Isolated corticotropin deficiency in adults. Report of 10 cases and review of literature

The clinical and laboratory findings in 76 patients with isolated corticotropin deficiency (10 of our own and 66 from literature) were analyzed with the following observations. With the exceptions of hyperpigmentation and hyperkalemia, the similarity of symptoms and signs to those of Addison's disease and their reversibility by glucocorticoids indicate that most, but not all, manifestation of isolated corticotropin deficiency is caused by glucocorticoid deficiency. Isolated corticotropin deficiency seems to be of pituitary origin in most patients, as shown by lack of corticotropin response to insulin-induced hypoglycemia, vasopressin, or corticotropin-releasing factor. Secretion of other pituitary hormones is frequently abnormal, which is mostly attributable to glucocorticoid deficiency. Although the pathogenesis of isolated corticotropin deficiency is unknown in most patients, association with other autoimmune endocrinopathies, postpartum onset in women, or serum antipituitary antibodies suggests an autoimmune pathogenesis in some patients. In two of our 10 patients, cancer developed during glucocorticoid treatment. More observations of complications and long-term prognosis following glucocorticoid therapy are needed for optimal clinical decision making.

[A case of Leydig cell tumor of the testis]

Leydig cell tumors represent about 3% of all testicular neoplasms. Actually no specific pathologic criteria has really distinguished the benign from the malignant tumors which represent about 11% of the cases. The presence of metastases is the only unequivocal criteria of malignancy. Authors present a rare Leydigoma case with gynecomastia. Clinical, diagnostical and most of all therapeutical aspects are discussed reconfirming the role of the orchifuniculectomy in T1 N0 M0 stage.

Biological aspects of pituitary tumors induced by synthetic salmon calcitonin (TZ-CT) in Sprague-Dawley rats. Immunohistochemical and ultrastructural studies

Rat pituitary tumors induced by synthetic salmon calcitonin (TZ-CT) were studied by the indirect peroxidase-labeled antibody method, together with ultrastructure and serum hormone measurement. Immunohistochemically, TZ-CT-induced pituitary tumors showed staining for only rLH alpha subunit, and were negative for other peptide hormones including GH, PRL, alpha MSH and ACTH, and the beta subunit of glycoprotein hormones. Electron microscopic examination showed that the majority of tumor cells possessed numerous small secretory granules, 100 to 200 nm in diameter. The serum PRL concentrations of rats with TZ-CT-induced pituitary tumors were markedly elevated, but not beyond 130 ng/ml. From our data, TZ-CT-induced pituitary tumors are considered to be endocrinologically inactive and to produce alpha subunit. Furthermore, these tumors are thought to be potentially useful models of alpha subunit-producing pituitary tumors in humans. This is the first report to document the tumorigenesis of alpha subunit-producing pituitary tumors in rats after long-term treatment with calcitonin.

Idiopathic anterior hypopituitarism: magnetic resonance imaging and clinical correlation

We describe the anatomical abnormalities in the hypothalamic-pituitary region revealed by magnetic resonance imaging (MRI) in 10 patients, 8 men and 2 women, affected by idiopathic anterior hypopituitarism (IAH). In all cases contiguous sagittal and coronal T-1 weighted images were obtained. In 9 patients the high-intensity posterior lobe was missing, in almost all patients the pituitary stalk was thin and/or transected, and in 8 a bright T-1 nodule was detected at the infundibular apex, near the tuber cinereum, in the median eminence. None had diabetes insipidus. MRI proves to be very useful in understanding the etiopathogenesis of IAH.

[Effect of long-term treatment with prazosin and its combination with nadolol on the levels of blood hormones of the hypophyseal- gonadal system in patients with hypertension]

The levels of pituitary and gonadal hormones were measured by radioimmunoassay during a long-term (12-month) therapy with prazosin and its combination in 23 patients aged 30-59 years who suffered from Stage II hypertensive disease. Prazosin monotherapy resulted in a significant decrease in prolactin levels, followed by inhibited elaboration of luteinizing, follicle-stimulating, and testicular hormones in the first 6 months of therapy without changing estradiol levels. The hypoprolactinemic effect of prazosin was significantly enhanced with an increase in therapy duration and more profound in patients who had high baseline prolactin levels and in younger patients. Prazosin in combination with nadolol was found to level off the hyperprolactinemic effect of the latter without potentiating the reduction in the levels of follicle-stimulating, luteinizing, and testicular hormones which was observed during therapy with each drug alone.

