RESUMEN
A 15-year-old girl with Cushing's disease exhibited adrenal insufficiency following incomplete trans-sphenoidal resection of a large pituitary corticotropinoma, approximately 35 mm in diameter. Within two weeks following surgery, her plasma ACTH level decreased from 42 to 13 pmol/l, while, her plasma cortisol levels and urinary excretion of free cortisol decreased from 607 nmol/l and 1112 nmol/day to 94 nmol/l and 55 nmol/day, respectively. Immunoreactive ACTH was characterized in plasma using Sephadex G-75 column chromatography and measuring ACTH with immunoradiometric assay (IRMA) and radioimmunoassay (RIA) to determine additional peaks, other than the one demonstrated for 1-39 ACTH. In particular, when measured with RIA, a broad peak including the high molecular weight ACTH was detected as well as 1-39 ACTH. The bioactivity of the high molecular weight ACTH in patient plasma was lower than the reference range of 1-39 ACTH, which is determined by the ability of dispersed rat adrenocortical cells to secrete corticosterone. The large pituitary corticotropinoma found in this patient secreted not only 1-39 ACTH but also high molecular weight proopiomelanocortin (POMC)-derived peptides, which could be detected by measuring with IRMA and RIA for ACTH. Based on the results of biological activity and molecular ratios, no positive evidence could be found to support the hypothesis that the high molecular weight ACTH induced any postoperative adrenal insufficiency in this patient. However, based on this study, the possibility of adrenal insufficiency should be carefully monitored, even when post-operative remnant tumor tissue is clearly present in patients with Cushing's disease, accompanied by macrocorticotropinoma.
Asunto(s)
Adenoma/metabolismo , Insuficiencia Suprarrenal/diagnóstico , Hormona Adrenocorticotrópica/química , Hormona Adrenocorticotrópica/metabolismo , Neoplasias Hipofisarias/metabolismo , Adenoma/patología , Adenoma/cirugía , Adolescente , Corteza Suprarrenal/efectos de los fármacos , Corteza Suprarrenal/metabolismo , Insuficiencia Suprarrenal/etiología , Hormona Adrenocorticotrópica/farmacología , Animales , Bioensayo , Cromatografía en Gel , Corticosterona/metabolismo , Femenino , Humanos , Hidrocortisona/sangre , Hidrocortisona/orina , Ensayo Inmunorradiométrico , Imagen por Resonancia Magnética , Peso Molecular , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Proopiomelanocortina/química , Proopiomelanocortina/metabolismo , Radioinmunoensayo , RatasRESUMEN
Preoperative therapy with octreotide, a long-acting somatostatin analog, suppresses GH hypersecretion, shrinks GH-producing tumors and leads to an improvement in subsequent surgical remission in acromegalic patients. A continuous infusion of octreotide has demonstrated more persistent suppression of GH secretion than intermittent injections, and only a few studies were reported on the effect of the tumor shrinkage with a continuous infusion of a small dose of octreotide. We therefore investigated the preoperative effects of small doses of octreotide (120-240 micrograms/day) administered continuously (with a subcutaneous infusion pump) over a short period (2 or 4 weeks) in nine untreated acromegalic patients. Octreotide therapy resulted in suppression of serum GH and IGF-1 concentrations in 8 out of 9 patients and reduction in pituitary tumor size measured by MRI in all patients (by 7.9 to 38.5%). In particular, considerable reduction in tumor size (more than 20%) occurred in 6 of 9 patients. In three patients assessed serially throughout the preoperative period, reduction in tumor size was noted within only one week after the start of octreotide therapy and reduction rate more than 20% was obtained within the first two weeks. In one patient, suprasellar tumor expansion totally disappeared after such therapy. Our results indicate that short-term continuous subcutaneous infusion of a small dose of octreotide results in not only inhibition of GH hypersecretion but also shrinkage of tumor size prior to surgery.
