[Analysis of blood from the inferior sinus petrosus in patients with Cushing syndrome and acromegaly]. / Analyse av blod fra sinus petrosus inferior hos pasienter med Cushings syndrom og med akromegali.

Bilateral catheterization of sinus petrosus inferior was performed in ten patients with Cushing's syndrome and five patients with acromegaly. This was done in order to secure the diagnosis (Cushing's syndrome) and localize an adenoma (Cushing's syndrome and acromegaly). Blood from sinus petrosus inferior on both sides and from the peripheral vein was analyzed for concentration of ACTH or growth hormone after injection of ACTH-releasing hormone and growth hormone-releasing hormone respectively. The quotient between the ACTH concentration in blood from sinus petrosus and peripheral blood determines the diagnosis in Cushing's syndrome and the quotient between the concentration of ACTH or growth hormone between right and left sinus petrosus determines localization of the pituitary adenoma. Correct diagnosis and localization of ACTH-producing pituitary adenoma was found in eight of ten patients with Cushing's syndrome. One result was doubtful and one was wrong. In four patients with Cushing's disease (ACTH-producing adenoma) magnetic tomography (MT) was negative, but catheterization showed the presence of adenoma. In acromegalic patients, correct localization of the adenoma was determined in two out of five patients. In the other three patients, anatomical difficulties prevented satisfactory interpretation.

CQP 201-403, a new dopamine agonist in the treatment of hyperprolactinemia.

Current drugs used for hyperprolactinemia may have severe side effects. Effects and side effects of a new propylergoline derivate (CQP 201-403 SANDOZ) have been evaluated. Twenty-four otherwise healthy women (21-44 years) with hyperprolactinemia (35-318 micrograms/l) without extrasellar extension of pituitary adenomas took part in a randomized, double-blind study. Fasting prolactin levels measured on day 7 was significantly decreased when compared with day 1 (P less than 0.05) in all CQP groups, to 78% with 0.005 mg daily, to 40% with 0.015 mg daily, and to 27% with 0.025 mg CQP per day for one week. The levels in the control group did not change (96%). The area under the curve of the prolactin day curve (1-8 h after drug administration) decreased significantly (P less than 0.05) at all doses when day 7 was compared with day 1, to 77% with 0.005 mg, to 51% with 0.015 mg, and to 37% with 0.025 mg CQP. No change was seen in the control group (96%). Four patients (one on 0.005 mg, one on 0.015 mg, and two on 0.025 mg) experienced orthostatic hypotension while standing blood pressure was to be measured on the first day of treatment, and they had to lie down. CQP 201-403 lowers prolactin levels in hyperprolactinemic women at all doses employed. The effect was seen after the first dose of treatment, and lasted for at least 24 h. The adverse reactions are few and tolerable, and might be less than with current bromocriptine therapy.

Volumes of pituitary adenomas related to hormone production, duration of symptoms and postoperative outcome.

In the period from December 1978 to February 1986, 292 patients with pituitary adenomas were operated transsphenoidally. We measured tumor volumes from CT scans and pneumoencephalograms. Tumor volumes varied from 0.5 to 160 cm3. The duration of the clinical history varied from 6 months to 24 years. All pituitary hormones were recorded pre- and postoperatively in each patient. We found a positive correlation between tumor size and duration of clinical symptoms, both in hormone producing (active) and non-producing (inactive) adenomas. Among the prolactin and growth-hormone producing adenomas there was also positive correlation between tumor size and hormone levels: small and medium sized hormone producing adenomas (volume 6 cm3 or less), showed normalization of the preoperatively increased hormone levels after surgery. In patients with hormone producing pituitary adenomas larger than 6 cm3, we still found elevated serum prolactin or serum growth-hormone levels postoperatively. This indicates that the largest tumors could not be completely removed surgically. Pituitary tumors should be operated before they reach a volume of 6 cm3. If non-surgical treatment is initiated, the patient has to be closely followed with computed tomography.

Intraoperative gas cisternography and gas dissection in the operative treatment of pituitary tumors. A methodological description.

We have given a methodological description of gas dissection and gas cisternography used during transsphenoidal surgery. 200 consecutive patients with pituitary adenomas or craniopharyngeomas have been operated according to Cushing- Guiot -Hardy's procedure. 68 patients had suprasellar expansions in which gas dissection was used. The operative procedure with technical equipment and staff requirement is reported as well as the combined neurosurgical and neuroradiological techniques.