Adenoma hipofisário (prolactinoma) proveniente da disfunção hormonal da prolactina: revisão de literatura / Pituitary adenoma (prolactinoma) from prolactin hormonal dysfunction: literature review

Os adenomas hipofisários são, geralmente, tumores benignos com características de hipersecreção ou hipersecreção hormonal, diagnosticados conforme o crescimento tumoral, síndromes de hiperprodução, deficiência da secreção dos hormônios, alterações visuais e cefaleias. A hiperprolactinemia é a produção excessiva de prolactina (PRL), apresentando níveis elevados de prolactina sérica, o que resulta no aparecimento de adenomas lactotróficos (prolactinomas), predominante em mulheres com idade fértil. O prolactinoma é um adenoma hipofisário secretor de prolactina, classificado como adenoma hipofisário microadenoma, em mulheres, e macroadenoma, em homens. Nas mulheres, o prolactinoma apresenta indícios como galactorreia, amenorreia, disfunção sexual e infertilidade. Em homens, a sintomatologia pauta-se em ganho de peso, disfunção erétil e infertilidade. Os exames laboratoriais, como dosagem de prolactina sérica, e os exames de imagem, principalmente a ressonância magnética (RM), são importantes para confirmar o diagnóstico e a escolha da terapêutica ideal. O tratamento medicamentoso inicial dá-se por drogas agonistas dopaminérgicos (AD), sendo padrão-ouro a cabergolina (CAB), em razão da eficácia e dos efeitos colaterais reduzidos. Quando agonistas dopaminérgicos não surtem efeitos, indica-se submissão a tratamento cirúrgico. Em casos de tumores agressivos ou prolactinomas malignos, indica-se radioterapia. Sendo assim, este artigo corresponde a uma revisão bibliográfica que visa relacionar o adenoma hipofisário (prolactinoma) com a produção excessiva de prolactina (PRL).

Pituitary adenomas are generally benign tumors with characteristics of hypersecretion or hormonal hypersecretion, diagnosed according to tumor growth, hyperproduction syndromes, deficiency in hormone secretion, visual changes and headaches. Hyperprolactinemia is the excessive production of prolactin (PRL), with high levels of serum prolactin, resulting in the appearance of lactotrophic adenomas (prolactinomas), predominant in women of childbearing age. Prolactinoma is a prolactin-secreting pituitary adenoma, classified as pituitary adenoma microadenoma in women and macroadenoma in men. In women, prolactinoma shows signs such as galactorrhea, amenorrhea, sexual dysfunction and infertility. In men, the symptoms are based on weight gain, erectile dysfunction and infertility. Laboratory tests, such as serum prolactin levels, and imaging tests, especially magnetic resonance imaging (MRI), are important to confirm the diagnosis and choose the ideal therapy. The initial drug treatment is done by dopaminergic agonist drugs (AD), with cabergoline (CAB) being the gold standard, due to the reduced efficacy and side effects. When dopaminergic agonists have no effect, submission to surgical treatment is indicated. In cases of aggressive tumors or malignant prolactinomas, radiotherapy is indicated. Thus, this article corresponds to a bibliographic review that aims to relate pituitary adenoma (prolactinoma) with excessive prolactin production (PRL).

Panhipopituitarismo secundario a hemorragia obstétrica profusa / Panhypopituitarism secondary to profuse obstetric haemorrhage

El síndrome de Sheehan o necrosis hipofisaria posparto, constituye la causa más importante de panhipopituitarismo, que de forma ocasional se asocia a hemorragia obstétrica profusa asociada a choque hipovolémico hemorrágico, ocasionando un colapso circulatorio intenso debido a isquemia de la adenohipófisis durante el parto o después del mismo, debido a que esta glándula endócrina sufre importantes cambios anatómicos e histológicos durante el embarazo, los cuales incrementan su volumen hasta en 40%. De esta forma, se produce una secreción reducida de las hormonas que ayudan a regular el crecimiento, la reproducción y el metabolismo, evidenciando en el examen hormonal detallado insuficiencia específicamente de la hormona de crecimiento, foliculoestimulante, luteinizante, estimulante de tiroides, adrenocorticotropica y prolactina predisponiendo a la paciente a inestabilidad hemodinámica a corto plazo así como desequilibrio hormonal permanente. Por esta importancia, es que se presenta el caso de una paciente que ingresó a la Unidad de Terapia Intensiva tras cesárea iterativa debido a acretismo placentario llegando a la histerectomía total intercurriendo con choque hemorrágico, quien cursó durante su estancia en la Unidad con ausencia de recuperación neurológica total y características propias de síndrome de Sheehan, confirmándose el mismo por los niveles hormonales bajos y la ausencia de imagen en la silla turca correspondiente a la necrosis hipofisaria evidenciado por resonancia magnética, realizándose además una sucinta revisión acerca de la literatura relacionada actual.

