Der Internist
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The incidence of pancreatic cancer is about 10,000 cases a year in Germany. The role of surgery as a curative modality is limited. The 5-year survival for all stages remains less than 5%. ⋯ Gemcitabine is the drug of choice in metastatic pancreatic cancer. In locally advanced disease, radiochemotherapy can be considered. Different treatment strategies against molecular targets are currently tested in clinical trials.
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Hypopituitarism is usually caused by tumours of the hypothalamus-pituitary region, but may also arise as the consequence of pituitary inflammation, infiltration or hypoperfusion. Tumour mass reduction by surgical intervention or following drug treatment may improve pituitary function. However, neurosurgical tumour resection and radiation therapy may lead to a permanent manifestation of hypopituitarism. ⋯ The treatment of permanent hypopituitarism consists of replacement of the peripheral hormones (hydrocortisone, DHEA, thyroxine, testosterone or oestradiol, growth hormone). Quality of life is impaired in a considerable number of patients with hypopituitarism and mortality is increased, mostly due to cardiovascular and cerebrovascular causes, but also as a consequence of recurrent respiratory infections. Long-term care and monitoring of patients with hypopituitarism requires the experienced endocrinologist.