Presurgical Octreotide: Treatment in Acromegaly

One hundred seventy-two acromegalics who were operated on using the trans-sphenoidal approach underwent long-term follow-up evaluation. Sixty-four received 100 micrograms octreotide subcutaneously three times daily: for 3 to 6 weeks before surgery in 14 patients (group 1); and for 3 to 9 months in 41 and for 13 to 39 months in nine (n = 50, group 2). In 18 group 2 patients, the dose was increased stepwise to 500 micrograms three times daily because of incomplete suppression of growth hormone (GH)/insulin-like growth factor-1 (IGF-1). Tumor shrinkage was seen in 60% within 3 weeks, being nearly maximal by 3 to 4 months. More group 2 patients had greater than 25% tumor shrinkage (14 of 48 v 1 of 14 in group 1). Clinical response was excellent or good in 89%. Decrease in soft-tissue swelling and weight loss, and improved vitality, performance, carbohydrate metabolism, and cardiovascular function, facilitated anesthetic and surgical management; tumor removal was easy in virtually all cases. In all 64 patients, GH levels decreased by > or = 50%, and to < 2 micrograms/L in three of 14 patients initially and 25 of 50 patients after more prolonged treatment. IGF-1 levels decreased to normal in seven of 14 group 1 and 31 of 50 group 2 patients. Light and electron microscopy showed that adenomatous tissue exposed to octreotide had lysosomal accumulation, amyloid deposition, mild to moderate perivascular fibrosis, and moderate size reduction in both cytoplasmic and nuclear areas, with virtually no cellular complications. Remission with enclosed adenomas was greater (p < .05) than for the 108 patients not treated with octreotide; there was no difference for invasive adenomas. Octreotide use for 3 to 4 months before surgery can be recommended

Somatic MEN1 gene mutation does not contribute significantly to sporadic pituitary tumorigenesis.

Pituitary adenomas are a common manifestation of multiple endocrine neoplasia type 1 (MEN1) but most of them occur sporadically. There are only a few well defined genetic abnormalities known to occur in these sporadic tumours. The MEN1 gene located on 11q13 has recently been cloned and allelic deletion and mutation analysis studies have implicated the MEN1 gene in a significant fraction of the sporadic counterparts of typical MEN1 neoplasms (parathyroid tumours, insulinomas and gastrinomas). To determine if MEN1 gene inactivation is also involved in the development of sporadic pituitary adenomas, allelic deletions of chromosome 11q13 and MEN1 gene mutations and polymorphisms were assessed in 35 sporadic tumours of the anterior pituitary (9 prolactin-secreting, 8 GH-secreting, 3 TSH-secreting, 2 TSH/GH-secreting, 4 Cushing, 9 silent). Thirty-one tumours were found to be heterozygous for at least one MEN1 intragenic polymorphism (25 cases) or for a flanking gene polymorphism (6 cases). The remaining tumours were not informative. No mutations were found in any tumour except in one prolactinoma which was homozygous or hemizygous for a mutation (1-117 C-->T) in a region close to the promoter. Unfortunately, blood or normal tissue was not available in this case. Our data show that somatic MEN1 mutations do not contribute significantly to tumorigenesis of sporadic pituitary adenomas and suggest that mutation of other genes are likely to contribute to the pathogenesis of these tumours

The extraforaminal juxtafacet cyst as a rare cause of L5 radiculopathy: a case report.

STUDY DESIGN: This is a report of a case. OBJECTIVE: To document the clinical, radiographic, and histologic characteristics of a lumbar extraforaminal juxtafacet cyst. SUMMARY OF BACKGROUND DATA: Spinal juxtafacet cysts develop most frequently at the dorsal aspect of the zygapophysial joint, sometimes in the posterolateral area of the canal. In one case, they have been described in the foraminal and extraforaminal region. METHODS: Description of the case report. RESULT: The authors report one case of a strictly extraforaminal juxtafacet cyst responsible for L5 sciatica. CONCLUSIONS: Juxtafacet cysts of the spine represent an infrequent cause of sciatica, usually when they grow in the canal, or more exceptionally when they occupy the foraminal or extraforaminal areas

An unusual pituitary pathology

peer reviewe

Acromegaly

Les premières descriptions d'acromégalie ont été effectuées à la fin du siècle dernier par Pierre MARIE (1886). Cette affection, caractérisée par une hypersécrétion d'hormone de croissance a été longtemps considérée comme rare. En raison de sa progression insidieuse, elle est souvent diagnostiquée très tardivement. Dans cet article, nous illustrons le cas d'une patiente chez qui le diagnostic d'acromégalie a été posé au cours d'une opération pour adénocarcinome colique

The gonadotropic adenomas

Les adénomes hypophysaires gonadotropes qui sont parmi les plus fréquents, ont été identifiés récemment; on estime aujourd'hui qu'environ 80 % des adénomes hypophysaires dits non-sécrétants sont en fait gonadotropes. Étant donné l'absente de symptomatologie spécifique, ils ne sont souvent reconnus que lorsqu'ils sont volumineux, ayant déjà entraîné un syndrome neurologique, une compression du chiasma optique. Dans la plupart des cas il est possible de les identifier grâce aux produits de sécrétion ou encore par méthodes d'immunohistochimie ou encore par la détection de l'ARN messager correspondant aux sous-unités hormonales. Le traitement reste essentiellement neuro-chirurgical (chirurgie trans-sphénoidale) car, dans la plupart des cas, les agonistes dopaminergiques et les analogues agonistes ou antagonistes de GnRH sont inefficaces