Nature reviews. Endocrinology · 2010
Harvey Cushing's attempt at the first human pituitary transplantation.
БиографияКлинический случайИсторическая статьяСтатьяНазвание и аннотация: Перевод в очереди
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Pendleton Courtney, Zaidi Hasan A, Pradilla Gustavo, Cohen-Gadol Aaron A, Quiñones-Hinojosa Alfredo
Аннотация
BACKGROUND: This case study illustrates Harvey Cushing's pioneering work in pituitary transplantation in the early 20th century and the essential relationship between laboratory research and clinical practice. In 1911, a 48 year-old man presented at Johns Hopkins Hospital with bitemporal hemianopsia, hypothermia, hypersomnolence, decreased libido, polydypsia and polyuria.
INVESTIGATION: A review of the Johns Hopkins Hospital surgical records from 1896-1912 on a patient with hypopituitarism secondary to a suprasellar mass, in whom the first documented pituitary gland transplantation was performed.
DIAGNOSIS: A diagnosis of hypopituitarism was made. Postmortem examination revealed a cystic cavity lined with squamous epithelium.
MANAGEMENT: The patient was treated with whole-gland pituitary extract, which improved his symptoms only temporarily. Cushing transplanted a pituitary gland obtained from a spontaneously aborted fetus into the cerebral cortex of the patient, who showed marked improvement of his somnolence and confusion, whereas his polyuria and polydypsia persisted. A recurrence of symptoms after 6 weeks prompted Cushing to attempt a second transplant of a fetal pituitary gland, without improvement. The patient resumed hormonal supplementation with whole-gland pituitary extract, but died a month after the second transplant from respiratory complications.
INVESTIGATION: A review of the Johns Hopkins Hospital surgical records from 1896-1912 on a patient with hypopituitarism secondary to a suprasellar mass, in whom the first documented pituitary gland transplantation was performed.
DIAGNOSIS: A diagnosis of hypopituitarism was made. Postmortem examination revealed a cystic cavity lined with squamous epithelium.
MANAGEMENT: The patient was treated with whole-gland pituitary extract, which improved his symptoms only temporarily. Cushing transplanted a pituitary gland obtained from a spontaneously aborted fetus into the cerebral cortex of the patient, who showed marked improvement of his somnolence and confusion, whereas his polyuria and polydypsia persisted. A recurrence of symptoms after 6 weeks prompted Cushing to attempt a second transplant of a fetal pituitary gland, without improvement. The patient resumed hormonal supplementation with whole-gland pituitary extract, but died a month after the second transplant from respiratory complications.