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Pituitary apoplexy and rivaroxaban
We report the first case of PA with rivaroxaban which is one of the new oral anticoagulants: a 73 year-old patient presenting with severe headache and visual field deterioration. Surgery was performed. Radiotherapy treatment was decided three months after surgery because of tumor residue. (Source: Pituitary)
Source: Pituitary - August 22, 2017 Category: Endocrinology Source Type: research

The changing sella: internal carotid artery shift during transsphenoidal pituitary surgery
ConclusionsWe have demonstrated a uniform narrowing in ICD at different levels of the ICA during and after TSS adenoma resection. Surgeons should be aware of this change since it determines the width of the surgical corridor and can thus influence the ease of surgery. (Source: Pituitary)
Source: Pituitary - August 21, 2017 Category: Endocrinology Source Type: research

Vasculogenic hyperprolactinemia: severe prolactin excess in association with internal carotid artery aneurysms
Conclusions We propose the term ‘vasculogenic hyperprolactinemia’ to encompass the hyperprolactinemia associated with ICA aneurysms. This may be mediated by an endothelial factor capable of paracrine stimulation of lactotrophs; however, angiotensin II, substance P, histamine and PRLH appear unlikely to be causative. (Source: Pituitary)
Source: Pituitary - August 21, 2017 Category: Endocrinology Source Type: research

Surgical debulking of pituitary adenomas improves responsiveness to octreotide lar in the treatment of acromegaly
AbstractBackgroundStudies comparing primary medical treatment of acromegaly with surgery are often non-randomized, and not stratified by illness severity. We prospectively compared primary medical therapy with pituitary surgery in patients with acromegaly. All patients had macroadenomas, at least one random human growth hormone (GH) level  ≥12.5 ng/mL, elevated IGF-I levels and failure to suppress GH to
Source: Pituitary - August 19, 2017 Category: Endocrinology Source Type: research

Evidence of dysexecutive syndrome in patients with acromegaly
ConclusionsAcromegalic patients were severely impaired in semantic inhibition, executive processing, working memory and executive inhibition, and they have realized a portion of these deficits. A high level of IGF-1, disease duration may contribute to the impairment of specific aspects of executive function. (Source: Pituitary)
Source: Pituitary - August 19, 2017 Category: Endocrinology Source Type: research

The prevalence of growth hormone deficiency in survivors of subarachnoid haemorrhage: results from a large single centre study
We report on the prevalence of GHD in a large cohort of patients following SAH, when dynamic and confirmatory pituitary hormone testing methods are systematically employed.DesignIn this cross-sectional study, pituitary function was assessed in 100 patients following SAH. Baseline pituitary hormonal profile measurement and glucagon stimulation testing (GST) was carried out in all patients. Isolated GHD was confirmed with an Arginine stimulation test and ACTH deficiency was confirmed with a short synacthen test.ResultsThe prevalence of hypopituitarism in our cohort was 19% and the prevalence of GHD was 14%. There was no asso...
Source: Pituitary - August 18, 2017 Category: Endocrinology Source Type: research

Incidence of myocardial infarction and stroke in acromegaly patients: results from the German Acromegaly Registry
In this study, we examine if the incidence of myocardial infarction (MI) and stroke differ from that of the general population.MethodsData from the German Acromegaly Registry in seven specialized endocrine centres were analysed (n  = 479, 56% female, 46 years old at diagnosis, 5549 person-years from diagnosis). Standardized incidence ratios (SIR) were calculated as compared to the general population.ResultsMI and stroke incidences were very close to those of the general population with an SIR (95% CI) of 0.89 (0.47 –1.52, p = 0.80) for MI and 1.17 (0.66–1.93, p =&thi...
Source: Pituitary - August 14, 2017 Category: Endocrinology Source Type: research

Double pituitary adenomas are most commonly associated with GH- and ACTH-secreting tumors: systematic review of the literature
ConclusionDouble pituitary adenomas are rare but most commonly found with GH- or ACTH-producing tumors. It is critical to remove all identified possible adenomas to achieve biochemical cure and clinicians should have heightened sensitivity in patients with acromegaly or Cushing ’s Disease. (Source: Pituitary)
Source: Pituitary - August 1, 2017 Category: Endocrinology Source Type: research

