Diagnóstico radiológico del síndrome de interrupción del tallo hipofisario. Neurohipófisis ectópica / Radiological Diagnosis of Pituitary Stalk Disruption Syndrome. Ectopic Neurohypophysis

Resumen: El síndrome de interrupción del tallo pituitario es una anomalía congénita que se caracteriza por la demostración neurorradiológica de un tallo pituitario ausente, interrumpido o hipoplásico, adenohipófisis aplásica/hipoplásica y neurohipófisis ectópica. Este síndrome se ha relacionado con formas severas de hipopituitarismo congénito, asociado a múltiples deficiencias de hormonas pituitarias. Los signos y los síntomas perinatales que presentan los pacientes incluyen hipoglucemia hasta en un 61%, ictericia en un 38%, micropene en un 77% y colestasis en un 19%, las convulsiones neonatales se dieron en el 75% de los niños. Durante la infancia suelen tener talla baja y disminución en la velocidad del crecimiento, así mismo pueden presentar retardo en la expresión de los caracteres sexuales secundarios (1). En nuestro caso clínico se trata de un paciente adolescente el cual tenía como manifestaciones clínicas principales, retardo en los caracteres sexuales secundarios, los hallazgos principales que se encontraron en la resonancia magnética nuclear, incluyeron ausencia del tallo hipofisario, neurohipófisis ectópica, localizada adyacente al túber cinereum y adenohipofisis hipoplásica.

Abstract: Pituitary stalk disruption syndrome is a congenital anomaly characterized by neuroradiologic demonstration of an absent, interrupted, or hypoplastic pituitary stalk, aplastic/ hypoplastic adenohypophysis, and ectopic neurohypophysis. This syndrome has been related to severe forms of congenital hypopituitarism, associated with multiple deficiencies of pitu- itary hormones. Perinatal signs and symptoms presented by patients include hypoglycemia in up to 61%, jaundice in 38%, micropenis in 77% and cholestasis in 19%, neonatal seizures occurred in 75% of children. During childhood, they tend to have short stature and a decrease in growth speed, as well as a delay in the expression of secondary sexual characteristics. In our clinical case, an adolescent patient was presented whose main clinical manifestations were delayed secondary sexual characteristics, the main findings were found in nuclear magnetic resonance, including absence of the pituitary stalk, ectopic neurohypophysis, located adjacent to the tuber cinereum and hypoplastic adenohypophys.

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.

Efectos del tratamiento antioxidante en la activación del eje hipotálamo-hipófiso-adrenal inducida por el consumo de dietas ricas en sacarosa / Effects of antioxidant treatment on the activation of the hipotalamo-hipofiso-adrenal axis induced by the consumption of sucrose rich diets

Introducción: dados los efectos pleiotrópicos de los glucocorticoides (GCs) sobre el metabolismo, los niveles excesivos y sostenidos de GCs circulantes tienen efectos deletéreos e incrementan la morbilidad y mortalidad cardiovascular. Objetivos: estudiar el efecto de la terapia antioxidante (con ácido lipoico o melatonina) sobre la hiperactivación del eje hipotálamo-hipófiso-adrenal (HHA) en animales alimentados con dieta rica en sacarosa (DRS). Materiales y métodos: se evaluó la actividad del eje HHA y se determinaron parámetros hormonales, de estrés oxidativo y de inflamación en la adenohipófisis de animales tratados con DRS durante tres semanas. Resultados: los animales del grupo DRS mostraron mayores niveles circulantes de hormona adrenocorticotropa (ACTH, por sus siglas en inglés) y corticosterona. En paralelo se detectó un aumento en la expresión del polipéptido precursor (proopiomelanocortina, POMC) y de ACTH en la adenohipófisis, donde también se observó un aumento de lipoperóxidos y proteínas nitradas en tirosina (daño oxidativo), un mayor número de macrófagos tisulares y un incremento en la producción de IL-1beta. El tratamiento antioxidante previno los cambios en estos parámetros. En particular la melatonina también normalizó la actividad del eje HHA y la expresión hipofisaria de POMC. Conclusiones: la sobrecarga metabólica inducida por la administración de DRS genera daño oxidativo e inflamación en la adenohipófisis. La activación de los macrófagos tisulares producida en consecuencia podría impactar sobre los corticotropos hipofisarios e inducir su hiperfunción. La melatonina podría utilizarse como herramienta terapéutica para normalizar la actividad del eje HHA en modelos de obesidad por dieta.

