Ultrasonic bruits in the circle of Willis due to a large nonfunctioning pituitary adenoma.

In a man with a histologically verified non-functioning pituitary adenoma with suprasellar extension, Doppler signals resembled those associated with bruits (ultrasonic bruits). These signals were detected in the anterior circulation of Willis both preoperatively and intraoperatively. The large tumor was resected subtotally via a right orbitozygomatic approach. The use of microvascular sonography for intraoperative monitoring can provide information on the potential cerebrovascular complications of surgery. No previous studies on the presence of ultrasonic bruits associated with pituitary adenomas have been reported. The clinical implications for the surgical treatment of pituitary adenomas are discussed.

[The visual field of patients with pituitary adenoma surgically treated]. / Le champ visuel des adénomes hypophysaires opérés.

The authors report the evolution of 72 patient's visual field operated for one pituitary adenoma. They specify the constant amelioration of this investigation in chromophobic adenomas. The stability in prolactinic adenomas or somatotropic. Allowing the supervision of the visual case, at these patients, the visual field does not seem useful in the diagnosis of the tumors recurrence.

Visual evoked potentials in the assessment of patients with non-functioning chromophobe adenomas.

The results of visual evoked potential (VEP) examination in 34 patients with histologically confirmed chromophobe adenoma are described and discussed in relation to the clinical, radiological and surgical findings. The VEP is shown to be a reliable method of assessing the function of the intracranial visual pathways which is often more sensitive than conventional methods of examination.

An early effect of Wyndham Lewis' pituitary tumour on his art: an inquiry prompted by a note in The World Through Blunted Sight.

An avenue of research suggested by Patrick Trevor-Roper's 'inquiry into the influence of defective vision on art and character' provides a possible solution to an art-historical problem. It is proposed that questions raised by Percy Wyndham Lewis' red portraits of 1937 can be answered in terms of his intracranial tumour.

'Normal' and 'abnormal' crossed asymmetry in monocular visual evoked potentials.

To restate the above, in the population of 29 normal subjects tested by us, 'normal' crossed asymmetry occurred in one-fifth on the FVEP study and in none on the PSVEP study; this 'normal' crossed asymmetry was always undirectional, larger Wave III being contralateral to the stimulated eye. Deviations from these observations, namely a larger Wave III ipsilateral to the stimulated eye, or a crossed asymmetry of P100 on the PSVEP study are probably examples of 'abnormal' crossed asymmetries. However, a 'normal' crossed asymmetry may occur in some abnormal situations as well, e.g. diseases and syndromes with optic misrouting as noted earlier.

Hypophyseal tumor and gynecomastia preceding bilateral breast cancer development in a man.

The case is reported of a 48-year-old man who, 26 years after treatment for a hypophyseal tumor and 11 years after the onset of bilateral gynecomastia, developed cancer of the left breast. Ten years after the first breast cancer operation a new cancer developed in his right breast. Hormonal investigation at the time of the second breast cancer operation revealed a low S-FSH and a relative estrogen excess compared to testosterone. Values of thyroid and adrenal hormones were essentially normal, while P-prolactin was elevated. Stimulatory tests of the hypophyseal function were in accordance with a partial hypophyseal insufficiency affecting the hypophyseal-gonadal axis. Also, a weak elevation of S-HGH was noted by an insulin tolerance test. Immunohistochemical analysis of the pituitary tumor 36 years later showed that the tumor could be classified as a prolactinoma. Cytogenetic analysis revealed a normal male chromosome karyotype.

Normal and abnormal function of the hypothalamic-pituitary-adrenocortical system in man.

The first half of this manuscript is devoted to a review of the methods used and the results obtained in the published measurements of the normal responses to tests of the three main types of hypothalamic-pituitary-adrenocortical (HPA) activity in man. These are, I, basal, unstressed activity leading to appropriate levels of total daily production of cortisol in the characteristic circadian pattern; II, responses to feedback stimulation of HPA activity by metyrapone administration; and III, responses to tests of the effects of stress on the HPA system including the effects of hypoglycemia, induced fever, vasopressin administration, and ACTH injections and infusions. The advantages and shortcomings of each type of procedure are discussed. The second half of this paper describes the authors' attempts to establish the limits of normality of standard and modified methods of evaluating the HPA system. The defined limits of normality have been used to assess the HPA function in 158 patients with known or suspected disorders of the HPA system. In normal controls, halfhourly plasma cortisol determinations established the normality of circadian and postprandial fluctuations and of mean plasma cortisol concentration, 6.2 +/- 0.3 (SEM) micrograms/dl, which were closely approximated by determinations every 6 h. Metyrapone, given in a dose of 500 mg every 2 h for 24 h increased urinary 17-OHCS excretion to 10.5-32.6 mg/day or to 1.7-7.8 times basal excretion rate. Increasing rates of insulin infusion disclosed significant relationships between resulting plasma glucose and cortisol concentrations. The slopes of the delta cortisol/delta glucose responses were similar after insulin infusions (0.46 +/- 0.05) and after insulin injections, 0.15 U/kg (0.43 +/- 0.09), and were always greater than 0.20 micrograms/mg. This index provides a useful objective measure of the normality of responses to hypoglycemic stress, 0.20-0.87 micrograms/mg. Adrenocortical responses to iv infusions of ACTH (cosyntropin 0.25 mg) may be equivocal at 2 h but are clear cut at 4, 6 and 8 h. Of 158 patients in whom hypopituitarism was known or suspected because of the presence of a pituitary tumor, acromegaly, hyperprolactinemia, or clinical features, HPA function was found to be entirely normal in 88 patients and partially or severely abnormal in the remaining 70 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Thyrotoxicosis and a thyrotropin-secreting pituitary tumor causing unilateral exophthalmos.

