Pituitary adenocarcinoma in an acromegalic patient: response to bromocriptine and pituitary testing: a review of the literature on 36 cases of pituitary carcinoma.

There are 36 reported cases of metastatic pituitary carcinoma and almost half (44%) of these were associated with syndromes of hormonal hypersecretion. The case of a 56-year-old acromegalic man with cervical lymphatic and spinal metastases from a primary pituitary carcinoma is described. Elevated basal levels of plasma growth hormone (GH) and insulin growth factor-1/Somatomedin C (IGF-1/SmC) were found. GH levels did not increase after TRH or LHRH administration but decreased after L-Dopa and glucose. Immunostaining of the metastatic tumor for GH and electron microscopy findings confirmed the diagnosis of pituitary GH-secreting carcinoma. Striking clinical improvement and a 46% decrease in plasma GH levels were observed with bromocriptine treatment, although IGF-1/SmC levels increased during therapy. The clinical course of most reported cases of pituitary adenocarcinoma has been one of progressive intracranial expansion of a pituitary neoplasm. In only 25% were metastatic lesions discovered antemortem, and disabling symptomatology caused by metastases was rare. Only four previously reported patients of 36 with pituitary carcinoma had acromegaly.

Spondylotic high cervical spinal cord compression presenting with hand complaints.

Three patients with spondylotic compression of the upper cervical spinal cord presented with complaints of sensory dysfunction in their hands. Sensory dysfunction in the hands may signal a lesion in the upper cervical spinal cord if other common neurological causes can be excluded. Somatosensory evoked potentials may be useful in providing objective information to supplement subjective complaints in the hands caused by a high cervical lesion.

Spinal cord glucose utilization after experimental spinal cord injury.

Metabolic alterations after experimental contusion injury of the spinal cord were evaluated by determining qualitative spinal cord glucose utilization (SCGU), SCGU was determined by the 2-deoxy-D-[14C] glucose technique. An increase in SCGU occurred at the site of maximal impact in the white matter after an injury causing paraparesis and in near trauma regions after an injury causing either paraparesis or paraplegia. These findings are most likely due to anaerobic glycolysis resulting from a reduction in blood flow that still allows delivery of substrate to tissue. Although an initial increase was observed at the site of maximal impact after a paraplegia-causing injury, SCGU in the white matter demonstrated a progressive deterioration by 4 and 8 hours after injury. A failure of substrate delivery resulting from ischemia is the most likely cause for this reduction in SCGU. The somatosensory evoked potential was found to be a very sensitive indicator of the remaining functional axons at the injury site.

Calcified pituitary prolactinoma.

A case of calcification in a pituitary prolactinoma is presented. Calcification was radiologically evident for 10 years and was histologically confirmed after surgery. Immunochemical staining showed prolactin only, and the calcified mass was surrounded by granulated lactotrophs without a boundary zone of tissue necrosis.

Prolactinomas: surgical therapy, indications and results.

This study indicates that transsphenoidal microsurgical removal of prolactinomas is highly effective for producing significant normalization of preoperative prolactin levels, resumption of menses, and the recovery of fertility in patients with microadenomas. Minimal morbidity and no mortality were encountered in this series. Surgical treatment in patients with microadenomas is comparable to bromocriptine therapy for achieving normalization of prolactin levels and fertility. In patients with macroadenomas, bromocriptine is more effective than surgery. This drug can also be used for achieving fertility when prolactin levels fail to normalize and resumption of menses does not occur following surgery. Radiation therapy should be reserved postoperatively for those patients who have macroadenomas with suprasellar or parasellar extension.

A neuropathologic study of Whipple's disease.

A patient with Whipple's disease developed massive and irreversible CNS involvement after a drug-induced intestinal remission. The multifocal brain lesions were apparent grossly with the heaviest concentration being noted in rhinencephalon, diencephalon, and mesencephalon. This patient exhibited progressive neurologic deterioration, although viable organisms could not be identified in the brain at autopsy. Astrocytes, pericytes, and choroid plexus cells attempted to dispose of the organism, in additional to the traditionally implicated microglial and ependymal cell.

Pressor response resulting from experimental contusion injury to the spinal cord.

