clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset... more clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma
The presence of corticotropin!releasing hormone "CRH# receptors has been previously dem! onstrate... more The presence of corticotropin!releasing hormone "CRH# receptors has been previously dem! onstrated in corticotrophs from normal pituitaries using a method combining immunocytochemistry and liquid emulsion autoradiography[ The aim of this study was to compare the characteristics of the 014 I!Tyr 9 ! hCRH binding in corticotrophs from normal pituitaries "three obtained at autopsy and one obtained at surgery# with corticotrophs from pituitary adenomas "six corticotroph adenomas responsible for Cushing|s disease and two silent corticotroph adenomas secreting a biologically inactive ACTH molecule#[ In normal corticotrophs\ the larger part of the 014 I!Tyr 9 !hCRH binding was localised in patchy conglomerates at the centre of the cell and\ to a much lesser degree\ in a di}use pattern at the cell periphery[ In adenomatous corticotrophs\ CRH receptor expression is disturbed both quantitatively and qualitatively[ Except for a minority of cells in one adenoma\ all adenomatous corticotrophs showed only peripherally bound 014 I!Tyr 9 ! hCRH and no centrally localised binding[ Furthermore\ adenomatous corticotrophs revealed a statistically signi_cant lower signal intensity when compared to normal corticotrophs and a strongly negative cor! relation was found between the labelling area in adenomatous corticotrophs and both the basal and CRH! stimulated plasma ACTH levels[ These _ndings suggest defective processing of CRH receptors and could be relevant to the sustained ACTH secretion by adenomatous corticotrophs in Cushing|s disease and\ more generally\ provide an explanation to its pathology[ The silent corticotrophs secreting a biologically inactive ACTH molecule were characterised by a very faint signal intensity\ although present on almost every cell[
Background: Isolated growth hormone deficiency (IGHD) provides the ideal model to characterize GH... more Background: Isolated growth hormone deficiency (IGHD) provides the ideal model to characterize GHD without interference from other pituitary deficiencies or their treatment. No study has addressed the question whether adult patients with IGHD differ in clinical presentation or in responsiveness to GH replacement from adult patients with multiple pituitary hormone deficiencies (MPHD) receiving conventional replacement therapy. Patients and methods: Data were retrieved from the outcomes research database KIMS (Pfizer international metabolic database). Patients with IGHD accounted for 9.6% (274/2868) of all GHD patients. Patients were separated according to the timing of onset. In the adult-onset (AO) group, 167 patients with IGHD were compared to 1992 patients with MPHD. In the childhood-onset (CO) group, 107 patients with IGHD were compared to 602 patients with MPHD. To assess the effect of GH replacement after one year, a longitudinal sub-analysis in the AO group was performed comparing 89 IGHD patients to 1234 MPHD patients. The same study was done in the CO group comparing 66 IGHD patients to 386 MPHD patients. Because IGHD patients were significantly younger than MPHD patients, data analysis was also performed after adjustment for gender and age. Results: In the AO group, non-functioning and secreting pituitary adenomas were the most common primary diagnoses in both IGHD and MPHD. Medical history revealed a high prevalence of hypertension and fractures in both subgroups, but also of non-insulin dependent diabetes mellitus. The prevalence of obesity was high and the waist circumference was elevated. The lipid profile was unfavourable in both IGHD and MPHD. IGF-I concentration and SDS were comparable in both subgroup. Quality of life assessed by QoL-AGHDA was equally poor in both IGHD and MPHD. GH replacement therapy induced favourable changes without distinction. In the CO group, the most common cause in both subgroups was idiopathic. Fracture rate was similarly prevalent in both IGHD and MPHD. Obesity was prominent in both subgroups, but BMI and waist circumference were lower in IGHD. Adverse lipid changes were similarly found in both IGHD and MPHD.
