The data demonstrate that low rh-GH dosages significantly improve psychological profiles as rated by HDS evaluation in adult-onset patients with GHD. On the other hand, a 6-month period of treatment does not produce any significant differences in quality of life as measured by KSQ between treated patients and placebo controls.

The coexistence of an unilateral adrenal macronodule and Cushing's disease is well documented in only few reports. We hereby describe two patients with ACTH-dependent Cushing's syndrome and asymmetric adrenal involvement. In both patients the left-sided adrenal contained a nodule sized 1.5 and 1.4 cm, respectively, while the contralateral gland appeared as normal at abdominal computerized tomography. Adrenal scintiscan revealed a bilateral uptake of the tracer. Dynamic testing of hypothalamic-pituitary-adrenal axis was suggestive of pituitary dependency but neuroradiologic imaging was inconclusive. Inferior petrosal sinus sampling demonstrated a clear center to periphery ACTH gradient and an ACTH-producing pituitary microadenoma was found and removed in both cases. Hypopituitarism ensued postoperatively and Cushing's syndrome resolved but the adrenal nodules regressed only many month after operation. The present cases confirm that the presence of an adrenal mass in a patient with Cushing's syndrome is insufficient to confidently conclude for the adrenal dependency of the syndrome.

Our data suggest that in liver cirrhosis the altered BCAA/AAA ratio may influence the altered basal GH secretion and the paradoxical GH response to the OGTT, probably by an increase of adrenergic mediators in the brain. Moreover, the increase of BCAA/AAA ratio seems to be able to abolish the GH paradoxical response to the OGTT.

An impairment of the pulmonary function has been described in adult patients with childhood-onset growth hormone deficiency (GHD). We examined forced vital capacity (FVC), forced expiratory volume (FEV1), total lung capacity (TLC), functional residual capacity (FRC), residual volume (VR) and the index of inspiratory strength, middle tidal volume and tidal inspiratory time ratio (TV/I), in 29 patients with adult-onset GHD. Data were compared with those obtained in 46 healthy control subjects. Only the FEV1/FVC ratio was statistically different (p = 0.04) between the two groups of subjects. In a group of 15 GHD patients low dosages (0.5-1 IU/day s.c., bedtime) of recombinant human GH (rh-GH; n. = 8 subjects) or placebo (n. = 7) were given at random for a 6-month period. A significant increase in IGF-I levels was noted in the rh-GH-treated group (p = 0.04) but not in the placebo group. After the 6-month period no statistically significant changes in pulmonary function were found between the rh-GH-treated and placebo-treated GHD patients. This study shows that adult-onset GHD patients suffer from minimal impairment of pulmonary function. Low rh-GH dosages able to induce an increase in IGF-I levels do not improve pulmonary function. The effect of rh-GH on respiratory muscle strength could be related to the age at which GHD diagnosis is made, or induced only by high rh-GH dosages given for a long time.

The rare macroprolactinomas seen in childhood frequently cause delayed puberty and GH deficiency. We report the combined use of cabergoline and recombinant human GH (rhGH) therapy in a male adolescent with macroprolactinoma and GH deficiency. Computed tomography and magnetic resonance imaging of the hypothalamic-pituitary region showed a macroadenoma with extrasellar extension. Neither bromocriptine nor dihydroergocryptine therapy was successful in decreasing serum PRL levels. On cabergoline treatment normal serum PRL levels were achieved'within 3 months along with a marked shrinkage of the adenoma but growth rate did not increase nor did puberty start. The addition of exogenous rhGH therapy improved the growth rate, but complete pubertal development was obtained only after the administration of exogenous gonadotropins. During the combined treatment no expansion of the macroadenoma was observed. In conclusion, the combined therapy with cabergoline and rhGH seems to be safe and highly effective. Nevertheless, it warrants careful monitoring and on-going evaluation.