Asunto(s)
Adenoma/metabolismo , Antineoplásicos Hormonales , Hormona de Crecimiento Humana/metabolismo , Octreótido/uso terapéutico , Neoplasias Hipofisarias/metabolismo , Premedicación , Adenoma/patología , Adenoma/cirugía , Adulto , Femenino , Humanos , Bombas de Infusión , Masculino , Persona de Mediana Edad , Octreótido/administración & dosificación , Neoplasias Hipofisarias/patología , Neoplasias Hipofisarias/cirugía , Estudios ProspectivosRESUMEN
There has been accumulating evidence that pituitary adenomas which cause Cushing's disease are located not only in sella turcica but also in various extrasellar and intracranial regions. We describe a case of Cushing's disease caused by a supra- and extrasellar ACTH-producing microadenoma, which originated in the anterior pituitary and extended upward without connecting to the stalk. The pituitary microadenoma was identified and removed by transsphenoidal microsurgery. After the surgery the patient experienced complete remission. This type of pituitary microadenoma is considered to be rare, but in order to accomplish successful surgical treatment, it is necessary to consider that pituitary adenomas which cause Cushing's disease may be located in such an unusual position.
Asunto(s)
Adenoma/complicaciones , Síndrome de Cushing/etiología , Neoplasias Hipofisarias/complicaciones , Adenoma/diagnóstico , Adenoma/cirugía , Hormona Adrenocorticotrópica/análisis , Adulto , Síndrome de Cushing/sangre , Femenino , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Microcirugia/métodos , Invasividad Neoplásica , Adenohipófisis , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , ReoperaciónAsunto(s)
Adenoma/diagnóstico , Biomarcadores de Tumor/sangre , Neoplasias Hipofisarias/diagnóstico , Tirotropina/biosíntesis , Adenoma/metabolismo , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Hipofisarias/metabolismo , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangreRESUMEN
Garsubellin A (1), a novel polyprenylated phloroglucin derivative, has been isolated from the wood of Garcinia subelliptica and its structure has been elucidated by spectroscopic analyses. Compound 1 could increase the ChAT activity at 10 microM in P10 rat septal neuron cultures.
Asunto(s)
Encéfalo/enzimología , Colina O-Acetiltransferasa/metabolismo , Neuronas/enzimología , Plantas Medicinales/química , Terpenos/farmacología , Animales , Encéfalo/citología , Encéfalo/efectos de los fármacos , Espectroscopía de Resonancia Magnética , Neuronas/efectos de los fármacos , Ratas , Estimulación Química , Terpenos/aislamiento & purificaciónRESUMEN
To investigate the expression of CRF receptor (CRF-R) in human corticotropic adenoma (hCA) cells, we analyzed messenger RNA (mRNA) levels of type-1 CRF-R (CRF-R1). Adenomas were obtained from 10 patients with Cushing's disease. Northern blot analysis using a rat CRF-R1 complementary RNA probe revealed a main hybridization band of 2.7 kilobases in all the hCAs. The CRF-R1 mRNA level significantly increased after 1 h, reached 15-fold the basal level at 8 h, and remained elevated 24 h after the addition of 10 nmol/L CRF in vitro. Dose dependency of the stimulatory effect of CRF was also demonstrated in hCA cells, whereas CRF down-regulated CRF-R1 mRNA levels in rat anterior pituitary (AP) cells. Treatment with dexamethasone or vasopressin decreased the CRF-R1 mRNA level in hCA cells, as observed in rat AP cells. In conclusion, we detected CRF-R1 mRNA in all hCAs tested. The CRF-R1 mRNA level was up-regulated by CRF itself in cultured hCA cells, in contrast to the down-regulation in rat AP cells.
Asunto(s)
Adenoma/genética , Hormona Adrenocorticotrópica/metabolismo , Hormona Liberadora de Corticotropina/farmacología , Expresión Génica/efectos de los fármacos , Receptores de Hormona Liberadora de Corticotropina/genética , Regulación hacia Arriba , Adenoma/metabolismo , Adenoma/patología , Animales , Arginina Vasopresina/farmacología , Northern Blotting , Dexametasona/farmacología , Relación Dosis-Respuesta a Droga , Glucocorticoides/farmacología , Humanos , Masculino , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Proteínas Recombinantes , Células Tumorales CultivadasRESUMEN
We evaluated the usefulness of a desmopressin (DDAVP) test in the diagnosis of ACTH-dependent Cushing's syndrome. After an intravenous injection of 5 microg DDAVP, plasma ACTH levels increased to more than 200% of the basal levels in 10 of 10 patients with Cushing's disease, but remained less than 150% in all of 11 normal subjects, 3 patients with Addison's disease, 5 cases of Cushing's disease in remission, and 3 patients with ectopic ACTH syndrome. Peak levels of plasma cortisol after the DDAVP stimulation were 159 +/- 14% in the patients with Cushing's disease, and less than 150% of the basal levels in the other 5 groups. We also found a case of Cushing's disease with periodicity which responded to DDAVP only in the active stage. In vitro studies revealed that DDAVP directly stimulates ACTH release from corticotropic adenoma cells through V1b but not V2 vasopressin receptors. In conclusion, the DDAVP stimulation test, i.e., determination of plasma ACTH levels after 5 microg DDAVP injection, seems useful for discriminating Cushing's disease from normality, and may serve to facilitate the differentiation between Cushing's disease and ectopic ACTH syndrome.
