pituitrin and Adenoma

Hypopituitarism refers to deficiency of one or more hormones produced by the anterior pituitary or released from the posterior pituitary. Hypopituitarism is associated with excess mortality, a key risk factor being cortisol deficiency due to adrenocorticotropic hormone (ACTH) deficiency. Onset can be acute or insidious, and the most common cause in adulthood is a pituitary adenoma, or treatment with pituitary surgery or radiotherapy. Hypopituitarism is diagnosed based on baseline blood sampling for thyroid stimulating hormone, gonadotropin, and prolactin deficiencies, whereas for ACTH, growth hormone, and antidiuretic hormone deficiency dynamic stimulation tests are usually needed. Repeated pituitary function assessment at regular intervals is needed for diagnosis of the predictable but slowly evolving forms of hypopituitarism. Replacement treatment exists in the form of thyroxine, hydrocortisone, sex steroids, growth hormone, and desmopressin. If onset is acute, cortisol deficiency should be replaced first. Modifications in replacement treatment are needed during the transition from paediatric to adult endocrine care, and during pregnancy.

Topics: Acute Disease; Adenoma; Adrenocorticotropic Hormone; Chronic Disease; Deamino Arginine Vasopressin; Gonadal Steroid Hormones; Gonadotropins, Pituitary; Hormone Replacement Therapy; Human Growth Hormone; Humans; Hydrocortisone; Hypophysectomy; Hypopituitarism; Pituitary Gland; Pituitary Hormones, Anterior; Pituitary Irradiation; Pituitary Neoplasms; Prolactin; Radiotherapy; Thyrotropin; Thyroxine; Vasopressins

Despite a stuttering course, gene therapy continues to provide a potential treatment avenue for many human diseases, including cancer and various inherited disorders. Gene therapy is also attractive for the treatment of local, benign disorders, such as pituitary adenomas. Advances in technology have focused on modifying existing viral vectors and developing targeted expression of therapeutic genes in an effort to achieve efficacy with minimal toxicity. Gene therapy also offers innovative strategies for treating hypopituitarism by replacing hormones such as growth hormone (GH) and vasopressin.

Topics: Adenoma; Animals; Gene Targeting; Genetic Therapy; Genetic Vectors; Growth Hormone; Hormone Replacement Therapy; Humans; Hypopituitarism; Models, Animal; Pituitary Diseases; Pituitary Neoplasms; Vasopressins

Cushing's disease remains a difficult diagnosis in spite of new technical procedures such as pituitary MRI, selective bilateral petrosal or cavernous sampling, (111)In pentreotide scan and 18 Flurodeoxyglucose pituitary PET scan. In this article, we review biological diagnostic procedures of Cushing's disease and corticotroph adenomas. According to our experience and the literature, we summarize the approach in medical treatment of Cushing's disease.

Topics: ACTH Syndrome, Ectopic; Adenoma; Adrenal Cortex Neoplasms; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Adult; Algorithms; Carcinoid Tumor; Child; Corticotropin-Releasing Hormone; Cushing Syndrome; Dexamethasone; Diagnosis, Differential; Diagnostic Imaging; Dopamine Agonists; Female; Humans; Hypothalamo-Hypophyseal System; Magnetic Resonance Imaging; Male; Petrosal Sinus Sampling; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Pregnancy; Pregnancy Complications, Neoplastic; Vasopressins

The diagnosis of Cushing's syndrome remains one of the most challenging tasks in clinical neuroendocrinology. The diagnostic procedure can be divided into two distinct steps: diagnosis of the neuroendocrine disorder and differential diagnosis of the precise aetiology. The goal of the first laboratory tests is to obtain biochemical proof of Cushing's syndrome. Patients with Cushing's syndrome are relatively insensitive to glucocorticoid feedback and exhibit an oversecretion of cortisol devoid of a circadian cycle. In our experience, a low-dose dexamethasone suppression test provides the most reliable confirmation of steroid resistance, a cortisol level of<50 nmol/l at 9 a.m. having 98% sensitivity. A cortisol level below 50 nmol/l at midnight rules out active Cushing's syndrome with, in our experience, 100% sensitivity and a specificity depending on numerous other variables. A very high level of free urinary corticol can be a useful sign. After having established the diagnosis of Cushing's syndrome, a persistently low level of ACTH (<10 pg/ml), or preferentially an undetectable level unresponsive to CRH (100 microgram iv), is suggestive of an ACTH-independent disorder, and consequently of primary adrenal disease. The precise location of the lesion can identified with CT or MRI imaging, generally prior to surgical cure. If the ACTH level is detectable, patients with pituitary Cushing's syndrome, or Cushing's disease, should be differentiated from those with ectopic ACTH secretion. The secreting tumour may be difficult to localise and diagnosis is never 100% sure with dynamic tests. Catheterisation of the petrosal sinus with CRH stimulation provides the best sensitivity for differentiating the two aetiologies. We consider a central to peripheral gradient of>3 to confirm the pituitary origin of the disorder with a 98% sensitivity. Chest or abdominal CT can be helpful to identify an ectopic tumour but very small tumours may go undetected. MRI can detect 60 or 70% of all pituitary adenomas but is virtually non-contributive to the diagnosis of Cushing's disease in children.

Topics: Adenoma; Adrenocorticotropic Hormone; Corticotropin-Releasing Hormone; Cushing Syndrome; Dexamethasone; Diagnosis, Differential; Diagnostic Imaging; Humans; Petrosal Sinus Sampling; Pituitary Neoplasms; Vasopressins

The authors describe several useful surgical techniques from our experiences in transsphenoidal microsurgery for pituitary adenomas. Intentional two-staged transsphenoidal removal with open sella floor and intrasellar drainage is available for most of giant adenomas with suprasellar extension. The open sella floor method and intrasellar drainage after first transsphenoidal adenomectomy accelerate to decrease the suprasellar tumor extension. In four of six patients in our series, macroscopically total selective adenomectomy was achieved by a second transsphenoidal operation without complications. As for extremely small microadenomas, represented in patients with Cushing's disease, stepwise systemic search is required to identify a subcortical microadenoma, preserving postoperative pituitary function. Edge resection around the microadenoma is also necessary for normalization of hormonal hypersecretion and permanent cure.

