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ObjectiveChanges observed during adult GH deficiency (GHD) are most often reversed with the administration of recombinant human GH (rhGH). To avoid daily injections, a long-acting GH molecule has been obtained by covalent binding of polyethylene glycol (PEG) with rhGH (PEG–GH), allowing weekly s.c. injections. This study was designed to assess its efficacy and safety, in adult GHD subjects.Design and methodsThis was a randomized, double-blind, placebo-controlled, multiple-dose, parallel group study. Subjects were recruited from 34 centers. A total of 105 subjects with GHD were assigned a treatment. They received 6 weekly injections of either PEG–GH or placebo. Subjects were randomized into one out of four treatment groups (Groups A–D) or placebo (Group E). Groups A, B, and C received 1, 3, and 4 mg PEG–GH respectively, for the first 3 weeks followed by 2, 6, and 8 mg PEG–GH respectively, for the remaining 3 weeks. Group D received 4 mg PEG–GH for 6 weeks. Group E received placebo. The study was suspended because of the development of lipoatrophy in certain subjects and restarted with an injection rotation plan, before being terminated due to further subjects developing lipoatrophy.ResultsA total of 13 cases of injection-site lipoatrophy were reported, of which ten were in females and three occurred after the first injection; all cases were independent of PEG–GH dose or IGF1 levels, either basal or under treatment.ConclusionThe unpredictable occurrence of injection-site lipoatrophy with weekly long-acting pegylated GH molecules may be a limiting factor for their development.

Einleitung: Die optimale Therapie für Patienten mit einem MEN1-assozierten Zollinger Ellison-Syndrom (MEN1-ZES) ist seit langem Gegenstand kontroverser Diskussionen. Ziel dieser Studie war, die Ergebnisse unterschiedlicher Operationsverfahren zu evaluieren Material und Methoden: Die prospektiven[for full text, please go to the a.m. URL], 129. Kongress der Deutschen Gesellschaft für Chirurgie

Einleitung: Primärer Hyperaldosteronismus (PHA) ist die häufigste endokrinologische Ursache für arterielle Hypertonie. Wir haben unsere Ergebnisse laparoskopischer Adrenalektomie (LA) mit dem Ziel anaylsiert klinische und laborchemische Parameter zu identifizieren, die eine erfolgreiche[for full text, please go to the a.m. URL], 127. Kongress der Deutschen Gesellschaft für Chirurgie

OBJECTIVE:: To evaluate the outcome of pancreaticoduodenectomy (PD) versus non-PD resections for the treatment of gastrinoma in multiple endocrine neoplasia type 1. BACKGROUND:: Gastrinoma in MEN1 is considered a rarely curable disease and its management is highly controversial both for timing and extent of surgery. METHODS:: Clinical characteristics, complications and outcomes of 27 prospectively collected MEN1 patients with biochemically proven gastrinoma, who underwent surgery, were analyzed with special regard to the gastrinoma type and the initial operative procedure. RESULTS:: Twenty-two (81\%) patients with gastrinoma in MEN1 had duodenal gastrinomas and 5 patients (19\%) had pancreatic gastrinomas. At the time of diagnosis, 21 (77\%) gastrinomas were malignant (18 duodenal, 3 pancreatic), but distant metastases were only present in 4 (15\%) patients. Patients with pancreatic gastrinomas underwent either distal pancreatic resections or gastrinoma enucleation with lymphadenectomy, 2 patients also had synchronous resections of liver metastases. One of these patients was biochemically cured after a median of 136 (77-312) months. Thirteen patients with duodenal gastrinomas underwent PD resections (group 1, partial PD [n = 11], total PD [n = 2]), whereas 9 patients had no-PD resections (group 2) as initial operative procedure. Perioperative morbidity and mortality, including postoperative diabetes, differed not significantly between groups (P > 0.5). All patients of group 1 and 5 of 9 (55\%) patients of group 2 had a negative secretin test at hospital discharge. However, after a median follow-up of 136 (3-276) months, 12 (92\%) patients of group 1 were still normogastrinemic compared to only 3 of 9 (33\%) patients of group 2 (P = 0.023). Three (33\%) patients of group 2 had to undergo up to 3 reoperations for recurrent or metastatic disease compared to none of group 1. CONCLUSIONS:: Duodenal gastrinoma in MEN1 should be considered a surgically curable disease. PD seems to be the adequate approach to this disease, providing a high cure rate and acceptable morbidity compared to non-PD resections.