Diagnosis and management of pituitary tumors: recent advances

Emmenagogue properties of Milicia excelsa (Welw.) C.C. Berg (Moraceae) based, at least in part, on its ability to correlate the activity of the hypothalamic-pituitary axis to that of the ovaries

ETHNOPHARMACOLOGICAL RELEVANCE

Milicia excelsa (Welw.) C.C. Berg (Moraceae) is a medicinal plant recommended over tropical Africa as a cure for several ailments including amenorrhea. This is the hallmark of an ovarian lesion or a dysfunction of the hypothalamic-pituitary-ovarian axis which may lead to infertility, osteoporosis or endometrial cancer. However, regardless these traditional claims, no scientific report dealing with emmenagogue properties has been reported yet.

AIM OF THE STUDY

To bring scientific evidence to the curative action of the plant, we proposed evaluating the effects of a root aqueous extract of Milicia excelsa on female Wistar rat sexual maturation.

MATERIAL AND METHODS

The study was performed in immature (45 days old) female Wistar rats orally treated with the root aqueous extract of Milicia excelsa at doses of 14, 77 and 140mg/kg BW/day for 7 and 15 consecutive days. Genistein (10mg/kg BW) served as the reference substance. Negative control animals, treated with the vehicle, were followed up for 7, 15, 30 and 45 days and rats were aged 52, 60, 75 and 90 days at these respective days. This allowed setting the nubile age of experimental animals and to determine the impact of treatments with genistein or the aqueous extract of Milicia excelsa on the age of rat sexual maturation. Since female rats do not have menstruation and that the normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries in response to hormonal signals from the pituitary gland, the effects of treatments were evaluated on the pituitary production of gonadotropins, the ovarian production of estradiol and progesterone, and uterine and vaginal growths.

RESULTS

The sexual maturation of untreated rats was set at 90 days old. This sexual maturation was indicated by the simultaneous elevation of gonadotropins (FSH and LH (p<0.01)) and ovarian hormones (estradiol (p<0.001) and progesterone (p<0.05)) in animals aged 90 days. Uterine and vaginal growths (p < 0.001) observed in these animals appear as the result of elevated level of estradiol. The root aqueous extract of Milicia excelsa displayed genistein-like effects and increased FSH and estradiol serum levels following both treatment periods (7 and 15 days). Estradiol serum concentration significantly increased following a 7-day treatment at the dose of 14mg/kg BW (p<0.001). This resulted in an increase in the uterine wet weight, uterine and vaginal epithelial heights (p<0.05). These results suggest that the root aqueous extract of Milicia excelsa reduced rats' sexual maturation from 90 to 52 days. Moreover, animals' body weight was not affected following treatment with Milicia excelsa.

CONCLUSION

The root aqueous extract of Milicia excelsa may solve the problem of amenorrhea by synchronizing the activity of the hypothalamic-pituitary axis to the ovarian production of estradiol and progesterone. The unaltered body weight following treatments justifies at least in part, the traditional use of Milicia excelsa for primary and secondary amenorrhea.

Pharmacological Management of Secreting Pituitary Tumors

Because pituitary adenomas can present in many ways, nurses need to be aware of the signs and symptoms of different hormone-secreting tumors and their related pharmacologic treatment. Although long-term medical management of secreting tumors and their hormonal complications is usually carried out on an outpatient basis, diagnosis often occurs during inpatient care. Consequently, nurses in both settings need to be knowledgeable about medications used, outcomes expected, and adverse effects experienced. Patient care should be centered around education and management of complications as patient compliance is increased with knowledge.

[Fractionated stereotactic-guided radiotherapy in the treatment of pituitary adenomas]

AIMS

To evaluate the survival rates, prognostic factors and adverse events in patients with pituitary adenomas following fractionated stereotactic-guided radiotherapy (FSRT).

MATERIAL AND METHODS

Fifty-six patients with pituitary adenomas were treated with FSRT; 23 patients (41.1%) had primary adenomas, 33 had recurrent disease; 24 (42.9%) with non-functional and 32 (57.1%) with functional adenomas. Using conventional fractionation, median total dose administered was 54 Gy (range: 24-56 Gy).

RESULTS

The median follow-up was 51 months (range: 9-102) and, at the time of analysis, 49 patients were alive and disease-free, 1 patient was alive with reduced visual acuity and biochemical indications of recurrence, 2 patients had died from the disease and 1 patient had died from unrelated causes. Overall survival was 94% (50/53) and overall local tumour control was 92% (49/53). Univariate analysis indicated hormonal secretion (ACTH) and previous radiotherapy as being statistically significant. Fourteen patients (25%) had minor side-effects during treatment and 3 patients (5.4%) had late-onset events; 2 with optical neuropathy (both patients had other relevant co-existing diseases) and 1 patient had brain necrosis (re-irradiation).

CONCLUSION

Fractionated stereotactic-guided radiotherapy is an effective modality for the treatment of pituitary adenomas. Care is required in patients with co-morbidities and/or previously-irradiated recurrent tumour so as to minimise late-onset secondary effects.

Reversal of hypogonadotropic hypogonadism with tamoxifen in a patient with hyperprolactinemia resistant to dopamine agonists

OBJECTIVE

To determine the response to tamoxifen in a woman with hypogonadotropic hypogonadism induced by hyperprolactinemia resistant to dopamine agonist drugs.

DESIGN

Case report.

SETTING

Academic fertility center.

PATIENT(S)

A young woman with persistent amenorrhea, symptomatic hypogonadotropic hypogonadism, and hyperprolactinemia.

INTERVENTION(S)

Tamoxifen was administered in addition to bromocriptine.

MAIN OUTCOME MEASURE(S)

Measurements of follicle-stimulating hormone, estradiol, prolactin, and progesterone.

RESULT(S)

Recovery of gonadal-hypothalamic-pituitary axis.

CONCLUSION(S)

Tamoxifen can revert the effects of chronic hypogonadotropic hypogonadism induced by hyperprolactinemia resistant to dopamine agonists.

Autoimmune hypophysitis

Autoimmune (lymphocytic) hypophysitis is a rare disease that should be considered in the differential diagnosis of any nonsecreting pituitary mass, especially when occurring during pregnancy or postpartum. We have analyzed 370 articles published from January 1962 to October 2004 and identified a total of 379 patients with primary lymphocytic hypophysitis. The present review synthesizes the clinical and research data reported in this body of scientific literature.