Topics: Adenoma; Deamino Arginine Vasopressin; Diabetes Insipidus; Humans; Hydrocortisone; Hypophysectomy; Pituitary Neoplasms; Postoperative Care; Vasopressins

Although the majority of patients with pituitary tumor, undergoing transsphenoidal microsurgery, have a low incidence of hormonal deficiency after surgery, the endocrinological evaluations should be carefully done before and after surgery. Glucocorticoid replacement is necessary in patients with Cushing's disease during and after surgery as well as those with adrenal insufficiency. Repeated CRF test is useful to assess the secondary adrenal insufficiency of Cushing's disease after surgery. Patients with impaired secretion of both ACTH and TSH should receive glucocorticoid replacement before thyroid hormone replacement in order to avoid adrenal crisis. A combination of CRF, GRF, TRH and GnRH is a safer and more reliable test to evaluate pituitary function than the conventional triple test consisting of insulin, TRH and GnRH, especially in patients predicted to have pituitary-adrenal insufficiency. Diabetes insipidus(DI), immediately after pituitary surgery, should be treated with subcutaneous injection of Pitressin. Even if patients seem to have recovered from DI several days after surgery, they must be monitored closely because of the incidence of triphasic DI. Less attention has been given to replacement for GH deficiency in adults. Recent reports revealed that GH replacement in adults with GH deficiency decreases visceral fat tissue and increases plasma calcium, phosphorus, osteocalcin and procollagen III levels. GH replacement will become more popular even in adults. Many options and technological advantages in the diagnosis and treatment of pituitary tumors have developed in a decade. In the near future, post-operative patients with pituitary tumors must be cared for in view of the "quality of life".

Topics: Adenoma; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Hydrocortisone; Hypophysectomy; Male; Pituitary Neoplasms; Postoperative Care; Vasopressins

Topics: Adenoma; Adrenocorticotropic Hormone; Bromocriptine; Growth Hormone; Humans; Hydrocortisone; Microsurgery; Pituitary Hormones; Pituitary Neoplasms; Prolactin; Sella Turcica; Thyrotropin; Tomography, X-Ray Computed; Vasopressins

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Cushing Syndrome; Diabetes Insipidus; Diagnosis, Differential; Growth Hormone; Hormones, Ectopic; Humans; Hyperpituitarism; Hypopituitarism; Pituitary Diseases; Pituitary Function Tests; Pituitary Gland; Pituitary Gland, Posterior; Vasopressins

Topics: 5-Hydroxytryptophan; Adenoma; Adenoma, Islet Cell; Adrenocorticotropic Hormone; Calcitonin; Catecholamines; Corticosterone; Gastrins; Glucagon; Growth Hormone; Humans; Insulin; Insulin Secretion; Kinins; Pancreas; Pancreatic Neoplasms; Peptides; Prostaglandins; Secretin; Thyrotropin; Vasopressins; Zollinger-Ellison Syndrome

Arginine vasopressin (AVP) stimulates steroid secretion from the normal human adrenal gland and some cortisol-producing adrenocortical tumors or hyperplasia through activation of the V(1a) receptor.. The objective of the study was to investigate in vitro and in vivo the possible involvement of AVP in the physiopathology of primary aldosteronism.. The design of the study included immunohistochemical, pharmacological, and molecular studies on aldosterone-producing adenoma (APA), followed by a monocentric, crossover trial of the orally active V(1a) receptor antagonist, SR 49059, in a double blind, randomized, and placebo-controlled fashion.. The study was conducted at a university hospital and research laboratory.. The study population included eight untreated patients with primary aldosteronism, four with APA and four with idiopathic hyperaldosteronism.. Aldosterone secretion of APA cells in vitro and plasma aldosterone, renin, and ACTH were measured.. SR 49059 (200 mg once daily) or placebo was administered during two 1-wk treatment periods separated by a 2-wk washout.. We observed the occurrence of AVP-containing cells in APA tissues. Administration of AVP to perifused APA cells induced an increase in aldosterone production, which was inhibited by a specific V(1a) antagonist. RT-PCR analysis showed the expression of V(1a) receptor mRNA in most APAs studied. In APA patients, SR 49059 did not induce any effect on basal aldosterone secretion but provoked a plasma aldosterone response to orthostatism (P < 0.03) and strengthened the positive correlation between plasma aldosterone and ACTH.. The present study indicates that functional V(1a) receptors are present in APA and suggests that AVP may exert an autocrine/paracrine control of aldosterone secretion in APA tissues.

Topics: Adenoma; Adrenocorticotropic Hormone; Aldosterone; Cross-Over Studies; Double-Blind Method; Female; Fluorescent Antibody Technique; Hormone Antagonists; Humans; Hyperaldosteronism; Immunohistochemistry; Indoles; Male; Middle Aged; Pituitary Neoplasms; Pyrrolidines; Receptors, Vasopressin; Reverse Transcriptase Polymerase Chain Reaction; RNA; Vasopressins

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma.. In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons.. In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0-0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9-1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1-9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0-5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3-26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1-0.9], p = 0.04).. Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

Topics: Adenoma; Diabetes Insipidus; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sodium; Vasopressins

