Stephen E. Rawe

Case Report: Pituitary Adenocarcinoma in an Acromegalic Patient: Response to Bromocriptine and Pituitary Testing: A Review of the Literature on 36 Cases of Pituitary Carcinoma

There are 36 reported cases of metastatic pituitary carcinoma and almost half (44%) of these were associated with syndromes of hormonal hypersecretion. The case of a 56-year-old acromegalic man with cervical lymphatic and spinal metastases from a primary pituitary carcinoma is described. Elevated basal levels of plasma growth hormone (GH) and insulin growth factor-1/Somatomedin C (IGF-1/SmC) were found. GH levels did not increase after TRH or LHRH administration but decreased after L-Dopa and glucose. Immunostaining of the metastatic tumor for GH and electron microscopy findings confirmed the diagnosis of pituitary GH-secreting carcinoma. Striking clinical improvement and a 46% decrease in plasma GH levels were observed with bromocriptine treatment, although IGF-1/SmC levels increased during therapy. The clinical course of most reported cases of pituitary adenocarcinoma has been one of progressive intracranial expansion of a pituitary neoplasm. In only 25% were metastatic lesions discovered antemortem, and disabling symptomatology caused by metastases was rare. Only four previously reported patients of 36 with pituitary carcinoma had acromegaly.

Spinal Cord Glucose Utilization after Experimental Spinal Cord Injury

Metabolic alterations after experimental contusion injury of the spinal cord were evaluated by determining qualitative spinal cord glucose utilization (SCGU), SCGU was determined by the 2-deoxy-D-[14C] glucose technique. An increase in SCGU occurred at the site of maximal impact in the white matter after an injury causing paraparesis and in near trauma regions after an injury causing either paraparesis or paraplegia. These findings are most likely due to anaerobic glycolysis resulting from a reduction in blood flow that still allows delivery of substrate to tissue. Although an initial increase was observed at the site of maximal impact after a paraplegia-causing injury, SCGU in the white matter demonstrated a progressive deterioration by 4 and 8 hours after injury. A failure of substrate delivery resulting from ischemia is the most likely cause for this reduction in SCGU. The somatosensory evoked potential was found to be a very sensitive indicator of the remaining functional axons at the injury site.

Combined Extracranial-Intracranial Resection of a Maxillary Desmoid Tumor

Desmoid tumors are a locally infiltrative, nonmetastasizing form of fibromatosis. Wide en bloc extirpation is the therapy of choice, with a high recurrence rate reported for lesser resections. The first case of a desmoid invading intracranially is reported, and the combined intracranial-extracranial resection is described.

Norepinephrine levels in experimental spinal cord trauma

Alpha methyl tyrosine (AMT) or reserpine administered intravenously 24 hours before sacrificed in the nontraumatized cat resulted in significant reduction in tissue levels of norepinephrine (NE) tested at the T-5 spinal cord level. Phenoxybenzamine given 2 hours before sacrifice did not alter NE levels at T-5. Histological sections of spinal cord examined 1 hour after a 500-gm-cm trauma at the T-5 level in cats, pretreated 24 hours before trauma by a single dose of AMT or reserpine demonstrated no reduction of gray or white matter hemorrhages when compared tocontrols. In cats pretreated with phenoxybenzamine 2 hours before trauma there was a marked reduction of hemorrhages at 1 hour posttrauma when compared to controls. The animals treated with phenoxybenzamine had a 32% reduction of systemic blood pressure before trauma, demonstrated no pressor response to spinal cord trauma, and were severely hypotensive posttrauma. It is concluded that posttraumatic blood pressure has greater etiological significance in the pathogenesis of experimental spinal cord hemorrhages than tissue levels of NE.

A neuropathologic study of Whipple's disease

SummaryA patient with Whipples disease developed massive and irreversible CNS involvement after a drug-induced intestinal remission. The multifocal brain lesions were apparent grossly with the heaviest concentration being noted in rhinencephalon, diencephalon, and mesencephalon. This patient exhibited progressive neurologic deterioration, although viable organisms could not be identified in the brain at autopsy. Astrocytes, pericytes, and choroid plexus cells attempted to dispose of the organism, in addition to the traditionally implicated microglial and ependymal cell.

Segmental norepinephrine and dopamine levels in cat spinal cord

Abstract Tissue levels of norepinephrine in the uninjured cat were determined by a fluorimetric or enzymatic radiometric assay technique. There were no significant differences of NE levels between the two techniques. The highest concentrations of NE were found in the cervical (.170 ug/g) and lumbar (.232 ug/g) enlargements and appear to be related to the relative amount of grey and white matter present at these levels. Dopamine levels, as determined by the enzymatic radiometric assay technique, were found to be low in those spinal segments measured (less than 0.030 ug/g). DA appears to be similarly distributed as norepinephrine in the spinal segments. Barbiturate or nitrous oxide anesthetic agents did not result in significant differences in NE determinations at cervical or thoracic segments. Variability of reported NE and DA levels from other studies appears to be related to differences in assay technique.

Prolactin‐secreting adenoma as part of the multiple endocrine neoplasia—type I (MEN‐I) syndrome

Two patients presented with the galactorrhea‐amenorrhea syndrome. One patient had previously had parathyroid hyperplasia and the other an insulinoma. Preoperative evaluation of each patient revealed hyperprolactinemia and radiological evidence of an abnormal sella turcica. Pituitary adenomas were identified and removed at surgery. Immunostaining techniques confirmed the presence of prolactin‐containing cells in both tumors. We propose that prolactin‐secreting tumors be considered as part of the MEN‐I syndrome, and that patients presenting with the galactorrhea‐amenorrhea syndrome be screened and followed sequentially for evidence of other endocrine neoplasia.

Computed tomography in patients with successfully shunted normal pressure hydrocephalus

Abstract Since our CT scanner became available, we have studied six patients who were considered on clinical and laboratory evidence to have normal pressure hydrocephalus (NPH). All were shunted, with excellent clinical response. Characteristic CT features included large lateral, third and fourth ventricles, absence of cortical sulci preoperatively and low density periventricular crescents in some. These findings are compared with those of other diseases with enlarged ventricles, and the change in the CT appearance of NPH patients after shunting is reviewed.