[Prognostic possibilities in genital endometriosis]

A total of 64 patients with genital endometriosis were examined. The reference group included 120 phenotypically healthy women. The dermatoglyphic pattern of patients with genital endometriosis was defined, pointing to a genetic predisposition to genital endometriosis and reflecting the risk of its development. Together with other clinical and laboratory criteria, the dermatoglyphic studies permit an early diagnosis of endometriosis.

[Hormonal and hemodynamic changes caused by whole body cooling in patients with rheumatoid arthritis]

A limited number of experiments have shown that treatment of rheumatoid arthritis by means of cooling the entire body in cryogenic chamber reduces the pain in joints affected by inflammatory process and increases their mobility. The aim of the present thesis was to try explain the mechanisms responsible for the observed improvement of the patients' condition, and an investigation of the treatment's effect on selected hemodynamic indices. Tests were carried out on 63 patients with rheumatoid arthritis mainly in the 3rd and 4th stage of illness, all of whom had been treated for 14 days, once daily, by cooling the body for two-minute periods in cryogenic chamber with temperatures ranging from -110 degrees C to -160 degrees C, followed by kinesitherapy. It was demonstrated that after a single session in the cryogenic chamber, after 7 and 14 days the level of ACTH, cortisol and beta-endorphins in blood serum rises. The level of TSH, T4, T3, GH and 6-keto-PGF1 alpha+, however, remains unchanged. The cryogenic chamber treatment does not affect the heart rate, arterial blood pressure nor the value of the left ventricle fractional shortening index and its ejection, neither does it cause of arrhythmias and ischemic changes of the heart.

Effects of antiepileptic drugs on hormones

A hormone is an intrinsic substance carried via the blood to a target organ which is then functionally stimulated. Similar to extrinsically administered medications, the metabolism and function of the hormones may be altered by antiepileptic drugs (AEDs). The proposed mechanisms are (a) enhanced metabolism (natural steroids, synthetic steroids, e.g., decadron and birth control pills, thyroxine, and vitamin D3), (b) altered protein bonding (thyroxine, sex hormones), (c) impaired release into the systemic circulation (calcitonin, insulin, vitamin K clotting factors) and (d) altered end-organ effect. The AEDs most likely to interact with hormones are barbiturates, carbamazepine, and phenytoin.

[Corrective effect of reflexotherapy on the hypophyseal-ovarian and sympathetic-adrenal systems after ovariectomy]

The time course of LH, FSH, prolactin, estradiol, hydrocortisone, insulin and catecholamine levels in the blood was followed up in 62 patients of a reproductive age after surgical switch-off of the ovaries. Reflex therapy (electroacupuncture, acupuncture, other types of reflex therapy) included in the complex of postoperative treatment was conductive to the maintenance of a favorable level of hormones contributing to compensatory defense reactions to surgical stress and total ovariectomy.

Testis volumes, semen quality, and hormonal patterns in adolescents with and without a varicocele

OBJECTIVE

To study the effects of varicocele on testicular function in adolescents.

DESIGN

A prospective controlled study in 88 randomly selected adolescents.

SETTING

All participants were referred to the fertility outpatient clinic of our University Hospital.

PARTICIPANTS

All participants with a grade II varicocele (group 2) or a grade III varicocele (group 3) were selected at a district military medical council, whereas a similar group of healthy volunteers without a varicocele served as controls (group 3).

INTERVENTIONS

Testis volumes were measured using an orchiometer. Semen analysis was performed according to standard procedures, and serum hormone levels were determined using a radioimmunoassay.

MAIN OUTCOME MEASURE(S)

Testis volumes, semen quality, and hormonal parameters in adolescents with and without a varicocele were compared.

RESULTS

In group 1 (n = 21), the mean left testis volume (24.5 mL; 95% confidence interval [CI]: 22.8 to 26.2) was significantly (P less than 0.05) different from group 2 (n = 15) (20.9 mL: 95% CI: 18.5 to 23.4) and group 3 (n = 52) (20.7 mL; 95% CI: 19.2 to 22.2) (P less than 0.01) adolescents. In adolescents with a pronounced varicocele-associated left testicular growth failure, the total sperm number was reduced. However, sperm concentration, motility, and morphology were not altered. Luteinizing hormone, follicle-stimulating hormone, testosterone, and prolactin levels were all within the normal ranges in the three groups.

CONCLUSIONS

Left testicular growth failure in adolescents with a varicocele is only associated with a decrease in total sperm number.

