Od roku 1999 do roku 2003 bylo na Neurochirurgické klinice 1. LF UK, IPVZ a ÚVN Praha operováno celkem 277 nemocných s adenomem hypofýzy. Z tohoto počtu bylo 108 pacientů s hormonálně aktivními adenomy hypofýzy. K normalizaci nebo k dostatečnému poklesu hormonální hladin došlo u 61 pacientů po první operaci. V 47 případech nebyl hormonální pokles po první operaci dostatečný. Celkem v 18 případech byla indikována sekundární operace, pooperační medikamentózní léčba byla indikována u 17 pacientů, na Leksellově gama noži bylo ozářeno 34 pacientů. Po transsfenoidální operaci byla mortalita nulová, morbidita byla zaznamenána u 2 pacientů (1× trvalé zhoršení zraku, 1× likvorea). Trvalá substituce adiuretinem je nutná u 7 pacientů., There had been treated 277 patients with pituitary adenoma in period from 1999 to 2003 at Department of Neurosurgery, Central Military Hospital, Prague. Altogether there had been treated 108 patients with hormone-secreting adenomas. Normalization or sufficient hormone level decrease was observed in 61 patients after the first surgery. Hormone level decrease was not sufficient in remaining cases. Second surgery was performed in 18 cases, medicamental treatment was indicated in 17 cases, radiosurgery was applied in 34 cases. There was no mortality after transsphenoidal surgery, morbidity was observed in 2 cases (visual impairment in 1 case, CSF leak in 1 case). Permanent adiuretine substitution is needed in 7 cases., Václav Masopust, D. Netuka, V. Hána, and Lit. 22
Pituitary hyperplasia as well as proliferation of the endometrium are typical responses to estrogen administration in rodents. Both insulin-like growth factor-I (IGF-I) and epidermal growth factor (EGF) have been implicated as paracrine mediators and amplifiers of estrogen action in the rodent uterus. The auto/paracrine role of IGF-I, EGF, their receptors and IGF binding proteins in pituitary proliferation has not yet been solved. Here we have used a semi-quantitative reverse transcription polymerase chain reaction (RT PCR) assay to demonstrate the changes in IGF-I mRNA and EGF mRNA abundance in the proliferating male rat pituitary in response to estradiol benzoate (EB; 1 mg/kg b.w. twice weekly i.m. for 3 weeks) and modifying effect of drugs antagonizing the pituitary enlargement — antiestrogen tamoxifen (TAM, 5 mg/kg b.w. daily) and also the dopaminergic agonist terguride (TER, 0.66 mg/kg b.w. daily, routinely used for the treatment of prolactinomas). In three separate experiments, EB induced a 2.2-2.5 fold increase in pituitary weight. The abundance of IGF-I and EGF mRNAs in pituitaries of EB-treated animals did not differ from the controls in two experiments and in the third series with the most marked pituitary hyperplasia mRNAs of both growth factors were even significantly decreased. Antiestrogen TAM administered with EB partially blocked the EB-induced proliferation and significantly stimulated IGF-I mRNA (p = 0.003) and EGF mRNA (p = 0.023) expression, while EB or TAM alone did not stimulate mRNAs of the studied growth factors. Significant antiproliferative effect of dopaminergic agonist TER on EB-induced pituitary proliferation (p = 0.006) was accompanied with decreased IGF-I mRNA (p = 0.025), but not EGF mRNA abundance. Our results suggest that the estrogen-induced pituitary proliferation is independent of the local expression of IGF-I and EGF mRNAs.
Ghrelin is an endogenous growth hormone (GH) secretagogue recently isolated from the stomach. Although it possesses a strong GH releasing activity in vitro and in vivo, its physiological significance in endogenous GH secretion remains unclear. The aim of this study was to characterize plasma ghrelin levels in acromegaly and growth hormone deficiency (GHD). We investigated plasma total and active ghrelin in 21 patients with acromegaly, 9 patients with GHD and 24 age-, sex- and BMI-matched controls. In all subjects, we further assessed the concentrations of leptin, soluble leptin receptor, insulin, IGF-I, free IGF-I and IGFBP-1, 2, 3 and 6. Patients with acromegaly and GHD as well as control subjects showed similar levels of total ghrelin (controls 2.004±0.18 ng/ml, acromegalics 1.755±0.16 ng/ml, p=0.31, GHD patients 1.704±0.17 ng/ml, p=0.35) and active ghrelin (controls 0.057±0.01 ng/ml, acromegalics 0.047±0.01 ng/ml, p=0.29, GHD patients 0.062±0.01 ng/ml, p=0.73). In acromegalic patients plasma total ghrelin values correlated negatively with IGF-I (p<0.05), in GHD patients active ghrelin correlated with IGF-I positively (p<0.05). In the control group, total ghrelin correlated positively with IGFBP-2 (p<0.05) and negatively with active ghrelin (p=0.05), BMI (p<0.05), WHR (p<0.05), insulin (p=0.01) and IGF-I (p=0.05). Plasma active ghrelin correlated positively with IGFBP-3 (p=0.005) but negatively with total ghrelin and free IGF-I (p=0.01). In conclusion, all groups of the tested subjects showed similar plasma levels of total and active ghrelin. In acromegaly and growth hormone deficiency plasma ghrelin does not seem to be significantly affected by changes in GH secretion.
Our aim was to analyze the correlation of early postoperative cortisol levels in patients after transsphenoidal pituitary adenoma surgery compared to the standard dose ACTH test and Insulin tolerance test (ITT) several months later. We retrospectively reviewed data from 94 patients operated for pituitary adenoma in years 2009-2012. The comparison of day 7 (median) postoperative basal cortisol levels and 3.6 months (median) after pituitary adenoma surgery stimulation test - standard dose 250 μg 1-24ACTH test in 83 patients or ITT in 11 patients were performed. All 16 patients with early postoperative cortisol levels >500 nmol/l proved a sufficient response in the stimulation tests. At basal cortisol levels of 370-500 nmol/l the sufficient response was found in 96 % (27/28) of patients. In the postoperative basal cortisol levels 200-370 nmol/l we found a preserved corticotroph axis later on in 88 % (28/32) of cases. Patients with basal cortisol levels 100-200 nmol/l had a maintained corticotroph axis function in 8/11 cases - 73 %. All patients with an early postoperative basal cortisol level above 500 nmol/l proved in the stimulation tests a preserved corticotroph axis function. The interval 370-500 nmol/l showed a minimal risk of postoperative adrenal insufficiency., V. Hána Jr., J. Ježková, M. Kosák, M. Kršek, J. Marek, D. Netuka, M. Hil, V. Hána., and Obsahuje bibliografii