Prolactinoma-associated headache and dopamine agonist treatment

Cephalalgia ◽  
2013 ◽  
Vol 34 (7) ◽  
pp. 493-502 ◽  
Author(s):  
Mia-Maiken Kallestrup ◽  
Helge Kasch ◽  
Toke Østerby ◽  
Edith Nielsen ◽  
Troels S Jensen ◽  
...  
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Tumor Volume ◽  
Serum Prolactin ◽  
Therapeutic Effects ◽  
Average Tumor Volume ◽  
Tumor Volume Reduction ◽  
One Year

Aim The aim of this article is to investigate the phenotype and etiology of prolactinoma-associated headache as well as present and discuss the plausible pain-relieving effect of dopamine agonist treatment. Methods In this case-based audit we included 11 patients with prolactinomas and one patient with idiopathic hyperprolactinemia presenting with headache that subsequently improved or resolved after dopamine agonist treatment. Results A significant ipsilateral location of tumor mass and reported headache symptoms was observed ( p = 0.018). After dopamine agonist treatment seven out of 12 patients became pain free within 2.5 months; after one year of treatment 11 out of 12 reported headache improvement or resolution. Average tumor volume reduction after treatment was 47 ± 22% during 9.5 ± 8.4 months of follow-up. There was no significant association between headache relief and tumor shrinkage ( p = 0.43) or normalization of serum prolactin ( p = 1.00), respectively. Conclusions 1) The significant association between lateralization of tumor and headache suggests a mechanical origin of the headache, 2) headache responded to dopamine agonist treatment in most patients, and 3) our observations encourage future prospective controlled trials to investigate the role of hyperprolactinemia in the pathogenesis of headache as well as the therapeutic effects of dopamine agonists.

scholarly journals Trans-sphenoidal surgery for microprolactinoma: an acceptable alternative to dopamine agonists?

1999 ◽  
pp. 43-47 ◽  
Author(s):  
HE Turner ◽  
CB Adams ◽  
JA Wass
Keyword(s):  
Dopamine Agonist ◽  
Dopamine Agonists ◽  
Hormone Deficiency ◽  
Serum Prolactin ◽  
Agonist Therapy ◽  
Recurrence Rates ◽  
Tertiary Referral Centre ◽  
Dopamine Agonist Therapy

AIMS: Reported cure rates following trans-sphenoidal surgery for microprolactinoma are variable and recurrence rates in some series are high. We wished to examine the cure rate of trans-sphenoidal surgery for microprolactinoma, and to assess the long-term complications and recurrence rate. DESIGN: A retrospective review of the outcome of trans-sphenoidal surgery for microprolactinoma, performed by a single neurosurgeon at a tertiary referral centre between 1976 and 1997. PATIENTS: All thirty-two patients operated on for microprolactinoma were female, with a mean age of 31 years (range 16-49). Indications for surgery were intolerance of dopamine agonists in ten (31%), resistance in six (19%) and resistance and intolerance in four (12.5%). Two patients were from countries where dopamine agonists were unavailable. RESULTS: The mean pre-operative prolactin level was 2933 mU/l (range 1125-6000). All but 1 had amenorrhoea or oligomenorrhoea, with galactorrhoea in 15 (46.9%). Twenty-five (78%) were cured by trans-sphenoidal surgery, as judged by a post-operative serum prolactin in the normal range. During a mean follow-up of 70 months (range 2 months to 16 years) there was one recurrence at 12 years. Post-operatively, one patient became LH deficient, two patients became cortisol deficient and two became TSH deficient. Out of 21 patients tested for post-operative growth hormone deficiency, 6 (28.6%) were deficient. Five patients developed post-operative diabetes insipidus which persisted for greater than 6 months. There were no other complications of surgery. The estimated cost of uncomplicated trans-sphenoidal surgery, and follow-up over 10 years, was similar to that of dopamine agonist therapy. CONCLUSION: In patients with hyperprolactinaemia due to a pituitary microprolactinoma, transsphenoidal surgery by an experienced pituitary surgeon should be considered as a potentially curative procedure. The cost of treatment over a 10 year period is similar in uncomplicated cases to long-term dopamine agonist therapy.

