Prolactinomas constitutes a major bulk of pituitary adenomas. All symptomatic prolactinomas require dopamine agonist (DA) therapy. Impulse control disorders (ICD) or pathological behaviours are rare adverse events described with use of DA. Herein we are describing a male patient with pathological gambling and doctor shopping following use of bromocriptine and higher dose of cabergoline.The pathological behaviour disappeard after debulking surgery, reduction in cabergoline dose and several sessions of counselling. Physicians prescribing DA should be aware of this potential adverse event.This should be emphasized to the patient and family members before starting DA and physician should be inquisitive for eliciting pathological behaviour on follow up.

Does low-fat diet for weight loss make the impaired microvascular dilation improved through switching to nitric oxide (NO)-dependent in obese adults? The answer is yes. Shane Phillips research group has tested this hypothesis through their most recent publication. While systemic NO doesn’t change, localized NO was increased after a six-week low-fat diet for weight loss (~25% calorie deficit) but not for weight maintenance to obsess subjects with body mass index (BMI most subjects in 30-35, and only a few in 35-40 kg/m2) through increasing flow-induced dilation of arterioles. These in vitro microvascular model data are consistent with data with clinical increase of flow-mediated dilation and decrease of BMI in post- compared to pre-low-fat diet for weight loss.

MicroRNAs (miRNAs) are short single-stranded noncoding RNAs (20- to 25-nucleotide (nt) long) representing a class of small regulatory RNAs. By inhibiting the translation of target mRNAs, miRNAs regulate gene expression posttranscriptionally and thus play an important role in a wide range of cellular processes. Currently, there are two known types of miRNAs: intergenic and intronic miRNAs. Biogenesis of an intergenic miRNA starts with the synthesis of a primary miRNA transcript (pri-miRNA) catalyzed by types-II or -III RNA polymerase (Pol-II/III). Pri-miRNAs are processed in the nucleus by the ribonuclease Drosha into a miRNA precursor (pre-miRNA) approximately 60-nt in length. After being transported into the cytoplasm, these pre-miRNAs are further processed into mature and functional miRNAs by the cytoplasmic ribonuclease Dicer.

Non-functioning pituitary adenomas (NFPA) are 30% of all pituitary adenomas. Although benign in nature but they may be invasive and recurrent. Markers of recurrence are needed to guide patient management. Recteptor Tyrosine Kinases (RTK) may sereve as therapeutic marker for recurrence as they can targeted by already available tyrosine kinase inhibitors. To examine differential RTK phosphorylation pattern of recurrent NFPAs, we recruited 20 patients and grouped them as non-recurrent (n=10), and recurrent (n=10). Recurrence was determined by follow-up of 15 years. We then performed a membrane-based antibody array (ARY001B) for the determination of the relative phosphorylation of 49 tyrosine kinases in recurrent NFPAs. As the experiment was replicated on two set of membranes, each tyrosine kinase was represented in quadruples. Student’s t-test was performed to compare the means between two groups. We found ErbB2, PDGFR beta, SCFR, Trk, VEGFR1, VEGFR2, EphA3, and Alk significantly hyperphosphorylated in recurrent NFPAs. Out of these eight hyperphosphorylated tyrosine kinases ErbB2 and EphA3 were 1.6 (p=0.01) and 1.9 (p=0.002) times hyperphosphorylated in recurrent NFPAs. This result indicates that EphA3 may be an effective therapeutic target in recurrent NFPAs.

Cushing syndrome is a state of prolonged exposure to excess cortisol production. Causes can be varied ranging from exogenous intake or endogenous production from a pituitary source due to overproduction of adrenocorticotropic hormone (ACTH) or due to over secretion from unilateral or bilateral adrenal glands. Cushing syndrome in an adult can present with proximal muscle weakness, facial plethora, wasting of the extremities with increased fat in the abdomen and face, wide purplish striae, bruising with no obvious trauma, and supraclavicular fat pads. Here, we report a 38 year old male who presented with suspicion of having Cushing syndrome due to his clinical manifestations and high cortisol levels. He presented to the clinic with new onset diabetes, severe hypertension, chronic abdominal pain and distension which was being investigating by different specialties. The patient underwent CT scan of the abdomen which show right adrenal adenoma and on examination, he was found to have proximal weakness and purple striae. Laboratory data showed high morning cortisol, 24 urine free cortisol and ACTH levels which were strongly suggestive of ACTH independent Cushing syndrome.