At our institution, a total of 320 patients were operated on between 2000 and 2010 for a newly diagnosed pituitary adenoma. In an attempt to improve quality of tumor resection, the transsphenoidal microscopic technique was replaced by the endoscopic technique in June 2008. This retrospective single center study compares the outcomes after microscopic (n = 144) and endoscopic (n = 41) tumor surgery of all patients operated on for a nonfunctional pituitary adenoma.. Tumor size and location, Knosp grade, prevalence of anterior hypopituitarism, diabetes insipidus, visual acuity/fields, complication rates, and operation time were compared between the groups.. At the 3-month follow-up, hypopituitarism had improved in 7% of patients in the microscopic group and in 9% in the endoscopic group, and had further impaired in 13% and 9%, respectively. At the 3-month follow-up magnetic resonance imaging, a total tumor removal was achieved in 45% versus 56% of patients, respectively (P = not significant [NS]). Visual fields had normalized or improved in 90% versus 88% of patients, respectively (P = NS). Postoperative cerebrospinal fluid leak occurred in 3.5% versus 2.4% (P = NS), and diabetes insipidus (transient or permanent) in 7.6% versus 4.9% (P = NS) of cases, respectively. Larger tumor size (P < 0.0005) and endoscopic technique (P = 0.03) were independent predictors of increased mean operative time.. Initial results with the endoscopic technique were statistically similar to those achieved with the microscopic technique. However, there was a trend toward improved outcomes and fewer complications in the endoscopic group.

Topics: Adenoma; Adolescent; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Hormone Replacement Therapy; Human Growth Hormone; Humans; Hydrocortisone; Magnetic Resonance Imaging; Male; Microsurgery; Middle Aged; Neoplasm, Residual; Neuroendoscopy; Pituitary Gland; Pituitary Neoplasms; Radiography; Retrospective Studies; Sphenoid Sinus; Testosterone; Thyroxine; Treatment Outcome; Vasopressins

We herein present the case of a 53-year-old patient with adrenocorticotropin-independent macronodular adrenocortical hyperplasia (AIMAH), which is a rare form of Cushing syndrome. He had hypercortisolemia and bilateral macronodular adrenal glands with a left side predominance. The administration of vasopressin significantly increased the plasma cortisol level (1.9-fold). Following left adrenalectomy, the patient's hypercortisolemia significantly improved and vasopressin responsiveness was lost, suggesting that the responsiveness originated from the resected left adrenal gland. The marked difference in vasopressin responsiveness between the adrenals corresponded with their asymmetrical size and function. Evaluating the differences in the vasopressin sensitivity may therefore be helpful for understanding the progression of AIMAH.

Topics: Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenalectomy; Adrenocorticotropic Hormone; Cushing Syndrome; Deamino Arginine Vasopressin; Dexamethasone; Diabetes Mellitus, Type 2; Glucose Tolerance Test; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Hypertriglyceridemia; Laparoscopy; Male; Middle Aged; Organ Size; Receptors, Vasopressin; Thyrotropin-Releasing Hormone; Vasopressins

Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study.. A retrospective survey of 129 surgical records for the occurrence of plasma sodium levels outside the normal range, following transsphenoidal procedures. Median patient age was 49 (range 20-78) years, 65 female. 73 of the operated lesions were non-functioning pituitary adenomas. Patients were considered to have impaired plasma sodium balance if the range of 135-145 mmol/L was not maintained.. Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance (≥ 149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6). Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours < 22 mm and in 76% of young patients, operated on for tumours ≥ 22 mm. Overall, tumour size increased with patients' age, and tumour size was less predictive for sodium disturbances in elderly patients. Median time in hospital was 5 days for patients without sodium imbalance, 6 days for patients with hypernatraemia and 11 days for patients with hyponatraemia.. Following pituitary surgery, patients with large tumours, in particular those of young age, are at higher risk for losing control of their plasma sodium level. Increased ADH secretion (hyponatraemia), but not transient diabetes insipidus was associated with a prolonged hospital stay. Postoperative follow-up of patients with sellar tumours should include careful monitoring of plasma sodium levels within the first two postoperative weeks and clear patients' instructions.

Topics: Adenoma; Adult; Aged; Analysis of Variance; Diabetes Insipidus, Neurogenic; Female; Homeostasis; Humans; Hypernatremia; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sella Turcica; Sodium; Tumor Burden; Vasopressins; Young Adult

We reported previously that hyperactivation of vasopressin type-2 receptor (V2R)-mediated signaling in the endolymphatic sac could affect endolymphatic fluid metabolism, resulting in the pathogenesis of endolymphatic hydrops. Taken together with the present endolymphatic sac tumor (ELST) study, it is suggested that disorder of V2R signaling in the endolymphatic sac for any reason could be involved in the pathogenesis of endolymphatic hydrops. Although it is due to tumor genesis in ELST, it is idiopathic in nature in Meniere's disease.. We encountered two cases of ELST showing Meniere's disease-like symptoms. Both cases were suspected of having endolymphatic hydrops using neuro-otological examinations. To clarify the histopathological diagnosis of ELST and the molecular pathogenesis of endolymphatic hydrops, we performed histopathological and molecular biological examinations of the endolymphatic sac.. ELSTs in two rare cases were removed completely through the transmastoidal approach. V2R mRNA expression was examined using real-time PCR.. The first case was diagnosed as inflammatory granulation adjacent to the endolymphatic sac, i.e. pseudo-ELST, and the second case was diagnosed as papillary adenoma of ELST. V2R mRNA expression was up-regulated in the endolymphatic sac of both cases as seen in Meniere's disease compared with controls.

Topics: Adenoma; Adult; Audiometry, Pure-Tone; Diagnosis, Differential; Ear Neoplasms; Endolymphatic Hydrops; Endolymphatic Sac; Female; Gene Expression; Granuloma, Plasma Cell; Humans; Magnetic Resonance Imaging; Male; Mastoid; Meniere Disease; Middle Aged; Neuroma, Acoustic; Neurophysins; Protein Precursors; Real-Time Polymerase Chain Reaction; RNA, Messenger; Signal Transduction; Tomography, X-Ray Computed; Vasopressins; Vestibular Diseases