Experimental contusion paraplegic injury to the posterior spinal cord in cats results in a sudden increase of systemic blood pressure to between 200 and 250 mm Hg, and an increase in pulse pressure and a slowing of pulse rate. This initial hypertensive phase lasts approximately 3 to 4 minutes, and then is followed by a hypotensive phase. This pressor response is mediated by the alpha adrenergic receptor sites of the peripheral sympathetic nervous system and can be blocked by intravenous phenoxybenzamine, an alpha adrenergic blocking agent. The hypotensive phase is the result of an overall reduction in alpha adrenergic vascular tone and can be reversed by the infusion of metaraminol or intravenous fluids. The alterations in blood pressure that follow impact injury are most likely related to alterations of peripheral arteriolar resistance and venous return of blood to the heart.

Radiographic diagnostic evaluation and surgical treatment of multiple cerebellar, brain stem, and spinal cord hemangioblastomas.

Multiple hemangioblastomas of the central nervous system present a greater challenge in their diagnosis and treatment than do single hemangioblastomas of the cerebellar hemisphere. Improved radiographic techniques of tomographic vertebral angiography and computed axial tomography (CT) are of considerable value in the diagnosis of multiple cerebellar, brain stem, and spinal cord hemangioblastomas. Microsurgical techniques now allow for total operative removal of many of these lesions. A case report is presented to emphasize the radiographic diagnostic evaluation as well as the microsurgical technique for removal of multiple central nervous system hemangioblastomas.

The histopathology of experimental spinal cord trauma. The effect of systemic blood pressure.

The early sequential histopathological alterations following a concussive paraplegic injury to the posterior thoracic spinal cord in cats were studied. The lack of significant progression of hemorrhages over a 4-hour period after injury indicates that most hemorrhages probably occur within the first hour. The marked enhancement or retardation of hemorrhages in the post-injury period, when the blood pressure was increased or decreased, respectively, demonstrates the loss of autoregulation of spinal cord vasculature at the trauma site after a concussive paraplegic injury. Progressive edema formation was evident over a 4-hour period following injury, and it could be enhanced or retarded by elevation or reduction of the systemic blood pressure.

Lead encephalopathy simulating a cerebral neoplasm in an adult. Case report.

The clinical and pathological findiing in an adult with lead encephalopathy due to moonshine consumption are presented. The remarkable focality of of the edema led both the clinicians and radiologists to consider this a cerebral glioma.

Norepinephrine levels in experimental spinal cord trauma. Part 1: Biochemical study of hemorrhagic necrosis.

Levels of norepinephrine (NE) in the spinal cord tissue of nontraumatized cats are highest in the cervical and lumbar enlargements. A rather uniform but slightly increasing concentration gradient from cephalad to caudad is observed in the thoracic segments. A 500 gm-cm trauma at the T-5 or C-7 spinal cord segment did not demonstrate any significant increase in NE levels measured sequentially over a 4-hour period after trauma. Dopamine levels could not be detected in the nontraumatized or traumatized cat spinal cords. Four traumatized cats treated with alpha methyl tyrosine, a tyrosine hydroxylase inhibitor, and followed clinically for 5 months showed no improvement in neurological function when compared to untreated traumatized cats. This study does not support the norepinephrine hypothesis of experimental spinal cord trauma.

Norepinephrine levels in experimental spinal cord trauma. Part 2: Histopathological study of hemorrhagic necrosis.

Alpha methyl tyrosine (AMT) or reserpine administered intravenously 24 hours before sacrificed in the nontraumatized cat resulted in significant reduction in tissue levels of norepinephrine (NE) tested at the T-5 spinal cord level. Phenoxybenzamine given 2 hours before sacrifice did not alter NE levels at T-5. Histological sections of spinal cord examined 1 hour after a 500-gm-cm trauma at the T-5 level in cats, pretreated 24 hours before trauma by a single dose of AMT or reserpine demonstrated no reduction of gray or white matter hemorrhages when compared tocontrols. In cats pretreated with phenoxybenzamine 2 hours before trauma there was a marked reduction of hemorrhages at 1 hour posttrauma when compared to controls. The animals treated with phenoxybenzamine had a 32% reduction of systemic blood pressure before trauma, demonstrated no pressor response to spinal cord trauma, and were severely hypotensive posttrauma. It is concluded that posttraumatic blood pressure has greater etiological significance in the pathogenesis of experimental spinal cord hemorrhages than tissue levels of NE.