A multicenter, observational study of lanreotide depot/autogel (LAN) in patients with acromegaly in the United States: 2-year experience from the SODA registry
AbstractPurposeThis analysis evaluates the 2-year effectiveness and safety of lanreotide depot/autogel (LAN), as well as treatment convenience and acromegaly symptom relief, from the Somatuline® Depot for Acromegaly (SODA) registry, a post-marketing, open-label, observational, multicenter, United States registry study.MethodsPatients with acromegaly treated with LAN were eligible for enrollment. Demographics, LAN dose, extended dosing interval (EDI) (interval of injections ≥42 days), insulin-like growth factor 1 (IGF-1), growth hormone (GH), glycated hemoglobin, adverse events (AEs), injection convenience, and sympt...
Source: Pituitary - July 24, 2017 Category: Endocrinology Source Type: research

Late-onset X-linked adrenal hypoplasia (DAX-1, NR0B1 ): two new adult-onset cases from a single center
ConclusionsWe describe two missense mutations within the putative carboxyl-terminal ligand binding domain of DAX-1, presenting with AHC and HH in adulthood, from a single center. DAX-1 mutations may be more frequent in adults than previously recognized. We recommend testing for DAX-1 mutations in all adults with primary AI and HH or impaired fertility where the etiology is unclear. (Source: Pituitary)
Source: Pituitary - July 24, 2017 Category: Endocrinology Source Type: research

Association between ACE and AGT polymorphism and cardiovascular risk in acromegalic patients
AbstractPurposeWhether the renin –angiotensin–aldosterone system plays a role or not in the development of cardiovascular morbidity in acromegaly patients is unknown. The aim of the study was to investigate the association between ACE (I/D) and AGT (M235T) gene polymorphisms and cardiovascular and metabolic disorders in the acr omegaly.MethodsThe study included one hundred and seventeen acromegalic patients (62  F/55 M, age: 50.2 ± 12.3 years) and 106 healthy controls (92 F/14 M, age: 41.4 ± 11.3 years). PCR method was used to evaluate the prevalence...
Source: Pituitary - July 15, 2017 Category: Endocrinology Source Type: research

Best candidates for dopamine agonist withdrawal in patients with prolactinomas
ConclusionsPatients who have no tumor visible on MRI, have a nadir PRL level6 years may be the best candidates for DA withdrawal. (Source: Pituitary)
Source: Pituitary - July 14, 2017 Category: Endocrinology Source Type: research

The extended, transnasal, transsphenoidal approach for anterior skull base meningioma: considerations in patient selection
ConclusionsAlthough more commonly treated transcranially, anterior skull base meningiomas are sometimes amenable to resection transphenoidally. Patient selection is critical, and multiple factors, including tumor size, consistency, and location, patient and surgeon preference, and presenting symptoms each affect the optimum surgical approach. We have developed criteria for patient selection so that transsphenoidal surgery can be used to resect or debulk anterior skull base meningiomas safely and with favorable outcomes. (Source: Pituitary)
Source: Pituitary - July 8, 2017 Category: Endocrinology Source Type: research

Erratum to: Acromegaly: surgical results in 548 patients
(Source: Pituitary)
Source: Pituitary - July 5, 2017 Category: Endocrinology Source Type: research

Ovarian hyperstimulation syndrome due to follicle-stimulating hormone-secreting pituitary adenomas
ConclusionsFrequency of OHSS due to a gonadotroph adenoma is not negligible. Increased awareness of the characteristic clinical and hormonal picture should permit an early detection of this condition in premenopausal women with a pituitary adenoma. (Source: Pituitary)
Source: Pituitary - July 4, 2017 Category: Endocrinology Source Type: research

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis
ConclusionWhile visual deficits improved after EETS in the majority of patients, complete recovery was only achieved in less than half of the patients and some patients even suffered from visual deterioration. (Source: Pituitary)
Source: Pituitary - June 22, 2017 Category: Endocrinology Source Type: research

Contribution of sellar dura integrity to symptom manifestation in pituitary adenomas with intratumoral hemorrhage
ConclusionRapid volume expansion of a hematoma and lack of extension or unidirectional extension might lead to significant compression of the sellar and surrounding structures. Of note, the integrity of the sellar dura might contribute to the acute onset of symptom manifestations caused by hemorrhage in pituitary adenomas. (Source: Pituitary)
Source: Pituitary - June 14, 2017 Category: Endocrinology Source Type: research

