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The Pituitary Nework Association has compiled and continues to collect important information regarding anything related to diagnosis, treatment, research and living with a pituitary disorder. This library is only available to our currently active members and will be available on this page after login into this site. 

The Women’s Assessment Calendar

The Women's Assessment Calendar is a tool that can be used for many situations and for every woman of menstruating age. We will provide examples of how this can help women understand their bodies better and communicate with their doctors more effectively as well. Mothers can use this as a training and communication tool with their teen daughters and women can learn about mild "normal" symptoms to those that need the follow-up of a specialty physician.


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Growth Hormone Use in Adults and Children

GH has been used to treat GH-deficient children for more than 35 years. Human GH originally was obtained from cadaver pituitaries and was available in only limited quantities. In 1985, however, data indicated that pituitary-derived GH was the likely source of contaminated material (prions) responsible for the development of Creutzfeldt-Jakobdisease (CJD) in three young men. CJD is a slowly developing, progressive, and fatal neurologic disorder. Consequently, production and distribution of pituitary GH for therapy were discontinued. CJD has now developed in more than 50 patients who received pituitary-derived GH.

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What is Acromegaly?

Acromegaly is an insidious disorder, due to chronic hypersecretion of growth hormone (GH) occurring in adulthood. GH hypersecretion prior to epiphyseal fusion results in gigantism. Elevated GH and/or insulin-like growth factor-1 (IGF-1) levels affect multiple organ systems resulting in acral and soft tissue growth, and metabolic dysfunction. Untreated acromegaly causes significant morbidity and mortality. Furthermore, mortality rates are twice the expected value, most commonly due to cardiovascular and respiratory complications. Control of GH hypersecretion lowers the morbidity and mortality associated with acromegaly. Ninety-fne percent of cases of acromegaly are caused by benign GH secreting pituitary adenomas; ectopic pituitary tumors and extrapituitary tumors (hypothalamus, pancreas, carcinoid, lung, ovary, breast) are found in a very small percentage of cases.

Treatment goals for patients harboring pituitary tumors include normalization of GH and IGF-1 levels, as well as removal of the adenoma with preservation of pituitary function and surrounding structures.

Therapeutic options include surgery, radiotherapy and drug therapy.

Approximately 30% of GH secreting pituitary adenomas are microadenomas (lOmm), resulting in persistence of GH hypersecretion postoperatively in half of the cases. Several patients, demonstrating postoperative "biochemical cure", show recurrent tumor growth and increased GH levels when retested subsequently. Transsphenoidal pituitary tumor resection should be performed by surgeons experienced in this technique.

Radiotherapy is very effective in shrinking GH secreting pituitary tumors, but may take up to 20 years to lower GH levels and is associated with a high incidence of hypopituitarism. Data from longterm studies investigating the safety and efficacy of stereotactic radiosurgery (gamma knife) are not yet available.

Medical therapy includes dopamine agonists (DA), somatostatin analogs and GH antagonists. Only 15-20% of patients demonstrate GH suppression and 10% normalization of IGF-1 level on high doses of DA therapy. Somatostatin analogs normalize IGF-1 levels in 60% of patients. Somatostatin analogs are administered by subcutaneous injection in divided doses three to four tlmes daily. However, longacting somatostatin analog formulations administered intramuscularly once or twice a month will soon be available in the USA. Trovert, a pegylated analog of human growth hormone, functions as a growth hormone antagonist, displacing GH from hepatic receptors, thereby lowering circulating IGF- 1 levels. The safety and efficacy of a once daily subcutaneous injection of Trovert are currently being evaluated.

The addition of these long-acting and novel formulations to the treatment modalities for acromegaly greatly enhance therapeutic options.


  1. Melmed S. Acromegaly. In: Melmed S., ed. The Pituitary. London Blackwell Science Inc., 1995: 413-442.
  2. Rajasoorya C, Holdaway IM, Wrightson P, Scott DJ, Ibbertson HK. 1994. Determinants of clinical outcome and survival in acromegaly. Clin Endocrinology (Oxf) 41:95-102.
  3. Fahlbusch R, Honegger J, Schot W, Buchfelder M. 1994 Results of surgery in acromegaly. In: Wass JAH ed. Treating acromegaly. Bristol: Journal of Endocrinology; 49-54.
  4. Laws Jr. ER, Carpenter SM, Scheithauer BW, Randall RV. 1987 Long term results of transsphenoidal surgery for the management of acromegaly. In: Robbins R, Melmed S, eds. Acromegaly: a century of scientific and clinical progress. New York: Plenum Press; 241-248.
  5. Eastman RC, Gorden P, Glatstein E, Roth J. 1992 Radiation Therapy of acromegaly. Endocrinol Metab Clin North Am 21: 693-712.
  6. Jaffe CA, Barkan AL. 1992 Treatment of acromegaly with dopamine agonists. Endocrinol Metab Clin North Amer 21:713-735.
  7. Ezzat S, Snyder PJ, Young WF et al. 1992. Octreotide treatment of acromegaly: a randomized multicenter study. Ann Intern Med. 117:711-718.
  8. Newman C, Melmed S, Snyder, PJ et al. 1995. Safety and efficacy of long term octreotide therapy of acromegaly: results of a multicenter trial in 103 patients-a clinical research center study. J Clin Endocrinol Metab 80:1768-2775.
  9. Sassolas G. 1995. Medical Therapy with somatostatin analogs for acromegaly. Eur J Endocrinol 133:675-677.
  10. Cheung NW, Taylor L, Boyages SC. 1997 An audit of long term octreotide therapy for acromegaly. Aust NZ J Med. 27: 12-18.
  11. Harris AG. 1996. Treatment of acromegaly. In: Daly AF, ed. Acromegaly and its managment. Philadelphia: Lippincott-Raven; 49-68.
  12. Flagstad AK, Halse J, Rakke S, et al. 1997 Sandostatin LAR in acromegalic patients; long term treatment. J Clin Endocrinol Metab 80:3601-3607.


