The objectives of this study were to analyze the characteristics of headache in patients with pituitary adenoma and to investigate the mechanisms involved. Fifty-one patients (27 females and 24 males) with pituitary adenoma were examined. Nineteen (37.3%) of these patients (13 females and 6 males) had headache preoperatively. Most commonly, the headache was generalized (42.1%); overall headache was more frequent in the anterior half of the head (84.2%). Seventeen (89.5%) patients had bilateral headache. Headache was usually described as head heaviness (57.9%) and continuous (57.9%). Pulsating headache and dull pain were only reported by the female patients and were mostly intermittent. The mean age of patients with headache was younger than that of those without headache. Headache was more prevalent in patients with a prolactin-secreting adenoma (57.1%). There were no correlations between visual disturbances, hypopituitarism, tumor size, or cavernous sinus invasion and headache. Hemorrhagic pituitary adenoma in 4 (57.1%) of 7 patients did not always contribute to headache. The headache was improved after surgery in 14 (73.6%) of the 19 patients. In the male patients who survived postoperatively (5 of 6), headache was improved.

Objective: To investigate the possible impact of pretreatment with octreotide on different subtypes of GH-secreting pituitary adenomas and on the outcome of transnasal surgery. Methods: We reviewed a consecutive series of 90 acromegalic patients treated with octreotide alone before transnasal surgery. On the basis of magnetic resonance imaging, the tumours were classi®ed into four groups: group A, microadenoma n 7; group B, transnasally resectable macroadenoma n 21; group C, invasive, potentially transnasally resectable macroadenoma n 43; group D, non-resectable grossly invasive macroadenoma n 19X All patients were treated for at least 3 months before surgery, with a mean daily dose of 221^31 mg octreotide. The mean follow-up was 51X7^1X4 months. The comparative group included 57 acromegalic patients who were not receiving octreotide treatment. Results: After pretreatment with octreotide, tumour shrinkage was clearly observed in 28 of the 90 patients (31%). At surgery, the tumours after octreotide treatment were more often white or grey in colour (91% compared with 75%) and were observed to be slightly more often¯uid or soft in texture (86% compared with 79%) than those in the comparative series. Endocrinological remission was achieved in all patients in group A, 95.2% in group B, and 81.4% in group C. In only 10 of the 14 patients with tumour shrinkage in group C, endocrinological remission was also achieved (71.4%). In the comparative series, endocrinological remission was achieved in 92.9% of group A, 87.5% of group B, and 73.9% of group C. Conclusions: Octreotide treatment slightly improved the already relatively high rate of endocrinological remission in invasive, potentially transnasally resectable macroadenomas. The rate of tumour shrinkage was found to decrease with extrasellar size. With the exception of tumour growth in approximately 7% of invasive adenomas and pituitary apoplexy in one patient, there was no disadvantage associated with the octreotide pretreatment. European Journal of Endocrinology 145 137±145

Covering: 2010-2011. Previous review: Nat. Prod. Rep. 2010, 27, 1630-1680This review covers the literature on simple indole alkaloids and those with a non-rearranged monoterpenoid unit from the beginning of 2010 up to the end of 2011, which includes newly isolated alkaloids, structure determinations, total syntheses and biological activities.

The aim of this short review is to inform about the possibilities and limits of transnasal microsurgery in acromegaly. The current reports on surgical remissions, according to the strict criteria with international consensus using age- and sex-related normal levels for insulin-like growth factor-I and suppression of growth hormone (GH) with oral glucose tolerance below 1 µg/l, are more or less agreeable with values between 34 and 74%. In microadenomas (<10 mm in diameter), 59–95% remissions are published. Some improvement might be achieved in macroadenomas which presently have a chance of 26–68% to be satisfactorily operated on. Special instruments introduced by us to visualize and remove partially invasive adenoma parts are described. Intraoperative magnetic resonance imaging is discussed. With intraoperative measurement of GH, small adenoma rests <3 mm can be diagnosed. When GH did not sufficiently decline, an additional tumor search resulted in a significant improvement in results in resectable macroadenomas. With these techniques, we achieved remission rates which can hardly be further increased (micros 95%, macros 68%). In grossly invasive grade 4 adenomas, which are frequent in our unit, only an 80–95% reduction in tumor mass is feasible. Preoperative treatment with somatostatin analogues as used in most of our patients reduces the comorbidity and facilitates adenoma removal which is still controversially discussed in the literature. The complication rate of microsurgery in experienced hands is low.

Quorum sensing (QS) systems have been proposed in a wide variety of bacteria. The AI-2-based QS system represents the most studied of these proposed interspecies systems, and has been shown to regulate diverse functions such as bioluminescence, expression of virulence factors, and biofilm formation. As such, the development of modulatory compounds, both agonists and antagonists, is of great interest for the study of unknown AI-2 based QS systems and the potential treatment of bacterial infections. The fimbrolide class of natural products has exhibited excellent inhibitory activity against AI-2-based QS, and as such may be considered the “gold-standard” of AI-2 inhibitors. Thus, we sought to include a fimbrolide as a control compound for our recently developed alkyl-DPD panel of AI-2 modulators. Herein, we present a revised synthesis of a commonly studied fimbrolide, as well as a direct comparison between the fimbrolide and alkyl-DPD analogs. We demonstrate that our alkyl-DPD analogs are more potent inhibitors of QS in both Vibrio harveyi and Salmonella typhimurium, the two organisms with defined AI-2 systems, and in doing so, call into question the widely accepted use of fimbrolide-derived compounds as the “gold standard” of AI-2 inhibition.