Calcium ion and pituitary hormones: effect of calcium channel blockers on stimulated secretion of pituitary hormones

The effects of two calcium channel blockers nifedipine (20 mg sublingual), and verapamil (10 mg i.v.) on growth hormone (GH), thyrotropin (TSH), prolactin (PRL) and gonadotropin (LH and FSH) secretion induced by growth hormone releasing hormone (GHRH), hypoglycemia, thyrotropin releasing hormone (TRH), metoclopramide and gonadotropin releasing hormone (GnRH), were studied in a group of normal volunteers (27 men and 8 women). Neither nifedipine nor verapamil had any effect on PRL, TSH or gonadotropin release. Verapamil did not cause variations in GH secretion following GHRH and insulin-induced hypoglycemia, whereas nifedipine significantly reduced the elevation in GH induced by GHRH; however the GHRH-mediated GH rise still remained within the normal range in all subjects. Our results suggest that neither nifedipine nor verapamil have important effects on stimulated pituitary hormone secretion, at least under conditions of acute administration.

[Hormonal changes and biologically active substances in alcoholic women in the reproductive age]

The levels of hormones and some bioactive substances were measured in women of a reproductive age, suffering from alcoholism, with different stages and duration of this condition. Studies of the serotonin-reactive, cholinergic, and cholino-reactive systems have shown a discordant activity of the neuromediator systems: reduced activity of the serotonin-reactive and elevated tone of the cholinergic systems. The findings evidence that chronic alcohol poisoning is associated with activation of the hypothalamohypophyseal system followed by depression of this activity with the progress of alcoholism. Alcoholism involves disordered functioning of the ovaries, thyroid, and adrenals; these disorders may augment due to direct toxic effect of alcohol and its metabolites on the endocrine glands. All this eventuates in menstrual dysfunction and infertility.

[Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses]

This clinical study has been designed to evaluate the efficacy of an extract of Pygeum Africanum (Tadenan) (Roussel-Pharma) in patients suffering from prostatic hypertrophy or chronic prostatitis. The drug has been administrated to 18 patients, for 60 days, as double of standard dosage (200 mg/die per os, instead of 100 mg/die). Because of the high frequency of association of sexual disorders with those two pathologies, we have extended the study also to sexual disorders selecting patients suffering from prostatic hypertrophy or chronic prostatitis and, simultaneously, from sexual disturbances. No side effects have been observed during the treatment. The urinary disturbances have been evaluated by anamnesis and prostatic transrectal echography; sexual disorders have been evaluated by anamnesis and nocturnal penile tumescence and rigidity (NPTR) monitoring. Furthermore, dosage of serum levels of the hormones LH, FSH, Prolactin, 17 beta-Estradiol and Testosterone has been performed before and after therapy. Pygeum Africanum extract administration improved all the urinary parameters we investigated; prostatic echography relieved reduction of peri-urethral edema. Also an improvement of sexual behaviour has been obtained; but we have not found significant differences between serum hormonal levels before and after therapy, as well as for NPTR.

[Late effects on the hypothalamo-pituitary function after the treatment of parasellar tumors]

Long term follow-up of patients submitted to treatment of parasellar tumours region is important for the detection of late therapeutic complications. In this study the authors conducted an evaluation of six patients with craniopharyngioma, one with germinoma, one with meningioma, and one epidermoid cyst. All above tumours were localized at parasellar region. Six out of nine patients had been treated both by surgery and by radiotherapy and the other three surgically only, on an average 3.8 +/- 3.2 years before this observation was carried out. Five patients were female with their ages average 24.3 +/- 18.8 years old. Evaluation consisted: in the first place, an intravenous infusion of thyrotropin-releasing hormone (TRH, 200 micrograms), gonadotropin-releasing hormone (GnRH, 100 micrograms), and insulin tolerance test (0.1 IU/Kg, regular insulin); and secondly, in measurements of pituitary hormones secretion at different time points--0, 20, 40, 60 and 80 minutes. We found both diminished response of growth hormone and cortisol in all the patients. Seven out of nine patients did not have adequate response to follicle-stimulating hormone. Three out of nine responded unsatisfactory to luteinizing hormone. Four out of nine showed inadequate responses to prolactin as well as, two out of eight to thyrotropin. We concluded that: (a) growth hormone and cortisol deficiency are the most frequent finding in these patients; (b) post-radiotherapy lesions can be located in the hypothalamus or pituitary, or even in both; (c) hypophysial and hypothalamic cells sensitivity to irradiation is different, according to their respective hormones; and (d) it is necessary a frequent endocrinologic follow-up of patients to detect late hormonal deficiencies.