ABSTRACT Sheehan syndrome or postpartum pituitary necrosis is the most common cause of hypopituitarism and occurs secondary to profuse obstetric haemorrhage with subsequent hypovolemic hemorrhagic shock, with intense circulatory collapse, predisposing to pituitary ischemia during delivery or after the same, due to the hypertrophic changes that occur in this gland during pregnancy. In this syndrome exists a reduced secretion of the hormones that regulate growth, reproduction and metabolism. We present the case of a female patient admitted to the Critical Care Unit after iterative cesarean due to placenta accreta and total hysterectomy, in hypovolemic shock secondary to severe hemorrhage, being suspicious of Sheehan´s syndrome, with characteristic clinical features, low hormone levels and the absence of image in the Turkish chair corresponding to the pituitary necrosis.

Tumores hipofisarios, casuística de Anatomía Patológica / Pituitary tumors: anatomopathological reports

This study examines a description of pituitary tumors considering an anatomopathological casuistic. The study of the tumors of the Central Nervous System (CNS) include the pituitary gland, located in the sella turcica. The pathology of the sellar region is represented by the adenomas, tumors of slow development with or without endocrine secretion, that usually involve the population of young adults. The aim of this report, was to describe the casuistic of the " J. Fernandez Hospital" between the years 2000 through 2017. A retrospective review was performed and 234 samples of the sellar region were processed. Mean age was 42 years with a range of 17 to 77 years. Sex distribution was 57% women and 43 % men. Of these, 77% of the cases resulted adenomas. The conclusions obtained in the study are detailed.

Caracterización de familia hondureña afectada por neoplasia endócrina múltiple (NEM-2A), Instituto Nacional Cardiopulmonar, Tegucigalpa, Honduras / Characterization of Honduran family affected by Multiple Endocrine Neoplasia (MEN-2A), Instituto Nacional Cardio-Pulmonar, Tegucigalpa, Honduras

RESUMEN. Introducción . Las Neoplasias Endocrinas Múltiples (NEM) son síndromes clínicos autosómico-dominantes. Se maniies - tan por tumores benignos y malignos que involucran órganos endócrinos y no endócrinos. Incidencia de 1/30,000 personas. Objetivo : Caracterizar una familia hondureña cuyos miembros presentan tumores endócrinos, Instituto Nacional Cardio-Pulmonar (INCP), Tegu - cigalpa, 2017. Métodos . Estudio descriptivo longitudinal. Análisis de información clínica, epidemiológica y de laboratorio, consignada en expedientes clínicos (INCP) y brindada por pacientes, previo consentimiento informado. Conirmación de dos casos mediante estudios genéticos. Resultados . Familia de 9 hijos, procedente de Olancho. Madre falleció por Adenocarcinoma Pancreático; padre sin información. Hija3, caso índice, se le realizó Tiroidectomía Total por Cáncer Medular de Tiroides (CMT). Hijo2 no evaluado. Hija4 portadora asintomática de la mutación del proto-oncogén RET. Hija1 se realizó Tiroidectomía Proiláctica por Hiperplasia Folicular de Tiroides e Hiperplasia Linfática Benigna en nódulo post-auricular derecho. Hija7 se practicó Parotidectomía izquierda por Adenoma Pleomórico Benigno. Hijo5 fue diagnosticado con CMT multifocal. Hija9 se le hizo Tiroidectomía Total con linfadenectomía por CMT multifocal. Hijos 6 y 8, residentes en Estados Unidos de América, se les realizó Adrenalectomía por Feocromocitoma y Tiroidectomía Total por CMT multifocal, respectivamente. Además, se les realizaron pruebas genéticas y moleculares, cuyos resultados conirmaron la mutación en los exones 10, 11, 13, 14, 15 y 16 del proto-oncogén RET, del codón 634 con la sustitución del amino ácido cisteína por triptófano (Cys634Trp), conirmatorio de NEM-2A. Discusión . Constituye el primer trabajo publicado de esta patología en Honduras. Sugerimos la búsqueda epidemiológica de NEM en todo paciente diagnosticado con CMT.

