Jörgen Lindholm

Frequent occurrence of pituitary apoplexy in patients with non-functioning pituitary adenoma

Background and objective  There is agreement in the literature that pituitary apoplexy is a rare disorder. As our experience differs from this view, we analysed the incidence in patients operated on for a nonfunctioning pituitary adenoma.

No effect of bromocriptine in acromegaly: a controlled trial.

Although bromocriptine, a dopamine receptor agonist, is now widely used in the treatment of acromegaly, there have been no controlled trials of its biochemical or clinical effects on this disorder. We assessed its effects in a double-blind, crossover study. Eighteen patients with acromegaly were given bromocriptine and placebo alternately for three months per medication. Their responses to oral glucose-tolerance tests during the two regimens did not differ significantly. The number of patients noting amelioration of clinical symptoms during treatment with bromocriptine was almost identical to the number with clinical improvement during placebo. We conclude that it remains doubtful whether bromocriptine has a beneficial effect in acromegaly.

Excess mortality in women with pituitary disease: a meta-analysis

Background  Increased mortality has been reported in patients with pituitary disease, with some studies showing higher standard mortality rates (SMR) in women than in men.

Pituitary Tumors Containing Cholecystokinin

We found small amounts of cholecystokinin in the normal human adenohypophysis and therefore examined pituitary tumors from 87 patients with acromegaly, Cushings disease, Nelsons syndrome, prolactinoma, or inactive pituitary adenomas. Five adenomas associated with Nelsons syndrome contained increased amounts of cholecystokinin, the concentrations being extremely high in two: 8281 and 13,453 pmol per gram as compared with less than 30 pmol per gram in normal pituitary glands. The cholecystokinin concentrations were moderately increased in adenomas from another 12 patients, of whom 5 had Cushings disease and 7 acromegaly with adenomas containing ACTH. The cholecystokinin peptides from the tumors were smaller and less sulfated than cholecystokinin from normal pituitary glands. We conclude that ACTH-producing pituitary cells may also produce an altered form of cholecystokinin.

Hypopituitarism and mortality in pituitary adenoma

Background and objective  Previous studies on hypopituitarism and mortality have concluded that insufficient pituitary function is associated with decreased survival. For several reasons the results are difficult to compare – particularly because definitions and treatment of hypopituitarism have varied and various underlying disorders have been included. The purpose was to assess the relationship between mortality and pituitary function.

A century of pituitary surgery: Schloffer's legacy.

Although pituitary tumors were well recognized by the end of the 20th century, very few surgeons had attempted to remove such tumors. In 1906, Hermann Schloffer at the Innsbruck University Clinic of Surgery reviewed the subject of pituitary surgery. Very little was known about the function of the pituitary, and no reports had yet been published on attempts to surgically remove pituitary neoplasms. Schloffer pointed out that ophthalmological symptoms evidently reflected mass effect of the tumor and, hence, resection of the tumor would be beneficial. He also proposed a transsphenoidal approach to the sella, although he was well aware of the risk of meningitis associated with this procedure. On March 16, 1907, Schloffer performed the first transsphenoidal operation for a pituitary adenoma. Unfortunately, the patient died 2 months later from a large residual tumor. Within a few years, several patients had undergone operation with procedures similar to the one described by Schloffer, several of whom experienced acromegaly, thus introducing neurosurgery as routine therapy for acromegaly and settling the long debate on the etiology of acromegaly.

Endocrine function in patients with Cushing's disease before and after treatment

objective To estimate the value of some commonly used tests In diagnosing Cushings disease and to assess the outcome after treatment

Pituitary histology in Cushing's disease

OBJECTIVE We assessed pituitary histology in patients with Cushings disease.

Growth hormone: Historical notes

A brief review of important contributions to our present knowledge of growth hormone is given. In 1887 it had been noted that a pituitary tumor was present in most patients with acromegaly. Even at the beginning of the 20. Century relationship between growth disorders and the pituitary was contested. From 1908 pituitary surgery became established treatment in GH hypersecretion. In 1922 it was demonstrated that injection of pituitary extract to animals caused excessive growth and soon after the opposite: removal of the pituitary caused growth retardation. A huge number of studies on the effects of GH were subsequently reported as were trials with GH treatment. They were impeded by failure to recognize the impact of species specificity of GH. After this issue was clarified in 1957, treatment with human growth hormone proved effective. In 1985 it was realized that Creutzfeldt-Jakob’s disease might be transmitted through human growth hormone. At this time recombinant GH had become available. In 1971 the structure of human GH was established. In the same period both GH releasing and inhibiting hormones were identified and an analogue of somatostatin had evolved into the first effective pharmacological treatment for acromegaly.

Pathogenesis of non-traumatic cerebrospinal fluid rhinorrhea

15 consecutive patients with non‐traumatic cerebrospinal fluid rhinorrhea were studied. 13 operations were performed on 10 patients. In 8 transcranial operations, an assumed defect in the anterior fossa was plugged with muscle, but only 3 operations were successful. In 4 operations, either transcranial or transsphenoidal, the sella was packed with muscle and rhinorrhea ceased immediately.