Progestin and oestrogen receptors in meningiomas. Biochemical characterization,clinical and pathological correlations in 42 cases

Summary Progestin receptors (PR) were evaluated in 40 intracranial and 2 spinal meningiomas. PR measured with radiolabelled R 5020 were found in 93% of cases (³⁹/₄₂). PR levels were significantly higher (p=0.05) in females (mean: 5,720 fmol/gmT) than in males (mean: 3,120 fmol/gmT). Biochemical characterization of the R 5020 saturable binding sites showed that they were mainly cytosolic, had a high affinity constant (Kd 1 nM) and were progestin specific. Correlation with sex suggested some biological activity of PR in meningiomas.Oestrogen receptors (OR) were evaluated in 36 intracranial and 2 spinal meningiomas. OR measured with radiolabelled R 2858 were present in 79% of cases (³⁰/₃₈). OR mean levels were equal in females (mean: 285 fmol/gmT) and in males (mean: 330 fmol/gmT). The relevance of PR and possibly OR in the biology of meningiomas and of leptomeninges was suggested by the presence of receptors in a sample of normal leptomeninges.     

垂体腺瘤性男性不育

垂体腺瘤是男性不育的重要病因。现代内分泌和影像学检查能够早期诊断垂体腺瘤引起的男性不育症。针对垂体腺瘤的病因治疗是治疗此类不育症的最佳选择。     

孕激素与男性生殖

孕激素对男性下丘脑 垂体 睾丸轴具有反馈抑制作用。垂体及生殖腺均检出明显的孕激素受体mRNA ,且呈不同分布特点。人生精细胞和精子中含有一定数量的孕酮 ,提示孕激素与精子产生的数量、精子胞膜完整性和染色体稳定性以及受精有关。孕、雄激素合用引起的可逆性抑制精子发生 ,其机制在于孕激素反馈抑制促性腺激素的分泌 ,近来还发现其可能直接作用于睾丸及附睾 ,在局部直接发生效应。生理剂量的孕激素可以促进雄激素依赖的雄性性行为 ;而药理浓度孕激素可以抑制雄性性行为 ,其机制不仅仅是通过降低睾酮水平 ,而且在中枢神经系统有直接的作用。孕烷衍生物具有部分选择性抑制Ⅱ型 5α 还原酶的作用 ,提示用于前列腺疾病有更多益处     

Progestin receptors in meningiomas

Summary The results are reported of ligand binding and enzyme immunoassays in tumour cytosols, and of immunoperoxidase assays in cryostat and paraffin sections measuring oestrogen (ER) and progestin receptors (PR) in 22 meningiomas and three non-meningioma tumours (two neurinomas and one haemangiopericytoma).With regard to the meningioma tissues, cytochemical immunoperoxidase PR-staining was present in all cryostat sections and in all but one of the paraffin sections. There was a good degree of qualitative accordance between all assay methods; they revealed the picture of typical meningiorna: high PR and low ER.In this series, immunoperoxidase staining for the detection of PR-receptors, both in cryostat and paraffin sections, rendered encouraging results, thus offering a method for the detection of progestin receptors, which can compete with cytosolic methods.     

Treatment of Pituitary Carcinomas and Atypical Pituitary Adenomas: A Review

Atypical pituitary adenomas (APAs) are aggressive tumors, harboring a Ki-67 (MIB-1) staining index of 3% or more, and positive immunohistochemical staining for p53 protein, according to the World Health Organization (WHO) classification in 2004. Pituitary carcinomas (PC) usually develop from progressive APAs and predominantly consist of hormone-generating tumors, defined by the presence of disseminations in the cerebrospinal system or systemic metastases. Most of the cases with these malignant pituitary adenomas underwent surgeries, irradiations and adjuvant medical treatments, nevertheless, the therapies are mainly palliative. Recently, the efficacy of temozolomide (TMZ), an orally administered alkylating agent, has been reported as an alternative medical treatment. However, some recent studies have demonstrated a significant recurrence rate after effective response to TMZ. Further clinical and pathological researches of malignant pituitary adenomas will be required to improve the outcome of patients with these tumors.     