Two novel heterozygous missense variations within the GLI2 gene in two unrelated argentine patients / Two novel heterozygous missense variations within the GLI2 gene in two unrelated Argentine patients

Several heterozygous GLI2 gene mutations have been reported in patients with isolated GH deficiency (IGHD) or multiple pituitary hormone deficiency (MPHD) with or without other malformations. The primary aim of this study was to analyze the presence of GLI2 gene alterations in a cohort of patients with IGHD or MPHD and ectopic/absent posterior pituitary. The coding sequence and flanking intronic regions of GLI2 gene were amplified and directly sequenced from gDNA of 18 affected subjects and relatives. In silico tools were applied to identify the functional impact of newly found variants (Polyphen2, SIFT, Mutation Taster). We identified two novel heterozygous missense variations in two unrelated patients, p.Arg231Gln and p.Arg226Leu, located in the repressor domain of the protein. Both variations affect highly conserved amino acids of the Gli2 protein and were not found in the available databases. In silico tools suggest that these variations might be disease causing. Our study suggests that the GLI2 gene may be one of the candidate genes to analyze when an association of pituitary hormone deficiency and developmental defects in posterior pituitary gland. The highly variable phenotype found suggests the presence of additional unknown factors that could contribute to the phenotype observed in these patients.

Mutaciones heterocigotas en el gen GLI2 fueron previamente comunicadas como causa de déficit aislado de hormona de crecimiento (IGHD) o déficit múltiple de hormonas hipofisarias (MPHD), con o sin otras malformaciones. El objetivo del estudio fue analizar la presencia de alteraciones en el gen GLI2 en un grupo de pacientes con IGHD o MPHD acompañado de neurohipófisis ectópica o ausente. La secuencia codificante y las regiones intrónicas flanqueantes del gen GLI2 fueron amplificadas y secuenciadas de manera directa a partir de ADN genómico extraído de sangre periférica proveniente de 18 sujetos afectados y sus familiares. Se utilizaron herramientas informáticas para predecir el impacto funcional de las nuevas variantes encontradas (Polyphen2, SIFT, Mutation Taster). Identificamos dos nuevas variantes heterocigotas con pérdida de sentido en dos pacientes no relacionados, p.Arg231Gln y p.Arg226Leu, localizadas en el dominio represor de la proteína. Estas variantes afectan aminoácidos altamente conservados en la secuencia proteica de GLI2 y no se encuentran informadas en las bases de datos disponibles. Las herramientas informáticas utilizadas sugieren que estas variantes pueden ser la causa del desarrollo de la enfermedad. Nuestro resultados indican que el gen GLI2 es uno de los genes candidatos a estudiar cuando existe una asociación entre déficit de hormonas hipofisarias y alteraciones en el desarrollo de la neurohipófisis. Se sugiere la existencia de otros factores adicionales que podrían contribuir a la variabilidad del fenotipo observado.

Clinical, hormonal and radiological features of partial Sheehan's syndrome: an Indian experience

ABSTRACT Objective The objective of this study was to describe clinical presentation, hormonal profile and imaging characteristics of 21 patients with partial Sheehan’s syndrome. Subjects and methods This prospective study was carried out over a period of six years (2008-2013). The evaluation of patients included clinical assessment, hormone estimations and contrast enhanced magnetic resonance imaging of pituitary. Results We documented preservation of gonadotroph, corticotroph and lactotroph function in 71.4, 61.9, and 9.5% of patients respectively. Conclusion To conclude some of the pituitary functions can be preserved in Sheehan’s syndrome and this has important implications from the treatment and long term morbidity point of view.

Incidencia de adenomas hipofisiarios en pacientes ingresados al servicio de neurocirugía del Hospital Roosevelt. Guatemala, enero 2010 a diciembre 2011 / Incidence of pituitary adenomas in patients admitted to the neurosurgery department of Roosevelt Hospital. Guatemala, January 2010 to December 2011

Introducción: Los adenomas de hipófisis sonneoplasias benignas que afectan más a adultosde sexo femenino. No se cuenta con tasa deincidencia anual de adenomas hipofisarios anivel nacional. Se realizó un estudio descriptivocon el fin de determinar la incidencia local deadenomas hipofisarios. Metodología: Se realizóun estudio descriptivo transversal en pacientesque ingresaron al Departamento de Neurocirugíadel Hospital Roosevelt para intervención quirúrgicadurante enero 2010 a diciembre 2011. Lasvariables estudiadas fueron edad, sexo, tipo deadenoma hipofisario, síntomas y signos clínicos,complicaciones postoperatorias tempranas,estancia en cuidados críticos y mortalidad. El plande análisis estadístico incluyó la recolección de lainformación, el ordenamiento de datos y uso delprograma Epi Info 3.5.6 para el análisis estadísticode medidas de frecuencia y proporciones. Se utilizóMicrosoft Excell para la elaboración de tablas ygráficas. Resultados: La tasa de incidencia deadenomas hipofisarios fue de 15 casos por cada 100tumores. El predominio del tumor fue en pacientesfemeninas y en edades comprendidas entre los 31-65 años. La disminución de la agudeza visual y lacefalea fueron los signos y síntomas más frecuentes(81% y 77% respectivamente). La complicaciónpostoperatoria inmediata más frecuente fue ladiabetes insípida (4/10 casos). El 54% de los casospermaneció en cuidados intensivos por un periodoentre uno y tres días. Para este estudio la tasa demortalidad fue cero...

