Mono- and plurihormonal thyrotropic pituitary adenomas: pathological, hormonal and clinical studies in 12 patients.

In a series of 12 patients (eight women and four men, aged between 20 and 62 years), operated on for a pituitary adenoma shown to be thyrotropic by immunocytochemistry, we performed a retrospective and comparative analysis of clinical and biological data, tumor studies including immunocytochemistry with double labeling, and proliferation marker (proliferative cell nuclear antigen (PCNA) and Ki-67) detection, electron microscopy and culture. Our study leads us to confirm that thyrotropic tumors are rare (12 of 1174 pituitary adenomas: 1%). The main points arising were that: (1) high or normal plasma TSH associated with an increase in plasma alpha-subunit and high thyroid hormone levels is the best criterion for diagnosis; (2) the failure of TSH to respond to TRH or Werner's test is not a reliable criterion for diagnosis; (3) thyrotropic adenomas may be 'silent', without clinical signs of hyperthyroidism and with only slight increase in TSH, tri-iodothyronine and thyroxine concentrations; (4) mitoses and nuclear atypies are frequently detected in large tumors, which are invasive in more than 50% of cases - the first analysis of two proliferation markers (PCNA and Ki-67) bears out the relative aggressiveness of thyrotropic adenomas; (5) thyrotropic adenomas are frequently plurihormonal. Immunocytochemical double labeling, complemented by in vitro study, showed that thyrotropic tumor cells sometimes can or sometimes cannot cosecrete TSH, GH or prolactin. The pathological identification of monohormonal and plurihormonal adenomas seems to be supported by clinical and biological differences.

Seminal transforming growth factor-beta in normal and infertile men.

Transforming growth factor-beta (TGFbeta) is a cytokine with autocrine and paracrine action in the testis and potent immunoregulatory and anti-inflammatory activities. In the present study, we examined the concentration of latent (acid-activatable) and free (active) TGFbeta in seminal plasma from normal subjects (n = 23) and infertile (n = 40) patients, by using a TGFbeta specific immunoenzymological assay, and a bioassay (CCL64 cell line growth inhibition) detecting any form of TGFbeta. Free TGFbeta1 was present in normal subjects at a concentration (1.82 +/- 1.06 ng/ml) close to that known to give maximal stimulation in vitro. In pathological groups, the mean concentrations were not significantly different from the normal ones. Latent TGFbeta1 was present in normal seminal plasma at a high concentration (92.4 +/- 29.2 ng/ml). In subjects with pathologies of both testis and genital apparatus, or with epididymal occlusion, mean latent TGFbeta1 concentrations were normal, whereas transferrin concentrations were lower. The concentrations found in the epididymal occlusion group indicate that TGFbeta1 is, for a large part, secreted by the genital tract. In the testicular pathology group, TGFbeta1 concentrations were 130.7 +/- 61.2 ng/ml, a mean not statistically different from normal, although higher. No differences were found between patients with high and normal blood plasma follicle stimulating hormone, and this is consistent with the notion that most TGFbeta1 in seminal plasma is not of testicular origin. The TGFbeta bioassay ensured that immunologically detected TGFbeta was present in a bioactive or bioactivatable form. Furthermore, the values found in normal and pathological seminal plasmas were usually higher than those detected by the immunoassay, suggesting that other forms of TGFbeta might be present. Together, the present data show that very large amounts of TGFbeta are present in human seminal plasma. The TGFbeta ligand assay in the seminal plasma appears to indicate no differences between normal and infertile subjects.

Somatotropic adenomas without acromegaly.

Seventeen somatotropic adenomas removed from patients without acromegaly were studied. Thirteen of them presented as a prolactinoma with amenorrhea and/or galactorrhea and elevated serum PRL levels. According to basal serum GH levels, the patients were divided into two groups, namely Group I: GH slightly elevated (n = 4) and group II: GH less than or equal to 5 micrograms/l (n = 13). The tumoral GH secretion was proved by immunocytochemistry in all cases and by intratumoral RIA, in vitro study and/or in situ hybridization in five of them. Pathological, clinical and biochemical relationships suggested two anatomoclinical aspects. In group I, the tumors were small, well-differentiated somatotropic adenomas with clinically silent GH hypersecretion. It is probably an early stage of the disease. In group II, the tumors were large with normal GH serum levels. They were poorly differentiated and secreted very low amounts of GH. In nine of them, PRL and/or PRL mRNA expression were also detected. These tumors do not secrete enough GH to increase serum levels and cause acromegaly. The somatotropic adenomas without acromegaly correspond to two anatomoclinical aspects of the disease.

Effect of thyroid hormone on the pre- and post-natal development of the rat testis.

