Pituitary tumors following fallout radiation exposure

Two pituitary tumors were diagnosed in a small population of Marshallese accidentally exposed to radioactive fallout in 1954.

The effect of diet on the incidence of pituitary tumours in female Wistar rats

Each of 5 groups of 50 weanling Wistar-derived female rats was fed a different diet ad libitum for 2 years. The diets included 3 commercial maintenance diets (R and M No. 1, R and M No. 491 and RDM 22), a purified or semi-synthetic diet (LJ 80) and the diet (LAD 2) normally used in this laboratory. A weighed amount of LAD 2 diet (less than would be consumed under ad libitum conditions) was fed each day to a 6th group of rats. The survivals of the groups of rats fed either the standard diet (LAD 2) in restricted amount or the maintenance diet (RDM 22) were 62% and 66% respectively and were significantly better than the 40% survival of the group fed LAD 2 ad libitum. The survivals of the groups fed either R and M No. 491 or LJ 80 were 40-42%, and the group fed R and M No. 1 had a survival of 52%. At the end of 2 years the 2 groups with the best (greater than 60%) survivals weighed significantly less than the group fed LAD 2 ad libitum. The groups fed either LAD 2 in restricted amount or RDM 22 had the least gross pathological lesions for the majority of the organs. These same groups also had fewer pituitary tumours per group (72% and 66%) than the group fed LAD 2 ad libitum (90%). The group fed RDM 22 also had the largest % (26%) of normal pituitaries of all the groups in the study. There were some significant differences between the haematological and clinical chemistry results of the group fed LAD 2 ad libitum and the other groups but none of the changes was considered adverse, although the groups fed either RDM 22 or R and M No. 491 had significantly increased mean aminotransferase (AST and ALT) values with large variations which were adjudged undesirable. There was less protein in the urine of the groups fed either RDM 22 or LAD 2 (restricted).

The dilemma of mild hyperprolactinaemia

Ninety-eight women with mild hyperprolactinaemia (less than 4N) were followed for a mean duration of 5.5 years. Where pregnancy was desired treatment with bromocriptine (+/- clomiphene) was effective in 87%. Following cessation of bromocriptine therapy almost one-third had a 'spontaneous' resolution of hyperprolactinaemia and resumed cyclical menstrual activity and fertility. Pituitary tumours were identified on coned-view assessment in 9% of patients at the time of presentation and a further 10% during follow-up. Although some of these latter tumours may have been diagnosed earlier had CAT scans been performed routinely in all hyperprolactinaemic patients, such a policy would be hard to justify for those with mild hyperprolactinaemia as the tumours were small, produced no harmful effects, and would almost certainly have responded to bromocriptine should this have been administered. All patients found to have pituitary tumours and given bromocriptine, showed no evidence of tumour progression subsequently, even where pregnancy occurred and the bromocriptine therapy was ceased. In addition, patients without pituitary tumours who were given bromocriptine to achieve pregnancy, were less likely to develop tumours during follow-up even when pregnancy had occurred. Bromocriptine therapy can thus be justified in mildly hyperprolactinaemic patients to reduce troublesome galactorrhoea, achieve pregnancy, improve the chance of 'spontaneous' resolution of the menstrual problem and infertility, control or reduce tumour growth where a pituitary tumour has been identified, and reduce the risk of tumour development in patients with normal radiographs at the time of presentation.

Second primaries in children with central nervous system tumors

Among 670 children diagnosed with central nervous system tumors before age 20 and recorded in the Connecticut Tumor Registry, nine had a second neoplasm as well. From known age-specific and year-specific cancer incidence figures for Connecticut, the expected number of second neoplasms for the series of 670 is 0.99; therefore the relative risk is 9.1 (95% confidence limits: 4.0, 17.3). Three patients developed two central nervous system tumors, while 0.16 were expected, giving a relative risk of 19 (95% confidence limits: 3.8, 55). Six patients developed two neoplasms in childhood, versus 0.66 expected; the relative risk of this event is 9.1 (95% confidence limits: 3.3, 20). In four cases of lapse in time between the diagnosis of the first and second tumor, the first tumor had been treated with radiation. Five cancers occurred in parents or siblings of these nine patients, versus 0.91 expected; the relative risk is 5.5 (95% confidence limits: 1.2, 10.0). Three of these relatives had leukemia, while only 0.04 cases were expected (relative risk = 75). We conclude that not only is a child with CNS cancer at increased risk for other cancers, but such a child with two cancers is often part of a familial cluster with increased risk of cancer.

