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NCI CANCERLIT^® Search: Pituitary Tumor - July 2002

Imprima English

National Cancer Institute^®
Ultima Vez Modificado: 1 de julio del 2002

The differential diagnosis of lesions involving the sella turcica.
[Novel pharmacologic therapies in acromegaly]
[Current alternative in the pharmacotherapy of acromegaly: the long-acting somatostatin analogue octreotide]
[Experience in treating acromegalic patients with long-acting octreotide]
[Thyrotropin-secreting pituitary adenomas--diagnosis and treatment in five case]
Technical considerations of transsphenoidal removal of fibrous pituitary adenomas and evaluation of collagen content and subtype in the adenomas.
Expression of phosphorylated p27(Kip1) protein and Jun activation domain-binding protein 1 in human pituitary tumors.
Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note.
Decreasing prostate specific antigen value leading to the diagnosis of a pituitary adenoma.
[Diagnosis and management of recurrent pituitary adenoma]
Photophobia as the presenting visual symptom of chiasmal compression.
Does normalization of prolactin levels result in weight loss in patients with prolactin secreting pituitary adenomas?
[Prognostic value of the Knosp scale in trans-sphenoidal surgery for pituitary adenomas]
Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report.
MR imaging of pituitary adenomas treated with the prolactin inhibitor quinagolide.
Genotype-phenotype analysis in multiple endocrine neoplasia type 1.
[Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report]
Increased menin expression in sporadic pituitary adenomas.
Pseudotumor of the pituitary due to PROP-1 deletion.
TRH synthesis in "mute" thyrotropinomas: cause-effect or coincidence?
Amyloid (spheroid) deposits in pituitary adenoma presenting as Cushing disease--a case report.
Craniopharyngioma in a mother and daughter.
Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?
Cytochemical and molecular biological aspects of the pituitary and pituitary adenomas--cell differentiation and transcription factors.
The electrical properties of isolated human prolactin-secreting adenoma cells and their modification by dopamine.
[Diagnostic image (72). An adult woman with coarsening of the face. Acromegaly]
Expression of p53 protein in pituitary adenomas.
Microscopic paraseptal sphenoidotomy approach for pituitary tumors.
Craniopharyngioma: the St. Jude Children's Research Hospital experience 1984-2001.
[Asymptomatic acoustic neurinoma associated with hypophyseal macroadenoma]
The role of somatostatin receptor scintigraphy in the management of pituitary tumours.
Rapid enlargement of a residual craniopharyngioma during short-term growth hormone replacement.
Mixed pituitary gangliocytoma/adenoma (prolactinoma) with histogenetic implications.
Long-term survival with ACTH-secreting carcinoma of the pituitary: a case report and review of the literature.
Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome.

1
UI - 11914472
AU - Kovacs K; Horvath E
TI - The differential diagnosis of lesions involving the sella turcica.
SO - Endocr Pathol 2001 Winter;12(4):389-95
AD - St. Michael's Hospital, Division of Pathology, Department of Laboratory Medicine, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.
The sella turcica and the surrounding area contain several different tissues varying in morphology and cytogenesis. Thus, it is not surprising that a large number of diverse lesions may arise in the sellar region. The most frequent abnormalities are the pituitary adenomas, which based on histology, immunocytochemistry, and transmission electron microscopy can be classified into several distinct entities. Pituitary adenomas originate in and consist of adenohypophyseal cells. They are usually slowly growing benign epithelial tumors, which may be associated with increased hormone secretion or may be endocrinologically nonfunctioning. Pituitary carcinomas also arise in adenohypophyseal cells. They are rare and can be diagnosed only when cerebrospinal and/or systemic metastases are documented. To illustrate the diversity, practical importance, and diagnostic difficulties, four cases were selected for presentation: lymphocytic hypophysitis, thyrotroph hyperplasia, growth hormone-producing pituitary adenoma with neuronal transformation, and composite tumor consisting of adenomatous periodic acid Schiff-positive as well as adrenocorticotropic hormone-immunoreactive adenohypophyseal cells and adrenocortical cells. The first two cases are important from a practical point of view because the proper diagnosis can easily be missed, and appropriate interpretation of the findings is essential to prognosis and treatment. The latter two cases are odd, unusual entities; their histogenesis is unresolved. Study of these and many other cases convinced us that careful and detailed morphologic investigation of lesions involving the sella turcica is of fundamental significance. Histology, immunocytochemistry, transmission electron microscopy, and, in some cases, molecular methods are essential to reach a correct diagnosis and to draw conclusions on histogenesis, growth potential, biologic behavior, prognosis, and therapeutic responsiveness.