Vasopressin was reported to stimulate secretion of both cortisol and aldosterone through eutopic V1a receptors in adrenal gland. Recently, adrenal hyper-responsiveness of plasma cortisol to vasopressin with eutopic overexpession of V1a receptors has been reported in Cushing's syndrome, such as a majority of cases of ACTH-independent macronodular adrenal hyperplasia and some cases of Cushing's adenomas. There were a few reports regarding the aldosterone response to vasopressin in aldosterone-producing adenoma. The aim of our study was to investigate the aldosterone response to vasopressin and its pathophysiological roles in the patients with aldosterone-producing adenoma. Vasopressin-loading test was performed in 10 patients with aldosterone-producing adenoma, and in 16 patients with non-functioning adrenal tumors. The roles of the aldosterone response to vasopressin were analyzed in terms of hormonal secretion and the expression of V1a receptor mRNA on the operated adrenal gland in aldosterone-producing adenoma. We found that (1) a varying aldosterone response to vasopressin was observed, (2) absolute response of plasma aldosterone in aldosterone-producing adenoma was significantly higher than that in non-functioning tumor, (3) aldosterone response rate to vasopressin was significantly and negatively correlated with the decline rate (%) in plasma aldosterone from morning to evening in aldosterone-producing adenoma, (4) V1a receptor mRNA was expressed at various values in aldosterone-producing adenoma, and (5) surgical removal of aldosterone-producing adenoma eliminated the aldosterone response to vasopressin observed in patients with aldosterone-producing adenoma. These findings indicated that vasopressin might be involved in the coordination of aldosterone secretion through eutopic expression of V1a receptor in aldosterone-producing adenoma.

Topics: Adenoma; Adrenal Glands; Aged; Aldosterone; Circadian Rhythm; Cushing Syndrome; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Prospective Studies; Receptors, Vasopressin; RNA, Messenger; Vasopressins

We performed an analysis of early factors influencing the outcome of Cushing's disease treated by transsphenoidal pituitary surgery.. Prospective study of 29 patients who underwent transsphenoidal pituitary surgery for Cushing's disease. The prognostic value of preoperative and operative variables, histological findings and serum cortisol (measured at 8:00 a.m. the day after surgery) were analyzed.. Of the 29 patients included in this study, 26 achieved postoperative remission while in 3 patients treatment failed. Tumor was identified at histology in 92.3% patients in the remission group and in 33.3% in the failure group, this difference being significant (p = 0.03). Median postoperative cortisol levels were 95.8 nmol/l in the remission group and 676 nmol/l in the failure group, this difference being significant (p = 0.024). Serum cortisol of 600 nmol/l correctly classified the remission and failure groups with a sensitivity of 100% and a specificity of 96%.. In our experience, no identification of an adenoma at histology and an early postoperative cortisol level higher than 600 nmol/l after transsphenoidal pituitary surgery for Cushing's disease was associated with a high risk of failed treatment.

Topics: Adenoma; Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Child; Female; Humans; Hydrocortisone; Male; Middle Aged; Pituitary ACTH Hypersecretion; Pituitary Neoplasms; Postoperative Period; Prognosis; Remission Induction; Risk Factors; Sensitivity and Specificity; Treatment Failure; Vasopressins

Hyponatremia can result from a wide range of causes. While hyponatremia is known to occur in patients with hypopituitarism, severe hyponatremia occurring as the presenting feature of hypopituitarism is very rare. We present two cases in which severe hyponatremia developed with weakness, light-headedness and seizure. The hyponatremia in these 2 cases mimicked the laboratory diagnostic criteria of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). However, the hormone studies displayed hypopituitarism. Hyponatremia was completely corrected after administering a supplement of prednisolone and L-thyroxine. Computerized tomography of the brain revealed an adenoma of the pituitary gland. These two cases illustrate that severe hyponatremia may be the presenting feature of clinically non-functional pituitary adenoma with hypopituitarism, which should be kept in mind in the differential diagnosis of hyponatremia mimicking SIADH.

Topics: Adenoma; Aged; Anti-Inflammatory Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Prednisolone; Thyroid Hormones; Thyroxine; Vasopressins

The purpose of this study was to determine the location of the pituitary bright spot in patients with pituitary macroadenomas before surgery.. A total of 54 patients with pituitary macroadenomas were retrospectively included in this study. Nonenhanced spin-echo T1-weighted MR images were reviewed to identify the location of the high-intensity-signal posterior pituitary lobe that indicates antidiuretic hormone (ADH) storage. Images were acquired with a 1.5-T machine by using 3-mm-thick contiguous sections in two or three orthogonal planes and a 300 x 512 matrix.. The bright spot corresponding to ADH storage was identified in 44 (81%) patients. Two groups of patients were defined by the height of the macroadenoma: Group A patients (n = 27) had pituitary macroadenomas less than 20 mm in height, and group B (n = 27) had macroadenomas 20 mm or larger. In group A, the bright spot was identified in 25 patients (93%); it was located in the sella in 24 of these cases (96%). In group B, the bright spot was identified in 19 patients (70%); it was in an ectopic location in 14 of these cases (74%).. MR imaging can be used to depict the pituitary bright spot in most patients with pituitary macroadenomas before surgery. The bright spot is usually identified at its expected location within the sella in patients with pituitary macroadenomas less than 20 mm in height, whereas an ectopic location is common when pituitary macroadenomas are larger more than 20 mm.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Gland, Posterior; Pituitary Neoplasms; Retrospective Studies; Vasopressins

Characteristic findings of the pituitary stalk on magnetic resonance (MR) imaging, which suggest a damming-up phenomenon of neurosecretory granules, were reported. Neurosecretory granules containing vasopressin influence the signal intensity on MR T1-weighted image (T1WI). The normal posterior lobe of the pituitary gland appears as a bright signal on T1WI. The bright signal of the posterior lobe represents the normal content of neurosecretory granules and disappears in patients with central diabetes insipidus. The normal pituitary stalk appears as a low-intermediate intensity signal on sagittal and coronal T1WIs with 3 mm-slice thickness. The pituitary stalk appeared as a bright signal in 20 patients; 13 with pituitary adenoma, 4 with an intrasellar cystic lesion, one with cavernous sinus mass, and 2 with no abnormal MR findings. The pituitary stalk was not severed in any of the cases. The normal bright signal of the posterior lobe disappeared in 17 patients. No patients suffered from symptoms of central diabetes insipidus when the bright pituitary stalk appeared. It is suggested that the origin of the bright signal in the pituitary stalk is the damming up and accumulation of neurosecretory granules in the nerve fibers of the hypothalamohypophyseal tract obstructed by adenoma, postoperative scarring, cystic mass and so on. Probably, the damming-up phenomenon on MR imaging represents the functional integrity of the hypothalamo-neurohypophyseal system, and should be distinguished from an ectopic posterior lobe formation which is caused by stalk transection.

