Achille Stevenaert

Classical pituitary tumour apoplexy: Clinical features, management and outcomes in a series of 24 patients

We retrospectively analysed the incidence, clinical presentation, endocrinological and radiological findings, medical and surgical management of pituitary apoplexy in our department (single-centre study), having a large experience in pituitary surgery. Among 1540 pituitary lesions, 24 patients presented with pituitary apoplexy. Their charts were retrospectively reviewed. The symptoms included headache (92%), nausea and vomiting (54%), visual deficit (50%), oculomotor paresis (54%) and/or an altered mental state (42%). Skull X-rays (n = 14) demonstrated an enlarged sella turcica in all cases; CT-scan and/or MRI always revealed a sellar and suprasellar expanding lesion. Panhypopituitarism was present on admission in 70% of the patients. Urgent therapeutic management included high-dose cortisone treatment in all but one patients and CSF drainage in three. Three patients were treated conservatively. Nine patients were operated on rapidly, within hours or a few days because of severe visual deficit and/or altered level of consciousness. Nineteen patients were operated by the trans-sphenoidal approach; one of them required a second operation by craniotomy. There were two deaths related to the illness and one to an ill-defined reason at 4 months. Among the other patients 95% made a good recovery. All but two patients required a substitutive treatment with adrenal (83%), thyroid (68%), gonadal (42%) and/or growth (16%) hormones. The preoperative visual deficits recovered in all but one patients (92%) whereas the oculomotor pareses improved in all but two patients (85%). In conclusion, pituitary tumour apoplexy is a rare event, complicating in our series 1.6% of 1540 pituitary adenomas. Even in severe cases, complete recovery is possible if the diagnosis is rapidly obtained and adequate management is initiated in time. Surgical results after trans-sphenoidal approach are in the majority of cases very satisfactory.

Effects of Schwann Cell Transplantation in a Contusion Model of Rat Spinal Cord Injury

Cultured Schwann cells were transplanted at various delays into a spinal cord contusion injury performed at low thoracic level in adult female rats. The Schwann cells were purified from the dorsal root ganglia of adult syngeneic animals. The transplants were well tolerated, and the transplanted Schwann cells invaded the injured spinal cord. As quantified using video image analysis, the survival and growth of the transplanted cells were poor when the grafting procedure was performed 3–4 days after injury and very good when performed immediately or 10 days after injury, in which cases post‐traumatic micro‐ and macrocavitation were strongly reduced. In animals grafted immediately after injury but not in animals grafted after 10 days, post‐traumatic astrogliosis was much reduced. The Schwann cells transplanted area was invaded by numerous regenerating axons, the vast majority of which were, based on the neurotransmitter (CGRP and SP) profile, originating from dorsal root ganglion. No regeneration of the cortico‐spinal tract as assessed after anterograde tracing or of descending aminergic fibers could be demonstrated.

Two years of replacement therapy in adults with growth hormone deficiency

Although several studies have shown beneficial short‐term effects of recombinant human growth hormone (rhGH) therapy in adult GH deficient (GHD) patients, few data are available on large groups of patients treated for more than one year. In addition, the optimal dose of rhGH for each patient and the baseline parameters that predict which patients will benefit most from therapy or will have adverse events are not entirely elucidated.

The treatment of sporadic versus MEN1-related pituitary adenomas

Abstract.  Beckers A, Betea D, Valdes Socin H, Stevenaert A (Domaine Universitaire du Sart‐Tilman, Liege, Belgium). The treatment of sporadic versus MEN1‐related pituitary adenomas (Minisymposium). J Intern Med 2003; 253: 599–605.

Familial acromegaly: case report and review of the literature.

