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Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983–2004. Results: Forty-five patients (28 men; mean age 49 years, range 16–72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1–121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. Conclusions: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage.

Hyperprolactinaemia frequently causes secondary hypogonadism through central suppression of gonadotropin secretion. Macroprolactinomas (>1 cm diameter) are more common in males and may additionally cause more generalised hypopituitarism. Recovery of the thyrotropic and/or corticotropic axes is well described following selective adenomectomy, but remains poorly defined in relation to medical (dopamine-agonist) therapy of macroprolactinomas. We therefore performed a retrospective examination of case records of male patients who had received medical therapy alone for macroprolactinoma between 1980–2001 (n = 35) and in whom tumor shrinkage was documented by interval pituitary imaging (reported throughout by a single neuroradiologist). Mean prolactin level at baseline was 59,932 mU/L (median 31,400; range 3,215–332,000); mean period of follow up was 4.2 years (median 2.6; range: 1.0–15). Defects of the following axes were evident at diagnosis: LH/FSH-testosterone (n = 27; 77%), TSH-T4 (n = 14; 41%-not including one case with pre-existing 1° hypothyroidism), ACTH-cortisol (n = 8; 23%). Overall, 14 men (40%) were deficient in 1 axis, seven (20%) in 2 axes and seven (20%) in 3 axes. Growth hormone secretory status was not systematically evaluated. In all but 6 patients, prolactin levels fell to normal or near-normal levels (mean 764 mU/L; median 260; range

The use of somatostatin analogues for the treatment of acromegaly is now well established. Recently long-acting preparations of octreotide and lanreotide have been introduced. In this study we have assessed the efficacy and tolerability of the long acting somatostatin analogue octreotide LAR in patients with acromegaly, and compared it with lanreotide SR.

The thyrotropin (TSH) receptor is implicated in the pathogenesis of thyroid-associated ophthalmopathy, but its presence has not been demonstrated in orbital tissues. Binding of 125I-TSH to porcine orbital connective tissue and thyroid membranes was studied. At pH 7.4 125I-TSH bound to thyroid membranes with high affinity, but not to orbital connective tissue membranes. At pH 5.2, binding of 125I-TSH was evident on thyroid and orbital connective tissue membranes, although of low affinity. Low affinity binding at pH 5.2, could also be demonstrated on orbital fibroblasts; binding to membranes prepared from extraocular muscle, or from abdominal adipose tissue was not detected. Immunoglobulin G from healthy subjects (n = 17) and patients with ophthalmopathy (n = 19) were tested for inhibition of 125I-TSH binding to membranes. As anticipated patients' IgG exhibited greater inhibition than normal controls with thyroid membranes at pH 7.4 (p0.001). Similar results were obtained with thyroid membranes (p0.05), and orbital connective tissue membranes at pH 5.2 (p0.001). Significant correlations were found when percentage inhibition by IgG was compared between: thyroid membranes at pH 7.4 and thyroid membranes at pH 5.2, orbital connective tissue membranes at pH 5.2 and thyroid membranes at pH 7.4, and orbital connective tissue membranes at pH 5.2 and thyroid membranes at pH 5.2. A low affinity TSH-binding site is present in orbital connective tissue, and is recognized by IgG's from patients with ophthalmopathy which suggests that TSH receptor antibodies may target the orbit.

Thec-erbB-2 proto-oncogene encodes a 190-kD putative membrane receptor that shows considerable homology to the epidermal growth factor (EGF) receptor.c-erbB-2 is overexpressed in many human tumors but has not previously been studied in pituitary tumors. In the normal pituitary gland, EGF is believed to play a regulatory role, but EGF receptors were found to be absent in a study of 22 pituitary adenomas. In the present study, 32 human pituitary adenomas and 7 samples of normal human pituitary were stained for thec-erbB-2 oncoprotein. All were negative for membrane staining, which suggests that amplification of thec-erbB-2 oncogene is not important in the etiology and progression of human pituitary adenomas.

PREMESSE: La terapia dell’ipertiroidismo con radioiodio e efficace e sicura, ma e stata indicata come potenziale fattore di rischio per il peggioramento o la comparsa ex novo della oftalmopatia basedowiana (OB). SCOPO: Lo scopo di questo studio era di determinare l’andamento della OB dopo terapia con radioiodio. DISEGNO: Studio prospettico osservazionale. I pazienti venivano valutati prima della terapia e 2, 4, 6, e 12 mesi dopo il radioiodio. SETTING: Lo studio veniva condotto in un Centro di riferimento terziario. PAZIENTI: 72 pazienti con OB minimamente attiva partecipavano allo studio. A tutti veniva somministrata una dose prefissata di radioiodio e dopo due settimane veniva iniziata la terapia con L-tiroxina per prevenire l’ipotiroidismo. PRINCIPALI OBIETTIVI:Valutazione delle variazioni della attivita e della gravita della OB. RISULTATI: La misurazione della proptosi, l’apertura palpebrale, la diplopia e il Clinical Activity Score miglioravano significativamente. Utilizzando un criterio di rilevanza clinica, si verificava un miglioramento sostanziale della OB in 4 pazienti (solo transitorio in 3 casi), verosimilmente attribuibile alla storia naturale della malattia. In nessun caso la OB peggiorava. CONCLUSIONI: la terapia con radioiodio non e associata ad un peggioramento della OB se l’ipotiroidismo post-radioiodio viene prevenuto.