Nelson's syndrome: incidence and prognosis

Fifty patients bilaterally adrenalectomized for Cushing's disease were followed for 1 to 22 (mean, 12) years. In 14 of them (28%) Nelson's syndrome appeared within 1.5 to 12 (mean, 4.8) years after adrenalectomy. All the patients were deeply pigmented, 12 had a radiologically demonstrable tumour and six had visual defects. Plasma ACTH levels ranged from 450 to 8000 ng/l. However in every case at least one estimation during circadian studies equalled 2000 ng/l. One patient with an anaplastic pituitary tumour died 3 years after the discovery of the tumour. Anaplasia was also diagnosed in another patient with recurrence of pituitary tumour after a transsphenoidal operation. Symptoms of tumour infarction occurred in two patients, followed by clinical remission of Nelson's syndrome. In the majority of cases the course was benign. We conclude that all cases, however, should be followed indefinitely because Nelson's tumours are not infrequently aggressive.

Oral contraceptive use and the occurrence of pituitary prolactinoma

To determine whether prior oral contraceptive (OC) use is a risk factor for pituitary prolactinoma, we attempted to identify all women (n = 72) with a prolactinoma diagnosed between 1976 and 1980 in three counties in western Washington. A control group of 303 women was selected by dialing random telephone numbers from the same counties. Prior OC use, according to OC indication, was ascertained during a standardized telephone interview. Relative to the risk for women who had never used an OC, the risk of prolactinoma for women who had used OCs for birth control was 1.3 (95% confidence interval, 0.7 to 2.6). This risk was 7.7 for women who used OCs for menstrual regulation (95% confidence interval, 3.7 to 17.0). Previous findings of an association between OC use and prolactinoma may have resulted from OC treatment of menstrual irregularity in women with an undiagnosed prolactinoma.

Incidental pituitary adenomas: a retrospective study

A retrospective study was performed to study the incidence, morphology, and endocrine activity of incidental pituitary tumors in 500 consecutive autopsied subjects. Forty-two pituitary glands were found to have occult pituitary adenomas. These tumors were more frequently found in patients who died in the sixth or seventh decade of life. There was no obvious sex predominance. Of these patients 48% were obese, 34% were diabetic, and 57% were hypertensive. However, in only one case a pituitary lesion was clinically questioned but specific endocrine functions were not performed. The tumor size ranged from 1 to 15 mm, with 62% of tumors being less than 3 mm. In 34 cases the tumors were located along the lateral aspect of the gland, and 36% of these tumors stained positive for the presence of prolactin. Suspicious or abnormal areas were found in 11 of 17 cases in which skull x-rays were taken. In this article we discuss the factors that may affect the recovery incidence of occult pituitary adenomas. The biologic behavior of these microadenomas, especially those classified as prolactinomas, is unclear, but there clinical effects appears to be relatively benign.