The Journal of Clinical Endocrinology & Metabolism, 1998
Cabergoline is a new, long acting, dopamine agonist that is more effective and better tolerated t... more Cabergoline is a new, long acting, dopamine agonist that is more effective and better tolerated than bromocriptine in patients with hyperprolactinemia. Because dopamine agonists still have a place in the medical management of acromegaly, cabergoline might be a useful treatment. We, therefore, evaluated the effect of long term administration of cabergoline in a large group of unselected acromegalic patients. Sixtyfour patients were included in a multicenter, prospective, open labeled study. A subgroup of 16 patients had GH-/PRL-cosecreting pituitary adenomas. Cabergoline was started at a dose of 1.0 mg/week and was gradually increased until normalization of plasma insulinlike growth factor I (IGF-I) levels, occurrence of unacceptable sideeffects, or a maximal weekly dose of 3.5 mg (7.0 mg in 1 case) was reached. Treatment with cabergoline suppressed plasma IGF-I below 300 g/L in 39% of cases and between 300-450 g/L in another 28%. With pretreatment plasma IGF-I concentrations less than 750 g/L, a suppression of IGF-I below 300 g/L was obtained in 53% of cases, and a suppression between 300-450 g/L was obtained in another 32%. By contrast, with pretreatment plasma IGF-I concentrations above 750 g/L, only 17% of cases showed a suppression of IGF-I below 300 g/L, and there was IGF-I suppression between 300-450 g/L in another 21%. In GH-/PRL-cosecreting adenomas, 50% of cases suppressed plasma IGF-I levels below 300 g/L, and another 31% did so between 300-450 g/L, in contrast to only 35% and 27%, respectively, in GH-secreting adenomas. Similar results were obtained concerning the secretion of GH. Tumor shrinkage was demonstrated in 13 of 21 patients, with a mass reduction by more than half in 5 GH-/PRL-cosecreting adenomas. Except for slight gastrointestinal discomfort and orthostatic hypotension in a few patients at the beginning of therapy, cabergoline treatment was well tolerated. Only 2 patients stopped medication because of nausea. The weekly dose of cabergoline ranged between 1.0-1.75 mg. A further increase in the dose was only effective in 1 GH-/PRL-cosecreting adenoma. The results of this study suggest that cabergoline is an effective, well tolerated therapy that should be considered in the management of acromegaly, especially if the pituitary adenoma cosecretes GH and PRL or if pretreatment plasma IGF-I levels are below 750 g/L.
Design: Data on lipids, body composition, and blood pressure (BP) from all published KIMS papers ... more Design: Data on lipids, body composition, and blood pressure (BP) from all published KIMS papers are summarized and compared with a literature review. Results: KIMS data confirm and extend previous research showing that adults with GH deficiency (GHD) have an adverse cardiovascular risk profile. GHD patients have high levels of dyslipidemia, elevated body mass index, unfavorable waist-to-hip ratio and body composition, and a high risk of hypertension. These abnormalities are likely to explain the increased cardiovascular mortality observed in patients with hypopituitarism. When given GH replacement therapy, an improvement is seen in KIMS as well as earlier studies for lipid profile, body composition, and BP. The added value of the different KIMS papers over previous research is that KIMS involves a much larger number of patients, that lipid concentrations and IGF1 are measured in a single central laboratory, and that the effects of GH replacement therapy can be followed longer than the duration of earlier trials. By the large number of patients, KIMS gives insight into the effects of GH in different patients' subgroups such as elderly patients, patients with idiopathic GHD, patients with craniopharyngioma, patients after irradiation, and so on. In addition, KIMS has made it possible to calculate more exactly the influence of baseline parameters on these cardiovascular risk parameters and their response to GH. Conclusions: Taken together, data from KIMS confirm earlier knowledge about the important benefits of GH replacement therapy, but also on the use of GH in specific subgroups such as isolated GHD, patients above 65 years, and patients after irradiation. No subgroup yet has been identified as not responding well to GH.
