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Unal TC, Aydoseli A, Ozgen U, Dolas I, Sabanci PA, Aras Y, Ozturk M, Ozata MS, Gul N, Kubat Uzum A, Mutlu U, Bilgic B, Saka E, Yarman S, Sencer A. A single-center experience of transsphenoidal endoscopic surgery for acromegaly in 73 patients: results and predictive factors for remission. Br J Neurosurg 2024; 38:648-653. [PMID: 34241568 DOI: 10.1080/02688697.2021.1947977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 05/29/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transsphenoidal endoscopic surgery is the first-line treatment for growth hormone-secreting adenomas. OBJECTIVE To analyse the results of the transsphenoidal endoscopic approach for acromegaly and to determine the predictive factors of remission. METHODS A single-centre retrospective review was performed in patients who underwent endoscopic transsphenoidal surgery for acromegaly between January 2009 and January 2019. Demographic features, clinical presentation, histopathology records, complications and pre- and postoperative radiologic and endocrinological assessments were evaluated. The factors that influenced the remission rates were investigated. RESULTS A total of 73 patients underwent surgery via the transsphenoidal endoscopic approach. Cavernous sinus invasion was detected in 32 patients (43.8%); and macroadenoma, in 57 (78%). The pathology specimens of the 27 patients (36.9%) showed dual-staining adenomas with prolactin. A total of 51 patients (69.8%) attained biochemical remission 1 year after surgery. A second operation was performed in 10 patients (13.6%) with residual tumours without biochemical remission in the first year. Six (60%) of the patients attained remission at the last follow-up. Transient diabetes insipidus was observed in 18 patients (24.6%); and rhinorrhoea, which was resolved with conservative treatment, in 4 (5.4%). None of the patients developed panhypopituitarism. The presence of cavernous sinus invasion and preoperative IGF-1, immediate postoperative GH and third-month IGF-1 levels were predictive of remission. CONCLUSION Transsphenoidal endoscopic surgery is a safe and effective treatment for acromegaly. Reoperation should be considered in patients with residual tumours without remission.
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Affiliation(s)
- Tugrul Cem Unal
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Utku Ozgen
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Pulat Akin Sabanci
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Metehan Ozturk
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Musa Samet Ozata
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurdan Gul
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ayse Kubat Uzum
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ummu Mutlu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bilge Bilgic
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esra Saka
- Department of Anesthesiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Yarman
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Araujo-Castro M, Marazuela M, Puig-Domingo M, Biagetti B. Prolactin and Growth Hormone Signaling and Interlink Focused on the Mammosomatotroph Paradigm: A Comprehensive Review of the Literature. Int J Mol Sci 2023; 24:14002. [PMID: 37762304 PMCID: PMC10531307 DOI: 10.3390/ijms241814002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Prolactin (PRL) and growth hormone (GH) are peptide hormones that bind to the class 1 cytokine receptor superfamily, a highly conserved cell surface class of receptors. Both hormones control their own secretion via a negative autocrine loop in their own mammosomatotroph, lactotroph or somatotroph. In this regard, GH and PRL are regulated by similar signaling pathways involving cell growth and hormone secretion. Thus, GH and PRL dysregulation and pituitary neuroendocrine tumor (PitNET) development may have common pathogenic pathways. Based on cell linage, lactotroph and somatotroph PitNETs come from pituitary-specific POU-class homeodomain transcription factor (Pit-1). Mammosomatotroph and plurihormonal PitNETs are a unique subtype of PitNETs that arise from a single-cell population of Pit-1 lineage. In contrast, mixed somatotroph-lactotroph PitNETs are composed of two distinct cell populations: somatotrophs and lactotrophs. Morphologic features that distinguish indolent PitNETs from locally aggressive ones are still unidentified, and no single prognostic parameter can predict tumor aggressiveness or treatment response. In this review, we aim to explore the latest research on lactotroph and somatotroph PitNETs, the molecular mechanisms involved in PRL and GH axis regulation and the signaling pathways involved in their aggressiveness, particularly focused on mammosomatotroph and mixed subtypes. Finally, we summarize epidemiological, clinical, and radiological features of these exceptional tumors. We aim to shed light, from basic to clinical settings, on new perspectives and scientific gaps in this field.