The relationship between thyroid function and testicular development in the rat was investigated. Hypothyroidism was induced during fetal or post-natal life by adding methimazole (MMI) to the drinking water of pregnant or lactating mothers. A group of newborn rats was treated with MMI and i.p. injections of L-tri-iodothyronine (L-T3). Hypothyroidism was shown by the reduced serum levels of total T3 and of total thyroxine (T4) in pregnant mothers and in pubertal rats. Testes were studied using light microscopy at 18 and 21 days post coitum or during puberty (21, 35 and 50 days after birth); serum levels of gonadotrophins were also evaluated in pubertal rats. Hypothyroidism had no effect on testicular development during fetal life and when induced in newborn rats it was associated at puberty with reduced serum levels of FSH and LH and with delayed maturation of the testis compared with control rats. The delay in maturation consisted of a reduction in the diameter of seminiferous tubules, and a reduction in the number of germ cells per tubule; this was associated with increased degeneration and arrested maturation of germ cells. In addition, Sertoli cells demonstrated retarded development, as indicated by a delay in the appearance of cytoplasmic lipids and in the development of a tubule lumen. Hormonal and morphological abnormalities were absent in rats treated with MMI plus L-T3. In conclusion, hypothyroidism occurring soon after birth caused reduced levels of gonadotrophins in the serum and a delay in pubertal spermatogenesis, possibly due to retarded differentiation of the Sertoli cells.

[Interaction between gonadotropins and "Transforming Growth Factor Beta" (TGF Beta) in testicular function control]. / Interactions entre les gonadotrphines et le "Transforming Growth Factor beta " (TGF beta) dans le contröle des fonctions testiculaires.

Testicular function is regulated not only by circulating hormones, among which the gonadotrophins play the main role, but also by local factors originating in multiple and complex interactions among cells. In this review, the example of gonadotrophins (LH and FSH) and Transforming Growth Factor beta (TGF beta) was chosen to illustrate the role of interactions between circulating hormones and gonadal growth factors in testicular function control; TGF beta-like activity has been found in the male gonad and we have used a model of cultured purified testicular cells to show that the action of TGF beta on testicular function mainly involves antagonism of the effect of gonadotrophins. Conversely, TGF beta promotes differentiated Leydig and Sertoli cell function. The example of interactions between TGF beta and gonadotrophins reported here shows that locally produced growth factors can regulate the response of testicular cells to gonadotrophins, a finding that extends our concept of reproductive endocrinology to cell-cell interactions.

Free cortisol of human plasma in the first three months of life.

Total cortisol as well as percentage and absolute free cortisol values were determined in 75 full-term, 88 premature and 38 small-for-age (born at term) infants in the first 3 months of life. Equilibrium dialysis and radioimmunoassay were used to estimate the percentage value of the unbound fraction and the value of total cortisol from which absolute free cortisol level was calculated, respectively. A systematic decrease in the free cortisol value was observed in all the three groups of infants during the study period (in full-term infants from 32.3 to 19%, in prematures from 36.6 to 20.8%, and in small-for-age infants from 32.3 to 19.2%). A comparison between the percentage values of free cortisol in the groups studied revealed only slight differences which were not significant. The absolute free cortisol values in full-term infants were highest immediately after birth (4.05 micrograms/dl), then they fell to the lowest level of 0.67 micrograms/dl observed between the third and fifth days of life, and increased afterwards reaching the level of 1.89 micrograms/dl in the third month. The absolute free cortisol values in premature newborns at 3-5 days of life exceeded the values observed in full-term subjects. The pattern of free cortisol in the prematures seems to be 'delayed' as compared with that in full-term newborns. The absolute free cortisol values in small-for-age infants were much more similar to those found in the full-term subjects, than to those in premature babies.

[Normal and tumorous human gonadotropic cells]. / La cellule gonadotrope humaine normale et tumorale.

Gonadotropic cells are scattered in the anterior and tuberal lobes and make up 10 to 20% of the anterior pituitary cells. Having a morphofunctional plasticity, they secrete FSH and LH, most often simultaneously. These hormones are stored together in the granulations. In addition, under the action of regulating factors, especially GnRH, the cells can secrete one hormone or the other, or even the alpha subunit. Gonadotropic adenomas range third in frequency among operated pituitary adenomas (12% in our series). The diagnosis is based on the presence of at least 5% of immunoreactive cells with specific antibodies to gonadotropic hormones. These adenomas are distributed into 3 major types: FSH-LH adenoma, the most frequent one, FSH adenoma and alpha-subunit adenoma. The LH adenoma and the beta FSH and beta LH adenomas are very rare. Tumoral gonadotropic cells lose their morphofunctional differentiation. They also lose, to an extent varying according to the cases, their control mechanisms as well as their capacity of synthesis and excretion of both subunits. The alpha subunit, the oldest one in ontogeny, remains the most often and longest-secreted substance. There is a continuum from the gonadotropic adenoma with high plasma gonadotropins levels to the non-functioning adenoma.