Genetic analysis of IRF6 , a gene involved in craniofacial midline formation, in relation to pituitary and facial morphology of patients with idiopathic growth hormone deficiency
ConclusionThis is the first report ofIRF6 analysis in an IGHD cohort. We found one new mutation which, based on in silico analysis, could be of functional relevance. However, we did not find any mutations in the other patients. Therefore, we conclude thatIRF6 defects are rare in IGHD patients and further research should focus on new candidate genes. (Source: Pituitary)
Source: Pituitary - June 7, 2017 Category: Endocrinology Source Type: research

Acromegaly: surgical results in 548 patients
ConclusionsSurgery remains the first line of therapy for a majority of acromegalic patients. This series proves to be very valuable in circumscribed adenomas but also in invasive tumours. Levels of GH and IGF-I were decreased in almost all the patients without remission. (Source: Pituitary)
Source: Pituitary - June 6, 2017 Category: Endocrinology Source Type: research

Impairment of osmotic challenge-induced neurohypophyseal hormones secretion in sepsis survivor rats
ConclusionThe results suggest that the inflammatory components mediated a persistent impairment in the component of the osmoregulatory reflex affecting the secretion of neurohypophyseal hormones in sepsis survivor animals. (Source: Pituitary)
Source: Pituitary - June 6, 2017 Category: Endocrinology Source Type: research

Pituitary dysfunction in granulomatosis with polyangiitis
ConclusionGPA should be carefully considered in patients with a sellar mass and unusual clinical presentation with DI and systemic disease. Although conventional induction-remission treatment improves systemic symptoms and radiological pituitary abnormalities, hormonal deficiencies persist in most of the patients. Therefore, follow-up should include both imaging and pituitary function assessment. (Source: Pituitary)
Source: Pituitary - May 24, 2017 Category: Endocrinology Source Type: research

Cross-sectional prevalence of pancreatic cystic lesions in patients with acromegaly, a single-center experience
AbstractPurposeAcromegaly is a disease associated with an increased risk for several kinds of neoplasms including colon and thyroid cancer. Although the association between acromegaly and pancreatic neoplasms has not been elucidated, it has recently been reported thatGNAS gene mutations were found in 58% of intraductal papillary mucinous neoplasms (IPMNs), which are representative pancreatic cystic lesions, suggesting a link between IPMNs and acromegaly. To assess the prevalence of pancreatic cystic lesions in patients with acromegaly, we performed a retrospective cross-sectional single institute study.MethodsThirty consec...
Source: Pituitary - May 24, 2017 Category: Endocrinology Source Type: research

Perioperative hypothalamic pituitary adrenal function in patients with silent corticotroph adenomas
This study investigates the hypothalamic pituitary adrenal axis (HPA) characteristics after adenomectomy in patients with SCAs.MethodsBiochemical parameters of HPA function were monitored frequently after surgical resection of non-functioning macroadenomas. Levels of ACTH, cortisol, DHEA and DHEA-S were measured frequently for 48  h after adenomectomy. HPA data of patients with SCAs (n = 38) were compared to others (Controls) with non-secreting, ACTH-negative immunostaining adenomas of similar age and gender distribution (n = 182) who had adenomectomy.ResultPlasma ACTH increased (P  
Source: Pituitary - May 20, 2017 Category: Endocrinology Source Type: research

‘Ectopic’ suprasellar type IIa PRL-secreting pituitary adenoma
ConclusionEctopic suprasellar pituitary adenomas (ESPAs) are extremely rare intracranial extracerebral tumors. SPAs can be classified into three types according to their origin and their relationship with surrounding tissue. Only type III is theoretically a true ectopic, based on previous reports. Thus, ESPAs are uncommon compared to other EPAs. Our case is the first reported case of a type IIa ‘E’SPA and the first description of this subtype classification until now. The pars tuberalis may be different from the pars distalis, and each subtype of adenohypophyseal cells may have different migration characteristi...
Source: Pituitary - May 19, 2017 Category: Endocrinology Source Type: research

Prolactinoma management: predictors of remission and recurrence after dopamine agonists withdrawal
AbstractObjectiveProlactinomas are the most common functional pituitary tumour. Dopamine agonists (DA) are its principal treatment. The criteria that should guide therapy withdrawal and the factors that influence disease remission or relapse are not yet fully established. Our purpose is to evaluate the proportion of patients who attempted DA withdrawal, and to identify the factors that influence clinicians to try it. In addition, we aim to study the factors that are involved in prolactinoma remission/relapse after therapy withdrawal.MethodsWe retrospectively evaluated 142 patients with prolactinoma diagnosis who had been t...
Source: Pituitary - May 18, 2017 Category: Endocrinology Source Type: research