Topics: Adenoma; Adolescent; Adult; Aged; Female; Humans; Hypothalamo-Hypophyseal System; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Neoplasms; Secretory Vesicles; Vasopressins

We report an unusual case of inappropriate antidiuresis with undetectable vasopressin in an elderly man presenting with confusion due to severe hyponatremia. Further investigations led to the diagnosis of non-functional pituitary macroadenoma. The patient had normal thyroid and adrenal function. The abnormal water balance resolved promptly after transsphenoidal removal of the tumor, confirmed by a repeat water loading test. We conclude that inappropriate antidiuresis in the absence of excess vasopressin secretion may implicate mass effect from an underlying pituitary tumor.

Topics: Adenoma; Aged; Confusion; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Pituitary Neoplasms; Vasopressins

Extrinsic factors such as hypothalamic hormones or intrapituitary growth factors may stimulate clonal expansion of a genomically altered cell and therefore play a role in pituitary tumorigenesis. Here we report on the effects of the hypophysiotrophic hormones corticotrophin-releasing hormone (CRH) and vasopressin (AVP) and the intrapituitary growth factor insulin-like growth factor-I (IGF-I) on the proliferation of, as measured by the bromodeoxyuridine labelling index, and ACTH secretion by normal canine pituitary cells and corticotrophic adenoma cells of dogs with pituitary-dependent hyperadrenocorticism. The sensitivity to inhibition by cortisol was analysed under various conditions. Under basal conditions, no significant differences were found in the bromodeoxyuridine labelling indices between control cells and tumour cells. CRH, AVP, IGF-I and cortisol had no effect on the proliferation of canine pituitary cells or canine corticotrophic adenoma cells. In contrast with normal pituitary cells, the proliferation of corticotrophic adenoma cells was stimulated by fetal calf serum (FCS). This FCS-induced proliferation was not inhibited by cortisol. The CRH-induced ACTH secretion by corticotrophic adenoma cells was significantly (P < 0.05) lower than that by normal pituitary cells after 4 h incubation with CRH. Incubation with cortisol for 24 h resulted in reduced ACTH secretion under basal and AVP- or IGF-I-stimulated conditions. The relative inhibition was, however, significantly (P < 0.05) lower in ACTH-producing tumour cells than in normal pituitary cells. Cortisol did not inhibit the CRH-induced ACTH secretion in normal pituitary cells after 24 h. In conclusion, canine corticotrophic adenomas are less sensitive to stimulation by CRH and less sensitive to inhibition by glucocorticoids. These tumours have an aberrant sensitivity to a growth-promoting factor present in FCS. This factor may have an important role in the growth promotion of canine corticotrophic tumours.

Topics: Adenoma; Adrenocorticotropic Hormone; Animals; Cell Division; Cells, Cultured; Corticotropin-Releasing Hormone; Dogs; Insulin-Like Growth Factor I; Pituitary Gland; Pituitary Neoplasms; Time Factors; Tumor Cells, Cultured; Vasopressins

We studied the putative role of the vasopressin receptors in the phenotypic response of steroid-secreting adrenocortical tumors. A retrospective analysis of a series of 26 adrenocortical tumors responsible for Cushing's syndrome (19 adenomas and 7 carcinomas) showed that vasopressin (10 IU, i.m., lysine vasopressin) induced an ACTH-independent cortisol response (arbitrarily defined as a cortisol rise above baseline of 30 ng/mL or more) in 7 cases (27%). In comparison, 68 of 90 patients with Cushing's disease (76%) had a positive cortisol response. We then prospectively examined the expression of vasopressin receptor genes in adrenocortical tumors of recently operated patients (20 adenomas and 19 adrenocortical carcinomas). We used highly sensitive and specific quantitative RT-PCR techniques for each of the newly characterized human vasopressin receptors: V1, V2, and V3. The V1 messenger ribonucleic acid (mRNA) was detected in normal adrenal cortex and in all tumors. Its level varied widely between 2.0 x 10(2) and 4.4 x 10(5) copies/0.1 microgram total RNA, and adenomas had significantly higher levels than carcinomas, although there was a large overlap. Among the 6 recently operated patients who had been subjected to the vasopressin test in vivo, the tumor V1 mRNA levels were higher in the 4 responders (9.5 x 10(3) to 5.0 x 10(4)) than in the 2 nonresponders (2.0 x 10(2) and 1.8 x 10(3)). One adenoma that had a brisk cortisol response in vivo, also had in vitro cortisol responses that were inhibited by a specific V1 antagonist. In situ hybridization showed the presence of V1 mRNA in the normal human adrenal cortex where the signal predominated in the compact cells of the zona reticularis. A positive signal was also present in the tumors with high RT-PCR V1 mRNA levels; its distribution pattern was heterogeneous and showed preferential association with compact cells. RT-PCR studies for the other vasopressin receptors showed a much lower signal for V2 and no evidence for V3 mRNA. We could not establish whether the V2 mRNA signal observed in normal and tumoral specimens was present within adrenocortical cells or merely within tissue vessels. We conclude that the vasopressin V1 receptor gene is expressed in normal and tumoral adrenocortical cells. High, and not ectopic, expression occurs in a minority of tumors that become directly responsive to vasopressin stimulation tests.

