores en el grupo tratado con 400 mg/kg del extracto de A. indica. Este grupo también presentó hipertrofia de los basófilos en comparación con el control. En conclusión, el extracto alcohólico de la hoja de de A. indica disminuye el nivel sérico de LH y FSH y provoca cambios histomorfológicos en la pars anterior de ratas Wistar adultas.