Introduction: Pituitary adenomas are benignneoplasms affecting more female adults. Thereis no annual incidence of pituitary adenomasnationwide. A descriptive study was conducted todetermine the local incidence of pituitary adenomas.Methodology: A descriptive cross-sectional studyin patients admitted to the Department of Neurosurgeryat Roosevelt Hospital for surgery injanuary 2010 to december 2011. The variablesstudied were age, sex, type of pituitary adenoma,clinical signs and symptoms, early postoperativecomplications, hospital stay and mortality in criticalcare. The statistical analysis plan included collectinginformation , the ordering of data and use of Epi Info3.5.6 program for statistical analysis of frequencymeasurements and proportions. Microsoft Excelwas used to produce tables and graphs. Results:The incidence of pituitary adenomas was 15 casesper 100 tumors. The prevalence of the tumor was infemale patients and aged 31-65 years. Decreasedvisual acuity and headache were the most commonsigns and symptoms (81% and 77% respectively).The most common immediate postoperative complicationwas diabetes insipidus (4 /10 cases) 54%of the cases remained in intensive care for a periodof one to three days. For this study, the mortality ratewas zero...

Deficiencia de hormona del crecimiento en el adulto / Growth hormone deficiency in adults

La hormona del crecimiento tiene funciones más allá de la que su nombre implica. En el adultoes una hormona importante en el metabolismo de lípidos y carbohidratos, cumple funciones vitales en estados de ayuno y juega un papel preponderante en el equilibrio energético del organismo. La deficiencia de hormona del crecimiento es una entidad bien reconocida en la edad pediátrica, con consecuencias bien establecidas y fácilmente identificables; en contraste, su deficiencia en la edad adulta es más difícil de establecer y puede obedecer a causas congénitas o adquiridas durante la infancia o a causas adquiridas en la edad adulta. En años recientes, se aisló y sintetizó una forma recombinantede la hormona del crecimiento humana, lo cual abrió la posibilidad de tratamiento para aquellas personas con deficiencia de dicha hormona. Sin embargo, hay muchos interrogantes con respecto a la deficiencia de hormona del crecimiento en el adulto, entre ellos, el diagnóstico adecuado y los verdaderosbeneficios y la seguridad del tratamiento con hormona del crecimiento humana recombinante. En este módulo se realiza un estado del arte acerca de la deficiencia de hormona del crecimiento en los adultos.

Growth hormone has other functions besides those that are implied by its name. During adulthood, it is for lipid and carbohydrate metabolism, it has vital function in non-fasting states and it has a pivotal role in maintaining the energy balance of the body. Growth hormone deficiency is a well-known disease in childhood, with established and easily recognizable manifestations. In contrast, adult growth hormone deficiency is more difficult to establish and it can result from either genetic or acquired causes during childhood, or acquired causes during adulthood. In recent years, the isolation and synthesis of recombinant human growth hormone was achieved, and this made it possible to treat affected patients. However, many questions remain regarding adult growth hormone deficiency, including questions about the criteria for an adequate diagnosis, and questions with regards to the real benefits and safety of treatment with human growth hormone. This article reviews the current state of the art regarding practices for the diagnosis and management of adult growth hormone deficiency.

Hormonal and Histomorphologic Effects of Azadirachta indica leaf Extract on the Pars Anterior of Wistar Rats / Efectos Hormonales e Histomorfológicosdel Extracto de la Hoja de Azadirachta indica en la Pars Anterior de Ratas Wistar

