Visual Fields in Pituitary Disease — A Case Report Showing the Influence of Endocrine Therapy

Abstract Case report - Introduction Relapsing polychondritis (RP) was first recognized as a clinical entity in 1923 by Jaksch-Wartenhorst (1923) and reported by him under the title "polychondropathia". The term "relapsing polychondritis" was first used by Pearson, Kline, and Newcomer (1960). Because the ocular findings can be the initial findings of RP, ophthalmologists should know the major ocular findings of this disease. Isaak et al reported that the most common ocular finding is episcleritis (39%) and the second is scleritis (14%). Other signs are iritis (9%), retinopathy (9%), muscle paresis (5%), and optic neuritis (5%). Case report - Case description A 45-year-old female with known rheumatoid arthritis referred by rheumatology in eye clinic due to blurred vision and dry eye. The patient was on hydroxychloroquine and sulfasalazine. No retinal toxicity was found on examination, OCT and Visual Fields. The vision was 6/6 both eyes. Follow-up was in 12 months. She presented 6 months later in casualty with severe pain in her right eye. Examination showed diffuse anterior scleritis with secondary conjunctival inflammation. Anterior chamber cells present. Posterior segment showed no inflammation. Left eye was unremarkable. She was started on Froben 100mg tds with omeprazole. She was seen after a week and condition was improving. She was asked to taper off the meds. Inflammation resolved with 6/5 vision in both eyes and the next appointment was made in a year to monitor for hydroxychloroquine toxicity. In November 2020 she was seen by ENT with inflammation of the right ear cartilage. The pictures showed that the pinna was spared and cartilage was only involved. There was nasal crusting and stuffy nose but without any respiratory symptoms. She was prescribed 50mgs of prednisolone and this helped with her inflammation. She was seen by rheumatology later on and hydroxychloroquine and sulfasalazine was stopped, and she was started on methotrexate 10mgs weekly and folic acid 5mg weekly. Pulmonary function test and echocardiogram was ordered. The case was discussed in MDT rheumatology and it was decided that if joint symptoms got worse than biologics could be started. Methotrexate increased to 15mg subcut. Echocardiogram was normal with satisfactory blood tests. Her next appointment is in October 2021. Case report - Discussion Initially the patient was diagnosed with rheumatoid arthritis with ocular inflammation (anterior scleritis) and was given the standard treatment of steroids to which the patient responded as well. Later when she developed the ear inflammation which involved only the cartilage the diagnosis was revised by rheumatology and changed to RP. As this is a rare life-threatening disease management was switched to immunosuppressive therapy to which she is currently responding well. Case report - Key learning points It is important to consider the possibility that a rheumatology patient may have more than one diagnosis or be open to the idea of revising the diagnosis as the clinical picture evolves over the time. Given the nature of the disease all the systemic features should be examined thoroughly as any one missed area can lead to delayed diagnosis.

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Synchronous and Metachronous Metastatic Breast Cancer, with Different Histology and Opposite Immunophenotype, Treated with Combination of Chemotherapy, Anti-Her2, and Endocrine Therapy: A Case Report

Case Reports in Oncology ◽

10.1159/000507433 ◽

2020 ◽

Vol 13 (2) ◽

pp. 544-549

Author(s):

Giacomina Megaro ◽

Luigi Rossi ◽

Serena Ceddia ◽

Marsela Sinjari ◽

Adele Mannino ◽

...

Keyword(s):

Breast Cancer ◽

Metastatic Breast Cancer ◽

Case Report ◽

Disease Control ◽

Endocrine Therapy ◽

Biological Markers ◽

Metastatic Breast ◽

Control Therapy

In the case of our patient, the synergic action of endocrine therapy and chemotherapy plus dual anti-HER2 combination allowed a complete disease control. Therapy should be scheduled by considering the two cancers as individual entities. The approach to breast cancer is changing from being considered a singular disease to a multiform one, according to current research focused on biological markers such as HER2, ERs, and PRs, with important implications in clinical, prognostic, and therapeutic features.

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Persistent Alopecia in a Breast Cancer Patient Following Taxane Chemotherapy and Adjuvant Endocrine Therapy: Case Report and Review of Post-treatment Hair Loss in Oncology Patients with Breast Cancer

Cureus ◽

10.7759/cureus.3056 ◽

2018 ◽

Author(s):

Tyler Werbel ◽

Philip R Cohen

Keyword(s):

Breast Cancer ◽

Case Report ◽

Cancer Patient ◽

Breast Cancer Patient ◽

Endocrine Therapy ◽

Hair Loss ◽

Post Treatment ◽

Adjuvant Endocrine Therapy ◽

Oncology Patients ◽

Taxane Chemotherapy

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Proptosis, Orbital Pain, and Long-Standing Monocular Vision Loss Resolved by Surgical Resection of Intraosseous Spheno-Orbital Meningioma: A Case Report and Literature Review

Journal of Neurological Surgery Reports ◽

10.1055/s-0040-1708845 ◽

2020 ◽

Vol 81 (01) ◽

pp. e28-e32

Author(s):

Jonathan M. Parish ◽

Michael Shields ◽

Mackenzie Jones ◽

Scott D. Wait ◽

Vinay R. Deshmukh

Keyword(s):

Case Report ◽

Vision Loss ◽

Visual Fields ◽

Residual Tumor ◽

Monocular Vision ◽

Optic Canal ◽

Subtotal Resection ◽

Orbital Reconstruction ◽

Orbital Pain ◽

Orbital Meningioma

Abstract Background and Importance We present a case of a patient with a residual intraosseous sphenoid wing meningioma presenting with proptosis, orbital pain, and monocular vision loss for 8 months who underwent decompression of the optic canal, orbital contents, and orbital reconstruction resulting in significant improvement in her vision loss with full resolution of proptosis and orbital pain. Clinical Presentation A 43-year-old female presented with a 1 year history of headache, peri-orbital pain, proptosis, and severe vision loss. She had previously undergone subtotal resection of a large Simpson Grade 1 spheno-orbital meningioma 3 years prior at an outside institution. Workup at our institution revealed hyperostosis of the left greater wing of the sphenoid bone and narrowing of the optic canal along with bony enhancement concerning for residual tumor. The patient was given the recommendation from outside institutions for radiation, presumably due to the chronicity of her visual loss. Our institution recommended resection of the residual osseous tumor with orbital reconstruction. Less than 2 weeks after surgery, the patient noted significant improvement in orbital pain and vision. At 3 months, she had regained full and symmetric orbital appearance with no orbital pain. Her visual acuity improved to 20/30 with full visual fields. Conclusion Surgical decompression of the optic canal and orbital contents for tumor related sphenoid wing hyperostosis should be strongly considered, despite an extended duration of visual change and loss. This case report shows that vision can be significantly restored even after symptoms have been present for greater than 6 months.

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