Background Adult-onset growth hormone deficiency (AO-GHD) is associated with an increased prevale... more Background Adult-onset growth hormone deficiency (AO-GHD) is associated with an increased prevalence of the metabolic syndrome (MetS). Aim To determine the effect of GH replacement on the prevalence of MetS in AO-GHD and to study the impact of MetS on the incidence of cardiovascular events during GH replacement. Patients and methods 1449 AO-GHD patients (males 48.9%; mean age 48.9 ± 12.8 year) were retrieved from KIMS (Pfizer International Metabolic Database). The prevalence of MetS (using International Diabetes Federation criteria) and its components were calculated at baseline and after one year of GH replacement. The relative risk to develop cardiovascular events according to the presence of MetS at baseline was assessed in another group of 3282 patients after prolonged GH replacement. Results The prevalence of MetS was 46.9% at baseline and 48.2% after one year of GH replacement (P = NS). The percentage of patients with abnormal waist circumference decreased significantly (80.3 ...
The Journal of clinical endocrinology and metabolism, Jan 29, 2017
Craniopharyngioma (CP) in adults, of either childhood-onset (CO-CP) or adult-onset (AO-CP), is as... more Craniopharyngioma (CP) in adults, of either childhood-onset (CO-CP) or adult-onset (AO-CP), is associated with increased morbidity and mortality, but data on the relative risks (RRs) of contributing factors are lacking. To assess the RRs of factors contributing to morbidity and mortality of adults with CO-CP and AO-CP. Data on 1,669 CP patients from KIMS (Pfizer International Metabolic Database) were analyzed using univariate and multiple Poisson and Cox regression methods. Combining CO-CP and AO-CP groups, history of stroke and hyperlipidemia increased cardiovascular risk, higher body mass index (BMI) and radiotherapy increased cerebrovascular risk, and increased waist circumference increased the risk of developing diabetes mellitus (DM). Compared to CO-CP patients, AO-CP patients had a 3-fold higher risk of tumor recurrence, whereas being female and previous radiotherapy exposure conferred lower risks. Radiotherapy and older age with every 10 years from disease-onset conferred a 2...
Samenvatting Model evaluatie en dynamica van een viscoelastische vloeistof in een complexe stromi... more Samenvatting Model evaluatie en dynamica van een viscoelastische vloeistof in een complexe stroming Jan M. Verhelst Abbreviations 2D two-dimensional 3D three-dimensional ARES advanced rheometric expansion system p. 70 LDV laser Doppler velocimetry p. 40, figure3.1 PAMH partially hydrolyzed polyacrylamide p. 70, figure 4.1 PAA polyacrylamide p. 42, figure 3.3 PEO polyethylene oxide p. 42, figure 3.3 UCM Upper Convected Maxwell fluid p. 15 wppm weight parts per million p. 48, figure 3.14
Since little is known about carcinoembryonic antigen (CEA) half-life in humans, we followed chang... more Since little is known about carcinoembryonic antigen (CEA) half-life in humans, we followed changes in CEA levels after curative resection of a small bronchial adenocarcinoma in a 54 yr old man with an unusually high preoperative serum CEA level of 1,199 ng.ml-1. Serum CEA followed a four phase curve with an initial increase, attributed to release of CEA from the tumour, a rapid fall during four days (CEA half-life 3.2 days), a slower exponential decay to normal levels during almost three months (CEA half-life 11 days) and eventually maintenance of normal levels for 14 months. These results are consistent with data from animal experiments and a single report on CEA half-life in humans, but CEA half-life seems longer in man than in animals. This observation also suggests that a very high serum CEA level should not in itself preclude curative surgical resection of a primary bronchogenic carcinoma.
s presented at the 19th Annual Congress of the Belgian Society of Internal Medicine 12-13 Decembe... more s presented at the 19th Annual Congress of the Belgian Society of Internal Medicine 12-13 December 2014 – Auditorium Brouwer, Medical Campus Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels
We report the case of a 39-year-old male presenting with panhypopituitarism and diabetes insipidu... more We report the case of a 39-year-old male presenting with panhypopituitarism and diabetes insipidus. MR imaging showed focal thickening of the pituitary infundibulum and infiltration of the anterior pituitary lobe, suggesting hypophysitis. Hormonal replacement therapy induced a pronounced amelioration of general well-being. Eight months later the subject developed visual disturbances. MR imaging now showed a cystic sellar mass. Surgical drainage was performed. A second operation was necessary six weeks Later because of recurrent visual field defects. Diagnosis of papillary craniopharyngioma was finally made. This case demonstrates the remarkably rapid development of a craniopharyngioma, which initial radiological appearance was suggestive of hypophysitis. It also emphasizes the need of repeat MR examination in case of unusual presentation of hypopituitarism.