2
UI - 12063860
AU - Goth M; Hubina E; Kovacs L; Szabolcs I
TI - [Novel pharmacologic therapies in acromegaly]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1057-62
The primary aim of therapy should be to remove symptoms, reduce tumor bulk, prevent relapse, and improve long-term outcome. Surgery, radiotherapy and medical therapies are used to achieve these aims. Post-treatment mean "safe" serum growth hormone values of < 2.5 ng/ml should be the therapeutic goal. Transsphenoidal surgery remains the first line treatment for acromegaly. Patients with microadenoma can expect 85%, while those with macroadenoma 50% chance to achieve safe serum growth hormone levels. Less than 20% of acromegalics respond to treatment with bromocriptine, while quinagolide and cabergoline may show better clinical response; the success rate is higher for tumors secreting both growth hormone and prolactin. Dopamine agonists may be considered either in combination with somatostatin-analogues or as monotherapy in selected patients, and in those with co-secretion of prolactin. Octreotide (Sandostatin, Novartis) is a synthetic somatostatin-analogue, which is administered subcutaneously in doses between 100 and 250 micrograms 3 times daily. Long-acting octreotide (Sandostatin LAR, Novartis) contains octreotide incorporated into microspheres of biodegradable polymer. To effectively lower serum growth hormone levels, monthly injections of 10-30 mg of long-acting octreotide are needed, serum growth hormone falls to 2.5 ng/ml in 70% of cases, and serum insulin-like growth factor I normalizes in 67%. Slow release lanreotide (Somatuline SR, Ipsen) is an alternative depot long-acting somatostatin-analogue, which is administered in a dose of 30 mg intramuscularly every 14, 10 or 7 days. Both compounds are equally, if not more, effective than subcutaneous octreotide, and significantly improve patient compliance. Pegvisomant (Sensus Drug Development Corporation) is a genetically engineered growth hormone receptor antagonist, which inhibits growth hormone action. When given subcutaneously in a dose of 20 mg/day, serum insulin-like growth factor I levels return to normal in 90% of patients. Theoretical concerns of tumor expansion have not been a problem to date, but long term studies are needed. Primary medical--somatostatin-analogue--therapy is recommended if surgery fails, if the patient refuses or unsuited for surgery and it may be also considered in patients with macroadenoma with extra--but not suprasellar extension, since the surgical "cure" rates of these tumors are low.

3
UI - 12063861
AU - Laczi F; Magony S; Julesz J
TI - [Current alternative in the pharmacotherapy of acromegaly: the long-acting somatostatin analogue octreotide]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1062-6
AD - Szegedi Tudomanyegyetem, Altalanos Orvostudomanyi Kar, Endokrinologiai Onallo Osztaly es Kutato Laboratorium.
Twelve active acromegalic patients (10 women, 2 men) were chronically treated with a long-acting microcapsulated preparation of octreotide (Sandostatin LAR, Novartis). In each case, a growth hormone-producing pituitary adenoma was responsible for the development of acromegaly (microadenomas in 3 and macroadenomas in the rest of the patients). Treatment with long-acting octreotide was indicated for those patients who had not reacted satisfactorily upon previous therapeutic procedures or proved to be unsuitable for irradiation therapy and/or surgery or refused both of these therapies. The preparation was given intramuscularly in every fourth week, generally in a dose of 20-30 mg. After a 6-month treatment, the daily mean of serum growth hormone became suppressed below 2.5 ng/ml in 58.3% of the patients, whereas the growth hormone nadir during oral glucose tolerance test was found at or below 2.5 ng/ml in an even higher proportion of patients (70%). During a 2-year period, the growth hormone-suppressive effect of long-acting octreotide remained stable in all but one patient. The size of the pituitary adenomas remarkably decreased in 50% of this patient cohort. The medication with this preparation was well tolerated. As adverse events, asymptomatic cholelithiasis was detected in 2 patients and biliary sludge-formation in 1 patient. The total number of patients with glucose metabolism disturbances increased only moderately, however, the occurrence of manifest diabetes mellitus became doubled. On the basis of relevant literature data, it can be stated that the mortality rate of successfully treated acromegalics significantly improves. The present retrospective study yields evidence for the microcapsulated octreotide to be an effective tool in the modern therapy of acromegaly.

4
UI - 12063862
AU - Szucs N; Meszaros J; Czirjak S; Mondok A; Varga I; Glaz E
TI - [Experience in treating acromegalic patients with long-acting octreotide]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1066-70
AD - Altalanos Orvostudomanyi Kar, II. Belgyogyaszati Klinika, Semmelweis Egyetem, Budapest.
The authors report clinical observations in 12 acromegalic patients treated with long-acting octreotide (Sandostatin LAR, Novartis, 20 mg intramuscular injection per 28 days administered for 6-36 months). Clinically and hormonally active acromegaly was evidenced in all patients by the presence of typical clinical symptoms, increased serum growth hormone and insulin-like growth factor I concentrations, and by non-suppressible serum growth hormone levels after oral glucose administration. In all patients previous treatments (transsphenoidal surgery, pituitary irradiation and bromocriptine therapy) were uneffective or contraindicated, or they were refused by the patients. Octreotide test (Sandostatin, Novartis, 100 g subcutaneously) performed in all patients before treatment precisely predicted the hormonal effectiveness of long-acting octreotide treatment. Three-six months after therapy serum growth hormone levels decreased from 13.6 +/- 3.9 ng/ml (mean +/- SD) to 3.4 +/- 1.7 ng/ml, while insulin-like growth factor I concentrations decreased from 483 +/- 127 ng/ml to 248 +/- ng/ml. Of the 12 patients 7 (58%) had serum growth hormone levels considered as safe values (< 2.5 ng/ml), whereas in 9 patients (75%) serum insulin-like growth factor I concentrations returned to age- and sex-matched normals. Repeat pituitary magnetic resonance imaging performed in 8 patients treated longer than 1 year revealed a decrease of tumor size in 3 patients (37%). There was a considerable clinical improvement during treatment: severe headache, which was present in most patients, as well as perspiration, joint pain, swelling of extremities, and weakness markedly decreased or disappeared. These results indicate that long-acting octreotide offers a very effective treatment of choice in acromegalic patients in whom other previous therapies were ineffective, contraindicated, or refused.

