Changes in the Options for Management of Prolactin Secreting Pituitary Adenomas

2021 ◽  
Author(s):  
Sherry L. Iuliano ◽  
Wenya Linda Bi ◽  
Edward R. Laws
Keyword(s):  
Side Effects ◽  
Medical Therapy ◽  
Therapeutic Option ◽  
Hormone Secretion ◽  
Three Dimensional ◽  
Pituitary Tumors ◽  
Initial Therapy ◽  
Fat Graft ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Endoscopic Operation

Abstract Objectives Initial therapy for the management of prolactinomas has long been maintained to be medical, consisting of a dopamine agonist. These therapies may have troublesome side effects, and some prolactinomas are resistant to medical therapy regarding lowering prolactin levels or shrinking the tumor. These issues have revived interest in surgery for prolactin-secreting adenomas as an early therapeutic option. We report our analysis of surgery for prolactin microadenomas in women, using the transsphenoidal endoscopic approach. Design We reviewed a contemporary series of 33 women (mean age = 31.8 years) with microprolactinomas who underwent early surgical intervention, which was a three-dimensional transnasal transsphenoidal endoscopic operation. Setting The study was conducted at a tertiary academic referral center for pituitary tumors. Main Outcome Measures Preoperative and postoperative prolactin. Results Overall, 28 patients had received preoperative dopamine agonists, 24 of these experienced a variety of drug-related side effects, and 4 had tumors that were resistant to lowering prolactin or tumor shrinkage. Preoperative prolactin levels averaged 90.3 ng/mL (range = 30.7–175.8 ng/mL). We observed a 94% normalization rate in postoperative prolactin (mean = 10.08 ng/mL, range = 0.3–63.1 ng/mL). During the follow-up (mean = 33.9 months), five patients had elevated prolactin; four required reinitiation of medical therapy, two had surgical reexploration, and none received radiation therapy. Complications included syndrome of inappropriate antidiuretic hormone secretion (n = 3), transient diabetes insipidus (n = 1), postoperative epistaxis (n = 1), and fat graft site infection (n = 1). Conclusion This review supports the consideration of transsphenoidal surgery as an early intervention for some women with prolactin-secreting microadenoma. Indications include significant side effects of medical therapy and tumors that do not respond to standard medical management.

scholarly journals Efficacy, Efficiency and Security of Urea Treatment in the Syndrome of Inappropiate Antidiuretic Hormone Secretion

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A627-A627
Author(s):  
Eva Perelló Camacho ◽  
Francisco José Pomares Gómez ◽  
Luis López Penabad ◽  
Rosa María Mirete López ◽  
María Rosa Pinedo Esteban ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Therapeutic Option ◽  
Hormone Secretion ◽  
Cost Effective ◽  
Plasma Sodium ◽  
Duration Of Treatment ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Number Of Patients ◽  
Effective Option

Abstract Introduction: In the present times, several strategies have been proposed for the treatment of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Urea has demonstrated to be an effective treatment but its use has not been extended. Our work analyzes our experience with urea in the treatment of SIADH. Material and Methods: Observational retrospective analysis of 39 patients with SIADH in which urea has been used in our hospital with pre- and post-analysis of plasmatic sodium concentrations. Results: We included 39 patients with SIADH win a mean age of 76,4 ± 15,8 years. The plasma sodium nadir was 120,0 ± 5,1 mmoL/L and at the initiation of treatment 125,2 ± 4,1 mmoL/L. Total time of treatment was 2,42 ± 3,86 months being the treatment still active in 4 patients. We observed an improvement of sodium in all patients with a mean sodium at the end of treatment of 134.3 + - 5.0 mmol/L being this values statistically significant compared to the initial sodium (p<0.01). As a matter of fact we found significant differences at one week of treatment (p<0.01), keeping sodium stable levels around 135 mmol/L during the treatment period. The treatment was stopped in 3 cases (7.7 %) by the patient, one for mild digestive symptomatology and two for limited palatability. Of them two were treated with tolvaptan and the other did not need any further treatment. There were no adverse events in the rest of the patients. From the economic perspective and considering the duration of treatment, if we compare this to the cost of tolvaptan during the same period and the same number of patients, there was a reduction of cost of 87.9 % in comparison with treatment with tolvaptan. Conclusions: In our experience urea has shown to be a safe and cost effective option in the treatment of hyponatremia caused by SIADH showing improvement in sodium levels from the first week of treatment in all patients. We think it should be considered a valid therapeutic option.

