Dieter K. Lüdecke

Dieter K. Lüdecke
University of Hamburg | UHH · Pituitary Surgery and Neuroendocrinology Lab

Doctor of Medicine

About

247
Publications
6,057
Reads
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4,895
Citations
Additional affiliations
January 1972 - present
University Medical Center Hamburg - Eppendorf
Position
  • Em. Head of Laboratory of Neuroendocrinology and Pituitary Surgery
Description
  • Continuous co-operation in research
January 1972 - November 2008
University of Hamburg
Position
  • Emeritus Head of Pituitary Surgery and Laboratory of Neuroendocrinology

Publications

Publications (247)
Article
Purpose/Objective Multiple tumorous lesions in one pituitary gland are rare and mostly described in case reports. Their incidences and combinations are defined in larger collectives. Therefore, we analyzed our large collection for double tumors and combinations of tumors, cysts, and inflammation. Methods The German Registry of Pituitary Tumors, in...
Article
Full-text available
Inflammatory pituitary lesions account for 1.8% of all specimens from the German Pituitary Tumor Registry. They occure in 0.5% of the autoptical specimens and in 2.2% of the surgical cases. Women are significantly more often affected than men and are often younger when first diagnosed. In general, primary and secondary inflammation can be distingui...
Preprint
Full-text available
Multiple tumorous lesions with an adenoma make up 1.4 % (232 cases) in the large collection of the German Registry of Pituitary Tumors. 2.0% of all PitNETs are associated with a second lesion. Within the selected cases synchronous multiple pituitary neuroendocrine tumors (PitNETs) account for 17,3%, PANCH cases for 14.7%, PitNETs and posterior lobe...
Article
Full-text available
Background Transnasal surgery (TNS) is the first choice in the treatment of pediatric Cushing’s disease. The question is how can high remission rates be achieved with minimally invasive investigations and TNS whilst avoiding radiotherapy or bilateral adrenalectomy in children. Methods Data from a published series 1 (n=55) of surgeon DKL will be co...
Article
Background: Recurrences of pituitary adenomas are not so rare. Methods: In the German Registry of Pituitary Tumors, more than 12,000 surgical specimens were collected between 1967 and 2012, of which 312 patients with altogether 334 recurrences (n = 646 specimens) were included in our study. Results: The histopathology of 162 recurrent adenomas...
Article
Full-text available
PurposeTo analyse the antigen expression profiles of 27 cases of pituicytoma, spindle cell oncocytoma, and granular cell tumour of the sellar region concerning a common pituicytic origin of neoplastic cells. Methods Material from 12 female and 15 male patients (13 granular cell tumours of the sellar region, 10 pituicytomas, four spindle cell oncocy...
Article
Full-text available
Introduction: The term atypical pituitary adenoma (APA) was revised in the 2004 World Health Organization (WHO) classification of pituitary tumors. However, two of the four parameters required for the diagnosis of APAs were formulated rather vaguely (i.e., "extensive" nuclear staining for p53; "elevated" mitotic index). Based on a case-control stu...
Article
Full-text available
OBJECT Correct diagnosis and precise localization of adenomas in patients with Cushing's disease are essential for avoiding unsuccessful transsphenoidal pituitary exploration. In addition to the well-established inferior petrosal sinus sampling, preoperative cavernous sinus sampling (CSS) was introduced as a potentially improved way to predict aden...
Article
Preceding studies have indicated that aberrant expression levels rather than genetic changes of GADD45γ, MEG3, and p8 gene might play a role in the pathogenesis of pituitary adenomas. We analysed their expression in various normal human tissues and in different pituitary tumour types, and investigated GADD45γ mutations in a subset of adenomas. Abso...
Article
Abstract Pituitary infarction or apoplexy with spontaneous cure of the underlying pituitary adenoma is rare. In the paediatric population, we found only a few reported cases. We report a rare case of pituitary infarction progressing to CSF-sella syndrome (or empty sella) in an 11-year-old girl. She presented with sudden onset vomiting, moderate hea...