Statistical analysis of central nervous system tumors in China

The authors present a statistical survey of the general incidence, age distribution, and preferential sites of 25, 122 tumors of the central nervous system (CNS), from 12 centers in China. Of these tumors, 22,457 were intracranial and the rest intraspinal. Of the 22,457 intracranial neoplasms collected tumors of neuroepithelial tissue comprised 43.85%, meningiomas 16.58% tumors of nerve sheath cells 9.5%, pituitary adenoma 9.52%, congenital tumors 8.46%, secondary tumors 6.8%, vascular malformations and tumors 3.82%, and primary sarcomas 0.72%. Neuroepithelial and meningeal tumors occurred first and second in all series, but the other tumors varied in frequency. There was a higher incidence of nerve-sheath tumors in southern than in northern regions. The age distribution of Chinese patients with tumors of the CNS was lower than that of Caucasians: nearly two-thirds (64.57%) had the clinical onset of their tumor between the ages of 31 and 40 years, with the peak incidence at 35 years. Nearly 20% of tumors of the CNS occurred before 20 years of age. The male:female ratio was 1.53:1; the only tumor with a definite preponderance of females over males was the meningioma. Intraspinal tumors derived from nerve sheaths comprised 47.13% of all tumors within the spinal canal. Meningiomas were second with an incidence of 14.06%, then followed congenital tumors (12.06%) and neoplasms of neuroepithelial tissue (10.83%). Secondary tumors, vascular malformations and neoplasms, and sarcoma were next in order of frequency with 4.6%, and 4.16%, respectively.

Brain tumors in the People's Republic of China: a statistical review

This review analyzes 12,785 cases of pathologically confirmed brain tumors from three published subseries in the People's Republic of China (PRC). No major differences among these series (from different geographical locations) were found. The incidence of glioma was lower in the PRC than in the West, but higher than in Japan; the incidence of meningioma in the PRC was close to that reported from Japan, but lower than that in the West. In the PRC, neurinomas and pituitary adenomas were more frequent than in the West or Japan, and dysembryoplastic tumors seemed to be much more common than in the West or Japan. Metastasis of breast carcinoma to the brain was rare in the PRC. According to a statistical study of 4,059 cases, there were more brain tumors in males than in females (ratio, 1.7:1). Children compose 19% of the series, and elderly patients (over 55 years old) constitute 2.8%.

Incidence of primary intracranial neoplasms in an isolated population (the Faroese) during the period 1962-1975

In a retrospective analysis covering a 14-year-period (1962-1975) the annual incidence of primary intracranial neoplasms in an isolated population of about 40,000 (the Faroese) was found to be 9.9 in 100,000. Out of the 52 patients with intracranial neoplasms 20 were alive, while 32 had died when the study was closed on 31st December 1979. Eighteen out of the 34 patients with supratentorial tumours and one patient with acoustic neurinoma had epilepsy.

Prolactin-secreting pituitary adenomas. III. Frequency and diagnosis in amenorrhea-galactorrhea

Hypocycloidal tomograms of the sella turcica and serum prolactin concentrations were obtained in 146 women with amenorrhea, galactorrhea, or both to diagnose prolactin-secreting pituitary adenomas. Findings suggesting an adenoma, ie, abnormal tomogram and elevated serum prolactin concentration, were found in 24.6% (16/65) of previously unscreened patients and 59.2% (48/81) of prescreened patients. The combination of an abnormal tomogram and elevated prolactin level was relatively specific for an adenoma, as 91% (42/46) of women with these findings who underwent surgery had histologically confirmed tumors. Tumors occurred in women from 15 to 45 years of age, with amenorrhea or galactorrhea ranging from less than six months to more than 20 years in duration. Some women in this series also had obesity, rapid weight loss, polycystic ovarian syndrome, amenorrhea following discontinuance of oral contraceptive use, or emotional stress.

Occurrence of pituitary adenomas and other neoplastic diseases in primary hyperparathyroidism

One hundred and forty-seven consecutive patients with primary hyperparathyroidism operted upon during the period of 1973 to 1978, have been studied with regard to incidence of neoplasms--malignant lesions, pituitary tumors and other benign tumors. The incidence was compared with that published in the Swedish Cancer Registry, which has been in existance since 1958. Patients who had undergone a cholecystectomy were used as another control group. The patients with primary hyperparathyroidism demonstrated 24 malignant tumors in a variety of organs, denoting an incidence of almost twice that calculated according to the Cancer Registry and that found in the control group. Sixteen instances of tumors of the pituitary were found--eight with hypersecretion of one or two pituitary hormones and eight with nonfunctioning adenomas. The incidence of neoplasms for the patients with primary hyperparathyroidism was 40, the expected incidence being 13. The neoplasms were predominant in the women. The data demonstrate that patients with primary hyperparathyroidism run an increased risk of having neoplasms develop. These may be encountered antecedant to, concomitant with or subsequent to the diagnosis of primary hyperparathyroidism.