Individualized Behavioural Treatment of Severe Stuttering

1991 ◽  
Vol 19 (4) ◽  
pp. 347-357 ◽  
Author(s):  
Willi Ecker ◽  
Victor Meyer
Keyword(s):  
Oral Reading ◽  
Reading Improvement ◽  
Behavioural Treatment ◽  
Communication Situations ◽  
Cognitive Techniques ◽  
One Year

This case study illustrates the reduction of severe stuttering by an individually tailored treatment programme. Interventions are derived from a tripartite analysis (Lang, 1971) and include EMG biofeedback, regulated breathing, exposure in vivo to stressful communication situations and cognitive techniques to reduce relapse risk. The role of dysfunctional response system interactions in stuttering is emphasized. Treatment resulted in a marked reduction of stuttering and associated facial contortions during videotaped conversations with strangers and oral reading. Improvement was maintained at one-year follow-up.

scholarly journals Role of methyleprednisolone succinate in the management of acute spinal cord injury

1970 ◽  
Vol 9 (3) ◽  
pp. 168-172
Author(s):  
NK Karn ◽  
BP Shrestha ◽  
GP Khanal ◽  
R Rijal ◽  
P Chaudhary ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Status ◽  
Acute Spinal Cord Injury ◽  
Cord Injury ◽  
And Gender ◽  
One Year

Objective: To see the role of methyleprednisolone succinate in the management of acute spinal cord injury. Methods: A randomized control trial was done including the patients with acute spinal cord injury. They were divided into age and gender matched two groups. Patients with presence of active infection, associated open fracture, those on long term steroid and those who did not give consent to participate in the trial were excluded. One group received methyleprednisolone succinate within 8 hours of injury and another group did not receive the drug. Both the groups were managed nonoperatively. The neurological status of the patients was assessed at presentation, once spinal shock was over, at 6th week and 6th month and after one year according to ASIA scoring. Frankel grading was also assessed in every follow up. Conclusion: Methylprednisolone succinct prevents secondary cord injury to a great extent and hence its administration within 8 hours of injury results in a better functional (motor and sensory) outcome. Keywords: acute spinal cord injury; methyleprednisolone succinate DOI: http://dx.doi.org/10.3126/hren.v9i3.5585   HR 2011; 9(3): 168-172

Posttraumatic Anterior Hypopituitarism—Revisited: The Role of TRH Provocative Release of Prolactin in the Confirmation of Anterior Pituitary Damage

PEDIATRICS ◽  
1977 ◽  
Vol 59 (6) ◽  
pp. 948-950
Author(s):  
David R. Brown ◽  
J. Michael McMillin
Keyword(s):  
Pituitary Gland ◽  
Anterior Pituitary ◽  
Thyroid Stimulating Hormone ◽  
Anterior Pituitary Gland ◽  
Serum Prolactin ◽  
Pituitary Insufficiency ◽  
Closed Head Trauma ◽  
One Year ◽  
Stimulating Hormone

We have previously reported a case of anterior pituitary insufficiency in a 14-year-old girl following closed head trauma.1 Endocrine evaluation one year after her accident revealed hypopituitarism manifested by cachexia, hypothyroidism, hypogonadism, and hypoadrenocorticism. Laboratory studies demonstrated deficiencies of adrenocorticotropic hormone, thyroid-stimulating hormone (TSH), growth hormone, and gonadotropic hormones (follicle-stimulating hormone and luteinizing hormone). We postulated that her hypopituitarism was due to anterior pituitary gland destruction rather than stalk section or hypothalamic damage. We have recently measured her serum prolactin concentrations following provocative stimulation with thyrotropin-releasing hormone (TRH), and these results strengthen the evidence for direct anterior pituitary gland destruction and provide a more complete delineation of her endocrinologic function.