Article
Introduction: Pharmacological treatments are still not ideal in ACTH-microadenomas and transnasal-trans-sphenoidal surgery (TSS) is first choice in the treatment of Cushing’s disease (CD). The question is how can a nearly 100% remission rate be achieved with minimally invasive diagnostic testing and TSS. In the discussion of the main lecture from a...
Article
Objective: The GH receptor antagonist pegvisomant is increasingly used as therapy in acromegaly. Pituitary surgery might be indicated on pegvisomant treatment, due to side effects, adenoma growth or intention to cure after primary treatment. This study was initiated to clarify if, and when, GH measurement could be useful postoperatively with an ass...
Article
Introduction: Pituitary infarction is rare in the paediatric age. In adolescents and adults it is often secondary to haemorrhage into an underlying lesion such as pituitary adenoma or cyst. Lymphocytic hypophysitis is rare in children and usually peri-tumoral due to germinoma, craniopharyngioma or Rathke’s cyst and often associated with hypopituita...
Article
Introduction: Pharmacological treatments are available for all functioning pituitary adenomas, but found to be only ideal in prolactinomas. Therefore, at least in ACTH- and GH-microadenomas we have to strive to achieve 100% remission with transnasal surgery. Our question is, which combination of an increasing arsenal of pre- and peri-operative meth...
Article
Cushing's disease rarely appears as a consequence of hereditary disease. However, familial diseases with diminished glucocorticoid feedback are associated with secondary hypercorticotropinism and have been shown to give rise to pituitary adenomas. We here describe the rare case of a 30-year old female patient with congenital adrenal hyperplasia who...
Article
Objective: Long-term follow-up data for patients with acromegaly after transsphenoidal surgery is needed. The goal of this study was to receive a follow-up of these patients, as well as an overview of the past and current care, including an evaluation from the patient's side regarding the quality of care. Patients and Methods: The charts of all 18...
Article
Cushing's syndrome is characterized by excessive elevation of glucocorticoid concentrations. In rare cases, the treatment of Cushing's syndrome may result in unmasking or aggravation of diseases responsive to glucocorticoid medication. We report two cases of sarcoidosis following Cushing's syndrome. A 43 year-old male developed cutaneous sarcoidosi...
Chapter
Pituitary adenomas with clinically relevant hypersecretion comprise approximately 40% of all pituitary adenomas. The most frequent is the prolactinoma, which for 25 years has mostly been treated primarily by dopamine agonists. A parallel comparison of pretreated and only surgically treated patients showed significant differences which are of import...
Article
Die Akromegalie ist eine seltene Erkrankung, die durch ein wachstumshormon- (HGH-)produzierendes Hypophysenadenom verursacht wird. Symptome wie eine Größenzunahme der Hände und Füße, des Kiefers mit Verbreiterung der Zahnzwischenräume, eine Makroglossie und eine Nasenschleimhauthyperplasie mit Polypenbildung finden sich bei Betroffenen. Die beiden...
Article
Acromegaly is a rare disease caused by a growth-hormone-secreting pituitary adenoma. Symptoms include enlargement of the hands, feet, and jaw with growing dental interspaces, as well as hypertrophy of the tongue and nasal and sinusoidal mucosa. The two latter symptoms are mostly responsible for the accompanying obstructive sleep apnea syndrome. Bes...
Article
The growth of prostate cancer is controlled by several hormones and growth factors. In cases of metastasized prostate cancer, antigonadotropic therapy is currently considered state-of-the-art treatment. Surgical therapies such as adrenalectomy and hypophysectomy are no longer in use. Nevertheless, hypophysectomy has proven efficacy for palliative p...
Article
Objective: The present study was designed to investigate the localization of VEGF in GH-secreting pituitary adenomas and to evaluate the characteristic differences of VEGF expression in relation to the clinical effect of preoperative treatment with octreotide. Methods: Fifty-six cases of GH-secreting adenomas, which were divided into three group...
