State of the cardiovascular system in chromophobe adenoma of the hypophysis]

The detected changes in the cardiovascular activity, primarily in the state of hemodynamics in patients with chromophobic adenoma of the hypophysis indicated a possible phasic character of the course of this disease. A sharp fall in the contractile capacity of the myocardium in a number of patients was most probably caused by marked hormonal and metabolic shifts developing against the background of insufficiency of the adeno-hypophysis. On the basis of the data obtained a detailed study of the state of the organs of circulation is recommended in all the patients with chromophobic adenoma of the hypophysis, particularly during the preoperative preparation.     

Pituitary apoplexy: retrospective study of 9 patients with hypophyseal adenoma

Pituitary apoplexy is an acute hemorrhage or ischemia infarction of the pituitary gland, almost invariably occurring in the presence of an pituitary adenoma. Although intratumoral bleeding occur in about 9.5 to 25% of pituitary adenomas, various series suggest that clinical apoplexy may be diagnosed in about 2% to 10% of the adenomas. In a retrospective study from 1988 to 1998 of 110 patients with hypophyseal adenomas, there were 9 cases with pituitary apoplexy, yielding an incidence of 8.2%. Their mean age was 52.4 +/- 12.8 a?os years, with a male to female ratio of 7:2. Symptoms observed were headache (89%), sudden visual deterioration (78%), vomiting (78%) and oculomotor nerves paresis (33%). The diagnosis of pituitary apoplexy was established by computerized tomographic scans, and hypophyseal macroadenoma with intratumoral bleeding was observed in every patient. Five patients underwent transphenoidal surgery. Improvement of visual deficit was observed in 3/4 (75%) and ocular paresis in 3/3 (100%) of affected patients. Four patients were treated conservatively with steroids. Two patients who had visual deficit recovered it completely without surgery. Two hypophyseal adenomas were resolved spontaneously after bleeding, one stayed unchanged and another presented recurrence of bleeding at six years of follow-up. Steroid and thyroid hormone replacement therapy was required in 62.5% of patients.     

Coincidence of hypophyseal adenoma and thyrogenic hyperthyroidism

It is reported on a patient with an adenoma of the hypophysis under the picture of acromegaly and simultaneously existing primary hyperthyroidism. In this very infrequent picture of a disease at first the removal of the hyperthyroid metabolic position should take place and then the therapy of an adenoma of the hypophysis should be introduced. Since our patient refused the operative treatment of the tumour of the hypophysis, we treated with bromocriptin.     

Screening for multiple endocrine neoplasia type 1 in patients with recognized pituitary adenoma

A total of 79 consecutive patients with pituitary tumours were screened for multiple endocrine neoplasia type 1 (MEN-1). The 79 patients included 21 patients with acromegaly, nine with Cushing's disease, 18 with prolactinomas, three with mixed pituitary adenomas (GH and PRL), and 28 patients with no detectable hypersecretion of hormones. The screening consisted of: (1) a family history, (2) a uniform medical history of the patient using a standard questionnaire, and (3) hormonal evaluation including measurements of the serum levels of insulin, gastrin, glucagon, somatostatin, vasoactive intestinal polypeptide and pancreatic polypeptide. Ionized calcium and glucose concentration in serum were also measured. We found no patients with the MEN-1 syndrome. In one patient, we found a transient elevation of serum concentrations of pancreatic polypeptide for which we have no explanation. In another patient, the serum gastrin concentration was elevated secondary to achlorhydria. No other endocrine disorders were found, and no patients had relatives with recognized endocrine pancreatic tumours, primary hyperparathyroidism (HPT), or pituitary adenomas.     

State of the cardiovascular system in patients with decompensated mitral valve defect under conditions of high altitude]

A clinical study was conducted in 236 patients with decompensated mitral valve disease--permanent residents of the areas located at various altitudes in the Pamirs and Tien Shan (760 to 4,200 m above the sea level). The main parameters of haemodynamics were studied by means of the dye dilution method in 158 of them, as well as the indices of cardiodynamics by way of polycardiography. The data obtained in 120 normal individuals living in foothills (760 m) served as control. It was demonstrated that with the same stages of cardiac insufficiency, the most striking changes in the haemo- and cardiodynamics were noted among the residents of the high altitude areas. Among those living at medium altitudes (1,650 to 2,020 m), the cardiac output and the left ventricular function appeared to be reduced most distinctly. These patients also exhibited a clear relationship between the main variables of the cardiovascular functions and the severity of cardiac insufficiency. The revealed clinical and functional peculiarities of the decompensated mitral valve disease in mountaneers are atrributable to the effect of hypoxic hyposy upon the regulation of the respiration and the pulmonary circulation.     