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Affiliation(s)
- Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Colmenar Viejo Street km 9, 28034 Madrid, Spain
- Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Colmenar Viejo Street km 9, 28034 Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario La Princesa, 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), Monforte de Lemos Avenue, 28029 Madrid, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras CIBERER G747, Monforte de Lemos Avenue, 28029 Madrid, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Vall d’Hebron University Hospital, Reference Networks (ERN) and Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Avenue, 119, 08035 Barcelona, Spain
- Diabetes and Metabolism Research Unit, Vall d’Hebron Research Institute and CIBERDEM (ISCIII), Universidad Autónoma de Barcelona, Avenida Can Domènech s/n, 08193 Bellaterra, Spain
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Gulbadin D, Li Z, Shahbaz M, Farhaj Z, Shabbir A, Qi Q, Tang K, Ni S, Sun L. Patients with true mixed growth hormone and prolactin-secreting pituitary adenoma: a case series of 12 patients. Br J Neurosurg 2020; 34:154-160. [PMID: 31975630 DOI: 10.1080/02688697.2020.1713989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Daqiq Gulbadin
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhiwei Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China
| | - Muhammad Shahbaz
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, Shandong, China
- The Institute of Laparoscopic-Endoscopic Minimally Invasive Surgery, Shandong University, Jinan, Shandong, China
| | - Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Arzoo Shabbir
- School of Medicine, Shandong University, Jinan, Shandong, China
| | - Qichao Qi
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Brain Function Remodeling, Jinan, Shandong, China
| | - Kuanxiao Tang
- Department of Geriatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shilei Ni
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
- Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, Shandong, China
| | - Lei Sun
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Rick J, Jahangiri A, Flanigan PM, Chandra A, Kunwar S, Blevins L, Aghi MK. Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes. J Neurosurg 2019; 131:147-153. [PMID: 30215558 DOI: 10.3171/2018.4.jns18230] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acromegaly results in disfiguring growth and numerous medical complications. This disease is typically caused by growth hormone (GH)-secreting pituitary adenomas, which are treated first by resection, followed by radiation and/or medical therapy if needed. A subset of acromegalics have dual-staining pituitary adenomas (DSPAs), which stain for GH and prolactin. Presentations and treatment outcomes for acromegalics with DSPAs are not well understood. METHODS The authors retrospectively reviewed the records of more than 5 years of pituitary adenomas resected at their institution. Data were collected on variables related to clinical presentation, tumor pathology, radiological size, and disease recurrence. The Fisher's exact test, ANOVA, Student t-test, chi-square test, and Cox proportional hazards and multiple logistic regression were used to measure statistical significance. RESULTS Of 593 patients with pituitary adenoma, 91 presented with acromegaly. Of these 91 patients, 69 (76%) had tumors that stained for GH only (single-staining somatotrophic adenomas [SSAs]), while 22 (24%) had tumors that stained for GH and prolactin (DSPAs). Patients with DSPAs were more likely to present with decreased libido (p = 0.012), signs of acromegalic growth (p = 0.0001), hyperhidrosis (p = 0.0001), and headaches (p = 0.043) than patients with SSAs. DSPAs presented with significantly higher serum prolactin (60.7 vs 10.0 µg/L, p = 0.0002) and insulin-like growth factor-1 (IGF-1) (803.6 vs 480.0 ng/ml, p = 0.0001), and were more likely to have IGF-1 levels > 650 ng/ml (n = 13 [81.3%] vs n = 6 [21.4%], p = 0.0001) than patients with SSAs despite similar sizes (1.8 vs 1.7 cm, p = 0.5). Patients with DSPAs under 35 years of age were more likely to have a recurrence (n = 4 [50.0%] vs n = 3 [11.1%], p = 0.01) than patients with SSAs under the age of 35. DSPA patients were less likely to achieve remission with surgery than SSA patients (n = 2 [20%] vs n = 19 [68%], p = 0.01). Univariate analysis identified single-staining tumors (p = 0.02), gross-total resection (p = 0.02), and tumor diameter (p = 0.05) as predictors of surgical remission. Multiple logistic regression demonstrated that SSAs (p = 0.04) were independently associated with surgical remission of acromegaly. Kaplan-Meier analysis revealed that DSPAs had more time until disease remission (p = 0.033). CONCLUSIONS Acromegalics with tumors that stain for prolactin and GH, which represented almost a quarter of acromegalics in this cohort, had more aggressive clinical presentations and postoperative outcomes than SSAs. Prolactin staining provides useful information for acromegalics undergoing pituitary surgery.
