Abstract #815: Visual Field Deterioration While on Medical Treatment in a Patient with Giant Prolactinoma

2017 ◽  
Vol 23 ◽  
pp. 169-170
Author(s):  
Joyce George ◽  
Betul Hatipoglu
Keyword(s):  
Visual Field ◽  
Medical Treatment ◽  
Giant Prolactinoma

scholarly journals SAT-247 Use of Double Dopamine Agonists in Giant Prolactinomas: A Series of 6 Cases

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yueh Chien Kuan
Keyword(s):  
Visual Field ◽  
Medical Therapy ◽  
Visual Field Defect ◽  
Tolerability Profile ◽  
Residual Tumour ◽  
Careful Monitoring ◽  
Presenting Symptoms ◽  
Giant Prolactinoma ◽  
Giant Prolactinomas ◽  
Field Defect

Abstract Dopamine agonist monotherapy is first line therapy in giant prolactinomas even when visual field defect is present. The costlier cabergoline is often preferred over bromocriptine due to higher efficacy and tolerability profile. Described herein combined cabergoline and bromocriptine therapy in 6 cases of giant prolactinomas. Retrospective records review of 6 patients with giant prolactinoma (3 males: M1-M3, 3 females: F1-F3) in a single tertiary centre was performed. Mean age at diagnosis: 29 years (range 17-39). Mean duration of follow up: 7 years (range 3-11). Headache and visual field defect were the presenting symptoms in all cases. Basal prolactin concentration: 100000 to 468851 mIU/L (<300 for male, <600 for female). Three patients have hypopituitarism at presentation, one after surgery and one remained eupitary 5 years after diagnosis. One developed late onset hypopituitarism 4 years after normalisation of prolactin levels. Three patients underwent debulking at presentation because of significant mass effects with obstructive hydrocephalus. In all patients cabergoline 1-1.5 mg/wk was started at diagnosis and gradually increased to 0.5 mg daily, aiming for normoprolactinemia. From May 2017 bromocriptine were given to these patients who continued to have hyperprolactinemia despite cabergoline 3.5-4mg/wk. Bromocriptine was commenced 1.25-5mg/day and gradually increased to 10 mg/day on top of cabergoline with careful monitoring of prolactin levels and side effects. Cabergoline was tapered down to 1.5-2mg/wk if prolactin levels remained stable between 2-3x normal while maintaining dose of bromocriptine. In M1, cabergoline was tapered off while maintaining bromocriptine 10mg/day with stable prolactin levels (~1000 mIU/L). In M2, normoprolactinemia was achieved after adding on bromocriptine and is currently on cabergoline 2mg/week and bromocriptine 10mg/day. In M3, whose prolactin were 4x normal value despite cabergoline 3.5mg/week, decreased 50% with bromocriptine 5 mg/day and remained stable when cabergoline reduced to 1.5mg/week. F1 had transphenoidal section twice due to failure of medical therapy. Her prolactin remained markedly elevated 10000-20000 mIU/L despite cabergoline 3.5 mg/week and bromocriptine 10mg/day, with persistent bitemporal hemianopia. F2 developed erythema nodosum after starting bromocriptine which was stopped and continued with cabergoline 1 mg/week. F3 showed partial response with 50% reduction in prolactin to 4485 mIU/L with bromocriptine 10 mg/day and cabergoline 1.5mg/week. In patients who underwent debulking, residual tumour remained unchanged. Two patients - tumour shrank 40% (F2) and 90% (M3) with medical therapy alone. In conclusion, adding on bromocriptine can be considered when high dose cabergoline is required for treatment of giant prolactinoma with careful monitoring. This reduces cabergoline dose which saves cost.

