Acromegaly

Ben-Shlomo, Anat; Мелмед, Шломо

doi:10.1016/j.ecl.2007.10.002

Cited by 210 publications

(101 citation statements)

References 163 publications

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“…Additionally, the surgical remission rate is high in patients with microadenoma [1,3,4,11,19,20]. For the diagnosis of acromegaly, it is important to measure the GH response to the 75 g OGTT suppression test.…”

Section: Discussionmentioning

confidence: 99%

“…Sustained Growth Hormone (GH) excess resulting from a GH secreting pituitary adenoma causes acromegaly, the diagnosis of which ranges from 2.5 to 10 years (mean 8 years) after the onset of symptoms [1][2][3][4][5][6]. Acromegaly is associated with a 2-3-fold higher mortality rate and a reduction of life expectancy by 10-15 years compared with the general population.…”

Section: Introductionmentioning

confidence: 99%

“…The duration of the disease is a prognostic factor. Therefore, establishing guidelines for the early diagnosis or assessment of the disease activity of acromegaly is a major challenge [1,4,6,10]. Acromegaly, which sometimes shows a false-negative or false-positive reaction to various hormone-loading tests, does not always fulfill the established diagnostic criteria.…”

Section: Introductionmentioning

confidence: 99%

“…Acromegaly is associated with a 2-3-fold higher mortality rate and a reduction of life expectancy by 10-15 years compared with the general population. These outcomes are mainly attributed to the presence of other severe diseases, such as diabetes mellitus, hypertension, hyperlipidemia, cardiovascular and respiratory disease, and neoplasms [1,3,5,[7][8][9][10][11][12][13]. The duration of the disease is a prognostic factor.…”

Section: Introductionmentioning

confidence: 99%

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Composite MET-PET Fusion 3.0 Tesla MRI is a New Sensitive Method for the Detection of GH Secreting Adenomas with Abnormal GH Secretary Dynamics

Satoh¹

2012

J Metabolic Synd

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Objective: To evaluate the usefulness of methionine (MET)-Positron Emission Tomography (PET) for the early diagnosis of Growth Hormone (GH) secreting adenomas, we retrospectively analyzed patients with abnormal GH dynamics and a histologically confirmed GH secreting pituitary adenoma who underwent pre-operative fluorodeoxyglucose-/MET-PET. Materials and methods:Thirty-two patients with abnormal GH dynamics were included in this study. 3 Tesla (3T) -MRI, [18 F]-flurodeoxyglucose (FDG) -/[ 11 C]-MET-PET, and transsphenoidal surgery were performed in all the patients. We determined correlations among FDG-/MET-PET (maximum standardized uptake value (SUVmax)), serum GH and IGF-1 levels, the GH response to a 75 g Oral Glucose Tolerance Test (OGTT), Thyrotropin-Releasing Hormone (TRH) /Luteinizing Hormone-Releasing Hormone (LHRH) loading tests, tumor volume, and proliferative activity. Results:The diagnostic sensitivity for early GH secreting adenoma was highest for MET-PET (100%), followed by TRH/LHRH (80%), 75 g OGTT (67%), and FDG-PET (47%). Significant correlations were observed between: MET-PET SUVmax and FDG-PET SUVmax (p<0.01), MET-/FDG-PET SUVmax and tumor volume (MET: p<0.01; FDG: p<0.01) ; MET-/FDG PET SUVmax and MIB-1 labeling index (MET: p<0.01; FDG: p=0.01) ; GH/insulin-like growth factor (IGF)-1 levels and tumor volume (GH: p=0.01; IGF-1: p<0.01) ; and GH and IGF-1 levels (p<0.01).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Composite MET-PET Fusion 3.0 Tesla MRI is a New Sensitive Method for the Detection of GH Secreting Adenomas with Abnormal GH Secretary Dynamics

Satoh¹

2012

J Metabolic Synd

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“…GH stimulates synthesis and secretion of IGF1, especially in the liver (1). Diagnosis of acromegaly is usually delayed for years and leads to increased morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute

Yoshida

Goto

Suzuki

et al. 2013

European Journal of Endocrinology

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Objective: Excess GH causes insulin resistance and impaired glucose metabolism. The objective of this study was to clarify the prevalence of ketoacidosis as the initial presenting symptom of acromegaly. Design and methods: Data were collected from 860 patients with acromegaly who underwent pituitary surgery at Toranomon Hospital over the last 32 years, between 1980 and 2011. Results: Nine cases had ketoacidosis before being diagnosed with acromegaly, including seven males and two females with a meanGS.D. age of 38.8G14.2 years. Serum GH and IGF1 levels were 155G 203 ng/ml and 9.86G0.68 SDS before pituitary surgery and 3.6G1.7 ng/ml and 3.72G3.40 SDS after surgery respectively. The maximum tumor diameter was 28.2G11.6 mm (ranging from 15 to 47 mm, nZ8). None of the patients were diagnosed with diabetes mellitus (DM) nor were they positive for antibodies related to type 1 DM. A possible precipitating factor for ketoacidosis in six cases was excessive ingestion of sugar-containing soft drinks. All the cases had invasive pituitary adenomas. After pituitary surgery, plasma glucose levels were under control without requiring insulin in all cases. Furthermore, six patients did not need oral hypoglycemic agents. Conclusions: Approximately 1% of patients with acromegaly presented with diabetic ketoacidosis as their first clinical condition.

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Diagnosis and Management of Pituitary Adenomas

Tritos

Miller

2023

JAMA

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ImportancePituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors. Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons.ObservationsPituitary adenomas are classified as either macroadenomas (≥10 mm) (48% of tumors) or microadenomas (&lt;10 mm). Macroadenomas may cause mass effect, such as visual field defects, headache, and/or hypopituitarism, which occur in about 18% to 78%, 17% to 75%, and 34% to 89% of patients, respectively. Thirty percent of pituitary adenomas are nonfunctioning adenomas, which do not produce hormones. Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas, which produce prolactin, growth hormone, corticotropin, and thyrotropin, respectively. Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea. Twelve percent are somatotropinomas, which cause acromegaly in adults and gigantism in children, and 4% are corticotropinomas, which secrete corticotropin autonomously, resulting in hypercortisolemia and Cushing disease. All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion. Patients with macroadenomas additionally require evaluation for hypopituitarism, and patients with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing. For those requiring treatment, first-line therapy is usually transsphenoidal pituitary surgery, except for prolactinomas, for which medical therapy, either bromocriptine or cabergoline, is usually first line.Conclusions and RelevanceClinically manifest pituitary adenomas affect approximately 1 in 1100 people and can be complicated by syndromes of hormone excess as well as visual field defects and hypopituitarism from mass effect in larger tumors. First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment.

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Acromegaly

Cited by 210 publications

References 163 publications

Composite MET-PET Fusion 3.0 Tesla MRI is a New Sensitive Method for the Detection of GH Secreting Adenomas with Abnormal GH Secretary Dynamics

Composite MET-PET Fusion 3.0 Tesla MRI is a New Sensitive Method for the Detection of GH Secreting Adenomas with Abnormal GH Secretary Dynamics

Ketoacidosis as the initial clinical condition in nine patients with acromegaly: a review of 860 cases at a single institute

Diagnosis and Management of Pituitary Adenomas

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