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Affiliation(s)
- Jonathan Rick
- 1Department of Neurosurgery, University of California, San Francisco, California
| | - Arman Jahangiri
- 1Department of Neurosurgery, University of California, San Francisco, California
| | | | - Ankush Chandra
- 3Wayne State University School of Medicine, Detroit, Michigan
| | - Sandeep Kunwar
- 1Department of Neurosurgery, University of California, San Francisco, California
| | - Lewis Blevins
- 1Department of Neurosurgery, University of California, San Francisco, California
| | - Manish K Aghi
- 1Department of Neurosurgery, University of California, San Francisco, California
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5
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Tachibana T, Ito T. Immunocytochemical study of the GH cells in the anterior pituitary gland of human fetus II. Anencephalic fetus. Hum Cell 2004; 16:205-15. [PMID: 15147041 DOI: 10.1111/j.1749-0774.2003.tb00155.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In order to elucidate the effects of hypothalamic regulation on the morphology of GH cells, light and electron microscopic immunocytochemical examinations were carried out comparing GH cells in the anterior pituitary gland of anencephalic fetus with those of normal fetuses. Three types of GH cells were identified in the anterior pituitary gland of anencephalic fetus as well as in the normal fetus. Type-I is a small, round cell containing a few small secretory granules. Type-III is a large, polygonal cell with numerous large secretory granules. Type-II is a polygonal cell with medium-sized secretory granules. The Type-II GH cell was predominant in both anencephalic and normal fetuses. The most striking difference between anencephalic and normal fetuses was the presence of atypical forms of the Type II cell. These were polygonal cells containing secretory granules, which were either immunopositive or immunonegative to anti-human GH (anti-hGH) serum. Furthermore, two other types of GH cells were identified. The somatomammotroph (SM cell) contained GH and PRL in different granules within the same cell. Also, a different type of the GH cell was noted containing two varieties of secretory granules; one was immunolabeled only with anti-hGH and the other was not immunolabeled to either anti-hGH or anti-human PRL (anti-hPRL). From these results, we suggest that an absence of hypothalamic regulation in the anencehpalic does not seriously modify GH cell morphology but induces an altered GH storage pattern in some of the cells.
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Affiliation(s)
- Toshiaki Tachibana
- Department of Anatomy, The Jikei University School of Medicine, Minato-Ku, Tokyo 105-8461, Japan.
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6
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Abstract
BACKGROUND/AIMS Pituitary adenomas are the third most common primary intracranial neoplasm, after astrocytomas and meningiomas, and about 30% of them secrete growth hormone (GH). Other subtypes of pituitary tumors are characterized by well-known gender-related differences, not only in clinical presentation and other biological characteristics but also in surgical outcome. For GH-releasing pituitary adenomas, however, detailed data on gender differences of postsurgical treatment are not available. PATIENTS AND METHODS The patient charts of a series of 18 patients with acromegaly who met strict immunohistochemical and electron microscopic criteria and who underwent surgical resection of their tumors between January 1990 and June 1999 were retrospectively reviewed. RESULTS There were eight women and ten men; the male-to-female-ratio was 1.3:1. The men and women were equal in age at surgery. Men demonstrated higher IGF-1 and smaller GH levels pre- and postoperatively, whereas the reduction in IGF-1 was more pronounced compared to women (58% vs. 27%). The overall outcome was better in women than in men. Mixed GH- and prolactin-secreting adenomas showed a worse outcome among all other histological subtypes. Mitose- and MIB-1 labeling index was increased in men compared to women. CONCLUSION The clinical course and tumor biology of GH-releasing pituitary adenomas appear to differ in women and men. Men demonstrated a shorter preoperative duration of symptoms, larger and more invasive tumors, and a worse clinical outcome. These findings suggest that therapy for GH-releasing adenomas should be more aggressive in men than in women. The gender-related differences in GH-releasing pituitary adenomas appear to have a basis in different biologic behavior, which warrants further investigation.