We describe a case of acute rupture of the left proximal ureter as a result of lithiasis. The pat... more We describe a case of acute rupture of the left proximal ureter as a result of lithiasis. The patient presented with a clinical picture of renal infarction: unilateral flank pain, more than 500 red blood cells per microliter urine and increased serum LDH levels. Abdominal ultrasound as well as a CT scan showed no abnormalities. Only CT angiography of the kidneys was able to demonstrate an acute rupture of the left proximal ureter with extravasation of contrast. Intravenous pyelogram confirmed this rupture with leaking of the contrast. One day after admission the patient urinated a 2 mm large calciumoxalate-monohydrate stone, the likely cause of the rupture. The rupture healed spontaneously. A review of the literature is given.
Dopamine agonists are effective in some patients with acromegaly and in this condition treatment ... more Dopamine agonists are effective in some patients with acromegaly and in this condition treatment is considered to be chronic. We describe two acromegalic patients who responded adequately to the long-acting dopamine agonist cabergoline, but surprisingly maintained normal GH and IGF-I levels once therapy was discontinued after 42 and 76 months because of possibly related side effects. A 32-year-old woman with mild acromegaly (IGF-I: 423 microg/l, GH after OGTT: 2.5 microg/l, adenoma 4 mm) was treated with cabergoline as primary therapy and reached safe GH levels (2 microg/l or less) and normal IGF-I levels with 3.5 mg cabergoline weekly. After 42 months of therapy the patient experienced a progressive decrease of libido, which she attributed to the intake of cabergoline. After stopping medication, serum levels of GH and IGF-I remained normal during the following 2.5 years. A 53-year-old man with moderate acromegaly (serum IGF-I: 547 microg/l, GH after OGTT: 5.9 microg/l, adenoma 7 mm...
clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset... more clinical, metabolic and endocrine features and the quality of life in adults with childhood-onset craniopharyngioma compared with adult-onset craniopharyngioma
The presence of corticotropin!releasing hormone "CRH# receptors has been previously dem! onstrate... more The presence of corticotropin!releasing hormone "CRH# receptors has been previously dem! onstrated in corticotrophs from normal pituitaries using a method combining immunocytochemistry and liquid emulsion autoradiography[ The aim of this study was to compare the characteristics of the 014 I!Tyr 9 ! hCRH binding in corticotrophs from normal pituitaries "three obtained at autopsy and one obtained at surgery# with corticotrophs from pituitary adenomas "six corticotroph adenomas responsible for Cushing|s disease and two silent corticotroph adenomas secreting a biologically inactive ACTH molecule#[ In normal corticotrophs\ the larger part of the 014 I!Tyr 9 !hCRH binding was localised in patchy conglomerates at the centre of the cell and\ to a much lesser degree\ in a di}use pattern at the cell periphery[ In adenomatous corticotrophs\ CRH receptor expression is disturbed both quantitatively and qualitatively[ Except for a minority of cells in one adenoma\ all adenomatous corticotrophs showed only peripherally bound 014 I!Tyr 9 ! hCRH and no centrally localised binding[ Furthermore\ adenomatous corticotrophs revealed a statistically signi_cant lower signal intensity when compared to normal corticotrophs and a strongly negative cor! relation was found between the labelling area in adenomatous corticotrophs and both the basal and CRH! stimulated plasma ACTH levels[ These _ndings suggest defective processing of CRH receptors and could be relevant to the sustained ACTH secretion by adenomatous corticotrophs in Cushing|s disease and\ more generally\ provide an explanation to its pathology[ The silent corticotrophs secreting a biologically inactive ACTH molecule were characterised by a very faint signal intensity\ although present on almost every cell[
