ABSTRACT
OBJECTIVE: To note that a thyrotropin (TSH)-secreting macroadenoma may be part of the multiple endocrine neoplasia-1 (MEN-1) syndrome and to report the use of octreotide-LAR (OCT-LAR) to treat a TSH-secreting macroadenoma in a patient with MEN-1 with previous surgery for hyperparathyroidism and gastrinoma. METHODS: We present a patient with a TSH-secreting pituitary macroadenoma and report the results of her endocrine, genetic, radiologic, and nuclear medicine testing and her response to treatment with octreotide (OCT), octreotide-LAR, and estrogen. RESULTS: This patient's TSH-induced hyperthyroidism responded to octreotide for 5 months and octreotide-LAR for more than 11 months. Her hypercalcemia normalized while she was taking estrogen. Her genetic testing is reported to show a genetic defect that is typical of patients with MEN-1. CONCLUSION: This report describes: (1) The use of octreotide-LAR to treat both a TSH-secreting pituitary tumor and a gastrinoma over 12 months; (2) the importance of including these tumors into the MEN-1 syndrome with its attendant implications; and (3) a genetic defect, typical of patients with MEN-1, associated with this tumor.
Subject(s)
Adenoma/drug therapy , Hormones/administration & dosage , Multiple Endocrine Neoplasia Type 1/drug therapy , Octreotide/administration & dosage , Thyroid Neoplasms/drug therapy , Thyrotropin/metabolism , Adenoma/diagnostic imaging , Adenoma/metabolism , Estrogens/administration & dosage , Female , Humans , Hypercalcemia/etiology , Hyperthyroidism/diagnostic imaging , Hyperthyroidism/drug therapy , Hyperthyroidism/etiology , Middle Aged , Multiple Endocrine Neoplasia Type 1/diagnostic imaging , Radionuclide Imaging , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/metabolismABSTRACT
A 28-yr-old woman with hyperthyroidism due to a TSH/GH-secreting macroadenoma was treated preoperatively with octreotide to attain euthyroidal status. Lectin chromatography, performed on her immunopurified serum TSH obtained at baseline and 1 week after 50 micrograms three times daily octreotide therapy, revealed a significant increase in ricin binding after octreotide. This result is consistent with increased amounts of TSH isoforms with more exposed galactose residues. Further clinical studies to elucidate the effects of pharmacological agents on serum TSH isoforms and TSH bioactivity are needed.
Subject(s)
Adenoma/complications , Octreotide/adverse effects , Pregnancy Complications, Neoplastic/drug therapy , Ricin/metabolism , Thyroid Neoplasms/complications , Thyrotropin/blood , Adenoma/metabolism , Adenoma/surgery , Adult , Chromatography , Female , Humans , Hyperthyroidism/etiology , Octreotide/therapeutic use , Pregnancy , Pregnancy Complications, Neoplastic/surgery , Thyroid Neoplasms/metabolism , Thyroid Neoplasms/surgery , Thyrotropin/metabolismABSTRACT
Two recently introduced commercially available methods, a minicolumn and an electrophoresis assay, both effectively remove labile glycated hemoglobin generated in vitro and give results for patients' samples similar to those by liquid chromatography with samples pre-incubated in saline.
Subject(s)
Glycated Hemoglobin/analysis , Reagent Kits, Diagnostic , Chromatography, High Pressure Liquid , Electrophoresis, Agar Gel , Evaluation Studies as Topic , HumansABSTRACT
We investigated the in vivo and in vitro effects of aspirin on several clinical assays of glycosylated hemoglobin. Acetylation of hemoglobin falsely increased the glycosylated hemoglobin fraction measured by "high-performance" liquid chromatography and electrophoresis, but isoelectric focusing and colorimetric techniques differentiated between acetylated and glycosylated fractions. Aspirin ingestion may result in an apparent increase in glycosylated hemoglobin measured with common clinical assays.
