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Double pituitary adenomas represent up to 2.6 % of pituitary adenomas in large surgical series and up to 3.3 % of patients with Cushing’s disease have been found to have double or multiple pituitary adenomas. We report the case of a 60-year-old male patient whose medical history began in 2002 with erectile dysfunction; hyperprolactinemia was found and MRI showed a 6-mm area of delayed enhancement in the lateral portion of the right pituitary lobe. Treatment with cabergoline was started with normalization of prolactin levels; the following MRI, performed in 2005 and 2008, showed shrinkage of the pituitary lesion. In 2005, the patient began to manifest weight gain, hypertension, and facial plethora, but no further evaluations were done. In January 2010, the patient came to our attention and underwent multiple tests that suggested Cushing’s disease. A new MRI was negative. Bilateral inferior petrosal sinus sampling showed significant pituitary-to-peripheral ratio and, in May 2010, the patient underwent exploratory pituitary surgery with evidence of a 1–2-mm white-coloured midline area compatible with pituitary adenoma that was surgically removed. Post-operatively, the patient’s clinical conditions improved with onset of secondary hypoadrenalism. The histologic examination confirmed a pituitary adenoma (immunostaining was found to be positive for ACTH and negative for prolactin). We report the case of an ACTH-producing microadenoma metachronous to a prolactin secreting microadenoma although not confirmed histologically, shrunk by medical treatment. A review of data in the literature regarding double or multiple pituitary adenomas has also been done.

The aim of this retrospective study was to evaluate the efficacy, safety, and tolerability of lanreotide autogel given to metastatic well-differentiated (WD) neuroendocrine tumors (NET) patients observed in our Institute between 2005 and 2008. Patients with metastatic NET referred to our tertiary referral center were given lanreotide autogel 120 mg/month by deep sc injection for a period of at least 24 months. The efficacy was evaluated by the relief of disease symptoms, behavior of tumor markers and response rate in terms of time to tumor progression. Safety and tolerability were evaluated by assessing the onset of adverse events and treatment feasibility. Twenty-three patients (13 males), median age 62 yr (range 32–87) were considered for the study. All patients were affected by WD metastatic NET and had tumor progression in the last 6 months before the enrolment in the study. Median duration of response was 28 months (range 6–50 months). Fourteen patients (60.9%) showed flushing and diarrhea which improved by 85.7% and 55.6%, respectively, bronchoconstrinction and abdominal pain also ameliorated. A complete, partial or no-changed response in the tumor markers behavior was observed, respectively, in 42.9%, 22.9%, and 17.1% of cases. According to RECIST (Response Evaluation Criteria In Solid Tumors) criteria (version 1.1), there were 2 partial regression (8.7%) and 15 stable disease (65.3%); 6 patients (26.0%) progressed. No patient complained from any severe adverse reaction. The results of our study suggest that lanreotide autogel is effective in the symptoms, biochemical markers, and tumor progression control of WD metastatic NET and confirm that the treatment is well tolerated.

Ring-current maps are constructed by Hückel−London theory for the 36 bicyclic systems CNHN-2 derived by formal cross-linking of even [N]annulenes (N ≤ 18). The patterns of circulation are classified according to the length of perimeter and position of the cross-link, described by the five possible combinations of perimeter and constituent ring sizes. The qualitative predictions are tested by ab initio distributed-origin (CTOCD) calculations of the maps for a subset of 15 bicycles in planar geometries. The ab initio calculations confirm the graph-theoretical prediction that the main current follows the Hückel rule:  diatropic for “aromatic” 4n + 2 and paratropic for “antiaromatic” 4n π electrons. A perimeter current is found in the ab initio maps, when the bicycle is formed by fusion of two odd rings ([2l + 1], [2m + 1]), two equal antiaromatic rings ([4l, 4l]) or two (not necessarily equal) aromatic rings ([4l + 2], [4m + 2]). Orbital analysis shows that these perimeter currents are four-electron diatropic or two-electron paratropic, as in the monocycles. In the other cases, of a 4n + 2 bicycle formed by fusion of two unequal antiaromatic rings ([4l, 4m]) or of a 4n bicycle formed from fusion of an antiaromatic and an aromatic ring ([4l, 4m + 2]), the current is concentrated in one of the component rings.