Asunto(s)
Pruebas de Función de la Corteza Suprarrenal/métodos , Hormona Adrenocorticotrópica/sangre , Síndrome de Cushing/diagnóstico , Desamino Arginina Vasopresina/farmacología , Fármacos Renales/farmacología , Adenoma/química , Adenoma/patología , Hormona Adrenocorticotrópica/efectos de los fármacos , Hormona Adrenocorticotrópica/metabolismo , Adulto , Estudios de Cohortes , Síndrome de Cushing/sangre , AMP Cíclico/metabolismo , Desamino Arginina Vasopresina/administración & dosificación , Femenino , Humanos , Hidrocortisona/sangre , Hidrocortisona/metabolismo , Inyecciones Intravenosas , Riñón/química , Riñón/patología , Masculino , Persona de Mediana Edad , Receptores de Vasopresinas/clasificación , Receptores de Vasopresinas/genética , Valores de Referencia , Fármacos Renales/administración & dosificación , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
A 33-year-old woman with inappropriate secretion of TSH and a 2-mm pituitary microadenoma is described. She had a high serum free T4 concentration (31 pmol/L) with an inappropriately nonsuppressible serum TSH concentration (0.93 mU/L). The alpha/TSH molar ratio was 2.3 and magnetic resonance imaging with gadolinium enhancement identified an area of low signal intensity in the left lateral pituitary gland. However, TSH secretion was not completely autonomous. There was a significant response to exogenous TRH stimulation and suppression by T3 administration. Therefore, it was difficult to rule out a nonfunctioning pituitary adenoma with concomitant pituitary selective thyroid hormone resistance syndrome. A 2-mm microadenoma was excised via transsphenoidal surgery. The tumor cells were immunoreactive to antisera to alpha-subunit and minimally immunoreactive to antisera to TSHbeta. The patient's thyroid function normalized after surgery without medication. Because the adenoma could become large and intractable if the patient was treated inadequately, early diagnosis and treatment are important in patients with TSH secreting adenomas.
Asunto(s)
Adenoma/metabolismo , Neoplasias Hipofisarias/metabolismo , Síndrome de Resistencia a Hormonas Tiroideas/diagnóstico , Tirotropina/metabolismo , Adenoma/complicaciones , Adenoma/diagnóstico , Adulto , Femenino , Gadolinio , Humanos , Imagen por Resonancia Magnética , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/diagnóstico , Síndrome de Resistencia a Hormonas Tiroideas/complicaciones , Tirotropina/sangre , Hormona Liberadora de Tirotropina , Tiroxina/sangre , TriyodotironinaRESUMEN
A 16-year-old boy presented with segmental muscular atrophy of the bilateral distal upper extremities. Cervical spine x-ray films showed occult spina bifida from C-1 to T-1 associated with an abnormal long club-like bone located parallel to the epidural space between C-5 and C-7. In neck flexion, the cervical spinal cord was stretched and compressed to the posterior aspect of the vertebral body. Moreover, the dorsally placed abnormal bone migrated ventrally, indenting the dorsal portion of the spinal cord. This is quite an unusual case of so-called "flexion myelopathy," aggravated by the abnormal bone located dorsally.