5
UI - 12063864
AU - Szabolcs I; Czirjak S; Hubina E; Goth M; Tarko M; Bako B; Konrady A;
TI - Patkay J; Kovacs L; Gorombey Z; Radacsi A; Kovacs G; Szilagyi G [Thyrotropin-secreting pituitary adenomas--diagnosis and treatment in five case]
SO - Orv Hetil 2002 May 12;143(19 Suppl):1074-7
AD - BAZ-megyei Korhaz, Miskolo. szabolcs@hiete.hu
The authors report five cases of thyrotropin secreting pituitary adenomas (4 males and 1 female) in whom the diagnosis was established by a combined occurrence of elevated serum free thyroid hormone levels and measurable serum thyrotropin concentration, as well as by visualisation of the pituitary adenomas using magnetic resonance imaging (pituitary microadenoma in two and macroadenoma in three cases). Other tests were less diagnostic: only two out of 4 patients proved to be non-responders during testing with thyrotropin releasing hormone, and serum alpha subunit was elevated in only 2 out of 3 cases. There was a significant decrease of serum thyrotropin concentration in all of the four patients tested by 100 micrograms octreotide (Sandostatin, Novartis). Somatostatin-analogue treatment (slow release preparation in two cases) restored euthyroidism in all three cases treated prior to surgery. In one case the hyperthyroidism persisted after surgery of the macroadenoma, but irradiation of the pituitary area and subsequent somatostatin-analogue treatment resulted finally in a complete cure (euthyroidism and no tumor remnant). In the three other operated patients surgery resulted in euthyroidism. These cases demonstrate the variety of diagnostic and therapeutical modalities in the management of thyrotropin secreting pituitary adenomas.

6
UI - 12064154
AU - Naganuma H; Satoh E; Nukui H
TI - Technical considerations of transsphenoidal removal of fibrous pituitary adenomas and evaluation of collagen content and subtype in the adenomas.
SO - Neurol Med Chir (Tokyo) 2002 May;42(5):202-12; discussion 213
AD - Department of Neurosurgery, Yamanashi Medical University, Yamanashi. naganuma@res.yamanashi-med.ac.jp
Pituitary adenomas are usually soft, but 5-13.5% are fibrous adenomas which are difficult to remove. Magnetic resonance (MR) imaging and operative findings were evaluated in eight patients (12.1%) with fibrous pituitary adenoma among 66 patients. Tumor specimens were examined histologically and immunohistochemically for collagen content and subtypes. Seven patients had clinically inactive non-functioning pituitary adenomas and one patient growth hormone-secreting adenoma. All patients underwent transsphenoidal surgery. Four cases were giant adenomas with suprasellar extension of more than 2 cm. T1- and T2-weighted MR imaging showed the tumors as nearly isointense to the surrounding brain, except in one case where the tumor was high intense on T2-weighted MR imaging. All tumors required piecemeal resection using a micro-dissector and tumor forceps. Four tumors of maximum size more than 3 cm needed a second operation. The interface between the thinned normal pituitary gland and fibrous adenoma was intended to identify at the anterior-superior portion in recent four cases, which was helpful to remove the tumors and preserve pituitary functions. Histological examination revealed prominent deposition of collagen in the perivascular area. The percentage of collagen content in fibrous adenomas was more than 5% and significantly higher than that in soft adenomas and normal pituitary glands. Immunohistochemical examination showed positive staining for collagen types I and III in the fibrous adenomas, but only for type V collagen in the normal pituitary glands. Large fibrous adenomas can be resected by transsphenoidal surgery which may require two-stage operations. Identification of the interface between the normal pituitary gland and adenoma is helpful to remove fibrous adenomas and to preserve pituitary functions. We propose that firm adenomas containing more than 5% collagen are "fibrous" adenomas.

7
UI - 12050228
AU - Korbonits M; Chahal HS; Kaltsas G; Jordan S; Urmanova Y; Khalimova Z;
TI - Harris PE; Farrell WE; Claret FX; Grossman AB Expression of phosphorylated p27(Kip1) protein and Jun activation domain-binding protein 1 in human pituitary tumors.
SO - J Clin Endocrinol Metab 2002 Jun;87(6):2635-43
AD - Department of Endocrinology, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
The cyclin-dependent kinase inhibitor p27(Kip1) (p27) plays a pivotal role in controlling cell proliferation during development and tumorigenesis. p27 has been implicated in pituitary tumorigenesis in studies of knockout mice and in analyses of human pituitary tumor samples. In this study, we further explored the role of p27 in human pituitary tumors by measuring levels of phosphorylated p27 (P-p27), and also Jun activation domain-binding protein 1 (Jab1), which is thought to facilitate the phosphorylation and degradation of p27, in normal pituitary tissue (n = 21), pituitary adenomas (n = 75), and pituitary carcinomas (n = 10). The amount of p27 protein in corticotroph adenomas and pituitary carcinomas was much lower than that in normal pituitary tissue or other types of pituitary adenoma. Nuclear P-p27 protein levels were significantly decreased in the adenomas, compared with the normals, and were much lower in the carcinomas, compared with either normal pituitary tissue or pituitary adenomas. However, P-p27 levels in corticotroph adenomas were similar to normal pituitary tissue, thus demonstrating a greatly increased ratio of P-p27 to p27 specifically in corticotroph tumors. No difference was found in Jab1 protein levels in either corticotroph tumors or other pituitary adenomas, compared with normal tissue, but there was a small but significant increase in Jab1 levels in carcinomas. Corticotroph and metastatic tumors both showed a significantly higher Ki-67 labeling index than normal pituitary or other types of pituitary adenomas, and in general the Ki-67 labeling index was negatively correlated with p27 nuclear staining. The amount of p27 and Jab1 mRNA was positively correlated in all pituitary samples studied but did not correlate with the changes in immunostaining. Our findings suggest that in corticotroph tumors there is an accentuated phosphorylation of p27 into P-p27, possibly related to increased cyclin E expression, whereas both p27 and P-p27 are subject to increased degradation in pituitary carcinomas. Such variations in phosphorylation may play a role in pituitary tumorigenesis, but modulation of Jab1 is unlikely to be important in the pathogenesis of pituitary adenomas.