Introduction: given the pleiotropic effects of glucocorticoids (GCs) on metabolism, excessive and sustained levels of circulating GCs, have deleterious effects and increase cardiovascular morbidity and mortality. Objectives: to study the effect of antioxidant therapy on hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis in animals fed a sucrose-rich diet (SRD). Materials and methods: the activity of the HPA axis was evaluated and hormonal, oxidative stress and inflammation parameters were determined in the adenohypophysis of animals treated with SRD for trhee weeks. Results: animals from the SRD group showed higher circulating levels of adrenocorticotropic hormone (ACTH) and corticosterone. In parallel, an increase in the expression of the polypeptide precursors, POMC and ACTH were detected in the adenohypophysis. We also observed an increase in lipoperoxides and proteins nitrated in tyrosine (oxidative damage), a greater number of tissue macrophages and an increase in the production of IL-1beta. Antioxidant treatment prevented all these changes. In particular, melatonin also normalized the activity of the HPA axis and pituitary expression of POMC. Conclusions: the metabolic overload induced by the administration of SRD generates oxidative damage and inflammation in the adenohypophysis. Activation of tissue macrophages could affect, in turn, pituitary corticotrophs inducing their activation. Melatonin could be used as a therapeutic tool to normalize the activity of the HPA axis in diet obesity models.

Morphofunctional Changes in Basophilic Cells of the Adenohypophysis during Post-resuscitation Disease

In the post-resuscitation period through the I-II-III-IV-V -stages and long -term periods (1 and 3 months) of post –resuscitation disease, the morphofunctional activity of β-and d-basophil cells of the adenohypophysis was studied in white male rats with a weight of 180-220 g, who suffered a 10-minute stop of systemic circulation (compression of the vascular bundle of the heart by the method ofV. G. Korpachev). False-operated animals served as a control.Morphological, morphometric, histochemical, and cytophotometric studies of the state of both β-and d -basophil cells of the adenohypophysis were performed. We used image analysis using a leys microscope with an electronic micro-nozzle attached to an Intel computer, and the content of the glycoprotein was studied using a cytophotometer. In the postoperative period during the phase I identified in the background of gipergidratace cytoplasmic β-and d -basophilic cells of the anterior pituitary, in the period of II-III stage disease gipergidratace nuclei β-and d -basophilic cells of the anterior pituitary revealed an increase in the excretion of glycoprotein in blood, i.e., the observed compensatory-adaptive reactions. Starting from stage IV and in remote periods of post-resuscitation disease, compensatory and restorative processes were observed against the background ofhyperhydration of the nuclei

Morphological and immunohistochemical comparison of the pituitary gland between a tropical Paracheirodon axelrodi and a subtropical Aphyocharax anisitsi characids (Characiformes: Characidae)

Cardinal tetra Paracheirodon axelrodi and bloodfin tetra Aphyocharax anisitsi are two species of characids with high trade value as ornamental fish in South America. Although both species inhabit middle water layers, cardinal neon exhibits a tropical distribution and bloodfin tetra a subtropical one. Generally, these species are difficult to grow, so it becomes essential to know some key components of the neuroendocrine system to achieve their reproduction in captivity. Considering the importance of deepening the knowledge of the reproductive physiology through functional morphology, for the first time in this work we performed an anatomical, morphological and immunohistochemical analysis of the pituitary gland of these two species. In both species, a leptobasic type pituitary is found in the ventral zone of the hypothalamus and it is characterized by a neurohypophysis which has a well-developed pituitary stalk and a globular adenohypophysis. The pituitary components, characterized by histochemistry and immunohistochemistry, shows a distribution pattern of cells types similar to other teleost species, with only slight differences in the distribution of βFSH and βLH for P. axelrodi.(AU)