Transsphenoidal Surgery: Lesions of the Sella Turcica

Andrew E. Sloan, Keith A. Black, and Donald P. Becker

The treatment of sellar lesions is one of the more challenging and satisfying aspects of skull base surgery. The wide variety of lesions that occur in this region and the complexity of their treatment necessitates a thorough understanding of sellar anatomy, as well as the clinical symptoms and diagnostic evaluation of the myriad disease processes involving the pituitary gland.

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Transsphenoidal Surgery: How Its Done, What To Expect

Donald P. Becker, M.D.


Fig1 smallFigure 1: Patient position for transsphenoidal approach.

The transsphenoidal approach is the procedure of choice for the removal of tumors of the sella that are still largely confined to this space. It is also indicated for removal of some tumors of the parasellar area. Pituitary tumors with substantial intracranial extension can engulf important structures and should be treated using a transcranial approach.

For transsphenoidal surgery, there are several alternative approaches to the sphenoid sinus. These include the transnasal paraseptal, sublabial-transseptal, and paranasal transethmoidal approaches. For processes that are largely located in the sella, the sublabial or trananasal approach is used. With extreme involvement of the paranasal sinuses, the paranasal transethmoidal exposure is of benefit.

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Pituitary Diseases During Pregnancy

Martin N. Montoro, MD, and Jorge H. Mestman, MD

Changes In The Normal Anterior Pituitary Gland During Pregnancy

Anatomic and functional changes take place in the pituitary gland during pregnancy that have to be taken into consideration to properly evaluate its function, and particularly to diagnose pituitary disorders during pregnancy.

The various anterior pituitary hormonesprolactin (PRL), thyroxine-stimulating hormone (TSH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), corticotropin (ACTH), and growth hormone (GH) are released into the systemic circulation in response to stimulating or inhibiting messages from hypothalamic peptide hormones. These peptides reach the pituitary gland through the portal circulation. Thus far several have been identified; they include thyrotropin-releasing hormone (TRH), gonadotropin-releasing hormone GnRH), corticotropin-releasing factor (CRF), growth hormone-releasing factor (GHRF), somatostatin (somatotropin release-inhibiting factor [SRIF]) and more recently, a GnRH-associated peptide (GAP) that inhibits prolactin secretion. Dopamine, a biogenic amine, also inhibits PRL secretion. Communications between the hypothalamus and the higher centers of the brain are accomplished by a variety of neurotransmitters, which include the already mentioned dopamine, serotonin, y-aminobutiric acid (GABA), norepinephrine and various opioid peptides, as well as many of the peptides also found in the intestinal tract.

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The Surgical Treatment of Prolactinomas

Predictors of Outcome and Long-Term Results

The February, l999 issue of the journal Neurosurgery contains a report by Tyrrell and colleagues from the University of California in San Francisco (UCSF) in which early outcomes and long-term results are analyzed in a large series of patients with prolactinomas following transsphenoidal microsurgery. Two groups of patients treated in different periods of time were followed, and outcomes including complications were evaluated to provide information on the benefits and risks of microsurgery in the management of prolactinomas. The author, J. Blake Tyrrell, is Professor of Medicine and Head of the Section of Endocrinology at UCSF. All patients were operated on by Charles B. Wilson, Professor of Neurosurgery at UCSF. The statistical analysis was performed by Kathleen R. Lamborn, also at UCSF.

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Endocrine Inactive Pituitary Adenomas

Clinicopathological Features and Long Term Outcome Following Transsphenoidal Resection

Gordon Tang (Barstow, CA), Ming-Ming Ning, Marielle H. Nyugen, Brooke Swearingen, Nicholas T. Zervas (Boston, MA)

Discussant: Kalmon Post

Endocrine-inactive adenomas (EIA) account for 30% of pituitary tumors but are infrequently studied. We aim to characterize their clinical presentation, identify endocrinological and radiographic features, study pathological characteristics and determine long-term outcome. We have therefore retrospectively reviewed the cases on 357 patients who underwent resections of EIA from 1978 to 1996 with an average follow up of 8.4 years.

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