Prevalent types of tumors developing in neonatally thymectomized mice

Tumor development was observed for 24 months in neonatally thymectomized (nTx) and normal (C3H/HeMs x 129/J)F1 mice. Thymectomy was performed at 3 days of age. Ovarian (29%, with significant difference from the control at P less than 0.001), pituitary (6%, P less than 0.08), and lymphoreticular tumors (16%, P less than 0.05) were observed in higher incidence in nTx females compared with normal controls, resulting in a significant increase in overall tumor incidence (99 tumors in 114 nTx females vs. 37 tumors in 71 normal females, P less than 0.01). No apparent difference in overall tumor incidence was observed between nTx and non-Tx males. Also, there was no higher risk for lung, liver, and mammary tumors in males and females after neonatal thymectomy. The finding that increased tumor incidence was limited to endocrine and lymphoreticular tissues does not support the concept of immune surveillance of carcinogenesis, but rather suggests the importance of tumor-prone conditioning of endocrine or immune systems as a result of neonatal thymectomy.

Intracranial tumours among Chinese in Hong Kong

Fifty-six surgical biopsies of intracranial tumours were seen within two years in a newly established neurosurgical unit in Hong Kong. Among the 52 cases of primary intracranial tumours, glioma is the most common, followed by meningioma and pituitary tumour. This is similar to findings in Caucasians. When the distribution of glioma is analyzed, Chinese, or possibly Orientals, have a much higher incidence of ependymoma and pinealoma than do Caucasians. Similar findings are found in other Chinese series reported in the literature.

Pituitary adenoma and oral contraceptives: a case-control study

A search of the centralized data resource available at the Mayo Clinic for all cases of pituitary adenoma diagnosed in the population of Olmstead County, Minnesota, disclosed an increasing incidence of this tumor in women of childbearing age. The sex, age, and temporal relationships suggest that, if this increase is real, oral contraceptives should be considered as one of the possible etiologic factors. A case-control study, however, did not reveal an association of prior use of oral contraceptives with pituitary tumor--relative risk, 0.5; 95% confidence interval, 0.1 to 2.2. No association was found with other possible risk factors, i.e., prior head injury, radiation therapy, seizures, and smoking. Thus, unless other etiologic agents can be identified, it appears that the increasing incidence is due to advances in diagnostic and surgical technology rather than to a specific etiologic factor.

Pituitary adenoma in Olmsted County, Minnesota, 1935--1977. A report of an increasing incidence of diagnosis in women of childbearing age

There has been a recent, rapid increase in the number of pituitary adenomas diagnosed in women of childbearing age in Olmsted County, Minnesota. The incidence rates in men of all ages and in women aged 45 and over have remained stable and are similar to rates reported from elsewhere. Since 1970 the mean annual incidence per 100,000 women aged 15 through 44 years has been 7.1, whereas it was 0.7 in the population of the same age and sex during the period 1935 through 1969.

Suprasellar germinoma

The clinical features of 18 cases of suprasellar germinoma were reviewed, and the following points stressed: 1) The incidence of intracranial germinoma and teratoma seems to be much higher in Japan than elsewhere. 2) Germinomas in the pineal region, the third ventricle, and the lateral ventricle were observed to be predominant in males. In suprasellar germinoma, however, males were not affected predominantly and the male:female ratio was 1:1. 3) Suprasellar germinomas caused three symptoms: diabetes insipidus, visual disturbances, and pituitary dysfunctions. 4) Pituitary functions were disturbed to various degrees. Some cases showed hypopituitarism but some showed an elevation of plasma concentrations of cortisol or luteinizing hormone and follicle stimulating hormone. 5) Some abnormalities showing a suprasellar mass were usually found on neuroradiological examination. 6) Suprasellar germinomas were very sensitive to radiotherapy and some of them rapidly disappeared on follow-up computerized tomography scanning after irradiation with as little as 1200 rads.