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Affiliation(s)
- Bernhard Schaller
- Department of Neurology, Inselspital, Freiburgstrasse 10, CH-3010 Berne, Germany.
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7
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Ho DM, Hsu CY, Ting LT, Chiang H. Plurihormonal pituitary adenomas: immunostaining of all pituitary hormones is mandatory for correct classification. Histopathology 2001; 39:310-9. [PMID: 11532042 DOI: 10.1046/j.1365-2559.2001.01204.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS We studied the clinicopathological characteristics of plurihormonal pituitary adenomas. METHODS AND RESULTS The study material included 167 plurihormonal adenomas, which consisted of 31% of the surgically removed pituitary adenomas that we collected during a 12-year period. The mean age of patients with plurihormonal adenoma was 45.7 years (range 13-75 years). There were 86 men and 81 women. All tumours were fully classified by immunohistochemical staining for seven pituitary hormones or subunits. Thirty immunohistochemical subtypes of plurihormonal adenomas were recognized. Hormonal symptoms were present in 70% of patients, while serum hormonal levels were increased in 89% of patients. Most patients had symptoms related to only one of the hormones and only 7% of patients had symptoms related to two hormones. The most common hormonal symptom was acromegaly (50%); symptoms related to hyperprolactinaemia ranked second (20%). Double immunostaining of all the possible combinations of the hormones was performed in 30 selected tumours, and they all showed mixtures of hormones in individual adenoma cells in any hormonal combinations studied. The latter finding supported the view that plurihormonal adenomas are monomorphous adenomas. CONCLUSIONS Plurihormonal adenomas are common pituitary adenomas. Immunohistochemical staining of all pituitary hormones is mandatory for correct classification.
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Affiliation(s)
- D M Ho
- Department of Pathology and Laboratory Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
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8
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Kabuto M, Kubota T, Kobayashi H, Nakagawa T, Kitai R, Kodera T. Detection of mammosomatotroph cells and identification of the coexistence of growth hormone and prolactin within the same secretory granules in these cells using confocal laser scanning microscopy. Histochem Cell Biol 1995; 104:363-7. [PMID: 8574886 DOI: 10.1007/bf01458130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study was designed to examine whether mammosomatotroph cells (MS cells) can be easily detected using confocal laser scanning microscopy (CLSM) and whether the coexistence of growth hormone (GH) and prolactin (PRL) within the same secretory granule can be identified in the MS cell using CLSM. Conventional epoxy resin-embedded tissues of mixed GH- and PRL-secreting human pituitary adenomas were used for this double-labelling immunofluorescent study by CLSM. A semithin section of the tissue after plastic removal and bleaching was immunohistochemically double-stained with primary antibodies against GH and PRL, followed by secondary antibodies conjugated with Rhodamine (GH) and FITC (PRL). MS cells simultaneously showing fluorescence of both Rhodamine and FITC were easily detected by CLSM at lower magnification. At higher magnification, the coexistence of Rhodamine and FITC on the same secretory granule was identified by using a superimposed display. This finding was confirmed by immunoelectron microscopy. The CLSM technique may be useful for the study of MS cells.
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Affiliation(s)
- M Kabuto
- Department of Neurosurgery, Fukui Medical School, Japan
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Shinkai T, Sakurai Y, Ooka H. Age-related changes in the numbers of mammotrophs, somatotrophs and mammosomatotrophs in the anterior pituitary gland of female rats: a flow cytometric study. Mech Ageing Dev 1995; 83:125-31. [PMID: 8583831 DOI: 10.1016/0047-6374(95)01614-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Age-related changes in the numbers of mammotrophs, somatotrophs, mammosomatotrophs, and the cells of other types in the anterior pituitary of female Wistar rat were measured by flow cytometry. The mammotrophs increased with age, and the somatotrophs decreased with senescence. The mammosomatotrophs increased remarkably in senescent rats, and these cells of the rats older than 21 months were about 10 times more than those of 3, and 12-13 months old rats. This result indicates that the stability of gene expression in cell differentiation is reduced in the aging process of the anterior pituitary.