El cardenal tetra Paracheirodon axelrodi y el tetra Aphyocharax anisitsi son dos especies de carácidos con alto valor comercial como peces ornamentales en América del Sur. Aunque ambas especies habitan en las capas medias de agua, el neón cardenal exhibe una distribución tropical, mientras que el tetra cola roja una distribución subtropical. En general estas especies son difíciles de cultivar, por lo que es esencial conocer algunos componentes clave de los sistemas neuroendocrinos para lograr su reproducción en cautiverio. Considerando la importancia de profundizar en el conocimiento de la fisiología reproductiva a través de la morfología funcional, en este trabajo realizamos, por primera vez, un análisis anatómico, morfológico e inmunohistoquímico de la glándula pituitaria de estas dos especies. En ambas especies, la hipófisis, del tipo leptobásica, se encontró en la zona ventral del hipotálamo y se caracteriza por una neurohipófisis con un tallo hipofisario bien desarrollado y una adenohipófisis globular. Los componentes hipofisarios, caracterizados por la histoquímica y la inmunohistoquímica, mostraron un patrón de distribución de tipos de células similares a otras especies de teleósteos, con solo pequeñas diferencias en la distribución de βFSH y βLH para P. axelrodi.(AU)

Neoplasia endocrina múltiple tipo 1 A propósito de un caso / Multiple endocrine neoplasia type 1 About a case

La neoplasia endocrina múltiple tipo 1 (NEM1) es un raro síndrome hereditario, autosómico dominante, clásicamente caracterizado por tumores en varias glándulas (paratiroides, adenohipófisis e islotes pancreáticos). La prevalencia del NEM1 es de aproximadamente 2 por 100.000 habitantes.El síndrome de Zollinger Ellison (SZE) es una de las 3 neoplasias que forman parte del NEM1 y corresponde al 20 a 60%. A continuación se presenta el caso clínico de un paciente de sexo masculino, 66 años de edad, con cuadro clínico de síndrome de Zollinger Ellison que, en investigación posterior, evidencia alteración funcional de las glándulas paratiroides, cumpliendo criterios diagnósticos de neoplasia endocrina múltiple tipo 1 (NEM1).(AU)

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant hereditary syndrome, classically characterized by the presence of tumors in several glands (parathyroid, anterior pituitary and pancreatic islets) The prevalence of MEN 1 is approximately 2 per 100,000 inhabitants. The Zollinger Ellison syndrome (ZES) is one of the three neoplasias that form part of the MEN 1, and corresponds to 20 to 60%. The clinical case of a 66-year-old male patient, with a clinical of Zollinger Ellison Syndrome, who in a subsequent investigation shows functional abnormality of the parathyroid glands, fulfilling diagnostic criteria of Multiple Endocrine Neoplasia type 1 (NEM1) (AU)

Effects of adenohypophysis function after treating with thyrotropin releasing hormone in patients with brain trauma / 中国生化药物杂志

Objective To analyze the effects of adenohypophysis function after treating with thyrotropin releasing hormone and its clinical significance in patients with brain trauma. Methods There were 22 cases with traumatic brain injuries from July 2010 to September 2012 in Chinese people's Liberation Army nine eight hospital,after injuried within 4 to 12 hours,then 1 1 cases who were given thyrotropin-releasing hormone(TRH)were selected as experimental group,while 1 1 cases who were given the same amount of isotonic saline were selected as control group,then the score of GCS, ICS,RLS85 and the improvement of adenohypophysis function were observed. Results After treatment,the score of glasgow coma scale (GCS ), innsbruck coma scale (ICS),and the reaction level scale (RLS85)between two groups were significantly increased in three days compared with before treatment,and within three days after injury situation,the improvements of ICS and RLS85 in experimental group were better than control group(P<0.05 ). Compared with control group,the levels of each gland pituitary hormone in experimental group were significantly increased(P<0.05 ),and on the third day,the growth hormone (GH)was reduced significantly,finally 50%of that in control group. Conclusion Patients with brain injury treated with thyrotropin releasing hormone,has no significant adverse reactions,with the characteristics of safe and effective.