Azadirachta indica is a tree whose medicinal value is unquantifiable. Any part of the tree can be used in the treatment of malarial infection. Reports have indicated its antifertility effects, and this necessitated this study on the effects of the methanol leaf extract on serum luteinizing (LH) and follicle stimulating hormones (FSH) levels and the histomorphology of the pars anterior of Wistar rats. Thirty adult male Wistar rats were equally divided into 3 groups of A, B and C. Group A was the control and the animals received distilled water orally, while groups B and C were treated with 200mg/kg and 400mg/kg respectively of the leaf extract by oral gavage for fourteen days. On day fifteen, the animals were sacrificed by chloroform anaesthesia. Blood was obtained from their hearts, while the skull was opened to assess the hypophysis. Hormonal assay showed that luteinizing (LH) and follicle stimulating (FSH) hormone levels in the serum were lower in groups B and C treated with 200mg/kg and 400mg/kg respectively of the leaf extract, while that of LH were significant (P<0.001). Histomorphologic sections of the pars anterior revealed reduced acidophil and basophil populations, with prominent degranulated chromophobes which were larger in the group treated with 400mg/kg of A. indica leaf extract. This group also presented hypertrophy of the basophils compared to the control. In conclusion, methanol leaf extract of A. indica decreases serum LH and FSH and caused histomorphologic changes in the pars anterior of adult male Wistar rats.

Azadirachta indica es un árbol cuyo valor medicinal es invaluable. Cualquier parte del árbol se puede utilizar en el tratamiento de la infección por malaria. Reportes han indicado su efecto antifertilidad, lo que requirió estudiar los efectos del extracto metanólico de la hoja sobre los niveles séricos de las hormonas luteinizante (LH) y folículo estimulante (FSH) y la histomorfología de la pars anterior de ratas Wistar. Treinta ratas Wistar adultas fueron divididas en tres grupos. El grupo A fue utilizado como control y los animales recibieron agua destilada por vía oral, mientras que los grupos B y C fueron tratados con 200 mg/kg y 400 mg/kg respectivamente, con extracto de hoja mediante una sonda nasogástrica durante catorce días. A los quince días, los animales fueron sacrificados por anestesia con cloroformo. Se obtuvo sangre desde sus corazones, mientras que el cráneo fue abierto para evaluar la hipófisis. Los ensayos hormonales mostraron que los niveles en suero de la LH y FSH se redujeron en los grupos B y C, tratados con 200 mg/kg y 400 mg/kg respectivamente, siendo la reducción de LH significativa (p<0,001). Secciones histomorfológicos de la pars anterior revelaron una reducción de las poblaciones acidófilas y basófilas, con prominentes cromófobos degranulados que fueron mayores en el grupo tratado con 400 mg/kg del extracto de A. indica. Este grupo también presentó hipertrofia de los basófilos en comparación con el control. En conclusión, el extracto alcohólico de la hoja de de A. indica disminuye el nivel sérico de LH y FSH y provoca cambios histomorfológicos en la pars anterior de ratas Wistar adultas.

Ultrastructural characterization of the pars distalis of the Indian female Sheath-tailed bat, Taphozous longimanus (Hardwicke) / Caracterización ultraestructural de la pars distalis del murciélago cola de vaina hembra indio, Taphozous longimanus (Hardwicke)

The present ultrastructural observations demonstrate the presence of six cell types in the pars distalis of non-pregnant and pregnant bats of Taphozous longimanus. In the pars distalis of T. longimanus, STH cells are round to oval with eccentrically placed nucleus, numerous secretory granules and well developed Golgi indicate a cell under vigorous synthetic activity while those filled with secretory granules with reduced Golgi complex suggest reserve or storage state of cells. LTH cell is characterized by the large secretory granules, dilated endoplasmic reticulum and numerous mitochondria in the cytoplasm which indicate that these cells are hypertrophied and synthetically very active during pregnancy. ACTH cells are found either singly or in groups and are elongated or angular with long cytoplasmic processes. The size and peripheral arrangement of secretory granules are characteristic of ACTH cell. TSH cells are distributed mostly towards the periphery of the pars distalis of T. longimanus. They are elongated, polygonal or triangular in shape. The secretory granules are small, electron dense, 150-200 nm in diameter. The rough endoplasmic reticulum is very well developed. In FSH, the secretory granules are small (200 to 400 nm) and less in number and are distributed towards the periphery of the cell. FSH cells show well developed mitochondria, Golgi and rough endoplasmic reticulum indicating active state of FSH during estrus and pregnancy. The hypertrophy of FSH and LH cells during pregnancy is associated with filigreed cytoplasmic pattern giving a bizarre appearance. At late pregnancy, FSH and LH cells are highly active and synthesize large quantities of hormone as indicated by the development of cell organelles.