Familial acromegaly is an exceptional clinical entity when not associated with features of multiple endocrine neoplasia type 1 (MEN1). We report here 3 pedigrees in each of which 2 patients have been shown to develop acromegaly. In 5/6 patients, clinical follow-up, and biological screening allowed to confidently exclude MEN1. Absence of mutation in the MEN1 gene after direct DNA analysis in 2 pedigrees reinforces the conviction that the families do not have MEN1. In families 1 and 2, diagnosis

Juxtafacet Cyst of the Lumbar Spine. Clinical, Radiological and Therapeutic Aspects in 28 Cases

Summary Object. A consecutive series of 28 “operated” juxtafacet cysts is reported. We emphasize the clinical and radiological aspects leading to diagnosis. We also discuss the results of the surgical treatment. Material and Methods. Medical information and radiological studies involving 28 patients were analyzed. Each patient has been operated on by decompressive laminectomy and resection of the cyst. The diagnosis was always confirmed by a pathological examination. The cyst most frequently occurred at the L4-L5 level (n=18), and seldom at the L5-S1 (n=6) or L3-L4 (n=4) levels. Results. The differential diagnosis from other pathological causes responsible for a radicular compression could not be done by physical examination. Spine X-rays or myelogram were nonspecific. Computed Tomography or CT-myelography could help in the diagnosis but MR imaging was the most sensitive. In our series, the respective sensitivities of these techniques are 56, 42 and 77%. The preoperative diagnosis was correct in 18 patients (64%). The cyst was sometimes adherent to the underlying dura, then significantly increasing the risk of dural tear and spinal fluid leak, especially when located at L3-L4 level. Surgical ablation lead to a complete recovery or an important improvement in 26 patients. Conclusions. The diagnosis of the juxtafacet cyst of the lumbar spine is better achieved by MRI. Surgery is the gold standard treatment, safe and long-term effective. When a total cyst removal with an internal facetectomy are performed, recurrence is exceptional.

Cyclical Cushing's disease and its successful control under sodium valproate.

Several subgroups of Cushing’s disease were recently described (anterior or intermediate lobe origin, hyper-or hypo-pulsatility of Cortisol, presence or absence of response after GRH or TRH, cyclical Cushing’s disease). We present here a detailed case report on a patient suffering from Cushing’s disease whose endocrine functions were extensively investigated. Treatment with bromocriptine, as well;as subsequent transsphenoidal surgery, were followed by rapid but transient reversal of symptoms. When clinical manifestations reoccurred, daily measurements of free urinary Cortisol revealed a cyclic pattern of Cortisol hyperexcretion. A study of ultradian rhythm revealed hyperpulsatility of Cortisol secretion. More interestingly, a treatment with sodium valproate, a drug known to inhibit CRH production, was followed by a rapid and longstanding normalization of clinical and biological data for 2 years. Based on these data, and on information from the literature, the present case of Cushing’s disease exhibits characteristics suggesting a possible hypothalamic origin.

The burden of illness of hypopituitary adults with growth hormone deficiency.

AbstractObjective: The negative metabolic and psychosocial consequences of growth hormone deficiency (GHD) in adults are now well established. In the present study, an attempt was made to quantify the burden of illness, in terms of lost productivity and increased medical consumption, associated with hypopituitarism and untreated GHD. Design and Setting: The study population consisted of 129 Belgian adults with untreated GHD associated with hypopituitarism after pituitary surgery. The Short-Form 36 Health Survey (SF-36) was used to assess health status, and the Health and Labour Questionnaire was used to measure production losses and labour performance. Data on medical consumption were also collected. Main Outcome Measures and Results: Hypopituitary patients reported a lower health status than that of the general population in all but two dimensions of the SF-36 (pain and physical functioning). Nearly 11% of the patients reported being incapacitated for paid employment due to health problems, compared with 4.8% of the general Belgian population. Patients in paid employment reported a mean of 19.8 days of sickness leave per year, which is twice that in the general population. The annual number of visits to general practitioners and specialists was also higher in the patients (9.6 and 6.5 visits, respectively, for the patients compared with corresponding figures of 2.1 and 1.5 for the general Belgian population). The average annual number of days spent in hospital was 3.5 for the patients compared with 2.3 in the general population. The annual healthcare costs and costs due to production losses calculated for hypopituitary patients who had received pituitary surgery amounted to 135 024 Belgian francs (BeF) or

Soft cervical disc herniation : a retrospective study of 100 cases

US4340 (1995 values). This compares with the mean annual cost per person for the Belgian population as a whole of BeF68 569 or

Acromegaly, multinodular goiter and silent polyostotic fibrous dysplasia. A variant of the McCune-Albright syndrome

US2204. Conclusions: Hypopituitary patients with untreated GHD therefore have a higher cost to society in terms of lost production and medical consumption than the average Belgian population.