scholarly journals Somatostatin analogues in acromegaly and gastroenteropancreatic neuroendocrine tumours: past, present and future

2016 ◽  
Vol 23 (12) ◽  
pp. R551-R566 ◽  
Author(s):  
Kjell Öberg ◽  
Steven W J Lamberts
Keyword(s):  
Medical Therapy ◽  
Neuroendocrine Tumours ◽  
Clinical Success ◽  
Serum Insulin ◽  
Therapeutic Option ◽  
Hormone Secretion ◽  
Somatostatin Analogues ◽  
Somatostatin Analogue ◽  
Prolonged Release ◽  
Gastroenteropancreatic Neuroendocrine Tumours

Acromegaly is a hormonal disorder that arises when the pituitary gland secretes excess growth hormone (GH), which in turn stimulates a concomitant increase in serum insulin-like growth factor 1 (IGF-1) levels. Gastroenteropancreatic neuroendocrine tumours (GEP-NET) constitute a heterogeneous group of tumours that can secrete serotonin and a variety of peptide hormones that may cause characteristic symptoms known as carcinoid syndrome or other symptoms and hormonal hypersecretion syndromes depending on the tumour’s site of origin. Current medical therapy for the treatment of acromegaly and GEP-NET involves the administration of somatostatin analogues that effectively suppress excess hormone secretion. After its discovery in 1979, octreotide became the first synthetic biologically stable somatostatin analogue with a short-acting formulation of octreotide introduced into clinical practice in the late 1980s. Lanreotide, another somatostatin analogue, became available in the mid-1990s initially as a prolonged-release formulation administered every 10 or 14 days. Long-acting release formulations of both octreotide (Sandostatin LAR and Novartis) and lanreotide (Somatuline Autogel, Ipsen), based on microparticle and nanoparticle drug-delivery technologies, respectively, were later developed, which allowed for once-monthly administration and improved convenience. First-generation somatostatin analogues remain one of the cornerstones of medical therapy in the management of pituitary and GEP-NET hormone hypersecretion, with octreotide having the longest established efficacy and safety profile of the somatostatin analogue class. More recently, pasireotide (Signifor), a next-generation multireceptor-targeted somatostatin analogue, has emerged as an alternative therapeutic option for the treatment of acromegaly. This review summarizes the development and clinical success of somatostatin analogues.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

2020 ◽  
Vol 14 (2) ◽  
pp. 87-90
Author(s):  
Sadaf Amin Chaudhry ◽  
Nadia Ali Zafar ◽  
Rabia Hayat ◽  
Ayesha Noreen ◽  
Gulnaz Ali ◽  
...  
Keyword(s):  
Side Effects ◽  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Treatment Options ◽  
Tertiary Care ◽  
Poor Response ◽  
Global Assessment Scale ◽  
Severe Acne ◽  
Hematologic Profile

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

Comprehensive Three-Dimensional Technology Strategies for Autologous Free Fat Graft in Parry-Romberg Syndrome

2020 ◽  
Vol 31 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Min Ji Kim ◽  
Woo Shik Jeong ◽  
Dong Nyuk Jeon ◽  
Jong Woo Choi ◽  
Don Han Kim
Keyword(s):  
Three Dimensional ◽  
Fat Graft ◽  
Free Fat Graft ◽  
Parry Romberg Syndrome ◽  
Technology Strategies

scholarly journals Endometrial regeneration with endometrial epithelium: homologous orchestration with endometrial stroma as a feeder

