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Clinical studies on pituitary adenoma with special reference to the dynamics of pituitary hormones

, : Clinical studies on pituitary adenoma with special reference to the dynamics of pituitary hormones. Fukuoka Igaku Zasshi 73(7): 359-368

The anterior pituitary function in 80 patients with pituitary adenomas (functioning adenomas 62 cases, nonfunctioning adenomas 18 cases) was evaluated neuropharmacologically. Histological examination of GH [growth hormone] secreting adenomas revealed 18 eosinophilic adenomas, 5 mixed type adenomas and 3 chromophobic adenomas. ACTH-secreting adenomas were all basophilic adenomas, and hyperprolactinemic and non-functioning adenomas were all chromophobic adenomas. In GH-secreting adenomas, the duration of illness was longer in the patients with microadenomas than in the patients with macroadenomas. Basal serum GH levels correlated well with tumor size. Of 26 patients with GH-secreting adenoma, 23 (88%) showed abnormal GH response to TRH. The response to TRH was most useful in the early diagnosis of the GH-secreting adenomas. Dopaminergic drugs markedly lowered serum GH levels in most cases of GH-secreting adenomas. This inhibitory effect of dopaminergic drugs may be attributed to the modified dopamine receptors of the GH-secreting adenoma cell. GH secretion from the adenoma was significantly suppressed by the i.v. infusion of somatostatin. The functional connection between the hypothalamus and the pituitary adenoma in acromegaly apparently still persisted. In the patients with ACTH-secreting adenomas, hyperresponse of plasma ACTH to lysine-vasopressin and abnormal response to LH-RH were noted. These findings were thought to be useful in the diagnosis of the ACTH-secreting adenoma. In the cases with high serum PRL [prolactin] levels, the PRL-secreting adenomas could be diagnosed even though there was no deformity of the sella turcica and no galactorrhea-amenorrhea. Impaired or absent responses of serum PRL to TRH was useful in diagnosing the PRL-secreting adenoma. The incidence of impaired pituitary hormone secretion was higher in the patients with macroadenomas than in the patients with microadenomas. Serum TSH response to TRH was markedly impaired in patients with GH-secreting adenomas, and serum LH response to LH-RH was selectively impaired in patients with hyperprolactinemic adenoma. Serum GH response to insulin-induced hypoglycemia appeared to be impaired in all patients with non-functioning adenomas.


PMID: 7141377

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