Hormonal factors associated with weight loss in patients with advanced breast cancer

Fasting blood samples were collected from 83 patients with histologically proven breast cancer and analysed for plasma glucagon, serum immunoreactive tumour necrosis factor (TNF alpha), insulin, glucose, growth hormone, cortisol and TSH. Samples from patients with known diabetes mellitus or thyroid disease, and those on parenteral nutrition or with evidence of infection were excluded as were patients who had a history of weight loss through dieting or who were anorexic. Fasting plasma glucagon, serum cortisol and immunoreactive TNF alpha concentrations in patients with stage IV breast cancer who had developed weight loss were significantly higher than those in patients with stage IV disease who had not developed weight loss. There were no significant differences in the fasting serum concentrations of insulin, glucose, growth hormone and TSH between the two patient groups. The association between weight loss in stage IV breast cancer and increased concentrations of plasma glucagon, serum cortisol and TNF alpha suggests a possible role for these hormonal factors in the development of cancer cachexia.

[The role of biologically active substances in the pathogenesis of dysfunctional uterine hemorrhage in the climacteric period]

The activities of the blood kallikrein-kinin system components (plasma kallikrein, alpha 1-antitrypsin, alpha 2-macroglobulin), and gonadotropin levels in various phases of the menstrual cycle were measured in 35 women ob various age groups. The same parameters were investigated in 28 women with dysfunctional uterine bleedings of the climacteric period. Phasic changes in the blood kallikrein-kinin system components, closely related to the hormonal status, were revealed over the course of the onto-genesis. Climacteric dysfunctional uterine bleedings were found associated with an elevated activity of the plasma kallikrein, parallelled by a relative insufficiency of the blood plasma inhibitor potential. A relationship between the activities of the blood kallikrein-kinin system components and endometrial function has been revealed. These findings necessitate search for approaches to pharmacologic regulation of the blood kallikrein-kinin system activity and to pathogenetic therapy of the climacteric dysfunctional uterine bleedings.

[Evaluation of the reproductive endocrine system in a population of hemodialyzed adult males]

There is a high incidence of sexual disorders of multifactorial origin in hemodialysed patients. The endocrine reproduction system was evaluated in 19 male adult hemodialysed patients. Slightly enhanced levels of prolactin and gonadotropins were found together with normal levels of total and free testosterone. Androgen biosynthesis intermediates were substantially normal. Hypophyseal stimulation tests using TRH and GnRH revealed a prolactin and gonadotropins response which was reduced, slow and protracted compared to normal. Hypophyseal stimulation did not cause any variation in testosterone levels. Prolactin and gonadotropins were not pulsatile. Data obtained appear to indicate that the hormonal component in sexual disorders in uremic patients is related to dynamic alterations of the system rather than basic hormonal changes.

[Clinico-immuno-hormonal parallels in obese women in the climacteric period]

A total of 178 women of a climacteric age with obesity of various degrees were examined. The time of the menopause onset was found directly related to body mass. A higher incidence of the climacteric syndrome and predominance of its complicated forms were characteristic of obese women, this may be explained by reduced functional activity of the T immunity system. A significant direct correlation between the immune response parameters and thyroid function was revealed, as was a reverse correlation between these two characteristics and blood serum follicle-stimulating hormone, hydrocortisone, and testosterone levels. The authors claim that the clinical picture of the climacteric syndrome is governed by the hormonal status and the immunity parameters, and recommend immunomodulating therapy for such patients.

The influence of portacaval anastomosis on gonadal and anterior pituitary hormones in a rat model standardized for gender, food intake, and time after surgery

Portacaval anastomosis causes delayed growth, decreased testes and liver weights, and elevated estradiol serum levels in male rats compared with sham-operated controls. Female rats treated with portacaval anastomosis grow at a normal rate despite changes in liver weight and estradiol levels similar to those observed in the male rats. This study examined the pituitary gonadal axis in both genders in this animal model. The rats receiving portacaval anastomosis were compared with both pair-fed and sham-operated control groups. Portacaval anastomosis decreased serum testosterone and increased estradiol in the male animals, while both testosterone and estradiol were increased in the females compared with gender-matched pair-fed and sham controls. Because pair feeding lowers male testosterone to a lesser extent, impaired nutrition may partially account for the decrease in the males treated with portacaval anastomosis. The ratio of estradiol to testosterone increased following anastomosis in male rats, but it was decreased in similarly treated females. Portacaval and anastomosis decreased luteinizing hormone without changing follicle-stimulating hormone in both male and female rats compared with sham-operated controls. Growth hormone was significantly decreased in male portacaval-treated rats compared with sham- and pair-fed animals. Increased insulin levels were found in both male and female pair-fed and portacaval anastomosis-treated animals. These data suggest that following portacaval anastomosis in rats, growth, serum testosterone, estradiol to testosterone ratios, and growth hormone are altered in a gender-specific manner with gender-independent changes in insulin and luteinizing hormone levels. These gender-specific effects may protect the portacaval anastomosis-treated female rat from growth retardation.