Inversely related evolution of growth hormone and prolactin secretions in long-term tissue cultures of human pituitary adenomas from acromegalic patients.

Pituitary tumoral tissue from 20 acromegalic patients was cultured for up to 120 d in a medium containing 5 nM cortisol. In all cultures, growth hormone (GH) release decreased. At the beginning of the culture, prolactin (PRL) was detected in 18 adenomas, varying from 0.5 to 1000 ng per flask per day. Thereafter, in 10 cases PRL secretion increased from 3 to 50 times the basal level, most frequently after a lapse of 9 to 30 d. PRL secretion remained low in three cases, undetectable in one case only. When added at 350 nM, cortisol increased GH secretion up to 20-fold and simultaneously decreased PRL secretion by as much as 10% of the basal level. Withdrawing cortisol reversed the situation. Immunocytochemical studies of the tumor at surgery showed, besides GH immunoreactive (IR) cells, PRL-IR cells (from rare cells to 10% of total cells) in 15 adenomas, correlating with the first days of culture PRL levels. In cultured explants, mitoses were never found. In 5 nM cortisol medium, the number of GH-IR cells decreased and PRL-IR cells increased or appeared. With 350 nM cortisol, the number of GH-IR cells increased, and PRL-IR cells were scarce or absent. Immunoreactivities for GH and PRL were found in different cells. Care was taken to exclude cultures containing normal pituitary tissue, and because no mitoses were found, these results suggest that most somatotropic adenomas can reversibly shift their secretion from GH to PRL in culture. This capacity to secrete PRL, hidden or low in vivo, is revealed by the favorable low cortisol conditions present in vitro.

The TSH secretion in the human pituitary adenomas.

TSH secretion by a pituitary tumor is very rare (2%) and it is often associated with another hormone: GH or PRL essentially. We present here nine tumors in which the TSH secretion was proved by immunocytochemistry (ICC) and by RIA in the tumor extracts, in the serum and in the culture medium. Four tumors secreted TSH only. Five tumors secreted TSH and GH predominantly. In 3 of them traces of other hormones (PRL and FSH) were also detected. The "pure" TSH adenomas were monomorphous with typical ultrastructural and immunocytochemical features. Plurihormonal TSH adenomas were bimorphous with different cells secreting GH and TSH or monomorphous with one type of cell which secreted TSH or GH or both TSH and GH. In a majority of the cases, the tumoral TSH secretion induced hyperthyroidism but in 2 patients with TSH adenoma there was euthyroidism and in another with TSH-GH adenoma there was no sign of acromegaly and GH serum levels were normal.

Gonadotropin-releasing hormone agonists are unsuccessful in reducing tumoral gonadotropin secretion in two patients with gonadotropin-secreting pituitary adenomas.

Whether GnRH agonist treatment leads to reduced gonadotropin secretion and tumor volume in patients with gonadotropin-secreting pituitary adenomas is controversial. We studied the effect of GnRH analog treatment in two such patients, one with a recurrent FSH- and LH-secreting pituitary adenoma (patient 1) and one with a recurrent FSH- and alpha-subunit-secreting pituitary adenoma (patient 2). Patient 1 was treated with 200 micrograms Buserelin daily for 65 days, and patient 2 received three injections of 3 mg [D-Trp6]-LHRH formulated in microcapsules at 21-day intervals. In both patients, plasma FSH, LH (RIA), and alpha-subunit concentrations increased initially and remained above the pretreatment values throughout the treatment period. Plasma LH, measured by immunoradiometric assay, remained well above the detection limit. Plasma bioactive LH and testosterone became undetectable in patient 2, but did not change in patient 1. In neither patient did pituitary tumor size (determined by computed tomographic scan) change during treatment. We conclude that 1) the overall effect of GnRH analogs in patients with gonadotroph cell adenomas is stimulation of gonadotropin release by the tumor, although LH release varies according to how plasma LH is measured, possibly related to the origin of the hormone (normal or tumor gonadotroph cells), and 2) GnRH analog treatment does not reduce tumor size.

Usefulness of plasma pregnenolone sulfate in testing pituitary-adrenal function in children.