8
UI - 12015864
AU - Kawamata T; Iseki H; Shibasaki T; Hori T
TI - Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note.
SO - Neurosurgery 2002 Jun;50(6):1393-7
AD - Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. tkawamata@nij.twmu.ac.jp
OBJECTIVE: Endoscopes have been commonly used in transsphenoidal surgery to treat pituitary tumors, to compensate for the narrow surgical field. Although many navigation systems have been introduced for neurosurgical procedures, there have been few reports of navigation systems for endoscopic operations. This report presents our recently developed, endoscopic, augmented reality (AR) navigation system. METHODS: The technology is based on the principles of AR environment technology. The system consisted of a rigid endoscope with light-emitting diodes, an optical tracking system, and a controller. The operation of the optical tracking system was based on two sets of infrared light-emitting diodes, which measured the position and orientation of the endoscope relative to the patient's head. We used the system during endonasal transsphenoidal operations to treat pituitary tumors in 12 recent cases. RESULTS: Anatomic, "real," three-dimensional, virtual images of the tumor and nearby anatomic structures (including the internal carotid arteries, sphenoid sinuses, and optic nerves) were superimposed on real- time endoscopic live images. The system also indicated the positions and directions of the endoscope and the endoscopic beam in three-dimensional magnetic resonance imaging or computed tomographic planes. Furthermore, the colors of the wire-frame images of the tumor changed according to the distance between the tip of the endoscope and the tumor. These features were superior to those of conventional navigation systems, which are available only for operating microscopes. CONCLUSION: The endoscopic AR navigation system allows surgeons to perform accurate, safe, endoscope-assisted operations to treat pituitary tumors; it is particularly useful for reoperations, in which midline landmarks may be absent. We consider the AR navigation system to be a promising tool for safe, minimally invasive, endonasal, transsphenoidal surgery to treat pituitary tumors.

9
UI - 12050526
AU - Yoon JH; Dewolf WC
TI - Decreasing prostate specific antigen value leading to the diagnosis of a pituitary adenoma.
SO - J Urol 2002 Jul;168(1):194
AD - Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

10
UI - 11798825
AU - Yu C; Geng S; Zhu G
TI - [Diagnosis and management of recurrent pituitary adenoma]
SO - Zhonghua Yi Xue Za Zhi 2000 Aug;80(8):593-5
AD - Department of Neurosurgery, Beijing Tiantan Hospital, Beijing 100050, China.
OBJECTIVE: To discuss the clinical features, diagnosis and management of recurrent pituitary adenoma. METHODS: 38 cases of recurrent pituitary reviewed. RESULTS: All cases were confirmed by surgery and pathology. The average recurrent interval of pituitary adenoma was 5.1 years, ranging from 3 months to 18 years. The main clinical manifestations were visual interference, pituitary dysfunction and headache. CT and MRI showed masses in the sellar region with contrast enhancement. Repeated surgeries were performed in 25 cases via transfrontal approach, 13 cases via transsphenoidal. Twenty-nine of 35 cases with visual interference were resolved, no improvement was achieved in 6 cases. Ten of 13 cases with PRL above normal level recovered within one week after surgery and no death was seen. 31 cases were followed up, and showed satisfying results. CONCLUSIONS: The diagnosis of recurrent pituitary adenoma mainly relies on the analysis of clinical manifestations, endocrinological and neuroradiological examinations. Operative management, medical treatment and radiation therapy are all treatment of choice for recurrent pituitary adenoma; while surgery is a main and effective method.

11
UI - 11937897
AU - Kawasaki A; Purvin VA
TI - Photophobia as the presenting visual symptom of chiasmal compression.
SO - J Neuroophthalmol 2002 Mar;22(1):3-8
AD - Hopital Ophtalmique Jules Gonin, Lausanne, Switzerland.
Five patients with a chief visual complaint of photophobia were subsequently found to have compressive lesions of the optic chiasm. Visual acuity and visual field deficits were often subtle. Magnetic resonance imaging scanning revealed large suprasellar masses, including three pituitary adenomas, a craniopharyngioma, and a clivus chordoma. Photophobia resolved in all patients following treatment of the tumors. A compressive lesion of the optic chiasm should be considered in patients who experience persistent photophobia unexplained by ocular abnormalities.

12
UI - 11966752
AU - Yermus R; Ezzat S
TI - Does normalization of prolactin levels result in weight loss in patients with prolactin secreting pituitary adenomas?
SO - Clin Endocrinol (Oxf) 2002 Apr;56(4):562
AD - Mount Sinai Hospital, Toronto, Ontario, Canada.

13
UI - 12053617
AU - Zielinski G; Podgorski JK
TI - [Prognostic value of the Knosp scale in trans-sphenoidal surgery for pituitary adenomas]
SO - Neurol Neurochir Pol 2002 Jan-Feb;36(1):69-82
AD - Kliniki Neurochirurgii Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej, Warszawie.
Various surgical approaches are available for the treatment of somatotroph pituitary adenomas. The treatment of choice remains surgical excision via transsphenoidal route. The results of that operation depend on the volume of the tumour, its suprasellar and parasellar extension, especially to the cavernous sinus. Modern neuroimaging by magnetic resonance provides visualization of the size and extension of the tumour, but invasion of the cavernous sinus space remains still a surgical diagnosis. According to intraoperative observations and proliferation marker (Ki-67) Knosp has evolved out radiological classification describing parasellar extension of pituitary adenomas. We present a series of 142 somatotroph pituitary adenomas surgically treated by transsphenoidal route. The radiological features of the tumours are described using Knosp classification. The results of surgery are analyzed with special reference to preoperative magnetic resonance findings. We found Knosp scale useful for prognostic classification for transsphenoidal surgery cases.