Article
The case of a 61-year-old man presenting with dizziness, nausea, vomiting, reduced serum osmolality, and hyponatremia is reported. Endocrinologically, low levels for ADH, cortisol and testosterone as well as low-normal values for ACTH, LH and FSH were detected. Cranial computed tomography and MRI scans revealed an intra- and suprasellar tumor of ad...
Article
As the development of clinically silent pituitary adenomas is not yet fully understood, the radiologically measured growth of inactive pituitary adenomas should be compared with adenoma classification and immunostainings for proliferation markers. In 32 patients with non-functioning adenomas (NFA) from 45 operations with retrospectively available p...
Article
Full-text available
In 1996, the German Registry of Pituitary Tumors was founded by the Pituitary Section of the German Society of Endocrinology as a reference center for collection and consultant pathohistological studies of pituitary tumors. The experiences of the first 10 years of this registry based on 4122 cases will herein be reported. The data supplement former...
Article
Mutations in the gene coding for the alpha-subunit of the heterotrimeric stimulatory G protein Gs are the most frequently identified molecular events in the development of somatotroph adenomas in adults. In children and adolescents, somatotroph adenomas are rare, and only two cases with the Gs alpha mutation have been reported so far. In this study...
Article
Aim: Somatostatin mediates its effects via five known receptor subtypes sst1-sst5. The somatostatin analogue octreotide, which binds preferentially to sst2 and to a lesser extent to sst3 and sst5, may be used prior to surgery of GH-secreting tumors. To investigate the variable response rates of such treatment, we analyzed sst expression levels in t...
Article
Surgical resection is the treatment of choice for pituitary adenomas, with the exception of prolactinomas which should be treated primarily with dopamine agonists. More than 90 per cent of adenomas can be removed transsphenoidally with sparing of the adenoma-free pituitary tissue. Large adenomas with suprasellar, retrosellar or subfrontal growth ma...
Article
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 gl...
Article
Full-text available
gamma-Aminobutyric acid (GABA) is an important regulatory factor of pituitary gland function, which in addition to hypothalamic neurons, can be derived from intrapituitary sources, ie, growth hormone (GH) cells of rat and monkey. We report that human pituitary glands also express 2 isoforms of the GABA-synthesizing enzyme glutamate decarboxylase (G...
Article
The measurement of cortisol in saliva is becoming more widely accepted as a screening test for the diagnosis of hypercortisolism. Since 1986, cortisol measurement in saliva has been continuously used in our department. In this study we compared salivary cortisol profiles from proven Cushing's disease patients with profiles from healthy subjects and...
Article
The pituitary tumor transforming gene (PTTG) has been implicated as an oncogene for pituitary tumors and other neoplasia. To further elucidate the role of PTTG, we established a quantitative method to analyze expression levels of PTTG. Normal tissues and pituitary adenomas of various etiologies were compared. Twenty-four normal human tissues were...
Article
Pituitary carcinomas, defined by brain invasion or metastatic tumor spread, are found in only 0.1% of pituitary tumors. The dedifferentiation of a hypersecreting adenoma to a non-secreting carcinoma is rarely observed. In 1978, a 25-year-old male with acromegaly was transnasally operated on for a sparsely granulated, acidophilic adenoma expressing...
Article
In children, there is little experience with octreotide therapy for pituitary tumors, especially growth hormone (GH) producing adenomas. We report on a 13-year-old boy with gigantism due to a GH-producing pituitary adenoma caused by a Gsalpha mutation on the basis of McCune-Albright syndrome. At the age of 6.5 years a GH- and prolactin-producing pi...
Article
BACKGROUND: Pituitary adenomas without clinically active hypersecretion are summarized under the term non-functioning pituitary adenomas (NFPA). Since there are no specific serum markers, the differential diagnosis and treatment imply special difficulties. Therefore, an expert group of the German Society of Endocrinology met in February 2002 and wo...