Topics: Adenoma; Adrenal Cortex Hormones; Adrenal Cortex Neoplasms; Carcinoma; Cushing Syndrome; Gene Expression; Humans; Hydrocortisone; In Situ Hybridization; Lypressin; Phenotype; Polymerase Chain Reaction; Receptors, Vasopressin; Retrospective Studies; RNA-Directed DNA Polymerase; RNA, Messenger; Vasopressins

The release of arginine vasopressin (AVP) and atrial natriuretic hormone (ANH) and their involvement in renal water and electrolyte metabolism in primary aldosteronism in humans were studied. An oral acute water load (20 ml/kg body weight) was given to each of 12 patients before and after surgical removal of their aldosterone-producing adenoma(s). Plasma AVP and ANH were measured simultaneously, and renal water and electrolyte metabolism and tubular functions were determined. The same water load was given to seven normal subjects and the same parameters were determined. In the presence of mineralocorticoid excess before the operation, plasma AVP was relatively low compared with plasma osmolality (Posm), but was not suppressed in response to decreases in Posm after the water load. Baseline plasma ANH was high and increased further after the water load; urinary dilution and diuresis both remained normal. After the operation, baseline plasma AVP was normal and decreased in response to the decrease in Posm after the water load, with normal urinary dilution and diuresis. Baseline plasma ANH was normal, and did not increase after the water load. The ratio of urinary K and Na clearances and distal tubular reabsorption of Na increased before the operation. These results suggest that there are perturbations of AVP and ANH release in primary aldosteronism, despite the normal urinary dilution after a water load.

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Adult; Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Blood; Drinking; Female; Humans; Hyperaldosteronism; Male; Middle Aged; Natriuresis; Osmolar Concentration; Postoperative Period; Potassium; Time Factors; Urine; Vasopressins

Gangliocytomas or gangliogliomas of the sellar region are very rare tumors. In a great proportion of those cases an adenoma of the anterior pituitary develops from the cell type that is hyperstimulated by the releasing hormone produced from the gangliocytoma. Five GHRH secreting gangliocytomas are reported. Four of these were localized adjacent to a GH secreting adenoma. In one case, no adenoma tissue was found beside the ganglicytoma. As only the adenomas can secrete GH, the adenomas and not the gangliocytomas are directly responsible for acromegaly so that such an adenoma has to be present in cases of acromegaly. A CRH secreting gangliocytoma was combined with an ACTH cell adenoma that had induced Cushing's disease. A ganglioglioma of the posterior pituitary had led to an inappropriate secretion of Vasopressin. The morphology of the different tumors is presented.

Topics: Acromegaly; Adenoma; Adult; Aged; Child; Female; Ganglioneuroma; Growth Hormone-Releasing Hormone; Human Growth Hormone; Humans; Male; Middle Aged; Pituitary Neoplasms; Sella Turcica; Vasopressins

We describe a case of diabetes insipidus (DI) due to a pituitary tumor in a 33-year-old pregnant woman who developed a sudden onset of polyuria (over 8 l/day) and polydipsia at 30 weeks of gestation. Her plasma concentration of vasopressin (AVP) was low compared with high serum osmolality (298 mOsm/kg), and her urine output was well controlled by treatment with desmopressin acetate (DDAVP). Cranial magnetic resonance imaging (MRI) demonstrated a 1.8 x 1.2-cm pituitary tumor, but she did not have any disturbance in the release of anterior pituitary hormones. The serum concentration of cystine aminopeptidase (CAP) was within the normal range for a woman at 34 weeks of gestation. After an uncomplicated delivery of a healthy girl, her polyuria gradually resolved. The size of the pituitary tumor gradually decreased in parallel to a reduction in her urine output, but a silent hemorrhage was detected in her pituitary gland 4 weeks after the delivery. Although pregnancy is sometimes associated with central DI, the occurrence of DI due to pituitary tumor under pregnancy is rare. The basal AVP recovered to within the normal range, but the low response of AVP secretion to high osmolality persisted. In this case, pregnancy may affect the manifestation of subclinical DI. This case may therefore enhance our understanding of the mechanisms of DI during pregnancy.

Topics: Adenoma; Adult; Body Weight; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hypoglycemic Agents; Magnetic Resonance Imaging; Osmolar Concentration; Pituitary Function Tests; Pituitary Gland, Anterior; Pituitary Neoplasms; Pregnancy; Pregnancy Complications; Pregnancy Complications, Neoplastic; Pregnancy Trimester, Third; Time Factors; Urine; Vasopressins

The action of arginine vasopressin (AVP) on cytosolic free calcium concentration ([Ca2+]i) was studied at the single-cell level in corticotrophs cultured from pituitary adenoma fragments removed from eight patients with Cushing's disease. AVP evoked distinct [Ca2+]i responses with regard to the tumor origin. In cells from two tumors, AVP consistently evoked a series of characteristic elevations of [Ca2+]i (transient pattern) that depended on Ca2+ entry. In cells from the other tumors, AVP triggered different patterns of [Ca2+]i rise, which consisted of low-amplitude slow monophasic increases at low AVP concentration and a high-amplitude spike increase followed by a sustained plateau (spike-plateau pattern) at higher concentration of AVP. Slow monophasic increases and the spike of spike-plateau responses were due to calcium release from internal stores, whereas the plateau was a consequence of calcium entry. These two patterns (transient vs. spike-plateau) resemble those observed in subpopulations of corticotrophs from healthy rat pituitary glands (Corcuff et al., J. Biol. Chem. 268: 22313-22321, 1993), suggesting that tumorigenesis can lead in pituitary tissues to a selection rather than alteration of AVP [Ca2+]i signals.

Topics: Adenoma; Adrenocorticotropic Hormone; Arginine Vasopressin; Calcium; Cells, Cultured; Corticotropin-Releasing Hormone; Cytosol; Electrophysiology; Humans; Osmolar Concentration; Pituitary Gland, Anterior; Pituitary Neoplasms; Signal Transduction; Vasopressins

Spontaneous pituitary adenomas are common in certain strains of the laboratory rat. Investigations of Wistar rats of two years chronic toxicity studies revealed pituitary tumors in 50% of the females and 26% of the males. The morphology of the spontaneous changes in the pituitary gland was investigated with immunohistochemical and histological methods. The peroxidase-antiperoxidase (PAP) technique was used to localize different hormones (LH, ACTH) in cells of the pars intermedia and pars distalis as well as neurophysin, oxytocin and vasopressin the terminals of the classic neurosecretory system of the pars nervosa. The results show that most of the neoplasms were endocrinologically inactive chromophobe adenomas of the pars distalis.