14
UI - 11817701
AU - Hill MD; Mackenzie I; Mason WP
TI - Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report.
SO - J Neurooncol 2001 Nov;55(2):113-6
AD - Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada.
BACKGROUND: Leptomeningeal gliomatosis is a rare and fatal disease. METHODS: Case report. RESULTS: We report the case of a man who was presented with severe intractable headaches, lymphocytic CSF pleocytosis, and spinal leptomeningeal enhancement on contrast MRI. Meningeal biopsy demonstrated diffuse infiltration by malignant glial cells, and symptom alleviation was achieved by CSF diversion. He later developed an enhancing thalamic tumor arising within the treatment field of a remotely irradiated pituitary adenoma. Subsequent management included chemotherapy and further radiotherapy with transient response, before death from leptomeningeal and parenchymal tumor progression 16 months after diagnosis. CONCLUSION: We report a unique case embodying two rare conditions: radiation induced glioma and leptomeningeal gliomatosis. Our patient's course is novel in that symptomatic relief was achieved with CSF diversion and a combination of chemotherapy and focal radiation allowed prolonged survival.

15
UI - 12010287
AU - Ilkko E; Tikkakoski T; Salmela P; Pyhtinen J; Kurunlahti M
TI - MR imaging of pituitary adenomas treated with the prolactin inhibitor quinagolide.
SO - Acta Radiol 2002 Mar;43(2):125-9
AD - Department of Diagnostic Radiology, Oulu University Hospital, Finland.
PURPOSE: To evaluate the volume of micro- and macroadenomas in quinagolide-treated patients with resistance to or intolerance of bromocriptine. MATERIAL AND METHODS: The effect of the prolactin inhibitor quinagolide on the volume of pituitary adenoma was evaluated retrospectively in 11 female patients. Prolactin levels before and after the treatment were also recorded. The indications for quinagolide therapy were side-effects of bromocriptine in 5 cases, a poor response to bromocriptine in 5 cases and both in 1 case. MR imaging with a 1.0-T magnet was performed to determine the volume reduction of the adenomas. RESULTS: The average volume reduction of macroadenomas was 324 mm3 (46%) and that of microadenomas 73 mm3 (57%). The level of prolactin secreted by macroadenomas was reduced by an average of 163 microg/l (65%) and that by microadenomas of 113 microg (73%). In 2 microadenomas and in 1 macroadenoma, signal intensity changed during the treatment in T1-weighted images. In follow-up no changes in signal intensity were seen in 8 adenomas in non-contrast T1-weighted images. A haemorrhagic lesion was seen in 1 macroadenoma before treatment, but it disappeared during treatment. CONCLUSION: Quinagolide was found to be an effective alternative to bromocriptine in cases with drug intolerance or resistance, and MR imaging a suitable method for the follow-up of macro- and microadenomas.

16
UI - 12049533
AU - Kouvaraki MA; Lee JE; Shapiro SE; Gagel RF; Sherman SI; Sellin RV; Cote
TI - GJ; Evans DB Genotype-phenotype analysis in multiple endocrine neoplasia type 1.
SO - Arch Surg 2002 Jun;137(6):641-7
AD - Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
HYPOTHESIS: Multiple endocrine neoplasia type 1 (MEN 1) syndrome is an autosomal dominant disorder caused by germline mutations in the MEN1 gene and characterized by multiple endocrine tumors, most notably in the parathyroid glands, pituitary, and pancreas. The syndrome demonstrates variable expressivity and considerable genetic heterogeneity. Patient data were examined for possible associations between genotype and phenotype. DESIGN: We reviewed recorded medical data from 1975 to 2001 on patients with MEN 1 and compared specific types and locations of MEN1 gene mutations with manifestations of the syndrome. PATIENTS AND RESULTS: We identified 109 affected patients from 24 MEN 1 kindreds. The phenotypic expression of MEN 1 in affected individuals included hyperparathyroidism in 74%, pancreatic endocrine tumors in 51%, and pituitary tumors in 35%. Twelve of 14 insulinomas occurred in patients with pituitary tumors. Mutation analysis was completed in 14 of 24 kindreds (80 of the 109 patients). Mutations were most common in exons 2 (31%), 9 (15%), and 10 (23%). All 21 patients with frameshift mutations (and known pancreatic endocrine tumor status) had such tumors. Pituitary tumors were associated with frameshift mutations in exon 2. CONCLUSIONS: The type and location of MEN1 mutations may be associated with the phenotypic expression of specific tumors. Such information may assist in the genetic counseling and surveillance of at-risk patients. A specific genotype-phenotype correlation is unlikely because of the heterogeneity of the mutations in the MEN1 gene.

17
UI - 12094689
AU - Sakakibara Y; Sekino H; Taguchi Y; Tadokoro M
TI - [Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report]
SO - No Shinkei Geka 2002 Jun;30(6):623-8
AD - Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.
OBJECTIVE: We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos. CASE: This 70-year-old woman presented an ophthalmologist with progressive left-sided exophthalmos over the previous 2 months. Bone window CT scan revealed extensive bony destructions of the skull base including the clivus, sphenoid sinus and medial aspect of the middle cranial fossa. Gd-DTPA MRI revealed an abnormal enhancement lesion in the sphenoid sinus, but no abnormal enhancement was seen in the sella turcica. Since these findings suggested malignant tumors of the cranial base, several biopsies through the transnasal route were carried out to confirm the diagnosis. This procedure caused the complication of cerebrospinal fluid (CSF) leakage. Because the biopsy specimen revealed a PRL producing adenoma (serum PRL-level 645.7 ng/ml), the patient was admitted to our department. On admission neurological examination showed an exophthalmos with external ocular movement disorders and disturbance of visual acuity on the left side. She underwent transsphenoidal surgery to remove the tumor and to reconstruct the sphenoid sinus and the sellar floor. Surgical exploration revealed a yellowish and soft tumor underneath the normal mucous membrane in the sphenoid sinus. The sellar floor was destructed extensively, but the dura mater of the pituitary fossa was intact except for a small pin-hole which was thought to be produced during the several biopsy procedures. No surgical procedure was applied to the intrasellar region. The sphenoid sinus was packed with a piece of fascia and fat applied with the aid of fibrin glue to prevent CSF leakage. RESULT: The patient followed a satisfactory postoperative course. Her visual acuity disturbance and exophthalmos disappeared one year after surgery. Postoperative serum PRL level remained high (66.9 ng/ml), but, subsequently, was normalized (9.5 ng/ml) with a bromocriptine therapy (15 mg daily). CONCLUSION: As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos.