Asunto(s)
Vértebras Cervicales/anomalías , Atrofia Muscular Espinal/cirugía , Espina Bífida Oculta/cirugía , Compresión de la Médula Espinal/cirugía , Adolescente , Vértebras Cervicales/diagnóstico por imagen , Vértebras Cervicales/cirugía , Humanos , Masculino , Atrofia Muscular Espinal/diagnóstico por imagen , Mielografía , Espina Bífida Oculta/diagnóstico por imagen , Compresión de la Médula Espinal/diagnóstico por imagen , Fusión Vertebral , Tomografía Computarizada por Rayos XRESUMEN
We developed a new method for measuring an unidentified ketosteroid glucuronide (US-G) detected by the method of Iwata et al. for measuring 17-ketosteroid glucuronides by reversed phase HPLC on a Capcell-Pak C8 column with three kinds of mobile phase solutions (Iwata method; Clin Chem 35: 795-799, 1989). The Iwata method inadequately separated US-G and two hydroxy 17-ketosteroides, 11 beta-hydroxyetiocholanolone and 11 beta-hydroxyandrosterone, and it exhibits insufficient sensitivity for measuring traces of US-G in the urine of healthy subjects. We solved these problems by developing a new method which measures US-G in urine, as a free type by hydrolyzing the glucuronide type enzymatically, by normal phase HPLC on a Capcell-Pak Silica column with one kind of mobile phase solution. By this method, the levels of US excreted as a glucuronide in the urine of healthy subjects and of patients with Cushing's syndrome were determined as proportions of the levels of 11 beta-hydroxyandrosterone. The average daily urinary excretion of US was 971 micrograms (125-4,995 micrograms) in patients with Cushing's syndrome (n = 22: two males and 20 females aged 26 to 65 years), and 34 micrograms (0-141 micrograms) in healthy subjects (n = 63: 49 males, and 14 females aged 21 to 54 years), and the differences were clearly significant. However, there were no differences between the urinary US levels of patients with pituitary adenoma and patients with adrenal adenoma. Furthermore, no US was detected in the urine of patients with aldosteronism (two males and eight females aged 34 to 61 years).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Cromatografía Líquida de Alta Presión/métodos , Síndrome de Cushing/orina , Cetosteroides/orina , 17-Cetosteroides/orina , Adenoma/orina , Adulto , Anciano , Cromatografía Líquida de Alta Presión/estadística & datos numéricos , Femenino , Glucuronatos/orina , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/orina , Valores de ReferenciaRESUMEN
The surgical treatment of large pituitary adenomas with suprasellar extensions has been controversial. To elucidate the indications for transsphenoidal surgery of large adenomas and to evaluate the techniques for removing the suprasellar portions of the tumors, surgical procedures on 100 consecutive patients with suprasellar extensions of nonfunctioning pituitary adenomas were retrospectively investigated. Patients were followed up for 1 to 12 years (mean, 4.5 yr). One hundred twenty-five transsphenoidal operations were performed on 100 patients. The removal of each suprasellar tumor was facilitated by the placement of a lumbar subarachnoid catheter and the injection of lactated Ringer's solution or saline. This method was used in 77 operations and was effective on 60 of 72 adenomas with < 30-mm suprasellar extensions (Hardy's Grades A, B, and C) but not on those that were fibrous or dumbbell-shaped. The descent of the remaining suprasellar tumor was facilitated by keeping the sella and sellar floor open with an intrasellar drain, and the subsequent removal was achieved with staged transsphenoidal operations. Of nine fibrous or dumbbell-shaped adenomas with 10- to 30-mm suprasellar extensions, gross total removal in eight was achieved by the open sella technique and two-stage transsphenoidal operation, whereas one required transcranial surgery. Adenomas with > 30-mm suprasellar or lateral extensions (Grade D) could not be removed sufficiently by transsphenoidal operations, except one adenoma for which a subtotal removal was achieved in the third staged operation. The disease-free rate 10 years after operation was 74% for all patients: 91% for Grade A, 74% for Grade B, and 61% for Grade C.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Adenoma/cirugía , Hipofisectomía/métodos , Neoplasias Hipofisarias/cirugía , Adenoma/patología , Adolescente , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasia Residual/patología , Neoplasia Residual/cirugía , Hipófisis/patología , Neoplasias Hipofisarias/patología , Reoperación , Seno Esfenoidal/patología , Seno Esfenoidal/cirugíaRESUMEN
On MRI, the authors were able to demonstrate the contused lesions of bilateral rectal gyri near the crista galli in all of five cases of traumatic anosmia. Thin slice coronal and sagittal images of MRI were very useful for detecting the lesions. Conventional CT scans failed to demonstrate the lesions in 3 out of the 5 cases, but, even in these cases, MRI was able to clearly depict the contused lesions of bilateral rectal gyri. Therefore, the depicted lesions of bilateral rectal gyri on MRI can be evidence of traumatic anosmia and this may be very significant in medico-legal cases.