Ectopic pituitary adenoma in the suprasellar cistern: case report

The case of a 56-year-old man with an ectopic pituitary adenoma is reported. Neurological examinations, neurodiagnostic imaging, surgical observation, endocrinological evaluation, histological examination, and immunohistological study demonstrated evidence of ectopic prolactinoma in the suprasellar cistern and the presence of a normal pituitary in the sella turcica. The patient underwent total removal of the suprasellar mass by a pterional approach, leading to a surgical and endocrinological cure.

Ovarian morphology, endocrine function and intra-follicular blood flow during the peri-ovulatory period

Transvaginal ultrasonography with colour flow mapping has been used to study changes in intra-follicular morphology and blood flow during a peri-ovulatory period in one volunteer. Aspects of uterine morphology and blood flow were also recorded. The intervals from a defined luteinizing hormone (LH) rise and peak to the mean time of follicular rupture were 37.5 and 17.5 h, respectively. Blood flow velocity waveforms were observed clearly at the time of the LH rise and blood vessels were visible when the hormone level reached a peak. Concurrently, the wall of the follicle became less clear, crenated, thicker and more echogenic. A structure resembling the detached cumulus and oocyte was seen before the follicle had ruptured. Peak systolic blood velocity was highest immediately after ovulation had occurred. Blood flow impedance in the uterine arteries suggested the presence of a circadian rhythm, but no pronounced daily changes were observed over the study period. In contrast, flow velocity waveforms were clearly visible in the endometrium around the time of ovulation. These preliminary data suggest that intra-follicular vascularization or angiogenesis may be critical processes that might be used to predict ovulation and could possibly be modified to help achieve or avoid a pregnancy.

Comparison of anterior pituitary hormone levels in the inferior petrosal sinuses and peripheral blood in various pituitary disorders during perihypophysial phlebography

The present study aimed at evaluating the anterior pituitary hormone levels in the inferior petrosal sinuses and in the peripheral blood of 55 patients affected by various pituitary disorders and undergoing perihypophysial phlebography on neurosurgical indication or for diagnostic purposes. The results indicated that in 6 patients with Cushing's disease and in 4 with hyperprolactinemia the secreting adenoma could be localized by inferior petrosal sinus sampling. Furthermore, the concentrations of all the pituitary hormones were found to be higher in the right and/or in the left inferior petrosal sinus than in peripheral blood, showing a clear gradient between central and peripheral samples. Moreover, the evaluation of hormone central/peripheral concentration ratios revealed noteworthy differences, namely, that central/peripheral concentration ratios of GH, ACTH, and PRL were significantly higher than those of TSH, FSH, and LH (p less than 0.01). On the contrary, no significant differences were found when the concentration ratios of GH, ACTH and PRL or TSH, FSH and LH were compared among themselves. This finding may be attributed to at least two factors: the increased pulsatility and the relatively short biological halftime of polypeptic hormones (GH, ACTH, and PRL) compared with glycoprotein hormones (TSH, FSH, and LH).

Effects of exogenous monoiodotyrosine on the serum levels of anterior pituitary hormones

Monoiodotyrosine is a tyrosine hydroxylase inhibitor. Ingestion of one gram monoiodotyrosine caused a 10,000-fold increase of serum monoiodotyrosine from basal levels of 0.69 +/- 0.20 nmol/l to a peak of 10.6 +/- 1.7 mumol/l in women and 7.1 +/- 2.3 mumol/l in men 30 min later, and the t1/2 was 45 min. Monoiodotyrosine stimulated PRL to a peak of 170 +/- 51 micrograms/l in women and 90 +/- 6 micrograms/l in men 30 min after the monoiodotyrosine peak, or 60 min after the ingestion. Other anterior pituitary hormones were unchanged. Dopamine infusion or L-dopa pretreatment attenuated the monoiodotyrosine effect. TRH exaggerated the PRL peak, and chlorpromazine did not increase but prolonged the hyperprolactinemia. These results suggest that dopamine synthesis inhibition may be the mechanism of PRL stimulation.

Adult panhypopituitarism presenting as idiopathic growth hormone deficiency in childhood

We report two patients who presented in childhood with isolated growth hormone deficiency and in whom progressive loss of anterior function led to panhypopituitarism in early adult life. The need for continued follow-up and reassessment of pituitary function in adult life is stressed in the light of the natural history of these patients.