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Affiliation(s)
- T Shinkai
- Department of Cell Biology, Tokyo Metropolitan Institute of Gerontology, Japan
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10
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Novel Features of Tumors That Secrete Both Growth Hormone and Prolactin in Acromegaly. Neurosurgery 1994. [DOI: 10.1097/00006123-199408000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Nyquist P, Laws ER, Elliott E. Novel features of tumors that secrete both growth hormone and prolactin in acromegaly. Neurosurgery 1994; 35:179-83; discussion 183-4. [PMID: 7969823 DOI: 10.1227/00006123-199408000-00001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The most prominent previously reported clinical features of growth hormone (GH) and prolactin (PRL)-secreting pituitary adenomas associated with acromegaly have included the high incidence of galactorrhea in women and a generally more favorable response to dopamine agonist therapy. The authors analyzed a consecutive series of 62 acromegalic patients treated with transsphenoidal microsurgery. GH-PRL tumors were found in 30% of the patients. There was a significant difference in sex distribution between acromegalics with the GH-PRL tumor subtype and all other acromegalics. Women represented 73% of the GH-PRL immunostain subtype, as compared with the overall sex distribution of 33 women (53%) and 29 men (47%) for the entire series of acromegalic patients. Individuals with the GH-PRL subtype had significantly higher postoperative GH levels than those with the GH subtype, and significantly higher postoperative GH levels when compared with all other acromegalics with a variety of immunostain subtypes. Linear regression analysis of the pre- and postoperative GH data revealed that the increased postoperative GH levels in the GH-PRL immunostain subtype were independent of the invasiveness of the tumor and of sex of the subject. When the same linear regression technique was used, lower preoperative levels of thyroxine and thyroid-stimulating hormone were observed in the GH-PRL subtype. These data suggest inherent differences characteristic of tumors that secrete both growth hormone and prolactin.
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Affiliation(s)
- P Nyquist
- Department of Neurological Surgery, George Washington University, Washington, District of Columbia
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12
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Abstract
A 40-year-old Black man presenting with increasing nasal discharge of bloody, mucoid pus as well as nasal obstruction over a 2-month period is described. Magnetic resonance imaging of the skull showed a tumor eroding through the skull base into the clivus and extending into the sphenoid sinus. Endoscopy of the sphenoid sinus demonstrated a polypoid mass extending into the posterior choanae. The lesion was partially resected. Histologic evaluation showed a cellular small blue cell tumor punctuated by bland, epithelial-lined microcysts. Electron microscopy revealed epithelial cells with abundant rough endoplasmic reticulum and electron-dense membrane-bound endocrine granules, some undergoing misplaced exocytosis. Immunohistochemical evaluation demonstrated cytoplasmic reactivity for neuron-specific enolase, synaptophysin, and prolactin. Stains for leukocyte common antigen, HMB-45, desmin, cytokeratin, chromogranin, and the remaining spectrum of pituitary hormones including growth hormone, corticotropin, luteinizing hormone, follicle-stimulating hormone, and thyrotrophic hormone were negative. In contrast, the epithelium lining the cysts was cytokeratin positive and synaptophysin negative. This ostensibly small cell tumor therefore represented a remarkably extensive and aggressive prolactin cell adenoma with unusual light microscopic features. Characterization of the lesion required electron microscopy and further confirmation by immunocytology. The distinction of pituitary adenomas and particularly of prolactin cell tumors from other adenoma types and from other small cell lesions markedly affects therapy and patient prognosis.