18
UI - 12030908
AU - Wrocklage C; Gold H; Hackl W; Buchfelder M; Fahlbusch R; Paulus W
TI - Increased menin expression in sporadic pituitary adenomas.
SO - Clin Endocrinol (Oxf) 2002 May;56(5):589-94
AD - Institute of Neuropathology, University Hospital, Domagkstrasse 19, D-48129 Munster, Germany.
BACKGROUND: Germline mutations of the multiple endocrine neoplasia type 1 (MEN1) tumour-suppressor gene are responsible for multiple endocrine neoplasia type 1, and menin, the MEN1 gene product, is usually downregulated or truncated in MEN1-associated adenomas. In contrast, exonic MEN1 mutations seem to be very rare in sporadic (MEN1-unrelated) pituitary adenomas, and it has been suggested that menin does not play a major role in these tumours. However, menin might be involved in sporadic adenoma tumorigenesis by downregulation through intronic mutations, epigenetic, posttranscriptional or posttranslational mechanisms. PATIENTS AND MEASUREMENTS: We screened MEN1 coding regions and flanking intronic sequences of 136 sporadic pituitary adenomas by temporal temperature gradient gel electrophoresis (TTGE) and studied menin expression by immunoblotting in 11 of these tumours. RESULTS: Sequencing of DNAs showing aberrant migration on TTGE revealed five somatic MEN1 mutations, including two missense mutations (F134L, E530K), a 2-bp deletion in exon 10 (c.1567-1568del) leading to a premature stop codon, and two 3-bp deletions in intron 5 (g.5236-5238del, g.5237-5239del). These mutations have not been reported previously in studies analysing the MEN1 gene. Immunoblotting showed menin upregulation in all adenomas examined (including one case with a missense mutation) from 1.7-fold to 10.4-fold (mean, 4.2-fold) compared to non-neoplastic adenohypophysis. CONCLUSIONS: Our data suggest that neither MEN1 mutations nor menin downregulation play a significant role in the development of sporadic pituitary adenomas.

19
UI - 11822586
AU - Teinturier C; Vallette S; Adamsbaum C; Bendaoud M; Brue T; Bougneres PF
TI - Pseudotumor of the pituitary due to PROP-1 deletion.
SO - J Pediatr Endocrinol Metab 2002 Jan;15(1):95-101
AD - Department of Pediatric Endocrinology, Hopital Saint-Vincent de Paul, Paris, France. teinturier@cochin.inserm.fr
Hypopituitarism associated with pituitary mass in childhood is most frequently the consequence of craniopharyngioma or Rathke's cleft cyst. We report a patient with an intrasellar pseudotumor associated with hypopituitarism, which led us to a misdiagnosis of intrasellar craniopharyngioma. After spontaneous involution of the mass, diagnosis was revised. DNA analysis showed a deletion in the Prophet of Pit-1 (PROP-1) gene, a pituitary transcription factor. It is important to recognize that a PROP-1 deletion can cause pituitary pseudotumor that can be mistaken for a craniopharyngioma or Rathke's pouch cyst.

20
UI - 12067454
AU - Badiu C; Ham J; Carnu R; Coculescu M
TI - TRH synthesis in "mute" thyrotropinomas: cause-effect or coincidence?
SO - J Cell Mol Med 2001 Jan-Mar;5(1):88-91
AD - Carol Davila University of Medicine and Pharmacy, Department of Endocrinology, PO Box 41-31, 78260 Bucharest, Romania. rpnes@sunu.rnc.ro
In the pathogenesis of thyrotropin (TSH) immunopositive pituitary adenomas, trigger mutagenetic events are well recognized. However, the way towards a clinical significant tumor is followed under the pressure of growth factors, among which the intrapituitary synthesis of releasing factors could bring a significant contribution. In this study, the production of thyrotropin releasing hormone (TRH) and beta TSH chain was evaluated at the mRNA level by in situ hybridization and end product level by immunohistochemistry, in 18 patients submitted to neurosurgery for pituitary macroadenomas. The hormonal sampling showed abnormal secretion for FSH in 5 and TSH in 4 patients. Seven cases were immunopositive for TSH, and expressed TSH beta mRNA. All but one out of these expressed also TRH mRNA. FSH immunoreactivity was documented in 12/ 18, only one of these being negative for TRH mRNA. Paracrine TRH could contribute to the pathogenesis of these "mute" adenomas.

21
UI - 12024930
AU - Rane SR; Deshmukh SD; Bapat VM
TI - Amyloid (spheroid) deposits in pituitary adenoma presenting as Cushing disease--a case report.
SO - Indian J Pathol Microbiol 2001 Jul;44(3):345-6
AD - Department of Pathology, B. J. Medical College & Sassoon General Hospital, Pune.
A rare case of pituitary adenoma with spheroid amyloid deposits encountered in a 40 year old male is presented.

22
UI - 12021891
AU - Green AL; Yeh JS; Dias PS
TI - Craniopharyngioma in a mother and daughter.
SO - Acta Neurochir (Wien) 2002 Apr;144(4):403-4
AD - Department of Neurosurgery, North Staffordshire Royal Infirmary, Stoke-on-Trent, UK.