Background: Isolated growth hormone deficiency (IGHD) provides the ideal model to characterize GH... more Background: Isolated growth hormone deficiency (IGHD) provides the ideal model to characterize GHD without interference from other pituitary deficiencies or their treatment. No study has addressed the question whether adult patients with IGHD differ in clinical presentation or in responsiveness to GH replacement from adult patients with multiple pituitary hormone deficiencies (MPHD) receiving conventional replacement therapy. Patients and methods: Data were retrieved from the outcomes research database KIMS (Pfizer international metabolic database). Patients with IGHD accounted for 9.6% (274/2868) of all GHD patients. Patients were separated according to the timing of onset. In the adult-onset (AO) group, 167 patients with IGHD were compared to 1992 patients with MPHD. In the childhood-onset (CO) group, 107 patients with IGHD were compared to 602 patients with MPHD. To assess the effect of GH replacement after one year, a longitudinal sub-analysis in the AO group was performed comparing 89 IGHD patients to 1234 MPHD patients. The same study was done in the CO group comparing 66 IGHD patients to 386 MPHD patients. Because IGHD patients were significantly younger than MPHD patients, data analysis was also performed after adjustment for gender and age. Results: In the AO group, non-functioning and secreting pituitary adenomas were the most common primary diagnoses in both IGHD and MPHD. Medical history revealed a high prevalence of hypertension and fractures in both subgroups, but also of non-insulin dependent diabetes mellitus. The prevalence of obesity was high and the waist circumference was elevated. The lipid profile was unfavourable in both IGHD and MPHD. IGF-I concentration and SDS were comparable in both subgroup. Quality of life assessed by QoL-AGHDA was equally poor in both IGHD and MPHD. GH replacement therapy induced favourable changes without distinction. In the CO group, the most common cause in both subgroups was idiopathic. Fracture rate was similarly prevalent in both IGHD and MPHD. Obesity was prominent in both subgroups, but BMI and waist circumference were lower in IGHD. Adverse lipid changes were similarly found in both IGHD and MPHD.
The Journal of Clinical Endocrinology & Metabolism, 1998
Cabergoline is a new, long acting, dopamine agonist that is more effective and better tolerated t... more Cabergoline is a new, long acting, dopamine agonist that is more effective and better tolerated than bromocriptine in patients with hyperprolactinemia. Because dopamine agonists still have a place in the medical management of acromegaly, cabergoline might be a useful treatment. We, therefore, evaluated the effect of long term administration of cabergoline in a large group of unselected acromegalic patients. Sixtyfour patients were included in a multicenter, prospective, open labeled study. A subgroup of 16 patients had GH-/PRL-cosecreting pituitary adenomas. Cabergoline was started at a dose of 1.0 mg/week and was gradually increased until normalization of plasma insulinlike growth factor I (IGF-I) levels, occurrence of unacceptable sideeffects, or a maximal weekly dose of 3.5 mg (7.0 mg in 1 case) was reached. Treatment with cabergoline suppressed plasma IGF-I below 300 g/L in 39% of cases and between 300-450 g/L in another 28%. With pretreatment plasma IGF-I concentrations less than 750 g/L, a suppression of IGF-I below 300 g/L was obtained in 53% of cases, and a suppression between 300-450 g/L was obtained in another 32%. By contrast, with pretreatment plasma IGF-I concentrations above 750 g/L, only 17% of cases showed a suppression of IGF-I below 300 g/L, and there was IGF-I suppression between 300-450 g/L in another 21%. In GH-/PRL-cosecreting adenomas, 50% of cases suppressed plasma IGF-I levels below 300 g/L, and another 31% did so between 300-450 g/L, in contrast to only 35% and 27%, respectively, in GH-secreting adenomas. Similar results were obtained concerning the secretion of GH. Tumor shrinkage was demonstrated in 13 of 21 patients, with a mass reduction by more than half in 5 GH-/PRL-cosecreting adenomas. Except for slight gastrointestinal discomfort and orthostatic hypotension in a few patients at the beginning of therapy, cabergoline treatment was well tolerated. Only 2 patients stopped medication because of nausea. The weekly dose of cabergoline ranged between 1.0-1.75 mg. A further increase in the dose was only effective in 1 GH-/PRL-cosecreting adenoma. The results of this study suggest that cabergoline is an effective, well tolerated therapy that should be considered in the management of acromegaly, especially if the pituitary adenoma cosecretes GH and PRL or if pretreatment plasma IGF-I levels are below 750 g/L.
