No abstract

We herein report a 31-year-old Japanese woman with evolving hypopituitarism due to pituitary stalk transection syndrome. She had a history of short stature treated with growth hormone (GH) in childhood and had hypothyroidism and primary amenorrhea at 20 years old. Levothyroxine replacement and recombinant follicle stimulating hormone-human chorionic gonadotropin (FSH-hCG) therapy for ovulation induction were started. GH replacement therapy (GHRT) was resumed when she was 26 years old. She developed mild adrenocortical insufficiency at 31 years old. She succeeded in becoming pregnant and delivered twice. GHRT was partially continued during pregnancy and stopped at the end of the second trimester without any complications.

A 60-year-old Japanese man diagnosed with acromegaly at 28 years old had difficulty walking due to worsening back pain. He had been treated with somatostatin analog since 57 years old, but his pain and numbness continued to worsen. Lumbar magnetic resonance imaging showed disc bulging at L3/4 and 4/5, and he was diagnosed with lumbar spinal canal stenosis due to hypertrophy of the yellow ligament. Patients with acromegaly may complain of osteoarthropathy, so we must pay attention to the symptoms of spinal canal stenosis in collaboration with orthopedic specialists.

Cyclosporin A (CsA), a potent immunosuppressant, is known to have various effects on the endocrine system, including the pituitary gland, the adrenal cortex, the testes, and the pancreatic islets. In this study, the effects of CsA on prolactin (PRL) synthesis and release were investigated in GH3 cells, a clonal strain of rat pituitary tumor. After incubation of confluent GH3 cells with various concentrations of CsA for 24 hr, the PRL content of the media decreased in a dose-dependent manner: by 28.5% with 100 ng/ml CsA (p < 0.01); and 45.8% with 2,000 ng/ml CsA (p < 0.001), compared with control. However, no significant change was observed in the intracellular PRL content. After removal of CsA from the medium, GH3 cells fully recovered normal secretory activity within 24-48 hr, thus indicating that the inhibitory effect of CsA on PRL secretion was reversible. Northern blot analysis revealed a decrease in the PRL mRNA level in cells treated with CsA. In conclusion, these data suggest that CsA inhibits PRL secretion by reducing the rate of biosynthesis. A possible site of action is on PRL gene expression at the level of mRNA transcription.

A 54-year-old man with Graves' disease