The Effect of Growth Hormone on Chondral Defect Repair.

Objective Focal chondral defects alter joint mechanics and cause pain and debilitation. Microfracture is a surgical technique used to treat such defects. This technique involves penetration of subchondral bone to release progenitor cells and growth factors from the marrow to promote cartilage regeneration. Often this results in fibrocartilage formation rather than structured hyaline cartilage. Some reports have suggested use of growth hormone (GH) with microfracture to augment cartilage regeneration. Our objective was to test whether intra-articular (IA) GH in conjunction with microfracture, improves cartilage repair in a rabbit chondral defect model. We hypothesized that GH would exhibit a dose-dependent improvement in regeneration. Design Sixteen New Zealand white rabbits received bilateral femoral chondral defects and standardized microfracture repair. One group of animals ( n = 8) received low-dose GH by IA injection in the left knee, and the other group ( n = 8) received high-dose GH in the same manner. All animals received IA injection of saline in the contralateral knee as control. Serum assays, macroscopic grading, and histological analyses were used to assess any improvements in cartilage repair. Results Peripheral serum GH was not elevated postoperatively ( P = 0.21). There was no improvement in macroscopic grading scores among either of the GH dosages ( P = 0.83). Scoring of safranin-O-stained sections showed no improvement in cartilage regeneration and some evidence of increased bone formation in the GH-treated knees. Conclusions Treatment with either low- or high-dose IA GH does not appear to enhance short-term repair in a rabbit chondral defect model.

[Sheehan's syndrome--a forgotten disease with 100 years' history]. / Zespól Sheehana--zapomniana choroba ze stuletnia historia.

Although named after Harold Sheehan, postpartum ischemic pituitary necrosis was reported for the first time 100 years ago in Przeglad Lekarski by Leon Konrad Glinski. In the majority of cases, the syndrome is a consequence of severe postpartum bleeding episode resulting in severe hypotension or hemorrhagic shock. The frequency of Sheehan's syndrome has decreased in developed countries as a result of improved obstetrical care, but this clinical entity remains a common cause of hypopituitarism in developing countries. The syndrome is characterized by varying degrees of anterior pituitary dysfunction resulting from the deficiency of multiple pituitary hormones. The order of frequency of hormone loss has generally been found to be growth hormone and prolactin, gonadotropins, ACTH and thyrotropin. Women with Sheehan's syndrome exhibit a variety of signs and symptoms including failure to lactate or resume menses, loss of genital and axillary hair, and often occurring long after delivery clinical manifestations of central hypothyroidism and secondary adrenal insufficiency. Diagnosis is based on laboratory studies, including hormone levels and hormone stimulation tests. Treatment of Sheehan's syndrome involves hormone replacement therapy. The aim of this study is to review current knowledge on clinically relevant aspects of this clinical entity and to provide the reader with recommendations concerning its diagnosis and treatment.

[Pituitary melanocytoma mimicking an adenoma]. / Un mélanocytome mimant un adénome hypophysaire.

A 62-year-old woman was referred for a pituitary tumour diagnosed because of a chronic asthenia and visual disorders. Cerebral MRI showed a pituitary tumour compressing the optic chiasm and enhanced after gadolinium injection. Biological findings showed panhypopituitarism and hyperprolactinemia. The diagnostic of pituitary macro-adenoma was performed and the patient was treated with hormone replacement therapy and dopaminergic agonist. Six months later, she presented visual disorders worsening leading to surgical excision. The diagnosis of pituitary melanocytoma was performed after anatomo-clinical confrontation. Post-operative radiation was done.

Anterior pituitary hormone replacement therapy--a clinical review.

This clinical review summarizes current approaches to diagnosis and treatment of anterior pituitary hormone deficiency. The diagnostic value of endocrine function tests and replacement strategies for hydrocortisone, thyroxine, sex steroids, and growth hormone replacement are reviewed. Female androgen deficiency syndrome and the current role of DHEA and testosterone replacement in women are also discussed.