Hyperthyroidism due to a TSH-secreting pituitary tumor has been noted by a number of investigators. We describe a unique case in which a 17-yr-old female presented with clinical hyperthyroidism, a goiter, and unilateral exophthalmos. Serum T4, free T4, and T3 (RIA) were consistently elevated along with elevated TSH levels (range, 10-100 microunits/ml). Skull x-rays and computed tomography scan revealed a tumor invading the right orbit. Other pituitary function studies were normal and LATs was undetectable. Surgery performed resulted in 70% removal of the pituitary tumor and confirmed the presence of tumor infiltration into the right orbit. TRH tests done pre- and postoperatively (patient still clinically hyperthyroid with elevated T4 and TSH levels) showed TSH and PRL responsiveness. Electron microscopy of the tumor demonstrated features typical of pituitary thyrotrophs. Monolayer cultures of pituitary cells released TSH over time into the media but did not respond to TRH stimulation. Pituitary adenoma tissue content of immunoreactive TSH was 65 microunits/g wet tissue and demonstrated immunosimilarity with human standard. We conclude that the patient had a TSH-secreting pituitary tumor responsive to TRH stimulation.

Endocrine function in children with intrasellar and suprasellar neoplasms: before and after therapy.

The records of 23 children with intrasellar and suprasellar neoplasms were reviewed for the results of endocrine evaluations before and after treatment with surgery, irradiation, and/or chemotherapy. Deficiency of at least one pituitary hormone was present in 13 patients before treatment and in 22 patients after treatment. Growth hormone deficiency, the most common endocrine abnormality in the pretreatment period, was present in 12 of 17 patients before treatment and in 17 of 21 patients after treatment. In the posttreatment period, thyroid-stimulating hormone deficiency was as common as growth hormone deficiency and was found in 17 of 21 patients evaluated. Hypothalamic-pituitary-gonadal dysfunction and deficiencies of adrenocorticotropic hormone and antidiuretic hormone also occurred in both the pretreatment and posttreatment periods, but were less common.

Amenorrhea-galactorrhea associated with Cushing's disease due to pituitary tumor.

Two patients with amenorrhea-galactorrhea and Cushing's disease due to pituitary tumor are presented. In both cases, a diagnosis of prolactin-secreting tumor with moderate hyperprolactinemia was established, then Cushing's disease developed years later. Despite the typical clinical features of Cushing's disease, a dexamethasone suppression test inhibited both blood ACTH and cortisol concentrations in the 2 patients. Hypophysectomy was performed in 1 case, and the histologic study revealed the presence of a cromophobe adenoma. The other case was treated by external radiation which improved the clinical situation. Clinical and endocrinological studies in these 2 cases were compared with previous reports in the literature in order to discuss the etiology of this unusual association. It is concluded that patients with pituitary tumors presenting moderate hyperprolactinemia may also have excessive secretion of ACTH.

[Hemodynamics and myocardial contractility in chromophobe adenoma of the pituitary gland after conservative, and surgical treatment]. / Sostoianie gemodinamiki i sokratitel'noi sposobnosti miokarda u bol'nykh khromofobnoi adenomoi gipofiza posle konservativnogo i khirurgicheskogo lecheniia.

Mechano- and polycardiographic methods were applied before and after the treatment to study the cardiovascular system in 35 patients suffering from chromophobic adenoma of the hypophysis. Both conservative treatment with the use of gamma irradiation and surgical removal of the tumour leads to normalization of hemodynamic parameters. Contractile capacity of the myocardium remained unchanged after gamma therapy and diminished after surgical treatment.

Lack of adrenal androgen stimulation by ACTH in extreme hyperprolactinemia.

Acute and prolonged alpha 1-24 corticotropin stimulation was performed on a treated chromophobe adenoma patient with partial ACTH deficiency and extreme hyperprolactinemia. Cortisol and aldosterone stimulated normally. However, the basal concentrations of androstenedione (A) and dehydroepiandrosterone (DHA) were low, and that of DHA-sulfate (DHAS) was undetectable. Furthermore, A and DHA did not stimulate normally, and DHAS did not stimulate at all. It has been claimed that adrenal androgen production is increased in hyperprolactinemia. However, the inability of prolactin (Prl) to maintain adrenal androgen (AA) secretion, with and without added ACTH, is demonstrated in this patient.

Symptomatic pituitary tumor enlargement after induced pregnancy. Case report.

A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. Patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.