1/18. Triple pituitary adenoma in Cushing's disease: case report.A case of a triple pituitary adenoma identified in a surgically removed pituitary gland from a 52-year-old woman operated on for Cushing's disease is presented. The histology revealed 3 distinctly separate microadenomas, 1 corticotroph and 2 immunoreactive for prolactin (PRL). The latter were apparently silent, since the serum PRL levels were within normal range. The problems associated with the inability to identify multiple adenomas pre-operatively and the possible failure of selective transsphenoidal adenomectomy in case of multiple adenomas are emphasised.- - - - - - - - - - ranking = 1keywords = pituitary gland, pituitary, gland (Clic here for more details about this article) |
2/18. An R201H activating mutation of the GNAS1 (Gsalpha) gene in a corticotroph pituitary adenoma.In the pituitary gland, activating mutations of the GNAS1 (Gsalpha) gene at Gln227 have been identified in adrenocorticotrophin secreting, growth hormone secreting, and prolactin secreting adenomas. To date, mutations at the codon encoding R201, typically underlying the McCune-Albright syndrome and isolated fibrous dysplasia of bone, have been demonstrated only in growth hormone secreting pituitary adenomas. In this study, a polymerase chain reaction amplified target sequence in exon 8 of the GNAS1 gene was sequenced, identifying the first R201 mutation seen in an isolated basophilic adenoma which generated Cushing's disease in a child. This case adds Cushing's disease to the range of human diseases caused by R201 mutations of the GNAS1 gene.- - - - - - - - - - ranking = 1keywords = pituitary gland, pituitary, gland (Clic here for more details about this article) |
3/18. Double adenomas of the pituitary: a clinicopathological study of 11 tumors.Of more than 3000 cases of surgically removed pituitary adenomas, 11 were defined as "double adenomas," i.e., 2 morphologically or immunocytologically distinct tumors. In 8 cases, the lesions exhibited differing histological features and immunophenotypes; in 2 specimens, distinct ultrastructural features were noted as well. In another instance, despite histological and immunocytological uniformity, the two neoplastic components demonstrated distinct ultrastructure. In yet another case, the two adenomas were consecutively removed; despite similar histological features, they differed in immunocytological and ultrastructural characteristics. Last, in one case, the adenoma was histologically uniform, but a portion of the mass exhibited immunoreactivity by ultrastructural features distinct from those of the remainder of the lesion. Hormonal excess attributed to both tumors could be correlated with endocrine manifestations in two cases. Double adenomas of the pituitary occur infrequently. In routine histological sections of surgical material, they are often difficult if not impossible to identify. Presented herein are clinical and endocrinological data on 10 cases of double pituitary adenomas correlated with morphological and immunocytochemical results. The literature regarding multiple adenomas is reviewed as are the diagnostic and therapeutic difficulties associated with these rare lesions.- - - - - - - - - - ranking = 0.9371092174247keywords = pituitary (Clic here for more details about this article) |
4/18. Cushing's disease in a 5-month infant due to a basophilic microadenoma of the pituitary gland.We report a female patient who developed severe Cushing's disease during the fifth month of life due to a basophilic pituitary adenoma Histological findings showed a basophilic microadenoma of the pituitary gland, leading to the diagnosis of Cushing's disease. The infant died because of untreatable septic shock. The importance of the present report resides in the age of the child at diagnosis, and that it was the necropsy finding of microadenoma which clarified the cause of the Cushing's syndrome, since it was not diagnosed during life. Cushing's disease is most often diagnosed in children older than 7 years, and our patient was only 5 months old when we detected the pituitary adenoma, the earliest case diagnosed so far. Cushing's syndrome in pediatric patients has been rarely reported and most cases are due to functioning adrenal tumors, usually a malignant carcinoma but occasionally a benign adenoma. The present case shows that the pituitary of these patients should be investigated with important implications in terms of therapeutic approaches, such as pituitary radiotherapy, which can cure the patient when treatment is started very soon.- - - - - - - - - - ranking = 2.1886723477259keywords = pituitary gland, pituitary, gland (Clic here for more details about this article) |
5/18. Postadrenalectomy pituitary adenoma (Nelson's syndrome) in childhood: clinical and roentgenologic detection.Following total adrenalectomy in Cushing's syndrome associated with adrenal hyperplasia, but not with adrenal adenoma or malignancy, elements of the pituitary may be stimulated to grow rapidly and even aggressively. There is strong evidence to support the idea that there is a pre-existing tumor in many, if not all, of these cases. In some, the tumor may be too small to deform the sella turcica. After adrenalectomy, these patients should be observed carefully and frequently for hyperpigmentation, visual field defects, and sella turcica enlargement.- - - - - - - - - - ranking = 0.66936372673193keywords = pituitary (Clic here for more details about this article) |