[Bernhard Schapiro (1888-1966): Talmudic scholar - andrologist - pioneer of hormonal treatment for cryptorchidism]. / Bernhard Schapiro (1888-1966): Talmudgelehrter - arzt - wegbereiter der hormonbehandlung des kryptorchismus.

Bernhard Schapiro was the first to recommend anterior pituitary lobe hormone for the treatment of cryptorchidism. He was born in 1888 into an orthodox family in Dvinsk (Daugavplis/Latvia), in the Pale of Settlements for Jewish Russian subjects. In simple schools he learned Hewbrew and basics of Torah and Talmud. Then he turned to the Talmudic Academy "Slobodka" in Kovno (Kaunas/Lithuania) for advanced studies. Here he internalized the "Musar" teachings, a doctrine of high-standard ethical behavior towards fellow beings, until he was eighteen. He abandoned a rabbincal carrer and studied medicine in Switzerland. After exams in 1919, he received a training in dermatology with JADASSOHN in Breslau. From 1922 until 1933 he worked at HIRSCHFELD's Institute for Sexual Science in Berlin. Here he pioneered in andrology working on the problems of impotency and premature ejaculation and developing new drug combinations. In males with underdeveloped genitalia he proved the cryptorch testicles may descend under treatment with anterior pituitary lobe. After Nazi students had looted the Institute in May, 1933 he left Germany with wife and four children and established a practice in Zurich. He chaired the Swiss branch of Mizrakhi, which aimed at influencing Zionism with orthodox spirituality. In 1940 he turned to New York where even rabbis recommended his treatment as in accordance with talmudic laws. From 1951 until his death in 1966 he lived and worked on the same issues in Jerusalem. His entire life was guided by Musar.

[Early diagnosis and correct treatment of cryptorchism]. / Diagnosi precoce e trattamento corretto del criptorchidismo.

Diagnosis in cryptorchidism should be as early as possible for therapeutical purposes and for the achievement of most positive results. Early but also exact diagnosis allows a selective therapy concerning type of procedure and age of performance. Aims of early diagnosis and selected treatment are: prevention of infertility and eventual decrease of androgenic endocrinal function in the adult; prevention of torsion in retractile testis; prevention of trauma in perineal ectopic situation; prevention of cancer especially in cryptorchidism of the adult; prevention of psychogenic defects of the empty scrotum. Those goals can be obtained by different approaches: pharmacological (hormonal stimulation), surgical (orchidopexy) or by their association. If hormonal administration is not suitable or without results surgical approach will be adopted. Which is now the most suitable age for surgery? Testicular damages begin at the second year of life. Therefore operation should be acted in advance. However, up to date international acknowledgement is in favour of surgical management around the fourth year for the advantages of a more mature anatomical situation without reducing quality of results. Purpose of early diagnosis and selective therapy in cryptorchidism is to avoid irreversibility of severe histological alteration able to compromise gonadal, especially germinal, function. It is never to forget that the high level of infertility in cryptorchidism can be depending not only on evident alteration in number, motility and morphology of spermatozoa but also on morphofunctional defects escaping from the routine seminal examination. All that is in tight connection with the intrinsic dysmorphism in cryptorchism where the abnormal position of the testis is only a partial aspect.(ABSTRACT TRUNCATED AT 250 WORDS)

Monoamine biosynthesis in hypothalamic regions of dwarf mice: effect of replacement of deficient anterior pituitary hormones.