Design: Data on lipids, body composition, and blood pressure (BP) from all published KIMS papers ... more Design: Data on lipids, body composition, and blood pressure (BP) from all published KIMS papers are summarized and compared with a literature review. Results: KIMS data confirm and extend previous research showing that adults with GH deficiency (GHD) have an adverse cardiovascular risk profile. GHD patients have high levels of dyslipidemia, elevated body mass index, unfavorable waist-to-hip ratio and body composition, and a high risk of hypertension. These abnormalities are likely to explain the increased cardiovascular mortality observed in patients with hypopituitarism. When given GH replacement therapy, an improvement is seen in KIMS as well as earlier studies for lipid profile, body composition, and BP. The added value of the different KIMS papers over previous research is that KIMS involves a much larger number of patients, that lipid concentrations and IGF1 are measured in a single central laboratory, and that the effects of GH replacement therapy can be followed longer than the duration of earlier trials. By the large number of patients, KIMS gives insight into the effects of GH in different patients' subgroups such as elderly patients, patients with idiopathic GHD, patients with craniopharyngioma, patients after irradiation, and so on. In addition, KIMS has made it possible to calculate more exactly the influence of baseline parameters on these cardiovascular risk parameters and their response to GH. Conclusions: Taken together, data from KIMS confirm earlier knowledge about the important benefits of GH replacement therapy, but also on the use of GH in specific subgroups such as isolated GHD, patients above 65 years, and patients after irradiation. No subgroup yet has been identified as not responding well to GH.
Background Adult-onset growth hormone deficiency (AO-GHD) is associated with an increased prevale... more Background Adult-onset growth hormone deficiency (AO-GHD) is associated with an increased prevalence of the metabolic syndrome (MetS). Aim To determine the effect of GH replacement on the prevalence of MetS in AO-GHD and to study the impact of MetS on the incidence of cardiovascular events during GH replacement. Patients and methods 1449 AO-GHD patients (males 48.9%; mean age 48.9 ± 12.8 year) were retrieved from KIMS (Pfizer International Metabolic Database). The prevalence of MetS (using International Diabetes Federation criteria) and its components were calculated at baseline and after one year of GH replacement. The relative risk to develop cardiovascular events according to the presence of MetS at baseline was assessed in another group of 3282 patients after prolonged GH replacement. Results The prevalence of MetS was 46.9% at baseline and 48.2% after one year of GH replacement (P = NS). The percentage of patients with abnormal waist circumference decreased significantly (80.3 ...
The Journal of clinical endocrinology and metabolism, Jan 29, 2017
Craniopharyngioma (CP) in adults, of either childhood-onset (CO-CP) or adult-onset (AO-CP), is as... more Craniopharyngioma (CP) in adults, of either childhood-onset (CO-CP) or adult-onset (AO-CP), is associated with increased morbidity and mortality, but data on the relative risks (RRs) of contributing factors are lacking. To assess the RRs of factors contributing to morbidity and mortality of adults with CO-CP and AO-CP. Data on 1,669 CP patients from KIMS (Pfizer International Metabolic Database) were analyzed using univariate and multiple Poisson and Cox regression methods. Combining CO-CP and AO-CP groups, history of stroke and hyperlipidemia increased cardiovascular risk, higher body mass index (BMI) and radiotherapy increased cerebrovascular risk, and increased waist circumference increased the risk of developing diabetes mellitus (DM). Compared to CO-CP patients, AO-CP patients had a 3-fold higher risk of tumor recurrence, whereas being female and previous radiotherapy exposure conferred lower risks. Radiotherapy and older age with every 10 years from disease-onset conferred a 2...