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

scholarly journals Cystic craniopharyngioma: intratumoral chemotherapy with alpha interferon

2011 ◽  
Vol 69 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Patrícia Alessandra Dastoli ◽  
Jardel Mendonça Nicácio ◽  
Nasjla Saba Silva ◽  
Andrea Maria Capellano ◽  
Silvia R.C. Toledo ◽  
...  
Keyword(s):  
Side Effects ◽  
Interferon Alpha ◽  
Tumor Volume ◽  
Response To Treatment ◽  
Lower Percentage ◽  
Intratumoral Chemotherapy ◽  
Cystic Craniopharyngioma ◽  
Tumor Reduction ◽  
One Year

OBJECTIVE: To assess whether the cystic craniopharyngiomas can be controlled with the use of intratumoral applications of interferon alpha. METHOD: Nineteen patients with the diagnosis of cystic craniopharyngioma were treated with intratumoral chemotherapy with interferon alpha from January 2002 to April 2006. All patients underwent placement of an intracystic catheter connected to an Ommaya reservoir. Through this reservoir were made applications during chemotherapy cycles. Each cycle corresponded to application of 3,000,000 units of interferon alpha three times per week on alternate days totalizing 36,000,000 units. Response to treatment was evaluated by calculating the tumor volume on MRI control after one, three and six months after the end of each cycle. Patients who developed worsening of symptoms or who had insignificant reduction in tumor volume during follow-up underwent repeat cycle chemotherapy. RESULTS: Four patients received four cycles of chemotherapy, three patients received three cycles, six patients received two cycles and six patients received one. The lower percentage of reduction in tumor volume was 60% and the bigger reduction was 98.37%. Eleven patients had a reduction greater than 90%. Five patients had a tumor reduction between 75 and 90% and in three patients the tumors were reduced by less than 75%. No deaths occurred during treatment and side effects of interferon alpha were well tolerated. No treatment was discontinued. Follow-up after the last application ranged from one year and five months to three years and nine months. CONCLUSION: The intratumoral chemotherapy with interferon alpha decreases the volume of cystic craniopharyngiomas and so far can be considered a new therapeutic alternative.

The role of patients education in the hygiene of removable dentures – a case report

2018 ◽  
Vol 68 (1) ◽  
pp. 95-100
Author(s):  
Bogna Scheffs ◽  
Agnieszka Marcinkowska
Keyword(s):  
Oral Hygiene ◽  
Bacterial Infections ◽  
Negative Influence ◽  
Therapeutic Effects ◽  
Prosthetic Rehabilitation ◽  
Negative Effects ◽  
Microbial Infections ◽  
Removable Prosthesis

Prosthetic treatment with removable dentures is long- lasting process, which requires from patients motivation and awareness about oral hygiene and proper maintantenance of dental prosthesis. Removable prosthesis wearers are much more susceptible to fungal and bacterial infections than people who do not use any dentures. Knowledge of negative influence of dental plaque, denture plaque and intraoral infections on oral and whole organism health is essential. Forcing patients, the role of oral hygiene and the need for follow- up care is an integral part of the treatment. Realization of this conditions enable specialists to get positive therapeutic effects. In addition, availability of numerous hygiene products provides effective protection against the negative effects of microbial infections. This paper presents cases of prosthetic rehabilitation of patients with unsatisfactory hygiene of removable prosthetic appliances. New dentures were prepared and focused on thorough education about appropriate handling and good oral hygiene maintenance. Improved hygiene and patients’ health awareness were observed.

Single-institution experience with neoadjuvant chemotherapy for metaplastic breast cancer (MBC).