Increased expression of the microRNA 106b~25 cluster and its host gene MCM7 in corticotroph pituitary adenomas is associated with tumor invasion and Crooke ’s cell morphology
ConclusionsmiR-106b~25 and its host gene MCM7 are potential novel biomarkers for invasive ACTH-immunopositive pituitary adenomas. Additionally, they are both significantly upregulated in rare Crooke ’s cell adenomas and might therefore contribute to their aggressive phenotype. (Source: Pituitary)
Source: Pituitary - April 21, 2017 Category: Endocrinology Source Type: research

Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy
AbstractPurposeIn pituitary apoplexy (PA), there are preliminary reports on the appearance of sphenoid sinus mucosal thickening (SSMT). SSMT is otherwise uncommon with an incidence of up to 7% in asymptomatic individuals. The aim of this study was to evaluate the incidence and clinical significance of SSMT in patients with PA and a control group of surgically treated non-functioning pituitary adenomas (NFPAs).MethodsRetrospective review of clinical and imaging variables in PA and NFPA patients. Sphenoid sinus mucosal thickness was measured on the presenting MRI scan by a blinded neuroradiologist. Pathological SSMT was defi...
Source: Pituitary - April 18, 2017 Category: Endocrinology Source Type: research

Expression of cell cycle regulators and biomarkers of proliferation and regrowth in human pituitary adenomas
ConclusionsInteresting and novel observations on the differences in expression of tumour markers studied are reported. Correlation between Ki-67 expression, PTTG nuclear expression and recurrence/regrowth of PAs, emphasizes the role that Ki-67 and PTTG expression have as markers of increased proliferation. c-MYC and PTTG nuclear expression levels were correlated providing evidence that PTTG induces c-MYC expression in PAs and we propose that c-MYC might principally have a role in early pituitary tumorigenesis. Evidence is shown that the anti-proliferative effect of somatostatin analogue treatment in vivo occurs through reg...
Source: Pituitary - March 24, 2017 Category: Endocrinology Source Type: research

White matter involvement on DTI-MRI in Cushing ’s syndrome relates to mood disturbances and processing speed: a case-control study
AbstractPurposeCushing ’s syndrome (CS) is an endocrine disorder due to prolonged exposure to cortisol. Recently, microstructural white matter (WM) alterations detected by diffusion tensor imaging (DTI) have been reported in CS patients, and related to depression, but other functional significances. remain otherwise unc lear. We aimed at investigating in more depth mood symptoms in CS patients, and how these relate to cognition (information processing speed), and to WM alterations on DTI.MethodsThe sample comprised 35 CS patients and 35 healthy controls. Beck Depression Inventory-II (BDI-II) was used to measure depre...
Source: Pituitary - March 22, 2017 Category: Endocrinology Source Type: research

Follow-up intervals in patients with Cushing ’s disease: recommendations from a panel of experienced pituitary clinicians
ConclusionsWith a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice. (Source: Pituitary)
Source: Pituitary - March 8, 2017 Category: Endocrinology Source Type: research

Jean Camus and Gustave Roussy: pioneering French researchers on the endocrine functions of the hypothalamus
This article aims to credit Camus and Roussy for their groundbreaking, decisive contributions to postulate the hypothalamus being the brain region in control of endocrine homeosta sis and energy metabolism. (Source: Pituitary)
Source: Pituitary - March 5, 2017 Category: Endocrinology Source Type: research

Surgical outcomes in patients with Cushing ’s disease: the Cleveland clinic experience
AbstractContextTranssphenoidal surgery (TSS) to resect a pituitary adenoma is considered first-line treatment for patients with Cushing ’s disease (CD). Early, post-operative remission rates>80% are expected for patients with a microadenoma ( ≤ 10 mm) visible on magnetic resonance (MR) imaging.ObjectiveTo report surgical outcomes and predictors of remission in a specialist center for patients with CD.Patients and methodsClinical data was obtained from a prospective CD database in addition to review of all electronic medical, laboratory and surgical patient records. Patients who underwent their first...
Source: Pituitary - March 5, 2017 Category: Endocrinology Source Type: research