Reversal of Short Photoperiod-Induced Sterility in Male Hamsters by Ectopic Pituitary Homografts

In the hamster testicular atrophy can be reversed by ectopic pituitary grafts but effects of this treatment on fertility have not been examined. Adult male hamsters were transferred from a long (14 h of light: 10 h of darkness) to a short photoperiod (5 h of light: 19 h of darkness) to induce atrophy of the testes. Two months later, the animals were given transplants of one or two pituitaries from adult females under the kidney capsule, were sham-operated, or left untreated. After an additional 2 months, all of 7 animals given one graft and 2 of 5 animals given two grafts were fertile while none of 10 control males sired litters. At autopsy, the concentration of testosterone in the plasma and the weights of the testes and the seminal vesicles were significantly higher in grafted than in control animals. Plasma FSH levels were increased only in animals given two transplants, while plasma LH levels were not affected by either of the treatments. Restoration of fertility by pituitary transplants was most likely due to increase in peripheral PRL concentration and in testicular LH receptor levels.     

LH Response to LH-RH Neonatally Estrogenized Male Rats

The LH response to 100 or 1000 ng of LH-RH was studied in adult male rats treated neonatally with 500 micrograms of estradiol benzoate or olive oil. The dose of 100 ng elicited the same LH increase in both groups, but the estrogenized animals responded more when 1000 ng of LH-RH was injected. These data suggest that the decreased LH response to orchidectomy found in estrogenized animals is not due to a failure in pituitary responsiveness to LH-RH.     

Pituitary apoplexy. Report of 25 patients

A series of 25 patients with a clinical diagnosis of pituitary apoplexy (PA) is reviewed. It included 14 men and 11 women aged between 20 to 79 years (mean age: 54 years). Twenty-two patients did not know that they had a pituitary tumor when the apoplexy occurred. A precipitating event was found in 3 cases. Symptoms and signs ranged from isolated ocular paresis to a deep coma. Seventeen patients experienced a decrease in their visual acuity. CTscan and MRI showed a pituitary adenoma in all cases, a hemorrhage was also present in 10 out of the 24 CTscans, and in all the 8 MRI performed. Twenty patients underwent surgery; 18 of them by a transsphenoidal approach. A complete recovery of visual acuity was observed in 75% of patients operated within the week following the onset of symptoms, and in 56% of patients operated later on. There was no case of complete visual recovery among the blind patients. Pituitary apoplexy is a clinical concept. It applies only to symptomatic cases. It is generally a complication of a pituitary adenoma which is in most cases unknown. There are different degrees of severity; PA can even be life-threatening. The principal aim of surgery in the acute phase is the improvement of visual prognosis. In our series, blind patients or those with a history of visual loss for more than a week or with a blindness had a poorer prognosis.     

改良翼点入路显微手术切除垂体巨腺瘤及术中垂体柄保护

目的 探讨巨大型垂体腺瘤显微手术切除及垂体柄保护方法。方法 采用改良翼点入路对48例巨大垂体腺瘤（直径〉40mm）行显微手术切除，术中注意保护垂体柄。结果 肿瘤伞切除36例，近全切除8例，大部切除4例，其中全切除患者垂体柄保留30例（83．3％）。所有病例无一例死亡。术后发生尿崩症31例（64．6％），其中21例在1～2周内恢复正常，7例在3个月内恢复，3例尿崩症状持续2年左右？随访2～3年，无复发病例，无其他并发症。结论 采用改良翼点入路治疗巨大垂体瘤效果确切，术中垂体柄保留是降低术后尿崩症发生率、提高手术疗效的关键措施。     

