Recognition of gonadotroph adenomas in women

Article Abstract:

Adenomas are pituitary gland tumors which may or may not secrete hormones. Some secreting adenomas secrete substances like prolactin or growth hormone, generally producing symptoms which lead rapidly to the diagnosis of the tumor. If the secreting adenoma arises from cells which secrete gonadotrophic hormones, the symptoms are usually subtler and the recognition of the tumor more difficult. In men, a substantial proportion of adenomas arise from gonadotroph cells which secrete hormones including follicle-stimulating hormone (FSH); far fewer gonadotroph adenomas are recognized in women. In some men, one of the indications of a gonadotroph adenoma can be enlarged testicles. Not only cannot such a sign be present in women, but the normal elevations which occur in some pituitary hormones after menopause may obscure higher levels resulting from an adenoma when laboratory tests are performed. A study was therefore conducted to determine if many of the women with apparently nonsecreting adenomas actually have secreting gonadotroph adenomas which have not been recognized. This determination may be made by injecting thyrotropin-releasing hormone (TRH) into the patients and monitoring the serum levels of FSH, luteinizing hormone (LH), and LH-beta (the beta chain of the two-chain LH molecule). In a normal pituitary gland, the injection of TRH should have no influence on the levels of these hormones, while in a secreting adenoma the stimulation by TRH may result in elevated hormone levels. Of 16 women with apparently nonsecreting adenomas, 11 had elevations of LH-beta after injection with TRH. Ten of 12 adenomas were found to secrete hormones when cultured after surgical removal, and the hormones secreted in culture correlated with the response to TRH. It should be noted that the LH measurements showed a response to TRH in only four patients. LH shares a common alpha chain with other hormones including FSH, thyroid stimulating hormone, and chorionic gonadotropin. It would appear that only a highly specific test for the specific beta chain is able to demonstrate relevant changes in gonadotrophic hormones in response to TRH. The results nevertheless confirm that secreting gonadotroph adenomas are more common among women than had been previously appreciated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Gonadotropin, Gonadotropins, Adenoma, Luteinizing hormone, Thyrotropin releasing factor, Thyrotropin releasing hormone, Pituitary gland tumors, Pituitary tumors, Follicle-stimulating hormone

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Cancer-associated retinopathy (CAR syndrome) with antibodies reacting with retinal, optic-nerve, and cancer cells

Article Abstract:

Paraneoplastic phenomena may occur as a secondary neurologic effect of some types of cancer (symptoms associated with the nervous system indirectly caused by a tumor). Cases of cancer-associated retinopathy (CAR), or the loss of eyesight as a result of a cancer, has been documented and one particular case is reviewed. The patient was a 60-year-old woman with a history of cigarette smoking who experienced a sudden loss of vision. She was examined for symptoms of CAR syndrome; tests detected the presence of small-cell carcinoma (cancer) and ocular antigens (foreign proteins in eye tissue which the immune system attacks). Her condition remained unchanged and no other symptoms were reported until the patient experienced shortness of breath six months later. Further evaluation led to a diagnosis of lung cancer. Discussion about the causes of this type of neurological symptom in cancer patients includes speculation of an autoimmune mechanism (in which the body produces antibodies that attack normal tissue) or direct damage by cancer-generated substances. In an effort to learn more about CAR syndrome, the patient's blood was injected into the optic nerve of a guinea pig. Several tests were performed and a strong immune reaction was detected. In addition to the sudden loss of vision, abnormal immunologic reactions may be an indication of some types of cancer. It is not clear to what extent observable immune reactions were responsible for the loss of vision in this patient, and a better understanding of the factors involved in CAR syndrome is needed. If autoimmunity is found to be a primary factor, immunosuppressive treatment (medications that halt the response of the immune system) may be indicated.

Evaluation, Paraneoplastic syndromes, Causes of, Complications and side effects, Autoimmune diseases, Cancer

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A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis

Article Abstract:

Patients with optic neuritis, or inflammation of the optic nerve, who receive intravenous methylprednisolone followed by oral prednisone may recover their vision more quickly. Of 457 patients with optic neuritis, 156 took oral prednisone, 151 received intravenous methylprednisolone followed by oral prednisone and 150 took an oral placebo ( an inactive substance) for 14 days. Their vision was tested over a six- month period. Patients who received methylprednisolone recovered their vision faster than patients given prednisone or a placebo. Their visual fields improved more than their visual acuity, contrast sensitivity or color vision. After six months, patients in the methylprednisolone group had only slightly better vision than those in the prednisone or placebo groups. Visual fields, contrast sensitivity and color vision were only slightly better in the patients receiving methlyprednisolone than in those taking prednisone and placebo, and they did not have better visual acuity. Thirteen percent of the methylprednisolone group, 27% of the prednisone group and 15% of the placebo group had a recurrence of optic neuritis six to 24 months after their treatment.

Health aspects, Drug therapy, Prednisone, Methylprednisolone, Optic neuritis

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