Asunto(s)
Lesiones Encefálicas/complicaciones , Imagen por Resonancia Magnética , Trastornos del Olfato/diagnóstico , Trastornos del Olfato/etiología , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Seven patients with growth hormone (GH)-secreting pituitary adenoma were treated preoperatively with octreotide (Sandostatin or SMS 201-995; a somatostatin analogue), and were compared with 18 non-treated patients in their clinical courses and adenoma analyses. Octreotide treatment improved the endocrinological data in all 7 cases. The octreotide-treated adenomas were soft and easily removed by suction and curettage. The postoperative normalization of endocrinological data was encountered more often in the octreotide-treated cases than in the non-treated, although the statistical significance was not observed by the limited number of cases. The adenoma tissues were examined with conventional histology and immunohistochemistry, and the amount of GH messenger ribonucleic acid (mRNA) was quantitatively assessed. The studies demonstrated: 1) No fibrosis nor necrosis was observed in the adenomas from the octreotide-treated patients. 2) Immunohistochemistry for human GH revealed no remarkable differences between the octreotide-treated and the non-treated adenomas. 3) The amounts of GH mRNA in the adenoma from the octreotide-treated patients were 4.2 +/- 1.8 (mean +/- SEM; expressed in an arbitrary unit) and were significantly less than those from the non-treated (33.6 +/- 9.1). These data suggest that octreotide inhibits not only GH release from the adenoma but also its biosynthesis.
Asunto(s)
Acromegalia/etiología , Adenoma/terapia , Antineoplásicos Hormonales/uso terapéutico , Hormona del Crecimiento/metabolismo , Octreótido/uso terapéutico , Neoplasias Hipofisarias/terapia , Adenoma/complicaciones , Adenoma/metabolismo , Adulto , Femenino , Regulación Neoplásica de la Expresión Génica , Hormona del Crecimiento/efectos de los fármacos , Hormona del Crecimiento/genética , Humanos , Inmunohistoquímica , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Neoplasias Hipofisarias/complicaciones , Neoplasias Hipofisarias/metabolismo , ARN Mensajero/análisisRESUMEN
The authors describe several useful surgical techniques from our experiences in transsphenoidal microsurgery for pituitary adenomas. Intentional two-staged transsphenoidal removal with open sella floor and intrasellar drainage is available for most of giant adenomas with suprasellar extension. The open sella floor method and intrasellar drainage after first transsphenoidal adenomectomy accelerate to decrease the suprasellar tumor extension. In four of six patients in our series, macroscopically total selective adenomectomy was achieved by a second transsphenoidal operation without complications. As for extremely small microadenomas, represented in patients with Cushing's disease, stepwise systemic search is required to identify a subcortical microadenoma, preserving postoperative pituitary function. Edge resection around the microadenoma is also necessary for normalization of hormonal hypersecretion and permanent cure.
Asunto(s)
Adenoma/cirugía , Hipofisectomía/métodos , Neoplasias Hipofisarias/cirugía , Desamino Arginina Vasopresina/administración & dosificación , Diabetes Insípida/prevención & control , Humanos , Hidrocortisona/administración & dosificación , Cuidados Posoperatorios , Vasopresinas/administración & dosificaciónRESUMEN
Myeloid calcium binding proteins MRP-8 and MRP-14 were induced, and their genes were coordinately expressed, during differentiation of human leukemia HL-60 cells into macrophage-like cells after treatment with 1,25-dihydroxyvitamin D3 (VD3). Both MRP-8 and MRP-14 mRNAs appeared on the day after VD3 treatment. Their level reached a peak on day 2, and then quickly declined. Nuclear factors that interact with the 5'-upstream regions of MRP-8 and MRP-14 genes were studied with gel mobility-shift assays. Two factors (MP8FI and MP8FII) that interacted with 379 bp (426-48 bp upstream from the transcription-initiation site of MRP-8 gene) and 67 bp (-47 - +20) DNA fragments, respectively, were found in the cells treated with VD3 for 1 day. MP8FI and MP8FII were present neither in the nuclei of untreated HL-60 cells, nor in the nuclei of the cells treated with VD3 for 6 days. Human monocytic leukemia THP-1 cells, which constitutively expressed MRP genes, had MP8FII but not MF8FI. MP8FII was found to interact with the 19-mer sequence located just upstream of the TATA box. Also, two factors that bound to the different upstream regions (-400 - -150 and -149 - +50) of MRP-14 gene were detected in the differentiated HL-60 cells. One of these, MP14FI, appeared on day 1, but on day 6 its concentration greatly decreased. The other, MP14FII, was found in greater quantity on day 6 than on day 1. MP14FI, but not MP14FII, was found in THP-1 cells. These factors may be involved in the expression of MRP-8 and MRP-14 genes in VD3-differentiated HL-60 cells.