6/18. Cure of Cushing's disease by transsphenoidal removal of a microadenoma from a pituitary gland despite a radiographically normal sella turcica.A 37-year-old woman had symptoms of Cushing's disease for two years. galactorrhea was present. The diagnosis was confirmed by finding intermittently elevated urinary 17-hydroxysteroids, absent circadian rhythm, and elevated plasma ACTH. plasma prolactin was slightly elevated. Films of the sella turcica were normal. A 9 mm basophilic microadenoma was removed by the transphenoidal approach. Immunocytochemical and electron-microscopic studies showed that the tumor was composed exclusively of ACTH secreting cells. Endocrine re-evaluation one year later revealed normal adrenal function. serum prolactin had returned to normal. This case provides further evidence that Cushing's disease can be caused by a pituitary microadenoma insufficient in size to deform the sella.- - - - - - - - - - ranking = 1.4564178384187keywords = pituitary gland, pituitary, gland (Clic here for more details about this article) |
7/18. Cushing's syndrome, nodular adrenal hyperplasia and virilizing carcinoma.A 48-year-old hypertensive diabetic woman rapidly became virilized. urine 17-oxo-and oxogenic steroids and plasma testosterone, androstenedione, DHEA, DHEA-sulphate and androstenediol were greatly elevated. plasma cortisol was constantly high and was not suppressed by dexamethasone. Circulating immunoreactive ACTH was consistently detectable at 18-24 ng/l. A 450 g carcinoma arising from a nodular hyperplastic right adrenal gland was resected. Production by the tumour of 17a-hydroxypregnenolone, 17a-hydroxyprogesterone and five C-19 steroids, but very little prenenolone, progesterone or cortisol, was shown by blood sampling, tumour culture and dramatic falls after operation. The plasma cortisol fell to half, with no diurnal variation, consistent with persistent Cushing's syndrome, and the plasma ACTH rose to 55 ng/l. She died 3 months later from a myocardial infarction. autopsy revealed a pituitary basophil adenoma at a site where radiologically there had been an indentation in the fossa floor for at least 7 years. The left adrenal gland showed nodular hyperplasia. Therefore we conclude that mild pituitary-dependent Cushing's syndrome may have been present for many years before development of a virilizing carcinoma. This case demonstrates that adrenal carcinoma in man can sometimes develop as a consequence of nodular adrenal hyperplasia which may in turn be due to long-standing trophic hyper-stimulation.- - - - - - - - - - ranking = 0.26814433448927keywords = pituitary, gland (Clic here for more details about this article) |
8/18. Is magnetic resonance imaging more sensitive than computed tomography in the location of corticotropin secreting pituitary adenomas?Two cases of pituitary-dependent Cushing's syndrome are described in which the computed tomography (CT) examination was negative; as the hormone dynamic investigations were directed towards the presence of corticotropin (ACTH) secreting pituitary formations, magnetic resonance imaging (MRI) of the pituitary was performed, which evidenced the presence of such lesions; subsequent neurosurgery confirmed in both cases the location indicated by MRI. In conclusion, the higher sensitivity of MRI compared to CT in the diagnosis of ACTH secreting pituitary adenomas can be noted.- - - - - - - - - - ranking = 1.0709819627711keywords = pituitary (Clic here for more details about this article) |
9/18. The definition of true recurrence of pituitary-dependent Cushing's syndrome after transsphenoidal operation.Two patients are described with pituitary-dependent Cushing's syndrome who had successful transsphenoidal selective removal of basophil microadenomas. After a period of adrenal insufficiency the clinical signs and the cortisol secretion rate became normal after 12-18 months, together with the return of a normal feedback response to glucocorticoids (dexamethasone suppression), a normal diurnal rhythm of plasma cortisol, and a normal response to stress (increase of plasma cortisol to insulin-induced hypoglycaemia). However, pituitary-dependent Cushing's syndrome recurred 38 and 56 months after operation. This was preceded by gradual changes of the results of the dexamethasone tests, disappearance of the diurnal rhythm of cortisol, and of the responses of plasma cortisol to hypoglycaemia. 'True recurrence' should be defined as the return of the clinical and biochemical characteristics of Cushing's syndrome after a successful transsphenoidal operation, with a normal hypothalamic-pituitary-adrenal axis as evidenced by a normal response to dexamethasone, a normal diurnal rhythm of cortisol and a normal increase of plasma cortisol with insulin-induced hypoglycaemia.- - - - - - - - - - ranking = 0.9371092174247keywords = pituitary (Clic here for more details about this article) |
10/18. A case of pituitary dependent Cushing's disease with clinical and biochemical features of the ectopic ACTH syndrome.A case of atypical pituitary dependent Cushing's disease is reported. The patient presented with clinical symptoms similar to those of the ectopic ACTH syndrome; notably a marked hypokalaemic alkalosis, widely fluctuating plasma cortisol levels, greatly elevated plasma ACTH levels, and failure to suppress both plasma cortisol and ACTH levels following high dose oral dexamethasone. However, a large aggressive pituitary tumour was detected by skull X-ray and computed tomography. Removal of the pituitary tumour led to full remission of the patient's Cushing's syndrome. pro-opiomelanocortin (POMC) related peptides in the plasma and tumour tissue extract of this patient have been characterized by gel-filtration and Concanavalin-A sepharose affinity chromatography, indicating processing of POMC in a manner more usually associated with ectopic tumours.- - - - - - - - - - ranking = 0.9371092174247keywords = pituitary (Clic here for more details about this article) |
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