[Restricted adenohyphophyseal function after neuroadenolysis for severe pain due to bony metastases.]. / Funktionseinschränkungen der adenohypophyse bei der neuroadenolyse zur behandlung schwerster schmerzzustände bei multiplen Knochenmetastasen.

Neuroadenolysis of the pituitary (NALP) is an efficient measure for treatment of severe pain in patients with bony metastases. It is especially recommended for primary carcinomas of the breast or prostate. The procedure, transsphenoidal puncture of the pituitary under radiographic control and instillation of up to 2 ml 95% alcohol, is simple. The pathomechanism of the analgesic effect is still unknown. Extensive determinations of the anterior pituitary hormones LH, FSH, HPRL, ACTH, and HGH were done before and up to 14 days after NALP in six consecutive patients receiving this treatment. The pituitary was stimulated with releasing hormones LHRH (100 mug) and TRH (200 mug) before and 3 days after NALP. Determinations of hormone parameters were done 25 and 60 min after injection. The results showed that hormone production by the adenohypophysis becomes unevenly suppressed. The following results are significant (P<0.05): (1) LH: poststimulation values are extremely suppressed; (2) FSH: basal values decrease; (3) ACTH: basal values decrease after the 6th day. The antalgic effect of NALP is independent of its hormonal consequences. NALP produces hormonal suppressions of various degrees, and is not a "chemical hypophysectomy".

[Behavior of hemodynamics and catecholamines in patients undergoing excision of pheochromocytoma]. / Verhalten von Hämodynamik und Katecholaminen bei Phäochromozytomexstirpationen.

In order to investigate the relation between catecholamine output and haemodynamics, 13 patients aged between 16 and 62 years, who were operated for active pheochromocytoma, were investigated. Patients had general anesthesia employing muscle relaxants, artificial ventilation with nitrous oxide/oxygen and predominantly intravenous analgetics. Before surgery 9 patients had increased norepinephrine blood levels and only 6 patients increased epinephrine levels. Intraoperatively an increase in pulse rate and blood pressure was found, although alpha- and beta-blockers were employed. At this time there was a massively increased level of epinephrine and norepinephrine, both however decreasing at the conclusion of surgery going along with a normalisation of cardial parameters. Comparing norepinephrine to cardiovascular parameters, the best correlation could be found between norepinephrine and mean arterial pressure, followed by total catecholamines and mean arterial pressure. Heart rate showed a smaller correlation coefficient to norepinephrine, followed by norepinephrine and total peripheral resistance. It is concluded that invasive haemodynamic monitoring helps to differentiate between haemodynamic disturbances and to improve the cardiovascular management, although direct relations between blood catecholamine levels and circular vascular parameters could not be found.

[Falipamil for decreasing intraoperative heart rate in pheochromocytoma]. / Falipamil zur intraoperativen Frequenzsenkung bei Phäochromozytom.

In 4 patients (2 males, 2 females), aged between 16 and 62 years, who had surgery for pheochromocytoma, the effects of Falipamil, a compound with selective negative chronotropic action, was tested. This drug, which is a slow calcium channel blocking agent, was administered during the period of massive endogenous catecholamine output caused by tumor mobilisation; the influence on mean arterial pressure, pulmonary artery pressure, central venous pressure and cardiac index as well as catecholamines was investigated. When the pulse rate exceeded 100 beats per minute in the course of surgical preparation, 2 mg/kg BW Falipamil were administered as in i.v. bolus dose. Epinephrine and norepinephrine were determined before and 5 minutes after Falipamil administration in one patient. The effect of this bolus dose was a significant decrease in heart rate. There was also a moderate decrease in mean arterial pressure and cardiac index, with was probably caused by pretreatment with alpha- and beta-blockers prior to surgery, whereas central venous pressure and pulmonary artery pressure remained unchanged. Norepinephrine increased, epinephrine decreased. These findings lead us to conclude that Falipamil is a valuable adjunct to control circulation in patients with high catecholamines.