PMC2045692_01
Upper panel shows the abdominal CT at the level of the pancreas and the lower panel the selective arteriography of the superior mesenterial artery
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Fig1
The abdominal CT-scan showed a 4 cm mass in the middle section of the pancreas (Fig. 1) and the mass was also visible with selective arteriography of the superior mesenterial artery (Fig. 1).
Follow-up of GH and IGF-I concentration in patient 1 after removal of the pancreatic source of GHRH. Fasting serum GH concentrations are depicted as circles, and IGF-I as triangles
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Fig2
Random serum GH during follow-up ranged from 0.16 mU/l to 1.81 mU/l and IGF-I ranged from 12 nmol/l to 17 nmol/l from 1994 till now (see Fig. 2).
PMC2045692_02
Dynamic GH (circles) and PRL (triangles) tests in two patients with a GHRH-secreting lung carcinoid before (closed symbols) and after surgery (open symbols). Note the GH increase after TRH (200 mug) administration in both patients, the decrease in serum GH concentration in patient 2 after GHRH (50 mug), and the moderate GH decrease after i.v. octreotide (50 mug)
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Fig3
Other investigations performed (TRH test and the i.v. octreotide test) are summarized in Fig. 3. Octreotide (50 mug i.v) caused a 94% inhibition of GH (Fig. 3).
MRI scans of the pituitary gland of patient 2 (left panel) and of patient 3 (right panel) before treatment
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Fig4
MRI scanning of the pituitary gland showed a macroadenoma II AE (Hardy classification, modified by Wilson see Fig. 4).
Chest X-rays of patient 2 (left panel) and patient 3 (right panel), showing the large bronchial carcinoid
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Fig5
One day before surgery a chest X-ray was taken, showing a large parahilar lesion (Fig. 5).
Octreoscans of the patients 2 and 3. In the female patient (left panel) the tumor is seen in the right lower lobe of the lung and also the positive staining of the pituitary gland. The male patient (right panel) had a large tumor in the left lung, without pituitary staining
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Fig6
On 111In-labelled-octreotide scanning the tumor was positive (see Fig. 6).
Decrease in serum GHRH concentration in two patients before and immediately following removal of the lung tumor. Patient 2 is shown by triangles and patient 3 by circles. Note that the GHRH concentration is shown on a logarithmic scale. The GHRH concentration did not normalize in the patients after 2 and 3 days, respectively. Upper normal GHRH is 50 pg/ml
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Fig7
After removal of the tumor GHRH concentrations remained slightly elevated, as shown in Fig. 7.
PMC2045692_03
Dynamic GH (circles) and PRL (triangles) tests in two patients with a GHRH-secreting lung carcinoid before (closed symbols) and after surgery (open symbols). Note the GH increase after TRH (200 mug) administration in both patients, the decrease in serum GH concentration in patient 2 after GHRH (50 mug), and the moderate GH decrease after i.v. octreotide (50 mug)
11102_2007_45_Fig3_HTML.jpg
PMC2045692_03_11102_2007_45_Fig3_HTML.jpg
Fig3
Other investigations performed (TRH test and the i.v. octreotide test) are summarized in Fig. 3. Octreotide (50 mug i.v) caused a 94% inhibition of GH (Fig. 3).
MRI scans of the pituitary gland of patient 2 (left panel) and of patient 3 (right panel) before treatment
11102_2007_45_Fig4_HTML.jpg
PMC2045692_03_11102_2007_45_Fig4_HTML.jpg
Fig4
MRI scanning of the pituitary gland showed a macroadenoma II AE (Hardy classification, modified by Wilson see Fig. 4).
Chest X-rays of patient 2 (left panel) and patient 3 (right panel), showing the large bronchial carcinoid
11102_2007_45_Fig5_HTML.jpg
PMC2045692_03_11102_2007_45_Fig5_HTML.jpg
Fig5
One day before surgery a chest X-ray was taken, showing a large parahilar lesion (Fig. 5).
Octreoscans of the patients 2 and 3. In the female patient (left panel) the tumor is seen in the right lower lobe of the lung and also the positive staining of the pituitary gland. The male patient (right panel) had a large tumor in the left lung, without pituitary staining
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Fig6
On 111In-labelled-octreotide scanning the tumor was positive (see Fig. 6).
Decrease in serum GHRH concentration in two patients before and immediately following removal of the lung tumor. Patient 2 is shown by triangles and patient 3 by circles. Note that the GHRH concentration is shown on a logarithmic scale. The GHRH concentration did not normalize in the patients after 2 and 3 days, respectively. Upper normal GHRH is 50 pg/ml
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Fig7
After removal of the tumor GHRH concentrations remained slightly elevated, as shown in Fig. 7.
MRI of the pituitary gland of patient 2 during therapy with octreotide. These pictures were taken after 12 months treatment with 300 mug octreotide given as a continuous subcutaneous infusion
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Fig8
The size of the pituitary gland decreased markedly (Fig. 8).
GH (circles) and IGF-I (triangles) concentrations during long-term treatment with octreotide. Patient 3 received only the long-acting repeatable form, but patient 2 was treated initially with chronic sc octreotide infusion. The time of change into the slow-release formulation is indicated by the arrow. Normal values for IGF-I for this age: <32 nmol/l. Normal value for random GH < 5 mU/l
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Fig9
GH and IGF-I concentrations normalized and are detailed in the left panel of Fig. 9. Growth hormone and IGF-I concentrations remained unchanged (see Fig. 9). GHRH, GH, and IGF-I concentrations remained elevated, and therefore he was also treated with the long-acting repeatable octreotide (20 mg/4 weeks). GH and IGF-I concentrations are shown in Fig. 9, right panel, showing clinically normal values. Subsequently, IGF-I levels increased, as shown in Fig. 9.
Serum GH concentrations obtained by 10 min blood sampling for 24 h. Patient 2 was studied before therapy and after surgical removal of the lung tumor. Note that GH concentration decreased more than 10-fold and that the secretion pattern became more regular, but basal GH concentration remained slightly elevated. The left lower panel represent the profile of patient 3 after pituitary surgery, but before removal of the carcinoid tumor. Nadir values were clearly increased. After thoracic surgery and under octreotide treatment GH secretion pattern visually normalized
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Fig10
Detailed GH secretory profiles were obtained before removal of the GHRH-producing bronchial carcinoids (Fig. 10).