[Acromegalic cardiopathy: a morphofunctional study with color-Doppler echocardiography]. / Cardiopatia acromegalica: studio morfo-funzionale con ecocardiografia color-Doppler.

We used color-Doppler echocardiography in an investigation of cardiac morphology and function to verify the cardiac anatomic and functional changes in acromegalic patients with or without hypertension and hyperlipemic states. Fifteen patients with growth hormone-secreting pituitary adenoma (mean age: 47.9 years) and 15 healthy control subjects were studied. We measured serum growth hormone (GH), somatomedin-C, cholesterol, triglyceride levels and carried out echocardiographic studies of the following cardiac morpho-functional parameters: left ventricular diameter, volume, mass and wall systolic stress. Serum GH and somatomedin-C levels were significantly higher in acromegalic patients than in controls (p < 0.001 and p < 0.001 respectively). Echocardiography evidenced increased left ventricular mass (60% of the acromegalic patients; p < 0.05) and increased wall systolic stress (53.3%; p < 0.05). Color-Doppler analysis evidenced abnormal diastolic function in 8 acromegalic patients (p < 0.001). We thus conclude that the most characteristic feature of acromegalic heart disease is left ventricular involvement, diastolic dysfunction, increased left ventricular mass or wall systolic stress. The pathogenesis is most probably multifactorial: essential hypertension, associated with slow and progressive evolution of heart disease, appears to be a determining factor.

Effectiveness of computer-assisted perimetry in the diagnosis of pituitary adenomas.

Computer-assisted perimetry (CP) is a new method which quantifies the differential light sensitivity threshold and allows the statistical analysis of the data. It offers advantages as compared with manual methods. This study has been carried out in 27 patients with pituitary adenomas (four males and 23 females; 13 with prolactinomas; six with acromegaly, four with Cushing's disease and four with non-secreting adenomas). A skull X-ray and a computed tomodensitometry (CT), a manual Goldman perimeter and a computer assisted visual field examination were performed in all cases. The presence of a pituitary tumour was suggested by the X-ray and by the CT in 12 and 23 patients respectively out of the 27: the CT scan revealed a suprasellar extension in seven cases. Visual field defects were detected by means of the Goldman perimeter in six patients and by means of the computer-assisted technique in 25/27. The effectiveness of this new technique was proved by the concordance with the CT scan results in 21 cases and by the histological examination of the four adenomas which were not apparent at CT scan. A significant difference was found for both eyes (right eye, chi squared = 258, P less than 0.001; left eye, chi squared = 295.0, P less than 0.001) between patients and controls. No correlation existed between visual defects and the pituitary size apparent at CT scan. Six patients were evaluated with the CT and CP after 1 year of bromocriptine treatment; a slight reduction of size was documented with the CT in four cases, whereas a significant positive change in visual acuity was observed in five patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormal responses to vasoactive intestinal peptide and corticotropin releasing hormone during the spontaneous remission of Cushing's disease.

Abnormalities in hypothalamic-pituitary adrenal axis function were demonstrated by measuring plasma adrenocorticotropin abnormal concentrations following Vasoactive Intestinal Peptide (VIP) and Corticotropin Releasing Hormone (CRH) administration during a phase of remission of Cushing's disease in a 45-year-old female patient. When observed 80 days after the first examination, the patient no longer showed cushingoid features and serum cortisol and plasma ACTH were not abnormally high. VIP infusion (75 micrograms during 12 min) induced a significant increase in serum cortisol and ACTH plasma levels with respect to the normal unresponsiveness. Exaggerated plasma ACTH response to CRH (50 micrograms iv) was also observed. We conclude that the study of ACTH and cortisol response to VIP and CRH may be useful in revealing Cushing's disease even during a remission phase of the disorder.