Las observaciones ultraestructurales actuales demuestran la presencia de seis tipos de células en la pars distalis de murciélagos Taphozous longimanus preñadas y no preñadas. En la pars distalis del T. longimanus, las células STH son redondas u ovaladas con un núcleo excéntrico, numerosos gránulos de secreción y un Golgi bien desarrollado que indican una célula en actividad de síntesis vigorosa, mientras que las llenas de gránulos de secreción con un complejo de Golgi reducido sugieren un estado celular de reserva o almacenamiento. Las células LTH se caracterizan por grandes gránulos de secreción, el retículo endoplásmico dilatado y numerosas mitocondrias en el citoplasma, indicando que estas células están hipertrofiadas y con una actividad sintética muy activa durante el embarazo. Células de ACTH se encuentran de forma individual o en grupos, son alargadas o angulares, con largos procesos citoplásmicos. El tamaño y la disposición periférica de los gránulos de secreción de ACTH son característicos de la célula. Células de TSH se distribuyen principalmente hacia la periferia de la pars distalis del T. longimanus. Ellos son alargadas, poligonales o de forma triangular. Los gránulos de secreción son pequeños, electrodensos, de 150-200 nm de diámetro. El retículo endoplasmático rugoso está muy bien desarrollado. En células FSH, los gránulos de secreción son pequeños (200 a 400 nm), menores en número y se distribuyen hacia la periferia de la célula. Células FSH muestran mitocondrias bien desarrolladas, Golgi y retículo endoplasmático rugoso que indica el estado activo de la FSH durante el estro y la preñez. La hipertrofia de las células de FSH y LH durante la preñez se asocia con un patrón citoplasmático filigrana dando una extraña apariencia. Al final de la preñez, las células de FSH y LH son muy activas y sintetizan grandes cantidades de hormonas, como producto del desarrollo de las organelos celulares.

Genistein affects the morphology of pituitary ACTH cells and decreases circulating levels of ACTH and corticosterone in middle-aged male rats

The soybean phytoestrogen, genistein, is increasingly consumed as an alternative therapeutic for age-related diseases, namely cardiovascular conditions, cancer and osteoporosis. However, despite the beneficial effects on health, concern has been raised that this isoflavone also acts as an endocrine-disrupting chemical. The aim of this study was to examine the effects of genistein on immunohistomorphometric features of pituitary adrenocorticotropic cells (ACTH) and blood concentrations of ACTH and corticosterone in orchidectomized middle-aged male rats. Sixteen-month-old Wistar rats were divided into sham-operated (SO), orchidectomized (Orx) and genistein-treated orchidectomized (Orx+G) groups. Genistein (30mg/kg/day) was administered subcutaneously for three weeks, while the control groups received the vehicle alone. ACTH cells were identified by the peroxidase-antiperoxidase (PAP) immunohistochemical procedure. Circulating concentrations of ACTH and corticosterone were measured by immunoassay. Orchidectomy reduced (p<0.05) the cell volume and the relative volume of ACTH cells in comparison to SO rats. Genistein treatment further decreased (p<0.05) these morphometric parameters and reduced (p<0.05) circulating ACTH and corticosterone concentrations by more than 20 percent in comparison to both Orx and SO rats. In conclusión, genistein modulated the immunohistomorphometric features of ACTH cells and decreased blood ACTH and corticosterone levels, which supports evidence that this isoflavone affects the hypothalamic-pituitary-adrenal axis and suppresses glucocorticoid hormone secretion.

Panhipopituitarismo: presentación de un caso clínico / Panhypopituitarism: clinical case

El Panhipopituitarismo es el déficit de las hormonas producidas en la adenohipofisis, clínicamente evidente cuando se ha destruido el 70 a 75 de la glándula. Las manifestaciones dependen del tipo de hormona afectada, edad, causa y rapidez de inicio. El déficit hormonal es progresivo: comienza con disminución de la GH, luego de la FSH /LH, TSH y finalmente la ACTH. Una mujer de 63 años de edad ingresa a UCI del hospital Abel Gilbert, con cuadro clínico de estupor, sudoración profusa, despigmentación de la piel, pérdida del vello axilar y pubiano. Antecedentes obstétricos: histerectomía por sangrado profuso y sepsis posparto. Por los datos clínicos y de laboratorio concluimos que se trataba de un Síndrome de Sheehan.

The panhypopituitarism is a deficit of the hormones produced by the adenohypophysis this is clinically evident when the 75 to 70 of the gland is destroyed. The symptoms depend on the type of hormone affected, age, cause and onset. The hormonal deficiency is progressive: it starts with a decrease of GH then of FSH/LH, TSH and finally ACTH. We have a clinical case of 63 year old woman admitted to ICU of Able Gilbert Hospital with a clinical case of stupor, hyperhidrosis, depigmentation of the skin, loss of pubic and axillary hair. Has an obstetric history of hysterectomy post-operative hemorrhaging and sepsis. Due the symptoms and lab findings we conclude that the diagnosis is Sheehan Syndrome.