In normal subjects, plasma pregnenolone sulfate (PS) levels high at birth, decreased during the first year of life in relation to the pattern of involution of the fetal adrenal zone. Thereafter, PS levels, in contrast with those of DHAS, did not show the abrupt rise characteristic of the adrenarche, but increased very progressively till adulthood. The response of PS to various provocative tests of adrenal and pituitary function (ACTH and Metyrapone stimulation, dexamethasone suppression), has been established in normal subjects. The measurement of plasma PS levels in basal conditions as well as in response to dynamic tests was very useful in the diagnosis of various adrenal and pituitary diseases in children.

Effect of indolamines on beta-endorphin release by rat anterior pituitary cells.

The effect of indolamine derivatives on beta-endorphin (beta-end) release has been studied in vitro using rat anterior pituitary cells. Incubation of primary cultures for 2 h with 100 nmol/l of melatonin, serotonin or 5-methoxytryptamine significantly increased the beta-end release in response to 20 nmol/l of ovine corticotropin-releasing factor (oCRF). Incubation of the cultures with 100 nmol/l of L-tryptophan, 5-hydroxy-L-tryptophan, 5-hydroxytryptophol or 5-methoxytryptophol had no effect on basal or CRF-induced beta-end release. The effect of serotonin and melatonin was further tested in a superfusion system of dispersed rat anterior pituitary cells. Superfusion with oCRF (200 nmol/l) for 4 min elicited an immediate rapid increase in beta-end release which lasted 30-40 min. Simultaneous superfusion with melatonin (1 mumol/l) or serotonin (1 mumol/l) significantly increased the effect of oCRF pulses on beta-end release. We conclude that melatonin and serotonin are able to act directly on anterior pituitary cells to potentiate the effect of oCRF on beta-end release.

Effect of phosphate supplementation to breast fed very low birthweight infants on urinary calcium excretion, serum immunoreactive parathyroid hormone and plasma 1,25-dihydroxy-vitamin D concentration.

The effect of two doses of Phosphorus (P) supplementation to pooled breast milk (BM): 0.48 and 0.800 mmol/kg/24 h given during the second month of life was evaluated in 22 very low birthweight infants. The concentration of calcium and phosphorus in serum and urine, the serum concentration of immunoreactive parathyroid hormone (iPTH) and the plasma 1,25-dihydroxy-vitamin D concentration (1,25-OH-D) were compared to the values in 19 control infants. The mean +/- SD concentrations in control infants and adults are 63 +/- 18 microliters Eq/ml for serum iPTH and 85 +/- pmol/l for plasma 1,25-OH-D. With 0.48 P supplementation, urinary Ca (UCa) excretion (median and range) 0.238 mmol/kg/24 h (0.105-0.520) was lower than in the control group 0.288 (0.205-0.679) (p less than 0.05); the reduction of UCa was larger with 0.8 P supplementation: 0.047 (0.023-0.163) (p less than 0.01). P supplementation induced no change in serum Ca concentration but a slight and significant increase in serum iPTH was observed only with the 0.8 P supplementation: 55 microliters Eq/ml (less than 25-80) (p less than 0.05). With 0.8 P supplementation there was no significant change of plasma 1,25-OH-D concentration: 173 pmol/l (106-271) vs. 255 (132-293) in the control group. These data show that with 0.8 P supplementation, the hypercalciuria in BM-fed infant disappears without secondary hyperparathyroidism, but without any change in plasma 1,25-OH-D concentration.

Neonatal hypercalcemia in preterm infants fed with human milk.

Hypercalcemia (serum Ca greater than or equal to 2.83 mmol/l) was detected in 10 premature infants (gestational age: 31-37 weeks and birthweight: 1100-1950 g). All were fed with pooled human breast milk. Urinary Ca excretion was high (greater than 0.200 mmol/kg/24 h) in all but one infant while serum phosphorus (P) concentration and urinary P excretion were low. Serum immunoreactive parathyroid hormone and plasma 25-hydroxyvitamin-D concentrations were normal. A significant positive correlation was found between serum Ca concentration and urinary Ca excretion, and a negative correlation between serum Ca concentration and serum P concentration or urinary P excretion. Hypercalcemia disappeared spontaneously in two patients, was corrected by a humanized milk in three patients and by P supplementation in five patients. These data suggest that neonatal hypercalcemia is related to P depletion induced by human breast milk in premature infants.

[GRF and human somatotropic adenoma. In vivo and in vitro correlations between GH release and morphological and immunocytochemical aspects]. / GRF et adénomes somatotropes humains. Corrélations in vivo et in vitro entre la libération de GH et les aspects morphologiques et immunocytochimiques.