Topics: Adenoma; Adrenocorticotropic Hormone; Animals; Female; Immunoenzyme Techniques; Luteinizing Hormone; Male; Neurophysins; Oxytocin; Pituitary Gland; Pituitary Neoplasms; Rats; Rats, Inbred Strains; Vasopressins

Topics: Adenoma; Adult; Aged; Diabetes Insipidus; Hemodynamics; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Period; Vascular Resistance; Vasopressins

Topics: Adenoma; Female; Humans; Hyponatremia; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Polyuria; Thirst; Vasopressins

Polyuria subsequent to pituitary surgery was studied in 64 cases. Most cases of postoperative polyuria were due to diabetes insipidus. These cases showed a triphasic pattern in daily urinary volume. Observation of hourly urinary volume in polyuria revealed four diurnal patterns of urinary excretion: rhythmic, continuous, transient, and unspecific. Clinical observation of diurnal patterns has an advantage, in terms of simplicity of procedure, in immediately determining the nature of the polyuria, prognosticating diabetes insipidus, and eliminating inappropriate procedures in treatment. Indomethacin suppository is considered to be a favorable agent in reducing polyuria without disturbing the diurnal pattern in diabetes insipidus.

Topics: Adenoma; Adolescent; Adult; Aged; Circadian Rhythm; Diabetes Insipidus; Female; Humans; Indomethacin; Male; Middle Aged; Pituitary Diseases; Pituitary Neoplasms; Polyuria; Postoperative Complications; Sodium; Vasopressins

Hyponatremia developing some days after transsphenoidal pituitary adenectomy is a treacherous complication of uncertain cause. Of 19 patients monitored in a pilot study at the Wessex Neurological Centre, plasma sodium fell below 125 mmol/liter in three patients at times ranging from 6 to 9 days postoperatively. One patient had evidence of inappropriate secretion of arginine vasopressin (AVP), and the other two probably had steroid insufficiency despite apparently adequate steroid cover. In a more detailed study, the fluid and sodium balance of a further 16 patients was monitored for 7 to 11 days following transsphenoidal surgery together with plasma cortisol, renin, and AVP concentrations. No patient became severely hyponatremic. Three developed partial diabetes insipidus. Two patients with Cushing's disease had evidence of postoperative corticosteroid insufficiency despite normal steroid protection. An inappropriately low plasma cortisol concentration was recorded in both. Plasma AVP concentrations did not show a delayed surge postoperatively. Delayed hyponatremia appears to occur most often in patients with hypoadrenalism, as glucocorticoid cover is decreased. It results from water retention combined with natriuresis, and is reversed by glucocorticoid treatment.

Topics: Adenoma; Adult; Arginine Vasopressin; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Pituitary Neoplasms; Vasopressins; Water-Electrolyte Imbalance

Posterior and anterior pituitary functions were assessed in 8 patients before, during, and after surgery for tumors in the suprasellar region. Preoperatively, all patients but one responded adequately to an osmotic stimulus with a rise in plasma vasopressin (AVP) and all but one showed adequate cortisol response to adrenocorticotropic hormone (ACTH) and hypoglycemia. During surgery a transient rise was seen in plasma levels of AVP (5 out of 8 patients), cortisol (7 out of 8 patients) and growth hormone (4 out of 8 patients). This response could be predicted from the preoperative stimulation tests. Postoperatively the AVP response to osmotic stimuli was impaired in 4 out of 5 patients, although urine volume had returned to normal after a transient polyuric phase. The response of plasma cortisol to ACTH was still adequate but lower than preoperatively.

Topics: Adenoma; Adult; Female; Growth Hormone; Humans; Hydrocortisone; Male; Meningioma; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Sella Turcica; Skull Neoplasms; Vasopressins

The response of pituitary adenomas obtained surgically from patients with Cushing's disease of Nelson's syndrome to synthetic ovine corticotropin-releasing factor (CRF), vasopressins, somatostatin-28, dexamethasone, 3-isobutylmethylxanthine or high [K+] was examined in vitro by measuring the amount of pro-opiomelanocortin (POMC)-derived peptides secreted into the culture medium. CRF did not stimulate the secretion of adrenocorticotropin-, beta-endorphin-, or gamma 3-melanotropin-like peptides from the pituitary adenomas at concentrations ranging from 1 x 10(-13) M to 1 x 10(-7) M whereas vasopressins, 3-isobutyrl-methylxanthine and high [K+] increased, while somatostatin-28 and dexamethasone suppressed, the secretion of these POMC-derived peptides. These findings suggest that either the pituitary ACTH-producing tumors have lost their receptors to CRF or their post-receptor mechanism to CRF is not functional.

Topics: Adenoma; Adolescent; Adrenocorticotropic Hormone; Adult; beta-Endorphin; Cells, Cultured; Corticotropin-Releasing Hormone; Cushing Syndrome; Dexamethasone; Endorphins; Female; Humans; Male; Melanocyte-Stimulating Hormones; Nelson Syndrome; Pituitary Neoplasms; Somatostatin; Somatostatin-28; Vasopressins

Topics: Acute Disease; Adenoma; Adult; Body Weight; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Solubility; Vasopressins

Various clinical disorders of water and electrolytes metabolism were reported in relation to decrease or increase of the plasma anti-diuretic hormone (ADH), however, the estimated ADH value was not infrequently found inconsistent with clinical features. In order to determine the influence from surgical intervention to the hypophyseo-hypothalamic system, continuous estimation of the urinary secretion and specific gravity was performed with computerized analyzer, and it was found that there were at least 5 patterns of postoperative change in rhythmicity of ADH secretion. Most interesting finding was that the ADH was discharged in phasic pattern and irregularly intermingled oligo- and polyuric phases were observed quite in early stage of postoperative observation. Forty cases were examined and this method of examination was found useful in the prognostic view point for the postoperative water and electrolytes disorders.