23
UI - 12039701
AU - Hatrick AG; Boghalo P; Bingham JB; Ayres AB; Sonksen PH; Russell-Jones
TI - DL Does GH replacement therapy in adult GH-deficient patients result in recurrence or increase in size of pituitary tumours?
SO - Eur J Endocrinol 2002 Jun;146(6):807-11
AD - Department of Medicine, United Medical and Dental School, St Thomas' Campus, London, UK.
OBJECTIVE: Hypopituitary GH-deficient patients have an increased cardiovascular mortality and GH replacement in this population has resulted in considerable therapeutic benefit. GH replacement involves administration of a potentially mitogenic substance to patients with a previous or residual pituitary tumour. Our objective was to evaluate whether GH replacement results in an increase in the size of pituitary tumours. METHODS: This was a non-randomised observational study on patients recruited from the endocrine clinic. All subjects had GH deficiency, proven on an insulin tolerance test and were divided into those who were or were not receiving long-term GH replacement. Comparison of change in pituitary size was made with interval radiological imaging of the pituitary. RESULTS: Seventy-five patients (40 men and 35 women) were in the study, 47 were on long-term GH replacement and there were 28 controls. The average length of treatment for the treated group was 3.6 patient years. Thirty-nine patients in the treated group had at least 2 years of GH treatment between imaging studies of the pituitary. Two patients in the treated group had an increase in pituitary size (non-functioning adenomas) and two in the control group (one functioning and one non-functioning adenoma adenoma). None of these four patients required further treatment. There was no statistically significant difference between the two groups. CONCLUSION: Using a representative cohort of hypopituitary patients attending an endocrine clinic, GH replacement was not associated with an increased pituitary tumour recurrence rate. Although the results are not conclusive, in the period of observation GH had little adverse effect but longer studies are required to be certain.

24
UI - 11822191
AU - Sanno N; Tahara S; Kurotani R; Matsuno A; Teramoto A; Osamura RY
TI - Cytochemical and molecular biological aspects of the pituitary and pituitary adenomas--cell differentiation and transcription factors.
SO - Prog Histochem Cytochem 2001;36(4):263-99
AD - Department of Neurosurgery, Nippon Medical School, Sendagi 1-1-5, Bunkyo-ku, Tokyo 113-8603, Japan.
The anterior pituitary is composed of several cell types, each responsible for the production of specific hormones. Each hormone secreting cells is defined by the activation of its respective hormone genes in a temporally and spatially regulated manner. Recent development in cytochemistry and molecular biology have provided various aspects of human pituitary adenomas, i.e., functional differentiation and classification. The molecular factors that determine hormone production have now been identified as transcription factors. Many novel transcription factors that play a role in anterior pituitary development are implicated. In this review, we focus on the transcriptional factors roles on functional differentiation of the pituitary cells and adenomas and the contribution of cytochemistry and recent development in molecular biological techniques.

25
UI - 4029087
AU - Israel JM; Jaquet P; Vincent JD
TI - The electrical properties of isolated human prolactin-secreting adenoma cells and their modification by dopamine.
SO - Endocrinology 1985 Oct;117(4):1448-55
Human prolactinoma cells were maintained in culture for a period of at least 8 days and were able to secrete PRL in large amounts. This secretion was inhibited by bromocriptine, an agonist of dopaminergic receptors, in a dose-dependent manner. The cells showed electrical activity (action potentials) which was blocked by inhibitors of calcium current (cobalt, manganese), whereas it was insensitive to blockers of sodium current (tetrodotoxin). At the resting potential of the cell, dopamine induced a hyperpolarizing response such that action potentials no longer occurred. This effect was due to increase of the membrane conductance and depended on the cell potential. The reversal potential of this response was at -100 mV, which suggests the involvement of potassium ions. Bromocriptine and RU 24213, which are strong dopaminergic receptor agonists, both induced responses identical to the dopamine-induced response. The D2 receptor antagonists (haloperidol, domperidone, and spiperone) blocked the dopamine-induced response in a reversible manner. The D1 antagonist of dopaminergic receptors flupentixol had no effect on the dopamine response. It is concluded that the dopamine modulation of electrical activity involving calcium current may be an early important step in the mechanism by which dopamine inhibits PRL release.

26
UI - 11925822
AU - Tanis AA
TI - [Diagnostic image (72). An adult woman with coarsening of the face. Acromegaly]
SO - Ned Tijdschr Geneeskd 2002 Mar 16;146(11):542; discussion 542

27
UI - 12011941
AU - Oliveira MC; Marroni CP; Pizarro CB; Pereira-Lima JF; Barbosa-Coutinho
TI - LM; Ferreira NP Expression of p53 protein in pituitary adenomas.
SO - Braz J Med Biol Res 2002 May;35(5):561-5
AD - Departamento de Endocrinologia, Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre e Irmandade Santa Casa de Misericordia de Porto Alegre, Dona Mimi Moro 40, 90480-050 Porto Alegre, RS, Brazil. mco@portoweb.com.br
Inactivating mutations of TP53, a tumor suppressor gene, are associated with abnormal cell proliferation. Although p53 expression is common in many human malignancies, p53 protein has seldom been evaluated in pituitary tumors. When detected, the percentage of p53-positive cells is low, and, in general, it is exclusive for invasive lesions. The aim of the present study was to use immunohistochemistry to determine the presence of p53 protein in pituitary adenomas from tumor samples of 163 surgeries performed in 148 patients (40% male, 60% female). In 35% of the cases the adenoma was nonfunctional, while in the others it was associated with PRL, GH and/or ACTH endocrine hypersecretion syndrome. Macroadenomas were observed in 83.2% of the cases with available neuroimage evaluation, of which 28% invaded the cavernous, sphenoid and/or ethmoidal sinus, bone, third ventricle or subfrontal lobe. p53 protein was detected in 2/148 patients (1.3%). Immunohistochemistry was positive for PRL and GH in these cases. Due to the high percentage of invasive pituitary adenomas found in our study, the low frequency of p53 detection suggests that it is inadequate as a routine marker for aggressiveness and as a predictive factor of tumor behavior.