Nine somatotropic adenomas identified by histological and immunocytochemical methods were studied in vitro during 40 days. The spontaneous release of GH decreased at various rates according to adenomas. A decrease in the size, number of secretory granules and in immunoreactivity with anti-hGH serum were also noted. When cortisol was added (350 nM), the GH secretion sustained for a longer time or even increased at its initial level. The effect of GRF (hpGRF1-44NH2, 10(-8)M) on GH release was tested by 3 hours incubation at 6-9 days of culture. The increase in GH varied from 106 to 420% compared to the basal release. It was similar to in vivo release in 3 out of 6 cases. The highest responses were found in densely granulated and strongly immunoreactive adenomas. The effect of GRF on the GH synthesis was studied by continuous incubation of GRF (10(-8)M) from the 10th the 40th day of culture. The quantity of GH in the culture medium was never higher than in culture mediums without GRF. No change in GH concentrations in mediums with or without cortisol was found when TRH (2.5, 10(-6)M) or TRH + GRF was added. No change in morphological and immunocytochemical cell characteristics were noted either with or without GRF. Thus, the variability of GH response to GRF in somatotropic adenomas in culture seems to be related to their morphofunctional heterogeneity. Under our experimental conditions, GRF stimulates the release of stored GH in tumoral cells but does not seem to stimulate its synthesis.

Demonstration of an antiglucocorticoid action of progesterone on the corticosterone inhibition of beta-endorphin release by rat anterior pituitary in primary culture.

The effects of progesterone or 17 alpha-hydroxyprogesterone on corticosterone regulation of beta-endorphin (beta-end) release have been studied in vitro using primary culture of rat anterior pituitaries. Incubation of pituitary cells with ovine corticotropin-releasing factor (CRF) for 2 h resulted in a dose-dependent increase in beta-end release. Maximal stimulation was obtained with 200 ng/ml CRF. Preincubation for 2 h with corticosterone resulted in a dose-dependent inhibition of CRF-induced beta-end release. When the cultures were preincubated for 2 h with 200 ng/ml corticosterone and increasing concentrations (1, 10, 100, 1,000, and 10,000 ng/ml) of progesterone, a significant decrease in the corticosterone feedback action was observed with 100 ng/ml progesterone. Complete inhibition of the action of 200 ng/ml corticosterone was achieved with 10,000 ng/ml progesterone. Moreover, when the cultures were preincubated with increasing concentrations of corticosterone in the presence of 100 ng/ml progesterone, the ED50 of corticosterone increased significantly from 212 +/- 36 to 940 +/- 42 ng/ml (mean +/- SEM; P less than 0.01). Under the same conditions, 17 alpha-hydroxyprogesterone had no effect. These data demonstrate that progesterone antagonizes the corticosterone feedback inhibition of beta-end release by rat anterior pituitary.

[Deficiency rickets in older children. Apropos of 2 cases]. / Rachitisme carentiel chez le grand enfant. A propos de 2 observations.

Typical rickets were observed in a 13 year old Turkish girl and in a 14 year old Moroccan girl. Hypocalcaemia was present in one case. Symptoms have easily regressed with vitamin D2. Seric 25 OH D3 was very low; seric 1-25 OH D3 was normal before treatment and increased very much with vitamin D. In the second case vitamin D deficiency was familial. Study of 15 immigrant children living in or near Saint-Etienne has shown low seric concentrations of 25 OH D3 in 9 (8 undetectable).

[Levels of plasma 1,25-dihydroxyvitamin D and parameters of phospho-calcium metabolism in children with non-dialyzed chronic renal failure]. / Taux de 1,25-dihydroxyvitamine D plasmatique et paramètres du métabolisme phosphocalcique de l'enfant en insuffisance rénale chronique non dialysé.

1,25-diOH vitamin D, 25-OH vitamin D, parathyroid hormone, calcium and phosphorus were measured in the blood of 34 children and correlated. These children, 3 months to 17 years old, had chronic renal insufficiency of varying intensity. 15 of them were treated with vitamin D. We found a negative correlation between the 1,25-diOHD levels and the reduction of the clearance of inuline, serum creatinine and uremia. This suggests a defect in 1,25-diOHD synthesis appearing when the glomerular filtration rate is decreased by about 50%, except in the case of tubulopathies, where it appears earlier. In these children, the 1,25-diOHD levels correlated with calcemia, but not with phosphoremia. The high levels of PTH were related with the lowest levels of 1,25-diOHD. The regulation of calcemia is thus basically controlled by the renal possibilities. There was a positive correlation between 1,25-diOHD and 25OHD levels when GFR was lower than 0.6 ml/sec./1,73 m2, indicating a dependence of 1,25-diOHD levels or its substrate in severe chronic renal failure.