Ursula Plöckinger

Well-Differentiated Pancreatic Nonfunctioning Tumors/Carcinoma

Departments of a Surgery and b Radiology, University of Verona, Verona , Italy; c Department of Internal Medicine, Charite, University of Berlin, Berlin , Germany; d Department of Nuclear Medicine, University of Rotterdam, Rotterdam , The Netherlands; e M. Korner, University of Bern, Institut fur Pathologie, Bern , Switzerland; f Department of Oncology, South Florida University, Tampa, Fla. , USA; g Department of Internal Medicine, Charite, University of Berlin, Berlin , Germany; h Department of Radiology, Charite Universitatsmedizin, Berlin , Germany; i Department of Surgery, Stadtisches Klinikum Neuss, Lukas Hospital, Neuss , Germany; j Department of Surgery, Zurich Hospital, Zurich , Switzerland; k Department of Surgery, Vivantes Humboldt Hospital, Berlin , Germany; l Department of Endocrine Oncology, University of Uppsala, Uppsala , Sweden; m Department of Pathology, University of Lyon, Lyon , France

Lymphocytic Hypophysitis: Light and Electron Microscopic Findings and Correlation to Clinical Appearance.

Light and electron microscopic findings of six cases of lymphocytic hypophysitis of a collective of 2500 surgical specimens are presented. Five cases were obtained by surgery, one case was obtained from autopsy. Light microscopy revealed an infiltration of mature lymphocytes and plasma cells in the interstitium, partly in the acini, as well as in the posterior lobe and the capsule. The structure of the remaining anterior lobe was normal. The final stage of lymphocytic hypophysitis is fibrosis, which was seen in all cases to varying degrees. The infiltrate consisted mainly of T-lymphocytes, being positive for CK 45 RO and CD 43. Immunocytochemical staining revealed different proportions of residual adenohypophyseal cells. Mainly prolactin reactive cells were observed as were growth hormone reactive cells. By electron microscopy some ruptured acini and damaged adenohypophyseal cells could be seen. Few pituitary cells contained enlarged lysosomal bodies or oncocytic changes. Inflammation causing enlargement of the pituitary leads to patients often being operated under the preoperative diagnosis of a tumor of the sellar region. It is important to identify this special type of hypophysitis, as a different course of treatment is required.

Evaluation of a repeatable depot-bromocriptine preparation(Parlodel LAR®) for the treatment of acromegaly

The effectiveness and side effects of a newly developed, repeatable depot-bromocriptine preparation, (Parlodel LAR®, depot-bromocriptine), were studied in 7 acromegalic patients. A dose of 100 mg was injected at intervals of 28 days for 4 months, followed by 200 mg for 2 months. GH profiles (14 h) and an oral glucose load (oGTT) were performed prior to each injection. Depot-bromocriptine suppressed the mean serum profile GH concentration to less than 50% of the pretreatment value in 3 out of 7 patients (responders). Normalization of GH secretion was not achieved. During oGTT the mean serum GH concentration declined to 73%, 19% and 56% of the pretreatment value in the three responders (while on depot-bromocriptine 200 mg). IGF-I was reduced to 84% and 65% with 200 mg depot-bromocriptine in 2 GH responders only. No tumour shrinkage was observed in 3 patients with a visible tumor mass in NMR tomography. Side effects consisted of pronounced orthostatic dysregulation, nausea and vomiting on the day of injection in 3/7 patients. These results are comparable to the reported effectiveness and side effects of oral bromocriptine therapy. Depot-bromocriptine may be useful in selected responsive patients, particularly when compliance during oral therapy is a problem.