28
UI - 12060820
AU - Vrionis FD; Saatman D; Sorenson J; Brem S
TI - Microscopic paraseptal sphenoidotomy approach for pituitary tumors.
SO - Cancer Control 2002 May-Jun;9(3):223-31
AD - Department of Neurosurgery, University of South Florida and H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA. vrionif@moffitt.usf.edu
BACKGROUND: Dissection of mucosa from the nasal septum during a transsphenoidal approach may lead to significant morbidity. Endoscopic techniques that obviate this dissection and its complications have been successful for pituitary operations. These techniques, however, are generally not stereoscopic, can add significant costs, and in many instances require additional surgical personnel. METHODS: We have exposed 11 sella lesions with the operating microscope without intranasal dissection or use of endoscopy. A paraseptal approach was utilized by following the middle turbinate to the nasopharynx and performing a bilateral sphenoidotomy. RESULTS: Of the 11 sella lesions addressed through this approach, 6 were macroadenomas (2 secreting and 4 nonsecreting), 1 was a craniopharyngioma, 1 was a Rathke's cleft cyst, and 2 were cerebrospinal fluid leaks into the sphenoid sinus. In 1 case, an ectopic pituitary adenoma was biopsied. Subtotal or near total tumor resection or successful repair of cerebrospinal fluid leaks was achieved. In all cases, the exposure was satisfactory. A fat graft was used in 6 cases. Postoperatively, no nasal packing was used and there were no nasal complications. Vision improved in all 5 cases with preoperative visual impairment. Complications included diabetes insipidus (1), impaired taste (1), and delirium tremens (1), all of which were transient. CONCLUSIONS: Microscopic sphenoidotomy is a safe and effective alternative to traditional transseptal or endoscopic exposures of the sella.

29
UI - 12062594
AU - Merchant TE; Kiehna EN; Sanford RA; Mulhern RK; Thompson SJ; Wilson MW;
TI - Lustig RH; Kun LE Craniopharyngioma: the St. Jude Children's Research Hospital experience 1984-2001.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):533-42
AD - Department of Radiation Oncology, St. Jude Children's Research Hospital, 332 N Lauderdale Street, Memphis, TN 38105-2794, USA. thomas.merchant@stjude.org
PURPOSE: To review our institution's experience in the treatment of craniopharyngioma and assess the merits of initial therapy with limited surgery and irradiation. METHODS AND MATERIALS: The data of 30 patients (median age 8.6 years) with a diagnosis of craniopharyngioma between neurologic, endocrine, and cognitive function, and quality of life at last follow-up were compared. RESULTS: Fifteen patients were initially treated with surgery (8 required irradiation after relapse) and 15 with limited surgery and irradiation (2 required additional treatment for tumor progression). Only 1 patient died of tumor progression. The surgery group lost a mean of 9.8 points in full-scale IQ, and the combined-modality group lost only 1.25 points (p <0.063). Patients in the surgery group who had relapses (n = 9) lost a mean of 13.1 points (p <0.067). A loss of 10 points was considered clinically significant. The surgery group also had more frequent neurologic, ophthalmic, and endocrine complications. The mean Health Utility Index (a functional quality-of-life index) was higher for the combined-modality group (0.85) than for the surgery group (0.71; p <0.063, one-sided t test). CONCLUSIONS: The acute neurologic, cognitive, and endocrine effects of surgery often affect long-term function and quality of life. Our experience suggests that limited surgery and radiotherapy cause lesser or comparable sequelae. Diabetes insipidus was the only endocrine deficiency that differed substantially in frequency between the two groups. Newer radiation planning and delivery techniques may make a combined-modality approach a good initial option for most patients.

30
UI - 11771366
AU - Vaamonde Lago P; Castro Vilas C; Soto Varela A; Frade Gonzalez C; Santos
TI - Perez S; Labella Caballero T [Asymptomatic acoustic neurinoma associated with hypophyseal macroadenoma]
SO - Acta Otorrinolaringol Esp 2001 Nov-Dec;52(8):705-8
AD - Catedra y Servicio de O.R.L., Hospital Clinico Universitario de Santiago de Compostela.
The widespread use of gadolinium-enhanced MRI (Gd-MRI) in our hospitals has supposed an increase in detection of asymptomatic acoustic neuromas (AN) as incidental finding. Concurrent primary intracranial tumors of different cell types are extremely uncommon. CLINICAL CASE: A 23 year-old woman complained of irregular menstrual cycles and galactorrhea for two years. A Gd-MRI scan showed a pituitary macroadenoma and an AN of 1.4 cm. with intracanalicular and cisternal extension. The patient did not have any otologic or neuro-otologic symptoms or signs. Audiograms revealed bilateral normal hearing. The results of acoustic reflex test and electronystagmographic caloric tests were normal. The AN underwent radiosurgery treatment. DISCUSSION: The literature about atypical AN is reviewed, giving a particular concern on asymptomatic cases. We only have found one case of association between AN and pituitary adenoma. The real prevalence of AN in general population is discussed.

31
UI - 11891464
AU - Moulik PK; Varma TR; Vora JP; Vinjamuri S
TI - The role of somatostatin receptor scintigraphy in the management of pituitary tumours.
SO - Nucl Med Commun 2002 Feb;23(2):117-20
AD - Department of Diabetes and Endocrinology, Royal Live

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