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 140-140
Author(s):  
Anna Kaminsky
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Neoadjuvant Chemotherapy ◽  
Triple Negative Breast Cancer ◽  
Tumor Volume ◽  
Triple Negative ◽  
Volume Reduction ◽  
Tumor Volume Reduction ◽  
Metaplastic Breast Carcinoma

140 Background: Metaplastic breast carcinoma (MBC) is a rare subtype that accounts for <1% of all breast carcinomas. MBC is frequently triple-negative and neoadjuvant chemotherapy (NAC) is often used in triple-negative breast cancer (TNBC). The objective of this analysis is to ascertain response rates of MBC to NAC as compared to non-metaplastic TNBC. Methods: We searched the Magee Women’s Cancer Center of UPMC IRB-approved neo-adjuvant treatment database which contains outcome data on 594 patients treated from 2004-2010. 116 patients with triple negative breast cancer (ER /PR negative or ER /PR weakly positive [H score of 10 or less] and HER2 negative or indeterminate [HER2 1+ or 2+ without amplification by FISH]), were identified. Nine of these TNBCs had metaplastic subtype and two groups were analyzed: metaplastic breast carcinoma (MBC) (N= 9) and non-metaplastic breast carcinoma (NMBC) (N = 107). Tumor volume reduction (TVR), pathologic complete response (pCR), recurrence and mortality were compared in both groups. Results: Average follow-up in MBC group was 43 months and no patients were lost to follow-up. Average tumor size on presentation in MBC group was 4.47 cm while in NMBC group it was 3.33 cm. pCR was noted in 0/9 MBC and 43/107 NMBC cases (p = 0.0253). 6/9 patients had mastectomy, 2/9 had breast conserving surgery (BCS) and 1/9 patients did not have a surgery yet. Average TVR was 28% in MBC cases compared to 74% in NMBCs when cases with pCR were included (p = 0.0001) and 56% when cases with pCR were excluded (p = 0.0202). Follow up on 9 MBC cases revealed 1 recurrence and subsequent death (11%). Follow-up on 64 NMBC patients who failed to achieve pCR revealed 22 recurrences (34%) and 18 of them subsequently died (28%). Follow-up on 43 NMBC cases that achieved pCR revealed 3 recurrences (7%) and 1 death (2%). Conclusions: MBC was characterized by larger size at baseline as compared to NMBC. There were no pCR’s seen in MBC, but some MBC did achieve response that allowed for breast conservation. Although the average tumor volume reduction was significantly less in MBC compared to NMBC, the NMBC that failed to achieve pCR fared much worse than MBC who did not achieve pCR. Therefore, the triple-negative paradox is likely not applicable to MBC.

scholarly journals Brain & Chiasmal Herniations into Sella after Medical Treatment of Prolactinoma

2006 ◽  
Vol 33 (2) ◽  
pp. 240-242 ◽  
Author(s):  
M.H. Bangash ◽  
D.B. Clarke ◽  
R.O. Holness
Keyword(s):  
Medical Treatment ◽  
Frontal Lobe ◽  
Dopamine Agonists ◽  
Medical Attention ◽  
Serum Prolactin ◽  
Complete Disappearance ◽  
Pituitary Macroadenoma ◽  
One Year ◽  
Visual Complaints ◽  
Gyrus Rectus

ABSTRACT:Background:Dopamine agonists are widely used in the treatment of pituitary prolactinomas. We report a case of inferior mesial frontal lobe (gyrus rectus) and chiasmal herniations into an enlarged sella following successful medical treatment of a pituitary macroadenoma.Method:A 71-year-old healthy man presented to medical attention with visual complaints. On examination, he was found to have bitemporal hemianopsia. Endocrine evaluation revealed an elevated prolactin level. He was treated medically with a dopamine agonist (bromocriptine).Results:Evaluation after one year of medical treatment revealed stabilization of the patient's vision, with a significant bitemporal field loss. Serum prolactin levels normalized (5.16 ng/ml). The MRI of the sella showed almost complete disappearance of the tumor, resulting in right mesial frontal lobe herniation inferiorly into an enlarged sella with associated chiasmal deformation.Conclusions:We report a case where successful medical treatment of a large pituitary prolactinoma has resulted in inferior frontal lobe and chiasmal herniatons into an enlarged sella.

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