Changes of PARP and NF-κB in adenohypophysis of rat model of severe acute pancreatitis / 中华急诊医学杂志

Objective To investigate the changes of poly-ADP-ribose polymerase (PARP) and NF kappa B (NF-κB) in adenohypophysis in rat model of severe acute pancreatitis (SAP),and their role in the mechanism of adenohypophysis injury in SAP.Methods Forty Wistar rats were randomly (random number) divided into 5 groups:the sham operation group (SO group,n =8),SAP 1 h,3 h,6 h and 12 h groups (n =8 in each group).SAP model was induced by retrograde injection of 5％ sodium taurocholate into the biliopancreatic duct.Serum levels of amylase,lipase and ascites were measured.After sacrifice of experiment rats,pancreas and adenohypophysis tissues were taken for pathological examination under light microscope.Adenohypophysis cells were observed under electronic microscopy as well.PARP and NF-κB expressions in adenohypophysis cell was studied by using immunohistochemisty assay.Results After modelling,serum levels of amylase,lipase and ascites in SAP group increased gradually,which were higher than those in SO group (P ＜ 0.05).Adenohypophysis cell swelling and partial necrosis were observed under light microscope.As the time prolonged,their nuclei became dark and pyknotic more and more,and the endoplasmic reticulum and mitochondrial swelling in adenohypophysis cells were observed under electronic microscopy.The expressions of PARP and NF-κB in SAP group increased gradually,which were higher than those in SO group.Conclusions Significant pathological and ultrastructural injuries were observed in adenohypophysis cells in severe acute pancreatitis.These changes might correlate with PARP and NF-κB signaling pathway.

Radiation-induced hypopituitarism in patients with nasopharyngeal carcinoma / 中华神经医学杂志

Objective To investigate the clinical characteristics and imaging features of radiation-induced hypopituitarism (RIH) in nasopharyngeal carcinoma (NPC) patients after radiotherapy.Methods Retrospective study was performed on the clinical data of 9 NPC patients (7 males and 2 females), diagnosed as RIH after radiotherapy in our hospital from 2000 to 2009; their clinical manifestations, anterior-pituitary hormone levels, cranial MRI features and follow-up results were analyzed. Results The interval between complications after radiotherapy and diagnoses of RIH varied from 10 months to 15 years.Multiple hormone deficits appeared in 5 patients; thyrotropin deficiency and hyperprolactinemia were the most common complications, followed by adrenocorticotropic hormone (ACTH) insufficiency.Typical radiological imaging of the pituitary gland displayed partially empty sella and atrophy of pituitaly gland,which was demonstrated in 2 patients.Five patients got improvement after hormone replacement therapy. Conclusion Radiation-induced hypopituitarism may occur in NPC patients; most patients are subclinical without typical radiological alterations in MRI for pituitary.Routine evaluation of adenohypophysis function is necessary for early detection of hormone deficiency and early hormone replacement treatment.