Some parameters of endocrine function in patients with hemophilia]

The hormonal status of 40 patients with hemophilia A and in 5 patients with hemophilia B was investigated by radioimmunoassay during exacerbation against a background of the hemorrhagic syndrome and in remission. A decrease in the plasma levels of cortisol, T3, insulin and high levels of ACTH and estradiol were observed in patients with a severe type hemophilia during exacerbation. Remission was characterized by an increase in the STH level and a decrease in the ACTH level. The severity of hemorrhagic manifestations was determined not only by a degree of a decrease in the level of blood factor VIII but also by a degree of a decrease in the levels of cortisol, T3 and insulin. Hormonal drugs (prednisolone, thyroidin and methyl androstenediol) were also included in multimodality therapy of hemophilia.     

Use of computed tomography in the examination of patients with endocrine ophthalmopathy]

Combined investigation of 29 patients with Basedow's disease, 5 patients with autoimmune thyroiditis, and 4 patients with mixed toxic goiter was carried out including computerized tomography (CT) of the orbits. The investigation of 10 patients was repeated 6 months after the first one. Signs of endocrine ophthalmopathy were detected in 28 patients with Basedow's disease and in 2 patients with autoimmune thyroiditis. Characteristic CT signs of retrobulbar tissue changes in endocrine ophthalmopathy were defined. The use of CT of the orbits was shown to improve early diagnosis of endocrine ophthalmopathies, to assess the time course of the disease and therapeutic efficacy. The authors proposed 3 variants of endocrine ophthalmopathy with regard to the involvement of the oculomotor muscles or retrobulbar fat tissue, revealed by CT.     

Change of the endocrine function of the pancreas in patients with chronic pancreatitis]

There was a study of 19 chronic pancreatitis patients (10 male and 9 female), 11 chronic pancreatitis and pancreatogenic diabetes mellitus patients (8 male and 3 female) and 12 type 2 diabetes mellitus patients (4 male and 8 female) at the age of 30-60 as well as 15 control group subjects at the same age range. The content of the C-peptide and such peptides as INCINE, PAMG-cine and PAMG-tin in the blood serum was subjected to the immunoradiometric assay. It was discovered that there is a trend to the increased C-peptide level in CP patients while the C-peptide level in CP patients with diabetes mellitus was smaller than that in the control group; the C-peptide level in CP patients with type 2 diabetes mellitus was higher as compared to that in the control group. It was shown that erythrocytes of CP patients are less sensitive to insulin action and do not respond to the presence of insulinomimetic peptides under examination during the glucose uptake test. CP patients with diabetes mellitus and type 2 diabetes mellitus patients are more sensitive to the action of insulin and peptides applied. Synthetic insulinomimetic peptides can serve as a means for discovering the functional cell deficiency under the glucose uptake test.     

Interrelationships between prolactin and the renin-aldosterone system in patients with various endocrine diseases]

Prolactin and aldosterone secretion and renin activity in the plasma were measured in the course of thyroliberin (TRH) test in women with various endocrine diseases, both connected with the water-salt metabolism disturbances and without these--with the idiopathic edemas (n = 11), hypothyrosis (n = 16), Stein-Leventhal'syndrome (n = 6), and obesity (n = 8). A reciprocal relationship between prolactin concentrations (a drastic elevation) and aldosterone levels (lowered) were revealed, as were universal responses of both the hormones to TRH administration in patients with various conditions. The authors come to a conclusion on the absence of a stimulating effect of prolactin on aldosterone secretion and plasma renin activity. They suggest an indirect contribution of prolactin to the regulation of the renin-aldosterone system, probably via dopaminergic mechanisms.     

Dopaminergic regulation of the hypothalamo-hypophyseal system in patients with hypophyseal adenomas

A study was made of the state of the hypothalamohypophyseal system in patients with different types of chromophobe adenoma. Altogether 62 patients were examined using metoclopramide and Parlodel tests (38 patients were with somatotropinoma, 13--with prolactinoma, 11--with somatotropinoma with hyperprolactinemia). The time course of STH, PRL and TSH secretion in the blood was investigated. Dopaminergic blockade in the Metoclopramide test was shown to cause no change in the time course of PRL secretion in patients with prolactinomas, and a PRL reaction in patients with somatotropinomas and adenomas with PRL and STH hypersecretion was sharply decreased. A paradoxical STH reaction (a decrease) in somatotropinomas and considerable disorders in the type of PRL and TSH secretion in all forms of adenomas was defined in the Parlodel test (a dopaminergic agonist). The results obtained suggest considerable disorders in the dopaminergic regulation of the hypothalamohypophyseal system of patients with chromophobe adenomas and the efficacy of the metoclopramide and Parlodel tests in the differential diagnosis of these conditions.