Contributing Factors for Progression of Visual Field Loss in Normal-tension Glaucoma Patients With Medical Treatment

2013 ◽  
Vol 22 (3) ◽  
pp. 250-254 ◽  
Author(s):  
Rei Sakata ◽  
Makoto Aihara ◽  
Hiroshi Murata ◽  
Chihiro Mayama ◽  
Atsuo Tomidokoro ◽  
...  
Keyword(s):  
Visual Field ◽  
Medical Treatment ◽  
Visual Field Loss ◽  
Normal Tension Glaucoma ◽  
Contributing Factors

scholarly journals Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma—study protocol

2017 ◽  
Vol 102 (7) ◽  
pp. 922-928 ◽  
Author(s):  
Anthony J King ◽  
Gordon Fernie ◽  
Augusto Azuara-Blanco ◽  
Jennifer M Burr ◽  
Ted Garway-Heath ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Visual Field ◽  
Randomised Controlled Trial ◽  
Medical Treatment ◽  
Incremental Cost ◽  
Visual Function ◽  
Controlled Trial ◽  
Utility Index ◽  
Advanced Glaucoma ◽  
Randomised Controlled

BackgroundPresentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients.AimTo compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG).MethodsDesign: A prospective, pragmatic multicentre randomised controlled trial (RCT).SettingTwenty-seven UK hospital eye services.ParticipantsFour hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss.InterventionParticipants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes).Main outcome measuresThe primary outcome is vision-related quality of life measured by the National Eye Institute—Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated.ResultsThe study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years.ConclusionsTreatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma.Trial registration numberISRCTN56878850, Pre-results.

scholarly journals Post-stroke Visual Impairment Treated with Korean Medical Treatment: A Case Series

2021 ◽  
Vol 42 (5) ◽  
pp. 1035-1044
Author(s):  
Young-ung Lee ◽  
Geonhui Kang ◽  
Kwangho Kim ◽  
Cheol-hyun Kim ◽  
Sunny Kang ◽  
...  
Keyword(s):  
Visual Field ◽  
Herbal Medicine ◽  
Medical Treatment ◽  
Visual Impairment ◽  
Parietal Lobe ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Left And Right ◽  
The Mean ◽  
The Right

Objective: This study investigated two cases of Korean medical treatment for visual field impairment after stroke: Case 1, a 56-year-old male with a posterior cerebral artery infarction and right homonymous hemianopsia, and Case 2, a 46-year-old male with an intracerebral hemorrhage in the left parietal lobe and right homonymous hemianopsia.Methods: Case 1 was treated with acupuncture, electroacupuncture, and herbal medicine (Mangeum-tang) for two months, and Case 2 was treated with acupuncture, electroacupuncture, and herbal medicine (Oryeong-san) for 40 days.Results: Following treatment, for Case 1, the Humphrey visual field test showed improvement. The visual field indexes (VFIs) for the left and right eyes improved from 44% to 55% and 49% to 64% respectively, and the mean deviations (MDs) for the left and right eyes improved from -21.11 dB to -19.91 dB and -17.45 dB to -13.89 dB, respectively. The mean visual sensitivities (MVSs) of the left and right eyes also improved from 8.67 dB to 11.33 dB and 1.67 dB to 9.67 dB, respectively, with no side effects. For Case 2, the VFI for the left eye improved from 36% to 64% and that for the right eye remained unchanged. The MDs for the left and right eyes also improved from -22.02 dB to -14.47dB and -22.11 dB to -21.34 dB, respectively, with no side effects.Conclusions: This study suggests that Korean medical treatment may improve visual impairment after stroke, but further research is needed.

scholarly journals A Case Study of Eyelid Edema Post Craniotomy

2021 ◽  
Vol 42 (5) ◽  
pp. 939-948
Author(s):  
Seo-young Kim ◽  
Jeong-woo Choi ◽  
Tae-bin Yim ◽  
Hye-jin Lee ◽  
Seung-yeon Cho ◽  
...  
Keyword(s):  
Visual Field ◽  
Medical Treatment ◽  
Visual Field Defect ◽  
Herbal Medicines ◽  
Korean Medicine ◽  
Eyelid Edema ◽  
Effective Option ◽  
Field Defect

Objectives: This study considered the effectiveness of Korean medicine for the treatment of eyelid edema post craniotomy.Methods: The patient was diagnosed with Taeumin-one of the four constitution types in Korean medicine-and treated with herbal medicines: Cheongsimyeunja-tang, Chungpyesagan-tang, and Hwangryunhaedok-tang pharmacoacupuncture treatment. The severity of eyelid edema was assessed using Kara and Gokalan’s scale, daily imaging of the patient’s eyelids, and the ratio of the length of the left eye to that of the right.Results: Following treatment, the Kara and Gokalan score decreased from 3 to 0. The changes in the ratios were 29% and 50%, respectively. The visual field defect due to edema in the left eye was also repaired.Conclusion: This study suggests that Korean medical treatment could be an effective option for treating eyelid edema following craniotomy.