Effect of Lysodren(R) on the Ultrastructural Changes in the Rat Adrenal Corex: Immunohistochemical staining for anti-ACTH antibody on the adenohypophysis

The toxicity and adrenostatic effect of o,p'-DDD, a derivative of the insecticidal DDT, on the adrenal cortex were well known. It known that the toxicity was based on the blocking of steroid biopsynthesis when cholesterol was converted to pregnenolone. Lysodren(R) was also known to be capable of producing a regression of adrenocortical carcinoma and its metastases, and this drug became one of useful choice for the treatment of unoperable adrenocortical carcinomas. Recently, fine structural effect of o,p'-DDD on the adrenocortical carcinoma show that the mitochondria is the primary target organelle. o,p'-DDD was dissolved in corn oil and it was orally administered for 28 days to investigate the ultrastructural effects of zona fasciculata of rat adrenal cortex. The results obtained were as follow: 1) The body weight was decreased after feeding o,p'-DDD. 2) Light microscopic examination showed no remarkable change except increased fine lipid droplets of zona fasciculata in group I (o,p'-DDD 75 mg/kg feeding). Moderately increased intracytoplasmic lipid droplets and pyknotic nuclei bearing membrane indentations were seen in group II (o,p'-DDD 150 mg/kg feeding). Large sized lipid droplet aggregates, pyknotic nuclei with severe nuclear membrane indentations and karyorrhexis in focal area were evident in group III. 3) Immunohistochemical staining for ACTH in pituitary gland showed increasing number of ACTH secretory cell and increasing intensity of staining property according to the dosage of o,p'-DDD. 4) Ultrastructural examination showed increased intracytoplasmic lipid droplets and mild increased peroxisome. There was no remarkable ultrastructural changes in mitochondria in group I. Moderately increased lipid droplets and clusters formation, compressed mitochondria, partial disappearance of mitochondrial cristae, increased peroxisome and nuclear membrane indentations were seen in group II. In group III, nuclear membrane showed prominent indentation. Numberous cytoplasmic vacuolation, double membrane ring in mitochondria, disappearance of mitochondrial cristae, myelin figure formation in mitochondrial matrix, and fatty changes in mitochondrial matrix were seen. These findings showed that the primary target organelle of attack by o,p'-DDD on zona fasciculata of adrenal gland in rat is mitochondria and it was developed from double ring formation in mitochondrial matrix.

EFFECTS OF GOSSYPOL ON THE ULTRASTRUCTURE OF THE CELLS OF RAT ADENOHYPOPHYSIS / 解剖学报

The ultrastruetural changes of the cells of adenohypophysis were observed in adult male rats following administration of gossypol at a daily dosage of 30 mg/kg for 5 weeks. The results indicated a remarkable increase in the secretory activity of gonadotrophs. In comparison with the control group, the number of the less actively functioning types Ⅰ and Ⅱ gonadotrophs of gossypol-treated rats decreased, while that of types Ⅲ and Ⅳ cells with developed Golgi complex and dilated rough endoplasmic reticulum increased. Moreover, castration-like cells (type Ⅴ) and degranulation cells (type Ⅵ) appeared in the experimental animals. No significant changes in the other tropic cells of adenohypophysis could be found. The classification of gonadotrophs and the possible mechanism of gossypol-induced changes in them are discussed.

ULTRASTRUCTURAL STUDY OF SUBSTANCE P-LIKE IMMUNOREACTIVE NERVE FIBERS IN THE PARS DISTALIS OF THE ADENOHYPOPHYSIS IN THE DOG / 解剖学报

In our previous studies, substance P-like immunoreactive varicose nerve fibers have been demonstrated in the pars distalis of the adenohypophysis of the dog. They were found, at light microscopical level, to be closely related to gland cells. In the present study, the ultrastructure of substance P-like immunoreactive nerve fibers and their relationship with the gland cells of the pars distalis in the dog were investigated by use of pre-embedding immuno-electron microscopy. Direct contacts could be ascertained on every cell type of the gland, including folliculo-stellate cells. Typical synapses were identified on somatotropes and corticotropes, more on the latter. Most of them were of asymmetrical type with round to oval small clear vesicles and scattered large dense cored vesicles. It is considered morphologically proved that the substance P-like immunoreactive nerve fibers have effector role in the pars distalis of the dog.