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ryo Yokomizo ◽  
Yukiko Fujiki ◽  
Harue Kishigami ◽  
Hiroshi Kishi ◽  
Tohru Kiyono ◽  
...  
Keyword(s):  
Epithelial Cells ◽  
Stromal Cells ◽  
Therapeutic Option ◽  
Three Dimensional ◽  
Fertility Treatment ◽  
Feeder Cells ◽  
Endometrial Stromal Cells ◽  
Thin Endometrium ◽  
Endometrial Epithelial Cells

Abstract Background Thin endometrium adversely affects reproductive success rates with fertility treatment. Autologous transplantation of exogenously prepared endometrium can be a promising therapeutic option for thin endometrium; however, endometrial epithelial cells have limited expansion potential, which needs to be overcome in order to make regenerative medicine a therapeutic strategy for refractory thin endometrium. Here, we aimed to perform long-term culture of endometrial epithelial cells in vitro. Methods We prepared primary human endometrial epithelial cells and endometrial stromal cells and investigated whether endometrial stromal cells and human embryonic stem cell-derived feeder cells could support proliferation of endometrial epithelial cells. We also investigated whether three-dimensional culture can be achieved using thawed endometrial epithelial cells and endometrial stromal cells. Results Co-cultivation with the feeder cells dramatically increased the proliferation rate of the endometrial epithelial cells. We serially passaged the endometrial epithelial cells on mouse embryonic fibroblasts up to passage 6 for 4 months. Among the human-derived feeder cells, endometrial stromal cells exhibited the best feeder activity for proliferation of the endometrial epithelial cells. We continued to propagate the endometrial epithelial cells on endometrial stromal cells up to passage 5 for 81 days. Furthermore, endometrial epithelium and stroma, after the freeze-thaw procedure and sequential culture, were able to establish an endometrial three-dimensional model. Conclusions We herein established a model of in vitro cultured endometrium as a potential therapeutic option for refractory thin endometrium. The three-dimensional culture model with endometrial epithelial and stromal cell orchestration via cytokines, membrane-bound molecules, extracellular matrices, and gap junction will provide a new framework for exploring the mechanisms underlying the phenomenon of implantation. Additionally, modified embryo culture, so-called “in vitro implantation”, will be possible therapeutic approaches in fertility treatment.

scholarly journals Regulation of Serum Sodium Levels during Chemotherapy Using Selective Arginine Vasopressin V2-Receptor Antagonist Tolvaptan in a Four-Year-Old Girl with a Suprasellar Germ Cell Tumor

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 293
Author(s):  
Shota Hiroshima ◽  
Hiromi Nyuzuki ◽  
Sunao Sasaki ◽  
Yohei Ogawa ◽  
Keisuke Nagasaki
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Serum Sodium ◽  
Hormone Secretion ◽  
Urine Volume ◽  
Cell Tumor ◽  
Sodium Balance ◽  
Infusion Therapy ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Control Serum

There are limited reports on the use of tolvaptan for syndrome of inappropriate antidiuretic hormone secretion (SIADH) in children. Managing serum sodium levels in SIADH patients during chemotherapy is often difficult because of the need for massive fluid infusions. We report the course of the use of tolvaptan for the treatment of hyponatremia during chemotherapy in a four-year-old girl with a suprasellar germ cell tumor. The patient was a Japanese girl who presented with left ptosis with a mass in the pituitary gland and cavernous sinus. She was diagnosed with an intermediate-grade germ cell tumor and was treated with carboplatin and etoposide combination chemotherapy. She developed hyponatremia due to SIADH caused by intravenous infusion therapy before chemotherapy. Subsequently, tolvaptan (3.25 mg; 0.20 mg/kg/dose) was administered orally to control serum sodium levels. After 4 h of administration, a marked increase in urine volume of up to 15 mL/kg/h was observed, and serum sodium level increased from 126 to 138 mEq/L after 10 h of tolvaptan administration, followed by a decrease in urine volume. The use of tolvaptan in pediatric patients with SIADH who require intravenous hydration during chemotherapy can be useful for the management of serum sodium balance.

Sign in / Sign up

Export Citation Format

Share Document