ABSTRACT
Six male patients (aged 21-34 years) with isolated hypothalamic hypogonadism were given subcutaneous pulses of gonadotrophin-releasing hormone every 90 min for 14-74 weeks. The therapy produced an increase in testicular volume (4 patients) and a rise in serum luteinizing hormone, follicle-stimulating hormone, and testosterone levels in every patient. Motile sperm developed in 3 patients after a mean of 17 weeks, but were not seen in other patients who were less sexually developed after a mean of 31 weeks of therapy. Computerized tomography scans of the pituitary fossa revealed an empty sella in 4 patients and a partially empty sella in 2. Subcutaneous pulsing of gonadotrophin-releasing hormone is a simple and safe way of inducing spermatogenesis, but it is more likely to be successful in patients whose pubertal development is otherwise near completion. Previous human chorionic gonadotrophin and/or testosterone treatment does not interfere with and may benefit subsequent gonadotrophin-releasing hormone therapy.
Subject(s)
Hypogonadism/drug therapy , Hypothalamic Diseases/drug therapy , Pituitary Hormone-Releasing Hormones/therapeutic use , Spermatogenesis/drug effects , Adult , Estradiol/blood , Follicle Stimulating Hormone/blood , Humans , Hypothalamic Diseases/metabolism , Infusion Pumps , Injections, Subcutaneous , Luteinizing Hormone/blood , Male , Pituitary Hormone-Releasing Hormones/administration & dosage , Testosterone/bloodABSTRACT
24 patients with an extrasellar prolactinoma (mean prolactin 4,722 ng/ml), 8 of whom had previously had surgery, received 5-40 mg bromocriptine daily for 13-252 weeks. The mean prolactin level had fallen 89% at 2 days, 95% at 6 weeks, and 15 patients achieved normal values. Tumor shrinkage occurred in all 9 patients rescanned within 2 weeks and later was documented in 23; in 18 the extrasellar tumour disappeared. 12 patients had visual abnormalities; 7, including 2 who had been completely blind, improved within 1 week. 2 patients had normal prolactin levels after withdrawal of bromocriptine, 1 following radiotherapy and the other during two uncomplicated pregnancies. Bromocriptine is safe and effective. We conclude that medical treatment should always precede surgery unless pituitary apoplexy causes sudden deterioration of vision. Most patients will subsequently require radiotherapy or surgery for permanent cure.
Subject(s)
Bromocriptine/therapeutic use , Pituitary Neoplasms/drug therapy , Prolactin/metabolism , Adult , Bromocriptine/adverse effects , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Pituitary Function Tests , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/metabolism , Pregnancy , Prolactin/blood , Tomography, X-Ray Computed , Visual FieldsSubject(s)
Adrenal Gland Neoplasms/pathology , Biopsy, Needle/adverse effects , Catecholamines/metabolism , Adenoma/diagnostic imaging , Adenoma/metabolism , Adenoma/pathology , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/metabolism , Adult , Biopsy, Needle/mortality , Hemorrhage/etiology , Humans , Male , Pheochromocytoma/diagnostic imaging , Pheochromocytoma/metabolism , Pheochromocytoma/pathology , Tomography, X-Ray ComputedABSTRACT
14 patients with 17 pyogenic liver abscesses were treated initially by non-surgical means. 3 patients received intravenous antibiotics alone, and 11 had intravenous antibiotics plus percutaneous aspiration. Non-surgical management alone was successful in only 1 patient. Among the 13 others 2 are well after percutaneous catheter insertion and 5 are well after surgical drainage. 6 patients died despite medical and surgical therapy. After large-needle aspiration 2 patients died and 3 had serious complications. Non-surgical management of infected space-occupying hepatic lesions or abscesses in immune-suppressed patients is unlikely to be successful. This report shows that medical management, with or without percutaneous aspiration, is not consistently successful even in patients with normal immune systems and no predisposing causes for their hepatic abscesses.