Asunto(s)
Proteínas de Unión al Calcio/genética , Proteínas de Unión al Calcio/metabolismo , Proteínas de Unión al ADN/metabolismo , Leucemia Mieloide/metabolismo , Proteínas Nucleares/metabolismo , Factores de Transcripción/metabolismo , Secuencia de Bases , Calgranulina A , Calgranulina B , Diferenciación Celular , Regulación de la Expresión Génica , Genes , Humanos , Técnicas In Vitro , Leucemia Mieloide/patología , Datos de Secuencia Molecular , Regiones Promotoras Genéticas , ARN Mensajero/genética , ARN Neoplásico/genética , Células Tumorales CultivadasRESUMEN
A 21-yr-old female with hyperthyroidism is described. Though her serum-free T3 was 17.8 pmol/L and free T4 was 60.2 pmol/L, TSH was as high as 10.7 mU/L. TRH stimulated an increase in TSH from 10.7-91.7 mU/L. T3 administration in gradually increasing doses of 100, 200, and 400 mg/day resulted in gradual reduction in serum TSH. Cranial computed tomography and magnetic resonance imaging revealed a microadenoma of the pituitary gland. Histology of the surgical specimen showed a TSH-producing adenoma with TSH cell cluster islets and decreased numbers of TSH cells in the nonneoplastic pituitary. Cultured cells from the adenoma secreted TSH spontaneously and in response to TRH. This TRH-stimulated TSH secretion was suppressed by T3 in a dose-dependent manner. One year postoperatively, neither residual tumor nor recurrence were seen by computed tomography and magnetic resonance imaging. However TSH, as well as free T3 or T4, was still high and overresponsive to TRH.
Asunto(s)
Adenoma/metabolismo , Hipófisis/efectos de los fármacos , Neoplasias Hipofisarias/metabolismo , Hormonas Tiroideas/farmacología , Tirotropina/biosíntesis , Adenoma/diagnóstico , Adenoma/patología , Adulto , Resistencia a Medicamentos , Femenino , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Microscopía Electrónica , Hipófisis/cirugía , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/patología , Periodo Posoperatorio , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/patología , Tirotropina/metabolismo , Hormona Liberadora de Tirotropina/farmacología , Tomografía Computarizada por Rayos X , Triyodotironina/farmacologíaRESUMEN
A 20-year-old female with Ph+ acute myelogenous leukemia (M2) associated with t(7;11)(p15;p15) is reported. Bone marrow aspirates were hypercellular with leukemic cells including Auer rods. Chromosome analysis showed t(7;11) and the Ph chromosome. After complete remission, normal karyotype was restored. Normal male karyotypic cells replaced the bone marrow following allogeneic bone marrow transplantation from her brother. On day 358, cytogenetic study at relapse revealed 14q+ as an additional change and clearly showed that the abnormal clone was derived from the patient, because metaphases with XX were all of abnormal karyotype and those with XY were normal.
