John A. Linfoot

Hyperthyroidism and acromegaly due to a thyrotropin- and growth hormone-secreting pituitary tumor: Lack of hormonal response to bromocriptine

A 47-year-old woman with acromegaly and hyperthyroidism was found to have an inappropriately normal serum thyrotropin level (1.5 to 2.5 microU/ml) that responded poorly to thyrotropin-releasing hormone but showed partial responsiveness to changes in circulating thyroid hormones. Serum alpha-subunit levels were high-normal and showed a normal response to thyrotropin-releasing hormone. Growth hormone and thyrotropin hypersecretion persisted despite radiotherapy and bromocriptine treatment. Selective trans-sphenoidal removal of a pituitary adenoma led to normalization of both growth hormone and thyrotropin levels. Both thyrotropes and somatotropes were demonstrated in the adenoma by the immunoperoxidase technique and electron microscopy.

Heavy Particles, the Bragg Curve and Suppression of Pituitary Function in Diabetic Retinopathy

During the past six years heavy particles such as protons and alpha panticles were used to achieve partial or complete hypophysectomy in an attempt to slow down the progressivee, severe diabetic retinopathy in 71 patients. Pituitary suppression was indicated by fall in the insulin requirements and target-organ outputs of these patients. Sixty-one patients were followed long enough for reevaluation; the retinopathy had stabilized in 38 of these, and it was further noted that 14 of these 38 patients also showed improvement in visual acuity. The objective improvements observed in the appearance of the eye grounds were decreases in frequency of hemorrhages and microaneurysms and a decrease in neovascularization and exudates. Eleven patients had died: six with uremia, three of acute myocardial infarction, one of auricular fibrillation, and one of cardiovascular collapse. The findings indicate that retinopathy- can be favorably influenced by suppression or ablation of pituitary function, but it is felt that patients with advanced cardiovascular and renal complications are not desirable candidates. (auth)

Heavy Particle Therapy in Acromegaly and Cushing's Disease.

A total of 349 patients with pituitary tumors, including acromegaly, Cushing disease, Nelson syndrome, prolactin-secreting adenoma, and chromophobe adenoma, have been treated with heavy-particle radiation during the past 17 years. The incidence of side effects has been low. Only 30 patients, 8.6%, have died, most of preexisting cardiovascular complications. Heavy particle therapy provides a form of treatment with no mortality and extremely low morbidity, and its use in treating pituitary disorders has resulted in dramatic improvement in the signs and symptoms of patients with acromegaly and Cushing disease.

HEAVY PARTICLES AND THE BRAGG PEAK IN THERAPY.

Excerpt It is indeed a pleasure and an honor to be asked to deliver a lecture honoring Dr. E. P. Richardson. He was our teacher during my third year of medical school and was in charge of bedside s...