糖尿病大鼠膀胱重构中M3受体改变的实验研究

目的:研究病程24周的2型糖尿病大鼠膀胱重构时,逼尿肌收缩功能的改变和M3受体含量及其基因转录水平的改变情况,并探讨二者之间的相关性。方法:2d龄雌性Wistar大鼠随机分成实验组和正常对照组,应用链脲佐菌素腹腔注射并结合高糖高脂饮食进行2型糖尿病大鼠动物模型制备。于糖尿病病程24周时进行下列实验:应用离体膀胱灌注方法观察逼尿肌收缩功能的变化;应用RT-PCR和Western blotting方法观察逼尿肌M3受体mRNA和蛋白表达的变化。结果:2型糖尿病组大鼠逼尿肌收缩功能低于正常对照组,为(16.52±2.97)cmH2O/100mgVS(25.66±3.56)cmH2O/100mg;2型糖尿病组大鼠逼尿肌M3受体mRNA和蛋白的表达均高于正常对照组,分别为(65.27±4.61)%VS(37.53±4.02)%和(45.19±2.37)%VS(23.67±2.85)%。结论:本研究证实了2型糖尿病大鼠在病程24周时膀胱逼尿肌的收缩力降低,但M3受体的生物合成却上调,这种不平行现象可能是病变进展的表现,为深入研究糖尿病膀胱病的发病机制提供了有价值     

Pituitary abscesses. Report of three cases

Three cases of pituitary abscess are presented. In spite of improvements in radiological evaluation, preoperative diagnosis of pituitary abscess is quite difficult and definite preoperative diagnosis is rare in the literature. In our three cases, diagnosis was made postoperatively. Pituitary abscesses are associated with high mortality and morbidity. When first suspected, prompt antibiotic therapy should be considered. Early operative drainage seems to be an important factor in decreasing this high mottality and morbidity.     

Effect of Fetal Irradiation on Testicular Receptors and Testosterone Response to Gonadotrophin Stimulation in Adult Rats

The amount of [125I]human chorionic gonadotrophin bound by testicular membrane preparations from adult male rats with germinal cell aplasia induced by x-irradiation in utero was significantly reduced in comparison to that of normal males. The in vivo serum testosterone response to an injection of human chorionic gonadotrophin was significantly decreased in the x-irradiated rats. Paradoxically, the in vitro maximal secretory response to gonadotrophin stimulation was markedly increased. It is concluded that a decrease in the number of receptors on Leydig cells subjected to chronically elevated serum levels of LH does not limit the capacity of the testis for steroid biosynthesis.     

Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers

Introduction Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results There were 14 men and 16 women with an average age of 53.8 years (range: 27–76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3–5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient outcomes.     

心理性勃起功能障碍的下丘脑PET研究

目的:研究心理性勃起功能障碍(ED)患者下丘脑代谢的改变,以期为心理性ED可能存在的潜在病因和病理生理机制的探讨提供线索。方法:运用正电子发射断层成像(PET)研究6例心理性ED患者和4例年龄匹配的健康志愿者双侧下丘脑的葡萄糖代谢特点,给予视听性刺激,测定脑组织中18F脱氧葡萄糖(18F-FDG)放射强度,计算单位像素内左(右)丘脑计数/全脑总计数。结果:接受视听性刺激后,健康志愿者双侧下丘脑的18F-FDG代谢明显增高(左:1.026±0.115vs2.400±0.210;右:1.003±0.187vs2.389±0.196;P<0.05),而心理性ED患者双侧下丘脑的18F-FDG代谢变化不明显(左:2.781±0.156vs2.769±0.223;右:2.809±0.129vs2.793±0.217,P>0.05)。结论:心理性ED可能不单纯是功能性疾病,下丘脑可能参与了心理性ED的病理生理过程。     