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Affiliation(s)
- M Arnesen
- Department of Pathology, Abbott Northwestern Hospital, Minneapolis, Minnesota 55407
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13
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Abstract
Twenty-two consecutive cases of adenoma in acromegalic patients were studied immunohistochemically. All the tumors contained prolactin (PRL)-reactive cells (3% to 53% of the total number of tumor cells) as well as growth hormone (GH)-reactive cells (4% to 74% of the total number of tumor cells). All acromegalic cases studied were thus plurihormonal adenomas containing GH and PRL; no pure GH cell adenoma was present. Twenty cases were further examined at the ultrastructural level in conjunction with postembedding double-labeling immunoelectron microscopy; 15 of these cases were diagnosed as mixed GH cell-PRL cell adenomas. The previously diagnosed pure GH cell adenomas possibly may have contained PRL cells and thus should be considered as mixed GH cell-PRL cell adenomas. Mammosomatotroph adenomas were rare in this series. Double-labeling immunoelectron microscopy, using protein A gold particles of two different sizes, greatly facilitated the distinction among GH, PRL, and mammosomatotroph cells.
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Affiliation(s)
- S Furuhata
- Department of Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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14
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Abstract
Recent advances in ultrastructural immunohistochemistry have provided insight into not only the subcellular localization of single antigens but also the colocalization of two distinct antigens in the same cellular constituent. In the field of pituitary pathology, precise identification of cell types, mechanism of processing, and dynamic intracellular transportation of hormones, as well as production of multiple hormones in the same cells of nontumorous and neoplastic adenohypophyses, have been documented by use of these techniques. The present review deals with the use of major methods for ultrastructural immunohistochemistry including pre-, post-, and non-embedding methods, particularly focusing on their application to human pituitary pathology. Problems of tissue processing and a protocol for double labeling technique using the protein A-gold complex are also described.
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Affiliation(s)
- T Sano
- Department of Pathology, University of Tokushima School of Medicine, Japan
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15
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Abstract
This paper deals with the cytological features of pituitary plurihormonal adenomas based on 62 cases examined by histology, immunohistochemistry, ultrastructural study and post-embedding immunogold electron microscopy, including double labeling. In GH-cell containing adenomas, there were 9 adenomas consisting of exclusively GH and PRL cells. The other 39 adenomas contained other hormones as well as GH and PRL. Other nine combinations of pituitary hormones or alpha-subunit were observed. Special emphasis was laid on the fact that a greater part of GH-producing adenomas (74% by immunostain) were PRL-producing, although the ratio of GH-cells to PRL-cells widely varied from case to case. Concerning the double labeling study on mixed GH-PRL secreting adenomas, we recognized the existence of secretory granules containing GH only, those containing PRL only, those containing both GH and PRL and those containing neither.
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Affiliation(s)
- T Kameya
- Department of Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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16
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Slater M. Plurihormonality in the secretory granules of the normal human pituitary. An immunoelectron microscopic study. EXPERIENTIA 1991; 47:267-70. [PMID: 2009937 DOI: 10.1007/bf01958156] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Normal human autopsy anterior pituitary tissue from 5 cases was embedded in LR White resin and immunolabelled using silver-enhanced 5-nm protein A gold probes. Follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), luteinizing hormone (LH), adrenocorticotrophic hormone (ACTH), growth hormone (GH) and prolactin (PRL) were immunolocalised to the level of secretory granule. A two-sided double-labelling method was used to cross-react two hormones at a time with respect to their corresponding antibodies. All possible combinations of the six pituitary hormones were tested. Plurihormonal granules were found that contained LH + FSH, LH + TSH, and FSH + TSH. Each hormone was also found in monohormonal granules. Granule diameter was significantly larger in the pluri as opposed to monohormonal granules.