Samenvatting Model evaluatie en dynamica van een viscoelastische vloeistof in een complexe stromi... more Samenvatting Model evaluatie en dynamica van een viscoelastische vloeistof in een complexe stroming Jan M. Verhelst Abbreviations 2D two-dimensional 3D three-dimensional ARES advanced rheometric expansion system p. 70 LDV laser Doppler velocimetry p. 40, figure3.1 PAMH partially hydrolyzed polyacrylamide p. 70, figure 4.1 PAA polyacrylamide p. 42, figure 3.3 PEO polyethylene oxide p. 42, figure 3.3 UCM Upper Convected Maxwell fluid p. 15 wppm weight parts per million p. 48, figure 3.14
Since little is known about carcinoembryonic antigen (CEA) half-life in humans, we followed chang... more Since little is known about carcinoembryonic antigen (CEA) half-life in humans, we followed changes in CEA levels after curative resection of a small bronchial adenocarcinoma in a 54 yr old man with an unusually high preoperative serum CEA level of 1,199 ng.ml-1. Serum CEA followed a four phase curve with an initial increase, attributed to release of CEA from the tumour, a rapid fall during four days (CEA half-life 3.2 days), a slower exponential decay to normal levels during almost three months (CEA half-life 11 days) and eventually maintenance of normal levels for 14 months. These results are consistent with data from animal experiments and a single report on CEA half-life in humans, but CEA half-life seems longer in man than in animals. This observation also suggests that a very high serum CEA level should not in itself preclude curative surgical resection of a primary bronchogenic carcinoma.
s presented at the 19th Annual Congress of the Belgian Society of Internal Medicine 12-13 Decembe... more s presented at the 19th Annual Congress of the Belgian Society of Internal Medicine 12-13 December 2014 – Auditorium Brouwer, Medical Campus Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels
We report the case of a 39-year-old male presenting with panhypopituitarism and diabetes insipidu... more We report the case of a 39-year-old male presenting with panhypopituitarism and diabetes insipidus. MR imaging showed focal thickening of the pituitary infundibulum and infiltration of the anterior pituitary lobe, suggesting hypophysitis. Hormonal replacement therapy induced a pronounced amelioration of general well-being. Eight months later the subject developed visual disturbances. MR imaging now showed a cystic sellar mass. Surgical drainage was performed. A second operation was necessary six weeks Later because of recurrent visual field defects. Diagnosis of papillary craniopharyngioma was finally made. This case demonstrates the remarkably rapid development of a craniopharyngioma, which initial radiological appearance was suggestive of hypophysitis. It also emphasizes the need of repeat MR examination in case of unusual presentation of hypopituitarism.
We describe a case of acute rupture of the left proximal ureter as a result of lithiasis. The pat... more We describe a case of acute rupture of the left proximal ureter as a result of lithiasis. The patient presented with a clinical picture of renal infarction: unilateral flank pain, more than 500 red blood cells per microliter urine and increased serum LDH levels. Abdominal ultrasound as well as a CT scan showed no abnormalities. Only CT angiography of the kidneys was able to demonstrate an acute rupture of the left proximal ureter with extravasation of contrast. Intravenous pyelogram confirmed this rupture with leaking of the contrast. One day after admission the patient urinated a 2 mm large calciumoxalate-monohydrate stone, the likely cause of the rupture. The rupture healed spontaneously. A review of the literature is given.
Dopamine agonists are effective in some patients with acromegaly and in this condition treatment ... more Dopamine agonists are effective in some patients with acromegaly and in this condition treatment is considered to be chronic. We describe two acromegalic patients who responded adequately to the long-acting dopamine agonist cabergoline, but surprisingly maintained normal GH and IGF-I levels once therapy was discontinued after 42 and 76 months because of possibly related side effects. A 32-year-old woman with mild acromegaly (IGF-I: 423 microg/l, GH after OGTT: 2.5 microg/l, adenoma 4 mm) was treated with cabergoline as primary therapy and reached safe GH levels (2 microg/l or less) and normal IGF-I levels with 3.5 mg cabergoline weekly. After 42 months of therapy the patient experienced a progressive decrease of libido, which she attributed to the intake of cabergoline. After stopping medication, serum levels of GH and IGF-I remained normal during the following 2.5 years. A 53-year-old man with moderate acromegaly (serum IGF-I: 547 microg/l, GH after OGTT: 5.9 microg/l, adenoma 7 mm...
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Papers by Johan Verhelst