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Araki T, Sangtian J, Ruanpeng D, Tummala R, Clark B, Burmeister L, Peterson D, Venteicher AS, Kawakami Y. Acute elevation of interleukin 6 and matrix metalloproteinase 9 during the onset of pituitary apoplexy in Cushing's disease. Pituitary 2021; 24:859-866. [PMID: 34041660 PMCID: PMC8551006 DOI: 10.1007/s11102-021-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Pituitary apoplexy is a rare endocrine emergency. The purpose of this study is to characterize physiological changes involved in pituitary apoplexy, especially during the acute phase. METHODS A Cushing's disease patient experienced corticotroph releasing hormone (CRH)-induced pituitary apoplexy during inferior petrosal sinus sampling (IPSS). The IPSS blood samples from the Cushing's disease patient were retrospectively analyzed for cytokine markers. For comparison, we also analyzed cytokine markers in blood samples from two pituitary ACTH-secreting microadenoma patients and one patient with an ectopic ACTH-secreting tumor. RESULTS Acute elevation of interleukin 6 (IL-6) and matrix metalloproteinase 9 (MMP9) was observed in the IPSS blood sample on the apoplectic hemorrhagic site of the tumor. In contrast, such a change was not observed in the blood samples from the contralateral side of the apoplexy patient and in other IPSS samples from two non-apoplexy Cushing's disease patient and a patient with ectopic Cushing's syndrome. CONCLUSION IL-6 and MMP9 may be involved in the acute process of pituitary apoplexy in Cushing's disease.
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Affiliation(s)
- Takako Araki
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, 516 Delaware Street, SE, Minneapolis, MN, 55455, USA.
| | - Jutarat Sangtian
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, 516 Delaware Street, SE, Minneapolis, MN, 55455, USA
| | - Darin Ruanpeng
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, 516 Delaware Street, SE, Minneapolis, MN, 55455, USA
| | - Ramachandra Tummala
- Department of Neurosurgery, University of Minnesota, 500 SE Harvard St., Minneapolis, MN, 55455, USA
| | - Brent Clark
- Department of Laboratory Medicine and Pathology, University of Minnesota, 500 SE Harvard St., Minneapolis, MN, 55455, USA
| | - Lynn Burmeister
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, 516 Delaware Street, SE, Minneapolis, MN, 55455, USA
| | - Daniel Peterson
- Special Chemistry Laboratory, University of Minnesota Fairview Clinic, 500 SE Harvard St., Minneapolis, MN, 55455, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, 500 SE Harvard St., Minneapolis, MN, 55455, USA
| | - Yasuhiko Kawakami
- Department of Genetics, Cell Biology and Development, University of Minnesota, 321 Church St. SE., 6-160 Jackson Hall, Minneapolis, MN, 55455, USA
- Stem Cell Institute, University of Minnesota, 2001 6th Street SE, Minneapolis, MN, 55455, USA
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Marques P, Grossman AB, Korbonits M. The tumour microenvironment of pituitary neuroendocrine tumours. Front Neuroendocrinol 2020; 58:100852. [PMID: 32553750 DOI: 10.1016/j.yfrne.2020.100852] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
Abstract
The tumour microenvironment (TME) includes a variety of non-neoplastic cells and non-cellular elements such as cytokines, growth factors and enzymes surrounding tumour cells. The TME emerged as a key modulator of tumour initiation, progression and invasion, with extensive data available in many cancers, but little is known in pituitary tumours. However, the understanding of the TME of pituitary tumours has advanced thanks to active research in this field over the last decade. Different immune and stromal cell subpopulations, and several cytokines, growth factors and matrix remodelling enzymes, have been characterised in pituitary tumours. Studying the TME in pituitary tumours may lead to a better understanding of tumourigenic mechanisms, identification of biomarkers useful to predict aggressive disease, and development of novel therapies. This review summarises the current knowledge on the different TME cellular/non-cellular elements in pituitary tumours and provides an overview of their role in tumourigenesis, biological behaviour and clinical outcomes.
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Affiliation(s)
- Pedro Marques
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Ashley B Grossman
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Márta Korbonits
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Giraldi FP, Cavallo LM, Tortora F, Pivonello R, Colao A, Cappabianca P, Mantero F. The role of inferior petrosal sinus sampling in ACTH-dependent Cushing's syndrome: review and joint opinion statement by members of the Italian Society for Endocrinology, Italian Society for Neurosurgery, and Italian Society for Neuroradiology. Neurosurg Focus 2015; 38:E5. [DOI: 10.3171/2014.11.focus14766] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the management of adrenocorticotropic hormone (ACTH)–dependent Cushing's syndrome, inferior petrosal sinus sampling (IPSS) provides information for the endocrinologist, the neurosurgeon, and the neuroradiologist. To the endocrinologist who performs the etiological diagnosis, results of IPSS confirm or exclude the diagnosis of Cushing's disease with 80%–100% sensitivity and over 95% specificity. Baseline central-peripheral gradients have suboptimal accuracy, and stimulation with corticotropin-releasing hormone (CRH), possibly desmopressin, has to be performed. The rationale for the use of IPSS in this context depends on other diagnostic means, taking availability of CRH and reliability of dynamic testing and pituitary imaging into account. As regards the other specialists, the neuroradiologist may collate results of IPSS with findings at imaging, while IPSS may prove useful to the neurosurgeon to chart a surgical course. The present review illustrates the current standpoint of these 3 specialists on the role of IPSS.