Article
Data on the dural invasiveness of pituitary adenomas have been correlated to the expression of matrix metalloproteinases (e.g. MMP-9). Serine proteases have not yet been investigated in human pituitary adenomas. In this study, paraffin-embedded material from 84 human pituitary adenomas (acromegaly n=18, Cushing's disease n=21, prolactinoma n=18, th...
Article
Hintergrund: Hypophysenadenome ohne Nachweis einer klinisch wirksamen Hormonhypersekretion aus dem Tumor werden im deutschen Sprachbereich unterschiedlich bezeichnet und behandelt. Auf dem Expertentreffen 2002 der Deutschen Gesellschaft für Endokrinologie einigte man sich auf die Bezeichnung hormoninaktive Hypophysenadenome (HIA). Wegen fehlender...
Article
Transsphenoidal surgery is the first therapeutic option in acromegaly, but the management of persistent or recurrent cases of the disease after surgery has been controversial. This study presented the results of secondary transnasal surgery for residual or recurring growth hormone (GH)-secreting macroadenoma with reference to intraoperative GH meas...
Article
The management of adrenocorticotropic hormone (ACTH)-dependent Cushing's disease implies difficulties in the differential diagnosis, and in the detection of minute pituitary adenomas of less than 4mm. The triad of detectable ACTH, suppression of cortisol in the high dose dexamethasone test, and stimulation in the corticotropin-releasing-hormone (CR...
Article
Gamma-aminobutyric acid (GABA) is known as an important regulatory factor of pituitary gland function along the hypothalamic-hypophysial axis. We have recently shown that GABA is a para- and/or autocrine factor in the rat and rhesus monkey pituitary gland. GABA-action is exerted via GABA-A-, GABA-B- and GABA-C-receptors present in many endocrine ce...
Article
The significance of polyclonal antibodies for demonstration of hormone expression in pituitary adenomas was compared with the significance of monoclonal antibodies (MAbs). Adenomas were classified by light microscopic structures in paraffin- and epon-embedded sections, by immunostaining for all pituitary hormones, and in part by electron microscopy...
Article
Full-text available
To investigate the presence and possible function of ether-à-go-go-related gene (erg) K(+) channels in human lactotroph cells (HERG channels), primary cultures were prepared from human prolactinoma tissue. In almost all primary cultures, HERG currents could be recorded in identified prolactin cells using an external high-K(+) solution. The antiarrh...
Article
The declines of ACTH and other POMC metabolites immediately after tumor extirpation do not predict the complete tumor removal of an ACTH-secreting pituitary adenoma in Cushing's disease. However, the pituitary surgeon should be in a position to evaluate the surgical result as soon as possible for the eventual planning of early repeat surgery. So fa...
Article
The classical trias in Cushing's disease, normal or moderately elevated plasma ACTH, significant suppression of cortisol in the high-dose dexamethasone test, and stimulation of ACTH and cortisol in the CRH test, confirms the diagnosis in most cases. However, as a referral centre for complex Cushing's disease cases, we are confronted with problems i...
Article
Prolactin (PRL)-secreting pituitary adenomas (prolactinomas) are rare in childhood and adolescence; there are only a few published series of patients who were surgically treated. We discuss the gender-dependent differences, and the surgical indications and results for 14 patients with prolactinomas under 18 years of age at surgery. We reviewed the...
Article
Differentiation among various non Langerhans cell histiocytoses granulomatous in adults is often difficult. Patients, moreover, may not have endocrinologic abnormalities. A 53-yr-old patient was admitted owing to central diabetes insipidus and partial hypopituitarism. Magnetic resonance imaging revealed a space-occupying lesion near the hypophyseal...
Article
The present study was designed to investigate the immunohistochemical characteristics of gangliocytomas associated with growth hormone (GH)-secreting pituitary adenomas. In our surgical collection of 476 GH-secreting adenoma cases, we examined tumor tissue from 6 patients (1.3%). All 6 patients were women, ranging from 29 to 52 years (mean, 40.3 +/...