Sellar and clival plasmacytomas: case series of 5 patients with systematic review of 65 published cases
ConclusionsParasellar plasmacytomas are rare tumors that should be considered in the differential diagnosis for lesions involving the sella and arising from the clivus, especially when cranial nerve paresis is apparent, even in the absence of known MM. Although recurrence rates for parasellar plasmacytoma is low, patients should be monitored for progression to MM. Treatment depends on the presence of systemic disease at diagnosis. (Source: Pituitary)
Source: Pituitary - February 28, 2017 Category: Endocrinology Source Type: research

David L. Kleinberg: in memoriam
(Source: Pituitary)
Source: Pituitary - February 23, 2017 Category: Endocrinology Source Type: research

Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery
ConclusionsCo-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear. (Source: Pituitary)
Source: Pituitary - February 22, 2017 Category: Endocrinology Source Type: research

Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities
AbstractAcromegaly is associated with an enhanced mortality, with cardiovascular and respiratory complications representing not only the most frequent comorbidities but also two of the main causes of deaths, whereas a minor role is played by metabolic complications, and particularly diabetes mellitus. The most prevalent cardiovascular complications of acromegaly include a cardiomyopathy, characterized by  cardiac hypertrophy and diastolic and systolic dysfunction together with arterial hypertension, cardiac rhythm disorders and valve diseases, as well as vascular endothelial dysfunction. Biochemica...
Source: Pituitary - February 20, 2017 Category: Endocrinology Source Type: research

Two-dimensional speckle tracking echocardiography demonstrates no effect of active acromegaly on left ventricular strain
AbstractBackgroundSpeckle tracking echocardiography (STE) allows for the study of myocardial strain ( ε), a marker of early and subclinical ventricular systolic dysfunction. Cardiac disease may be present in patients with acromegaly; however, STE has never been used to evaluate these patients.ObjectiveTo evaluate left ventricular (LV) global longitudinal strain in patients with active acromegaly with normal LV systolic function.DesignCross-sectional clinical study.MethodsPatients with active acromegaly with no detectable heart disease and a control group were matched for age, gender, arterial hypertension and diabe...
Source: Pituitary - February 19, 2017 Category: Endocrinology Source Type: research

The longest stalk: preserved pituitary function after regression of a giant prolactinoma
(Source: Pituitary)
Source: Pituitary - February 15, 2017 Category: Endocrinology Source Type: research

Updates in outcomes of stereotactic radiation therapy in acromegaly
Conclusion Although the use of radiotherapy in patients with acromegaly has decreased with advances in medical treatments, it remains an effective treatment option after unsuccessful surgery and/or resistance or unavailability of medical therapy. Long-term studies evaluating secondary morbidity and mortality rate after the new stereotactic techniques are needed, in order to evaluate their potential brain-sparing effect. (Source: Pituitary)
Source: Pituitary - February 15, 2017 Category: Endocrinology Source Type: research

T2-weighted MRI signal intensity as a predictor of hormonal and tumoral responses to somatostatin receptor ligands in acromegaly: a perspective
AbstractT2-weighted MRI signal intensity of GH-secreting pituitary adenomas is gaining recognition as a marker of disease characteristics and may be a predictor of response to treatment of acromegaly. Adenomas that are T2-hypointense are more common, are smaller and are less likely to invade the cavernous sinus compared to the T2-iso and hyperintense tumors. T2-hypointense tumors are also accompanied by higher IGF1 values at baseline. When presurgical somatostatin receptor ligand (SRL) therapy is administered, T2-hypointense adenomas have better hormonal responses and have greater tumor shrinkage. Adjuvant SRL therapy of p...
Source: Pituitary - February 13, 2017 Category: Endocrinology Source Type: research

Somatostatin receptor ligands in the treatment of acromegaly
AbstractFirst-generation somatostatin receptors ligands (SRL) are the mainstay in the medical treatment of acromegaly, however the percentage of patients controlled with these drugs significantly varies in the different studies. Many factors are involved in the resistance to SRL. In this review, we update the physiology of somatostatin and its receptors (sst), the use of SRL in the treatment of acromegaly and the factors involved in the response to these drugs. The SRL act through interaction with the sst, which up to now have been characterized as five subtypes. The first-generation SRL, octreotide and lanreotide, are con...
Source: Pituitary - February 6, 2017 Category: Endocrinology Source Type: research