Topics: Adenoma; Circadian Rhythm; Humans; Hydrocortisone; Hypophysectomy; Hypothalamus; Inappropriate ADH Syndrome; Pituitary Neoplasms; Postoperative Period; Vasopressins

A systematic method for the perioperative management of routine cases of pituitary microadenoma treated by transsphenoidal microsurgery is presented. These methods have evolved over a 7-year period and have been utilized in the management of more than 750 patients with pituitary tumors and related problems treated by trans-sphenoidal surgery. The goals in this joint neurosurgical, endocrinological, and otorhinolaryngological team effort are to eliminate errors in patient management, to assure the safety of the patient in the perioperative period, and to make the therapy as efficient and as cost-effective as possible.

Topics: Adenoma; Female; Humans; Hypopituitarism; Male; Metyrapone; Microsurgery; Pituitary Neoplasms; Postoperative Care; Prednisone; Preoperative Care; Vasopressins

A 50-yr-old woman with Addison's disease from the age of 14 yr was diagnosed as empty sella turcica in 1974 (Rev Clin Esp 139: 183, 1975). She subsequently continued with hyperpigmentation in spite of adequate hormone substitution therapy which permitted her to lead a normal life. When studied she showed an extreme elevation of plasma ACTH (1500--2000 pg/ml), and with dexamethasone (2 and 8 mg/day) continued to have levels of 900 pg/ml. With 60 mg hydrocortisone daily, effects of overdosage were observed (swelling and Cushingoid facies) associated with depigmentation. However, she continued to manifest levels of plasma ACTH of 700 pg/ml and an absence of circadian rhythm. It seems likely that this patient represents a case of pituitary ACTH secretory adenoma (corticotropinoma) secondary to the preexisting Addison's disease. The circulating levels of other pituitary hormones were normal.

Topics: Addison Disease; Adenoma; Adrenocorticotropic Hormone; Adult; Dexamethasone; Female; Humans; Hydrocortisone; Male; Middle Aged; Pituitary Neoplasms; Somatostatin; Vasopressins

While pituitary tumors are not as rare as was once thought, it is difficult to assess how many are of clinical significance. Trans-sphenoidal pituitary exploration is a technique which can be performed with low operative morbidity and mortality, and when instituted early can prevent subsequent visual and endocrine impairment from an expanding lesion. Thus early recognition has increased importance.

Topics: Acromegaly; Adenoma; Adenoma, Chromophobe; Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Luteinizing Hormone; Male; Middle Aged; Pituitary Neoplasms; Prolactin; Thyrotropin; Vasopressins

Topics: Adenoma; Adrenal Cortex Neoplasms; Animals; Humans; Hypertension; Hypertension, Malignant; Rats; Vasopressins

Topics: Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Circadian Rhythm; Cushing Syndrome; Electroencephalography; Female; Growth Hormone; Humans; Hydrocortisone; Insulin; Middle Aged; Secretory Rate; Sleep; Sleep, REM; Vasopressins

Topics: Adenocarcinoma; Adenoma; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Arginine; Carbon Isotopes; Cushing Syndrome; Growth Hormone; Humans; Hydroxycorticosteroids; Hypoglycemia; Insulin; Luteinizing Hormone; Lysine; Pituitary Irradiation; Stimulation, Chemical; Vasopressins

Topics: Adenoma; Adolescent; Adult; Craniopharyngioma; Diabetes Insipidus; Diuresis; Female; Humans; Hypophysectomy; Kidney Concentrating Ability; Male; Middle Aged; Osmolar Concentration; Osmotic Pressure; Pituitary Neoplasms; Thirst; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adrenocortical Hyperfunction; Adult; Depression, Chemical; Dexamethasone; Diagnosis, Differential; Humans; Hydrocortisone; Hyperplasia; Male; Methods; Metyrapone; Phlebography; Stimulation, Chemical; Vasopressins

Topics: Adenoma; Cerebral Angiography; Female; Humans; Hyponatremia; Middle Aged; Pituitary Function Tests; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Circadian Rhythm; Cushing Syndrome; Dexamethasone; Diagnosis, Differential; Female; Humans; Hydrocortisone; Hyperplasia; Hypoglycemia; Hypothalamo-Hypophyseal System; Male; Metyrapone; Middle Aged; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System; Secretory Rate; Vasopressins

Topics: Adenoma; Adrenocorticotropic Hormone; Adult; Aged; Cerebral Ventriculography; Female; Humans; Hydrocortisone; Hypoglycemia; Insulin; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Pyrogens; Vasopressins

Topics: Acromegaly; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Anorexia Nervosa; Brain Diseases; Brain Neoplasms; Cushing Syndrome; Endocrine System Diseases; Female; Humans; Hydrocortisone; Hypothalamus; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Adenoma; Adrenal Glands; Adult; Ethanol; Female; Humans; Hydrocortisone; Hypothalamus; Male; Middle Aged; Morphine; Pituitary Gland; Pituitary Neoplasms; Vasopressins

Topics: Acetylcholine; Adenoma; Animals; Cortisone; Estrone; Female; Neoplasms, Experimental; Nicotine; Oxytocin; Pituitary Neoplasms; Rats; Sodium Chloride; Vasopressins; Water-Electrolyte Balance

Topics: Adenoma; Adenoma, Acidophil; Adenoma, Chromophobe; Adrenocorticotropic Hormone; Breast Neoplasms; Diabetes Insipidus; Endocrinology; Follicle Stimulating Hormone; Growth Hormone; Humans; Hypophysectomy; Pituitary Hormones, Anterior; Prednisone; Prolactin; Thyrotropin; Vasopressins