Article
Purpose: Microsurgical selective adenomectomy is the established method available for the treatment of Cushing's disease. However, this surgical method warrants still more efforts to improve the outcome. In this paper the authors evaluate a method of intraoperative cytological investigations and ACTH measurements in adenoma and anterior lobe micros...
Article
Full-text available
To investigate the possible impact of pretreatment with octreotide on different subtypes of GH-secreting pituitary adenomas and on the outcome of transnasal surgery. 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...
Article
The management of adrenocorticotropic hormone (ACTH)-dependent Cushing's disease implies difficulties in the differential diagnosis, in the detection of minute pituitary adenomas, as well as in the radical removal of invasive adenomas. Magnetic resonance imaging (MRI) is unspecific and often negative in minute adenomas of three or less millimeters...
Article
In situ hybridization (ISH) enables the visualization of specific mRNA for pituitary hormones. Our collection consists of 40 surgically removed pituitary adenomas that were classified as follicle stimulating hormone/luteinizing hormone (FSH/LH) cell adenomas by structure and by immunostaining (IH) for all pituitary hormones. All forty adenomas were...
Article
The present study was designed to investigate the incidence and immunohistochemical characteristics of pituitary tumors in the elderly. In our surgical collection of 1925 cases, we examined tumor tissue from 15 patients over 80 years of age. Pituitaries obtained at routine autopsies from 692 subjects over 80 years of age were also investigated. Of...
Article
The oncogenes cyclin D1 and D3 are overexpressed in many tumors. Topoisomerase IIα is found in proliferating cells. The immunohistological expression of cyclin D1, cyclin D3, and Topoisomerase IIα was studied in a collection of 60 clinically inactive surgically removed pituitary adenomas of the follicle-stimulating hormone/luteinizing hormone (FSH/...
Article
Full-text available
Although craniopharyngiomas have been examined in several microscopical studies to date, immunohistochemical analysis has not been sufficient. In addition to the routine haematoxylin and eosin staining, 38 cases of intra- and/or supra-sellar craniopharyngioma, including 34 adamatinomatous and 4 squamous papillary types, were studied using immunohis...
Article
Null cell adenomas and oncocytomas are clinically inactive adenomas of the pituitary gland. They do not show any significant hormone content detectable by immunohistochemistry.This study aimed at demonstrating mRNAs for all main pituitary hormones in 32 null cell adenomas and 31 oncocytomas by non-isotopic in situ hybridization using digoxigenin-la...
Article
There is increasing evidence for the role of members of the Interleukin (IL)-6 family in pituitary function, particularly in the regulation of the hypothalamo-pituitary-adrenal axis. However, there is only a limited amount of data available on the expression in human normal and tumorous pituitary tissue. In this study we investigated the expression...
Article
The goal of this study was to evaluate the efficacy and safety of transsphenoidal pituitary surgery for elderly patients, using improved techniques of the past decade. We retrospectively analyzed 32 surgically treated cases of clinically nonsecreting pituitary adenomas in patients more than 70 years of age (mean, 73.9+/-3.4 yr). These patients were...
Article
In many acromegalic patients the paradoxical release of GH in response to TRH has been well documented, but the mechanisms underlying this phenomenon are not understood. It has been suggested that aberrant GH secretion may result from TRH endogenously synthesized by the adenoma. In 32 adenomas from acromegalic patients, TRH-like immunoreactivity (T...
Article
The management of pituitary macroadenomas which lead to gigantism may require multiple therapeutical approaches, including medical treatment, surgery, and radiation therapy. Transsphenoidal surgery (TSS) during early childhood that achieves total removal of a growth hormone (GH) secreting tumor is rarely reported. The surgeon is confronted with spe...
Article
Although androgen receptors have been identified in normal gonadotroph and somatotroph cells of the pituitary, immunohistochemical studies have failed to reveal these receptors in pituitary adenomas so far. Using a monoclonal antibody to androgen receptor in our series of 60 adenomas of the gonadotroph cell complex (20 FSH/LH cell adenomas, 20 null...