Biochemical investigations in diagnosis and follow up of acromegaly
AbstractMeasurements of human growth hormone (GH) and insulin-like growth-factor I (IGF-I) are cornerstones in the diagnosis of acromegaly. Both hormones are also used as biochemical markers in the evaluation of disease activity during treatment. Management of acromegaly is particularly challenging in cases where discordant information is obtained from measurement of GH concentrations following oral glucose load and from measurement of IGF-I. While in some patients biological factors can explain the discrepancy, in many cases issues with the analytical methods seem to be responsible. Assays used by endocrine laboratories t...
Source: Pituitary - February 5, 2017 Category: Endocrinology Source Type: research

The genetic background of acromegaly
AbstractAcromegaly is caused by a somatotropinoma in the vast majority of the cases. These are monoclonal tumors that can occur sporadically or rarely in a familial setting. In the last few years, novel familial syndromes have been described and recent studies explored the landscape of somatic mutations in sporadic somatotropinomas. This short review concentrates on the current knowledge of the genetic basis of both familial and sporadic acromegaly. (Source: Pituitary)
Source: Pituitary - February 3, 2017 Category: Endocrinology Source Type: research

Radiological features for the approach in trans-sphenoidal pituitary surgery
ConclusionsThere are significant variations in the anatomical and pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new ‘teddy bear’ sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal pituitary surgery. (Source: Pituitary)
Source: Pituitary - February 1, 2017 Category: Endocrinology Source Type: research

Acromegaly, a pituitary special issue
(Source: Pituitary)
Source: Pituitary - January 31, 2017 Category: Endocrinology Source Type: research

Inhibition of neuronal nitric oxide synthase activity does not alter vasopressin secretion in septic rats
ConclusionWe concluded that nNOS does not have a substantial role in vasopressin secretion during experimental sepsis. (Source: Pituitary)
Source: Pituitary - January 15, 2017 Category: Endocrinology Source Type: research

New medical therapies on the horizon: oral octreotide
AbstractSomatostatin analog treatment is first line medical treatment in patients with acromegaly. This drug is currently mainly administered by monthly depot preparations of octreotide and lanreotide. With the innovative transient permeability enhancer, a technology enabling the absorption of drug molecules via transient opening of the tight junctions of the gut epithelium, it is possible to achieve therapeutic octreotide levels after oral ingestion. The present review summarized the preclinical work and the recently reported phase I and III study on oral octreotide capsules in patients with acromegaly. Maintenance of con...
Source: Pituitary - January 15, 2017 Category: Endocrinology Source Type: research

Adipsic diabetes insipidus in adult patients
ConclusionThe management of ADI is challenging and is associated with significant morbidity and mortality. Prognosis is variable; hypothalamic complications lead to early death in some patients, but recent reports highlight the possibility of recovery of thirst. (Source: Pituitary)
Source: Pituitary - January 9, 2017 Category: Endocrinology Source Type: research

Cabergoline in acromegaly
AbstractAcromegaly, a rare disease due to growth hormone (GH) hypersecretion by a pituitary adenoma, is associated with severe comorbidity and premature death if not adequately treated. The usual first-line treatment is surgery. Various drugs, including somatostatin receptor ligands, dopamine agonists and GH receptor antagonists, are now available for use if surgery fails to suppress GH/IGF-I hypersecretion. Cabergoline, now the preferred dopamine agonist for treating hyperprolactinemia, is also used off-label for treating acromegaly. Cabergoline monotherapy is reported to normalize IGF-I levels in more than one-third of p...
Source: Pituitary - December 25, 2016 Category: Endocrinology Source Type: research

Management of aggressive growth hormone secreting pituitary adenomas
AbstractAggressive GH-secreting pituitary adenomas (GHPAs) represent an important clinical problem in patients with acromegaly. Surgical therapy, although often the mainstay of treatment for GHPAs, is less effective in aggressive GHPAs due to their invasive and destructive growth patterns, and their proclivity for infrasellar invasion. Medical therapies for GHPAs, including somatostatin analogues and GH receptor antagonists, are becoming increasingly important adjuncts to surgical intervention. Stereotactic radiosurgery serves as an important fallback therapy for tumors that cannot be cured with surgery and medications. Da...
Source: Pituitary - December 15, 2016 Category: Endocrinology Source Type: research