理气开郁法板块方对慢性应激大鼠下丘脑和胃P物质的影响

目的：探讨理气开郁法四个小复方对慢性应激大鼠胃和下丘脑P物质的影响。方法：采用多四素随机性反复刺激引起慢性应激大鼠模型,再分别淡用四个理气开郁小复方及阳性对照药进行治疗。应用放射免疫法测定组织匀浆中的P物质。结果：慢性应激大鼠出现类似肝郁脾虚的表现。与正常组大鼠比较,模型组大鼠胃和下丘脑SP含量显著降低（P〈0．05）;13．5g／kg痛泻要方可提高胃组织SP,且作用强于4．5g／kg痛泻要方和氯米帕明（P〈0．05）;13．5g／kg会铃子散的作用也强于氯米帕明（P〈0．05）。13．5g／kg柴郁汤能提高下丘脑SP,且作用强于1．5g／kg柴郁汤（P〈0．05）。结论：采用多因素随机性反复刺激引起慢性应激大鼠胃和下丘脑SP水平降低,痛泻要方提高胃组织SP的作用较强,柴郁汤提高下丘脑SP的作用较强。     

Chronic Renal Failure Impacts the Expression of Ghrelin and Its Receptor in Hypothalamus and Hippocampus

Background/Aims: Ghrelin plays a central role in the regulation of gastrointestinal (GI) motility. This study aimed to investigate the expression of ghrelin and growth hormone secretagogue receptor (GHSR) in the central nervous system of rats with chronic renal failure (CRF). Methods: Sprague-Dawley rats (male, 180 ± 20 g, n = 24) were treated by 5/6 nephrectomy to construct CRF model. As their plasma creatinine concentration and blood urea nitrogen were maintained more than double the normal level for 2 weeks, they were killed for assessing the expression of ghrelin and GHSR in hypothalamus and hippocampus using immunohistochemistry and real-time polymerase chain reaction (RT-PCR). The rats (male, 180 ± 20 g, n = 24) treated by Sham operation served as a control. One-way analysis of variance and Student–Newman–Keuls q test were used to analyze group difference and a p-value of <0.05 was considered as statistically significant. Results: Compared with the controls, the ghrelin and GHSR expression was obviously increased in the hippocampus (p < 0.05) but decreased in the hypothalamus of rats with CRF (p < 0.05). Conclusions: CRF was found to impact the expression of ghrelin and GHSR in hypothalamus and hippocampus. This might be associated with the CRF-induced GI motility dysfunction.     

Pituitary disease and anaesthesia

Patients with pituitary gland tumours comprise a significant proportion of the neurosurgical population, making transphenoidal pituitary surgery a relatively common procedure. These patients present unique anaesthetic challenges resulting from hormone hypersecretion, pituitary hypofunction or tumour mass effect. To understand this pathophysiology requires knowledge of normal pituitary anatomy and physiology. Respiratory and cardiovascular sequelae of pituitary tumours also pose anaesthetic challenges. We aim to review the key principles involved in the preoperative assessment, intraoperative management and postoperative care of these patients.     

理气开郁法板块方对慢性应激大鼠胃及下丘脑胃动素的影响

目的：探讨四个理气开郁法板块方对慢性应激大鼠胃和下丘脑胃动素的影响。方法：采用多因素随机性反复刺激引起慢性应激大鼠模型,再分别使用四个理气开郁小复方及阳性对照药进行治疗。应用放射免疫法测定组织匀浆中的胃动素。结果：慢性应激大鼠的外在表现类似于中医症候中的肝郁脾虚证。与正常组大鼠比较,模型组大鼠胃和下丘脑胃动素水平显著降低（P〈0．01）。与模型组比较,4．5g/kg芍甘汤可提高胃组织胃动素水平（P=0．055）,4．5g／kg芍甘汤的作用强于13．5g/kg芍甘汤、4．5g／kg痛泻要方和马普替林（P〈0．05）;与模型组比较,13．5g/kg痛泻要方可提高下丘脑胃动素水平（P=0．091）,作用强于氯米帕明和马普替林（P〈0．05）,结论：多因素随机性反复刺激可引起慢性应激大鼠胃和下丘脑胃动素水平降低,芍甘汤可提高胃组织胃动素水平,痛泻要方可提高下丘脑胃动素水平。