Asunto(s)
Trasplante de Médula Ósea , Cromosomas Humanos Par 11 , Cromosomas Humanos Par 7 , Leucemia Mielógena Crónica BCR-ABL Positiva/genética , Leucemia Mieloide Aguda/genética , Translocación Genética , Adulto , Femenino , Humanos , Cariotipificación , Leucemia Mielógena Crónica BCR-ABL Positiva/terapia , Leucemia Mieloide Aguda/terapia , RecurrenciaRESUMEN
It has been hypothesized by Lamberts and coworkers in their analysis of 15 cases that adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas may be derived from either the anterior lobe or the intermediate lobe. The intermediate lobe type of Cushing's disease is thought to be controlled through a hypothalamic pathway and is characterized by hyperprolactinemia; suppressibility of cortisol with bromocriptine, and lower sensitivity to dexamethasone. The authors investigated the validity of this hypothesis in 125 cases of ACTH-secreting pituitary microadenomas by analyzing the endocrine findings, the locations of the microadenomas, and alpha-melanocyte stimulating hormone (alpha-MSH) immunoreactivity in the adenoma cells. No significant differences in the basal hormone levels, cortisol suppressibility with bromocriptine, sensitivity to dexamethasone, and recurrence rate were observed between patients with the microadenoma adjacent to the posterior lobe (considered typical of the intermediate lobe-derived tumor) or those with the microadenoma located in the anterior lobe. The locations of the microadenoma were not correlated with alpha-MSH immunoreactivity in the adenoma cells. No significant differences in endocrine findings were noticed between adenomas positive or negative for alpha-MSH. Thus, Cushing's disease cannot be simply divided into either the anterior lobe type or the intermediate lobe type by endocrinological evaluation as described by Lamberts, et al.
Asunto(s)
Adenoma/química , Hormona Adrenocorticotrópica/metabolismo , Neoplasias Hipofisarias/química , alfa-MSH/análisis , Adenoma/metabolismo , Humanos , Neoplasias Hipofisarias/metabolismoRESUMEN
Ten patients with non-Hodgkin's lymphoma originated in the nasal cavity (four patients) and in the paranasal sinuses (six patients) were treated mainly with irradiation and combination chemotherapy including adriamycin. According to the TNM AJC staging system, four patients were in stage T1-T2, and six patients were in stage T3-T4. Nine patients, other than one with stage IV (Ann Arbor) disease, achieved complete remission. Death due to lymphoma occurred in four patients, 4 to 39 months following diagnosis. Three of these patients developed systemic extranodal dissemination, and died in a short time after relapse. Death due to second malignancies occurred in two patients. One died of acute myelogenous leukemia, and the other died of colon cancer, 26 and 53 months after diagnosis, respectively. Four patients were alive and disease-free, from 23 to 68 months following diagnosis (median 40 months). Out of four patients who died of disease, three were in stage T3-T4, and one was in stage T1. Two patients with stage T1 originated in the nasal cavity were both alive and disease-free. Except for lymphomas with stage T1 originated in the nasal cavity, more intensive chemotherapy should be instituted in an attempt to achieve better disease-free survival.
Asunto(s)
Linfoma no Hodgkin/patología , Neoplasias Nasales/patología , Neoplasias de los Senos Paranasales/patología , Adulto , Anciano , Terapia Combinada , Femenino , Humanos , Linfoma no Hodgkin/terapia , Masculino , Persona de Mediana Edad , Neoplasias Nasales/terapia , Neoplasias de los Senos Paranasales/terapia , Pronóstico , Inducción de RemisiónRESUMEN
To elucidate the mechanism of hyperprolactinemia often observed in patients with growth hormone (GH)-secreting pituitary adenomas, the presence of immunoreactive prolactin (ir-PRL) and prolactin (PRL) messenger ribonucleic acid (mRNA) in the tumor tissue was examined by immunohistochemistry and cytoplasmic dot hybridization. Hyperprolactinemia was observed in three of 18 patients with GH-secreting adenoma. The tumor tissue was demonstrated to contain ir-PRL in nine patients and PRL mRNA in 13. The presence of ir-PRL in the tumor tissue was always associated with positive PRL mRNA, indicating production of PRL in GH-secreting tumors. Among the three patients with hyperprolactinemia, both ir-PRL and PRL mRNA was revealed in the tumor tissue of one, PRL mRNA but not ir-PRL was detected in the adenoma tissue of another, and neither PRL mRNA nor ir-PRL was found in the tumor tissue of the third. The association of hyperprolactinemia with the presence of both ir-PRL and PRL mRNA or PRL mRNA alone is indicative of PRL production and secretion. However, the absence of ir-PRL and PRL mRNA in the tumor tissue may indicate that hyperprolactinemia is caused by the suppression of PRL inhibitory factor due to hypothalamic dysfunction by the tumor mass. Thus, the study of PRL gene expression and immunohistochemistry in GH-secreting adenomas is valuable to understanding the pathophysiology of pituitary tumors.