Female Ames dwarf and phenotypically normal female mice were killed 30 min after treatment with NSD-1015, an aromatic L-amino acid decarboxylase inhibitor. The accumulation of dihydroxyphenylalanine (DOPA) and 5-hydroxytryptophan were measured by high-performance liquid chromatography with electrochemical detection and provided estimates of the endogenous biosynthesis of dopamine (DA) in the median eminence (ME) and serotonin biosynthesis (5-HT) in all brain regions which were examined. Dopamine synthesis was markedly suppressed in the ME while 5-HT synthesis was enhanced in both the ME and mediobasal hypothalamus (MBH) of dwarfs as compared to phenotypically normal mice. Overall, catecholamine biosynthesis (DOPA accumulation) was suppressed in the MBH of the dwarf mice but was not different from that observed in normal mice in the preoptic area anterior hypothalamus (POA-AH). The biosynthesis of 5-HT was not different in the POA-AH of dwarf mice as compared to normal mice. In the second experiment dwarf mice received saline vehicle, ovine prolactin (PRL), growth hormone (GH) or thyroxin (T4) daily for 14 days. Normal mice received saline only. Replacement with PRL significantly enhanced DA synthesis in the ME and was the only hormone to suppress significantly the elevation of 5-HT synthesis normally observed in the ME and the MBH of the dwarfs. Both GH and T4 only partially reduced 5-HT synthesis in the ME and MBH so that this parameter was no longer statistically different from either saline-treated dwarfs or normal mice.(ABSTRACT TRUNCATED AT 250 WORDS)

The induction of antibodies to human luteinizing hormone by contaminated clinical pituitary hormone preparations.

Three children with hypopituitarism had elevated LH levels measured by RIA which were incompatible with their stage of sexual maturation. Each of the children had been administered parenteral pituitary hormone preparations: one patient, human (h) GH for 3 2/1 yr; one patient, bovine TSH twice to evaluate thyroid responsiveness; and two patients, posterior pituitary extract by nasal insufflation for 7 5/12 ad 4 9/12 yr to treat diabetes insipidus. Each of these children had developed antibodies of the immunoglobulin G class which bound [125I]hLH in vitro in a displaceable fashion. In two of the patients, the antibody reacting with hLH was found after therapy with pituitary hormones of bovine or porcine origin and before treatment with hGH, while on child had received only hGH therapy. These antibodies interfered in the assay for hLH and were responsible for the spurious elevations of serum immunoreactive hLH. None of these children had undergone spontaneous puberty, including at least one who may not have been gonadotropin deficient. To reduce the risk of generating high potency neutralizing antibodies, only highly purified, monomeric pituitary hormone preparations or pure synthetic hormone preparations should be used for diagnosis and chronic replacement therapy.

The rhinologist and the management of pituitary disease.

Since the early days of pituitary surgery, a variety of transnasal approaches have been used to gain access to the sella turcica. Each of these approaches requires crossing the sphenoid sinus, hence the transsphenoidalnoidal designation of these methods. Since the growth and refinement of microsurgery as a distinct surgical discipline, there has been a coincidental maturation of transsphenoidal microsurgical techniques for the management of a variety of pituitary disorders. The present paper reviews the historical events leading to the current methods of transphenoidal pituitary surgery. Detailed descriptions of each method are given, with the advantages and disadvantages of each. The author's method is described and illustrated in a step-by-step manner, and the criteria which determine operability by transsphenoidal versus transfrontal craniotomy are discussed. The advantages which transsphenoidal techniques offer over transfrontal methods are emphasized. The paper deals with pituitary disorders on a clinical and pathological basis. The work-up of pituitary lesions is discussed, with a detailed presentation of the endocrine evaluation. Further emphasis is given to the value of tomography of the sphenosellar complex in planning operative approaches for removal of pituitary lesions, particularly when the lesion is a so-called "microadenoma," producing no obvious expansion nor erosion of the cellar floor. The author's experience in the management of 125 lesions of the pituitary or associated sella turcica is presented and complications are discussed. Because of the relatively brief period of follow-up, no conclusive evidence can be offered regarding cures in the author's series. However, on the basis of reported experience by others working in the same area, one may expect acceptable long-term improvement or cures in selected pituitary lesions operated on by transshpenoidal methods. The team management of pituitary disorders is stressed. In particular, emphasis is given to the contributions which the current day otorhinolaryngologist can make, because of his knowledge and experience in rhinological and microsurgical techniques. There is no other surgical specialty so uniquely qualified to provide operative treatment of pituitary lesions using transsphenoidal surgical pathways.