Adenosine A1 receptor-mediated inhibition of in vitro prolactin secretion from the rat anterior pituitary

In previous studies, we demonstrated biphasic purinergic effects on prolactin (PRL) secretion stimulated by an adenosine A2 agonist. In the present study, we investigated the role of the activation of adenosine A1 receptors by (R)-N6-(2-phenylisopropyl)adenosine (R-PIA) at the pituitary level in in vitro PRL secretion. Hemipituitaries (one per cuvette in five replicates) from adult male rats were incubated. Administration of R-PIA (0.001, 0.01, 0.1, 1, and 10 æM) induced a reduction of PRL secretion into the medium in a U-shaped dose-response curve. The maximal reduction was obtained with 0.1 æM R-PIA (mean ± SEM, 36.01 ± 5.53 ng/mg tissue weight (t.w.)) treatment compared to control (264.56 ± 15.46 ng/mg t.w.). R-PIA inhibition (0.01 æM = 141.97 ± 15.79 vs control = 244.77 ± 13.79 ng/mg t.w.) of PRL release was blocked by 1 æM cyclopentyltheophylline, a specific A1 receptor antagonist (1 æM = 212.360 ± 26.560 ng/mg t.w.), whereas cyclopentyltheophylline alone (0.01, 0.1, 1 æM) had no effect. R-PIA (0.001, 0.01, 0.1, 1 æM) produced inhibition of PRL secretion stimulated by both phospholipase C (0.5 IU/mL; 977.44 ± 76.17 ng/mg t.w.) and dibutyryl cAMP (1 mM; 415.93 ± 37.66 ng/mg t.w.) with nadir established at the dose of 0.1 æM (225.55 ± 71.42 and 201.9 ± 19.08 ng/mg t.w., respectively). Similarly, R-PIA (0.01 æM) decreased (242.00 ± 24.00 ng/mg t.w.) the PRL secretion stimulated by cholera toxin (0.5 mg/mL; 1050.00 ± 70.00 ng/mg t.w.). In contrast, R-PIA had no effect (468.00 ± 34.00 ng/mg t.w.) on PRL secretion stimulation by pertussis toxin (0.5 mg/mL; 430.00 ± 26.00 ng/mg t.w.). These results suggest that inhibition of PRL secretion after A1 receptor activation by R-PIA is mediated by a Gi protein-dependent mechanism.

La prolactina en el sistema inmunológico: aspectos de síntesis y efectos biológicos / Prolactin in the immune system: synthesis and biological effects

Prolactin (PRL) Is a 23 κDa protein hormone that is produced and secreted by the pituitary lactotrophs. Although PRL was initially regarded as an exclusive pituitary hormone, many nonpituitary tissues were later found to contain and produce this hormone. The most established extrapituitary sites that produce PRL are the decidua, the immune system, brain and endometrium. In the immune system, PRL acts as a cytokine where it plays an important role in human immune responses, including in autoimmune diseases. Here, we will discuss the regulation of PRL gene expression in human lymphocytes and review the functions of PRL made by the immune cells, including its involvement in autoimmunity.

La prolactina es una hormona que fue considerada durante mucho tiempo de origen exclusivamente hipofisario, y cuya función más importante era la promoción de la lactancia. Sin embargo, la prolactina no sólo se sintetiza en diversos sitios del organismo, sino que también participa en una amplia variedad de procesos biológicos. Dentro de los sitios de síntesis extrahipofisarios de esta hormona se encuentran diversas células del sistema inmunológico. A este nivel, la prolactina actúa afectando desde la proliferación celular hasta el estado inmune del individuo. En esta revisión presentamos algunos aspectos relativos a la prolactina de origen linfocitario tales como su síntesis, su participación en el sistema inmunológico y su relación con estados de autoinmunidad.

Proliferación y regresión de células lactotropas en cultivo interacción de factores reguladores / Proliferation and regressions of celulas lactotropas in culture interation of regulating factors

Los mecanismos que regulan la actividad mitótica de las lactotropas son comlejos. Los efectos directos de factores inhibitorios y estimulatorios hipotalámicos sobre las células, son modificadors por hormonas periféricas que en la hipófisis. Por otra parte, también son reguladas por factores intrapituitarios, donde la comunicación intercelular juega un papel clave en el crecimiento. En el presente trabajo de tesis se evaluaron los efectos de 17 B estradiol, insulina e IGF-I y sus interacciones sobre la proliferación de las lactotropas. Cultivos primarios adenohipofisarios de ratas Wistar hembras y machos en medios con o sin suero, fueron tratados con los distintos factores por 48 y 72h. la proliferación celular fue determinada por doble inmunomarcación para BrdU y PRL. Distintas dosis 17 B estradiol (1,10 ó 100nM) en medio sin suero, no estimularon la proliferación celular en los tiempos estudiados. Sin embargo, en medio con suero, la actividad mitogénica de las lactotropas se incrementó significativamente, indicando que algunos de los factores del suero son necesarios para que el estradiol ejerza este efecto. En los modelos con tamoxifeno, un antiestrógeno no esteroideo, se inhibio la proliferación celular inducida por 17 B estradiol en un 40-60