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Affiliation(s)
- Francesca Pecori Giraldi
- 1Department of Clinical Sciences and Community Health, University of Milan
- 2Neuroendocrine Research Laboratory, Istituto Auxologico Italiano, Milan
| | - Luigi Maria Cavallo
- 3Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, and
| | - Fabio Tortora
- 4Department of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Naples; and
| | - Rosario Pivonello
- 6Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Annamaria Colao
- 6Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Paolo Cappabianca
- 3Division of Neurosurgery, Department of Neurosciences and Reproductive and Odontostomatological Sciences, and
| | - Franco Mantero
- 5Endocrinology Unit, Department of Medicine, University of Padua, Italy
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Homocysteine and alpha-1 antitrypsin concentration in patients with subclinical hypercortisolemia. Adv Med Sci 2012; 57:302-7. [PMID: 23154425 DOI: 10.2478/v10039-012-0032-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Glucocorticoids have particularly strong impact on the thromboembolic complications. A factor which increases the risk of thrombosis is hyperhomocysteinemia, observed in patients with hypercortisolemia. Proinflammatory factors also affect the haemostatic balance. There has been an extensive research which estimates hemostatic system in patients with Cushing's syndrome. Undoubtedly, much fewer publications are available on thromboembolic complications in patients with Subclinical Cushing's Syndrome (SCS). The purpose of this study was to estimate of homocysteine (HCY) and alpha-1 antitrypsin (α1ATp) concentrations in patients with SCS. MATERIALS AND METHODS We studied 35 patients (56.0 ± 15.0 years) with SCS and 33 healthy volunteers (53.3 ± 17.7 years). In all subjects the analysis of HCY and α1ATp concentration in serum was determined with an immunonephelometric method. P-values below 0.05 were considered statistically significant. RESULTS A comparison of HCY and α1ATp mean concentrations in patients with SCS and healthy representatives indicated statistically higher values of both analysed parameters in the sera of patients than in the healthy controls (p values were 0.018 and 0.008, respectively). In the patients with SCS a negative correlation between α1ATp and cortisol concentration in overnight dexamethasone test was found (p=0.017, R=-0.40). We did not reveal any statistically significant correlation between the concentrations of HCY and α1ATp, and coagulation parameters such as INR, APTT, fibrinogen concentration in patients with SCS. CONCLUSIONS On the basis of the obtained results, a slight increase in the concentration of homocysteine and α1ATp is observed in patients with SCS, which may influence vascular complications.
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Paoletta A, Arnaldi G, Papa R, Boscaro M, Tirabassi G. Intrapituitary cytokines in Cushing's disease: do they play a role? Pituitary 2011; 14:236-41. [PMID: 21181277 DOI: 10.1007/s11102-010-0285-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A large body of in vitro evidence shows that cytokines influence the hypothalamic-pituitary-adrenal axis both in physiological conditions and in Cushing's disease (CD). In order to study in vivo the role of intrapituitary cytokines in CD, we assayed two cytokines known for their action on the pituitary, i.e. interleukin-1 beta (IL-1β) and interleukin-6 (IL-6), and also soluble interleukin-6 receptor (sIL-6R), important for the neural activities of IL-6, in a carefully selected sample of subjects affected by CD undergoing bilateral inferior petrosal sinus sampling. Similarly to ACTH, all cytokines basally showed a higher concentration in the ipsilateral sinus compared to the controlateral one and to that of peripheral blood; after CRH infusion, both ipsilaterally and controlaterally, IL-6 and sIL-6R values increased compared to basal ones, while IL-1β increased significantly up to 5 min after CRH and then decreased significantly compared to basal values in subsequent measurements; peripherically no significant variations in the cytokines were observed after CRH. Again similarly to ACTH, the three cytokines presented a higher increase ipsilaterally than controlaterally; moreover all three interleukins in the ipsilateral sinuses showed positive and significant correlations between their basal value and that of basal ACTH. These findings allow us to hypothesize that the central production of IL-1β and IL-6 could be involved in ACTH hypersecretion which occurs in CD: more specifically, we hypothesize that these cytokines are produced directly by the corticotroph adenoma and have the task of enhancing tumoral secretion of ACTH with an autocrine-paracrine mechanism.
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