scholarly journals Reversal of severe cognitive impairment following medical treatment of cystic invasive giant prolactinoma

2016 ◽  
Vol 2016 ◽  
Author(s):  
J Bukowczan ◽  
K Lois ◽  
M Mathiopoulou ◽  
A B Grossman ◽  
R A James
Keyword(s):  
Cognitive Impairment ◽  
Medical Treatment ◽  
Young Patients ◽  
List Type ◽  
Familial Predisposition ◽  
Giant Prolactinoma ◽  
Dopamine Agonist Therapy ◽  
Rare Tumours ◽  
Giant Prolactinomas

Summary Giant prolactinomas are rare tumours of the pituitary, which typically exceed 40 mm in their largest dimension. Impairment of higher cognitive function has been noted post-operatively after transcranial surgery and as a long-term consequence of the radiotherapy treatment. However, there has been little that is reported on such disturbances in relation to the tumour per se, and to our knowledge, there has been none in terms of responsivity to dopamine agonist therapy and shrinkage in these tumours. We present a case of successful restoration of severely impaired cognitive functions achieved safely after significant adenoma involution with medical treatment alone. Learning points Giant prolactinomas can be present with profound cognitive defects. Dopamine agonists remain in the mainstay first-line treatment of giant prolactinomas. Mechanisms of the reversible cognitive impairment associated with giant prolactinoma treatment appear to be complex and remain open to further studies. Young patients with giant prolactinomas mandate genetic testing towards familial predisposition.

Rapid Size Reduction of Giant Prolactinoma Following Medical Treatment

1984 ◽  
Vol 8 (1) ◽  
pp. 131-133 ◽  
Author(s):  
Daniela Perani ◽  
Nadia Colombo ◽  
Giuseppe Scotti ◽  
Cristina Tonon
Keyword(s):  
Medical Treatment ◽  
Size Reduction ◽  
Giant Prolactinoma

scholarly journals Effectiveness of long-term cabergoline treatment for giant prolactinoma: study of 12 men

2007 ◽  
Vol 156 (2) ◽  
pp. 225-231 ◽  
Author(s):  
Ilan Shimon ◽  
Carlos Benbassat ◽  
Moshe Hadani
Keyword(s):  
Visual Field ◽  
The Other ◽  
Serum Prolactin ◽  
Visual Field Defects ◽  
First Line ◽  
Giant Prolactinoma ◽  
First Line Therapy ◽  
Line Therapy ◽  
Giant Prolactinomas ◽  
Field Defects

Objective: To review our experience with cabergoline, a D2-selective dopamine agonist, for the treatment of giant prolactinomas. Design: A retrospective case series; descriptive statistics. Methods: The study group included 12 men aged 24–52 years (mean 39.2 years) treated for giant prolactinoma at our centers from 1997 to 2006. Cabergoline was started at a dose of 0.5 mg/three times a week and progressively increased as necessary to up to 7 mg/week. Patients were followed by hormone measurements, sellar magnetic resonance imaging, and visual examinations. Results: In ten patients, cabergoline served as first-line therapy. The other two patients had previously undergone transsphenoidal partial tumor resection because of visual deterioration. Mean serum prolactin level before treatment was 14 393 ± 14 579 ng/ml (range 2047–55 033 ng/ml; normal 5–17 ng/ml). Following treatment, levels normalized in ten men within 1–84 months (mean, 25.3 months) and decreased in the other two to 2–3 times of normal. Tumor diameter, which measured 40–70 mm at diagnosis, showed a mean maximal decrease of 47 ± 21%; response was first noted about 6 months after the onset of treatment. Nine patients had visual field defects at diagnosis; vision returned to normal in three of them and improved in five. Testosterone levels, initially low in all patients, normalized in eight. There were no side effects of treatment. Conclusion: Cabergoline therapy appears to be effective and safe in men with giant prolactinomas. These findings suggest that cabergoline should be the first-line therapy for aggressive prolactinomas, even in patients with visual field defects.

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