Deficiência progressiva dos hormônios adeno-hipofisários após radioterapia em adultos / Progressive pituitary hormone deficiency following radiation therapy in adults

A radioterapia é um dos fatores desencadeantes do hipopituitarismo, mesmo quando não direcionada diretamente para o eixo hipotálamo-hipofisário, podendo resultar em redução de hormônios adeno-hipofisários, principalmente por lesão hipotalâmica. A perda da função da hipófise anterior é progressiva e geralmente na seguinte ordem: hormônio do crescimento, gonadotrofinas, adrenocorticotrofina e o hormônio estimulante da tireóide. Vários testes estão disponíveis para a confirmação das deficiências, sendo discutidos, neste artigo, os melhores testes para pacientes submetidos à irradiação. Enfatizamos que o desenvolvimento do hipopituitarismo após a radioterapia é dose e tempo dependente de irradiação, com algumas diferenças entre os eixos hipofisários. Portanto, a conscientização da necessidade de terapia em conjunto de endocrinologistas e oncologistas otimizará o tratamento e a qualidade de vida do paciente.

Anatomia microcirúrgica do seio cavernoso: contribuição ao estudo da parede medial do seio cavernoso / Microsurgical anatomy of the cavernous sinus: contribution to the study of the medial wall of the cavernous sinus

Este estudo foi realizado para detalhar a anatomia microcirúrgica do seio cavernoso e esclarecer os limites, relações e componentes da parede medial do seio cavernoso. Métodos: Setenta e quatro seios cavernosos foram dissecados, sendo quarenta e quatro para estudar e identificar a parede medial do seio cavernoso e trinta para estudar a anatomia microcirúrgica do seio cavernoso. Exemplos cirúrgicos foram mostrados para ilustrar os diferentes tipos de acessos cirúrgicos à região do seio cavernoso. Utilizou-se aumento de 4 a 24 vezes, mediante uso de microscópio cirúrgico, para realizações das dissecções. / This study was conducted to detail microsurgical anatomy of the cavernous sinus and clarify the boundaries, relationships and components of the medial wall of the cavernous sinus (CS). Methods: Seventy four CS were dissected. Forty four CS were dissected to identify and clarify the medial wall of the CS and thirty CS were dissected to describe microsurgical anatomy of the CS. Illustrative clinical cases were exposed to show different accesses to the CS region. Dissections were performed under surgical microscope and 4X to 24X of magnification were used...

Stimulatory effects of adenosine on prolactin secretion in the pituitary gland of the rat

We investigated the effects of adenosine on prolactin (PRL) secretion from rat anterior pituitaries incubated in vitro. The administration of 5-N-methylcarboxamidoadenosine (MECA), an analog agonist that preferentially activates A2 receptors, induced a dose-dependent (1 nM to 1 æM) increase in the levels of PRL released, an effect abolished by 1,3-dipropyl-7-methylxanthine, an antagonist of A2 adenosine receptors. In addition, the basal levels of PRL secretion were decreased by the blockade of cyclooxygenase or lipoxygenase pathways, with indomethacin and nordihydroguaiaretic acid (NDGA), respectively. The stimulatory effects of MECA on PRL secretion persisted even after the addition of indomethacin, but not of NDGA, to the medium. MECA was unable to stimulate PRL secretion in the presence of dopamine, the strongest inhibitor of PRL release that works by inducing a decrease in adenylyl cyclase activity. Furthermore, the addition of adenosine (10 nM) mimicked the effects of MECA on PRL secretion, an effect that persisted regardless of the presence of LiCl (5 mM). The basal secretion of PRL was significatively reduced by LiCl, and restored by the concomitant addition of both LiCl and myo-inositol. These results indicate that PRL secretion is under a multifactorial regulatory mechanism, with the participation of different enzymes, including adenylyl cyclase, inositol-1-phosphatase, cyclooxygenase, and lipoxygenase. However, the increase in PRL secretion observed in the lactotroph in response to A2 adenosine receptor activation probably was mediated by mechanisms involving regulation of adenylyl cyclase, independent of membrane phosphoinositide synthesis or cyclooxygenase activity and partially dependent on lipoxygenase arachidonic acid-derived substances