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Affiliation(s)
- M Slater
- Electron Microscope Unit, Prince Henry Hospital, Little Bay, Sydney, NSW, Australia
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17
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Giannattasio G, Bassetti M. Human pituitary adenomas. Recent advances in morphological studies. J Endocrinol Invest 1990; 13:435-54. [PMID: 2166105 DOI: 10.1007/bf03350700] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- G Giannattasio
- Centro CNR per lo Studio della Farmacologia delle Infrastrutture Cellulari, Dipartimento di Farmacologia, Università di Milano, Italy
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18
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Jin L, Song J, Chandler WF, England BG, Smart JB, Barkan A, Lloyd RV. Hybridization studies of cultured human pituitary prl and gh producing adenoma cells: Effects of thyrotropin-releasing hormone, somatostatin, and phorbol ester. Endocr Pathol 1990; 1:25. [PMID: 32357622 DOI: 10.1007/bf02915152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The effects of the hypothalamic hormones, thyrotropin-releasing hormone (TRH), and somatostatin (SRIH), and of phorbol 12-myristate 13-acetate (PMA) on PRL and GH secretion and messenger RNA (mRNA) levels were analyzed in 10 GH and/or PRL producing adenomas after culturing the tumor cells in the presence of these secretagogues for 7 days. The expression of chromogranin A and B mRNAs was also examined. All four of the clinically diagnosed GH adenomas expressed or secreted both GH and PRL while four of six clinically diagnosed prolactinomas produced or secreted both PRL and GH. Prolactinomas had less than 10% of tumor cells expressing chromogranin A mRNA while more than 40% of the adenoma cells expressed chromogranin B mRNA. TRH stimulated PRL secretion and increased PRL mRNA levels while SRIH decreased GH secretion and mRNA expression in some cases. Unexpectedly, PMA stimulated PRL mRNA levels four- to sevenfold above control levels in two adenomas and generally stimulated chromogranin A and B mRNA expression but not GH mRNA, as determined by Northern hybridization and in situ hybridization analyses.These results indicate that cultured prolactinoma cells express significantly more chromogranin B mRNA than chromogranin A mRNA, and that PMA increases PRL mRNA expression in some prolactinomas, although the effect of PMA on various adenomas reflects the heterogeneity of these tumors with respect to protein kinase C stimulation.
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Affiliation(s)
- Long Jin
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - Jiangyue Song
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - William F Chandler
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - Barry G England
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - James B Smart
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - Ariel Barkan
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
| | - Ricardo V Lloyd
- Departments of Pathology (LJ, JS, BGE, JBS, RVL), Surgery-Section of Neurosurgery (WFC), and Medicine (AB) University of Michigan Medical School, Ann Arbor
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19
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Serri O, Somma M, Rasio E, Brazeau P. Growth hormone-releasing factor increases serum prolactin concentrations in normal subjects and in patients with pituitary adenomas. Clin Endocrinol (Oxf) 1989; 30:65-75. [PMID: 2505955 DOI: 10.1111/j.1365-2265.1989.tb03728.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We have examined the serum growth hormone (GH) and prolactin (PRL) response to growth hormone releasing factor (hGRF-(1-44)NH2 (GRF) 1 microgram/kg i.v. bolus) in 16 acromegalic patients (eight of whom were hyperprolactinaemic), 13 patients with microprolactinoma, and 14 healthy subjects. The GH responses to TRH and to the somatostatin analogue SMS 201-995 were also studied in acromegalic patients. In these, and in patients with microprolactinoma, GH responses after GRF (P less than 0.001 vs saline) were variable. The absolute GH increase (calculated as area under the curve) in acromegalic patients (2489 +/- 920 micrograms/l min), or in patients with microprolactinoma (1322 +/- 279 micrograms/l min) was not different from that in controls (2238 +/- 633 micrograms/l min). In addition, a significant increase in PRL release was observed after GRF in comparison to saline in acromegalic patients (P less than 0.01), in patients with microprolactinoma and in normal subjects (P less than 0.001). The PRL increase was significantly correlated with basal PRL levels in acromegalic patients (r = 0.99, P less than 0.001) and in patients with microprolactinomas (r = 0.61, P less than 0.05). Furthermore, a significant correlation was found between GH rise after GRF and basal GH, and between GH rise after GRF and GH decrement after SMS in patients with acromegaly. These results suggest that GRF can stimulate PRL release by actions on the normal pituitary and on pituitary adenomas, including microprolactinomas. Moreover, the data suggest that in acromegaly there is a relative functional deficiency of hypothalamic somatostatin.
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Affiliation(s)
- O Serri
- Metabolic Unit, Hôpital Notre-Dame, Montreal, Quebec, Canada
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