scholarly journals Successful Pregnancies in an Acromegalic Woman After Non-Radical Pituitary Adenomectomy for Somatoprolactinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A612-A612
Author(s):  
Anna Catarina Gatzk Arruda ◽  
Giovana Outuki ◽  
Marcos Antonio Dias ◽  
Alexandre Jose Faria Carrilho ◽  
Tania Longo Mazzuco
Keyword(s):  
Fertility Restoration ◽  
Cranial Nerves ◽  
Optic Chiasm ◽  
Screening Tests ◽  
Blood Levels ◽  
Primary Amenorrhea ◽  
Biochemical Control ◽  
Octreotide Lar ◽  
Post Surgery ◽  
Tumor Residue

Abstract Background: Pregnancy is unusual in patients with acromegaly due to somatotropinomas or somatoprolactinomas. Fertility is impaired because of hormonal hypersecretion, pituitary damage by tumor compression or both. Managing somatoprolactinomas and fertility issues are often challenging. Clinical Case: A 20-year woman with primary amenorrhea and headache was diagnosed with hypogonadotrophic hypogonadism secondary to hyperprolactinemia (2500 µg/L, n<23 µg/L). No other abnormalities were found on the pituitary function screening tests. MRI revealed an intra and suprasellar adenoma (2.5x1.8x1.8 cm) with optic chiasm compression. The onset of menses occurred after 11 months under dopaminergic treatment, and tumor size diminished (1.9x1.5x1.5 cm), bringing on optic chiasm decompression. She remained under dopamine agonist treatment for 6 years, when she realized extremities enlargement and height increase by 3 cm. Acromegaly was confirmed by blood levels of IGF-1 (3.37xULN), GH (8 µg/L, n<8 µg/L), and GH nadir (4.3 µg/L, n<1 µg/L) during OGTT. Then, octreotide LAR was added to cabergoline treatment while waiting for elective surgical treatment. She underwent to transsphenoidal endonasal neurosurgical microscopy approach guided by neuronavigation, with the removal of a large portion of tumor. However, it was not possible to extract the part of invasive adenoma close to right carotid artery due to the risk of vascular and intracavernous cranial nerves injury. Immunohistochemistry analysis of the adenoma was positive only for GH cells with low Ki67 index (<1%). Due to the poor biochemical control (unsuppressed post-OGTT GH, IGF-1 1.66xULN and PRL 301 µg/L) and the presence of a small stable tumor residue, treatment with cabergoline and somatostatin analogues was maintained (3-year octreotide LAR, transitioned to lanreotide in an attempt to achieve a better biochemical response). After 14 years of the initial diagnosis and 5 years post-surgery, the patient expressed the desire to get pregnant and all medications in use were suspended. In the following 3 years, she had two uneventful gestation without complications or worsen of acromegaly; she only breastfed for few months after her first pregnancy. The second one was a twin pregnancy. After one year, the MRI revealed no increase of tumor mass (1.0x0.3x1.0 cm), and PRL levels withing normal range, IGF-1 slightly elevated, but GH not suppressed by OGTT. Cabergoline was reintroduced and the biochemical control of acromegaly was achieved. Conclusion: We reported the very unusual spontaneous conception and normal course of pregnancies in a woman with acromegaly, who was submitted to successful transsphenoidal neurosurgical microscopy approach in which large part of the tumor was removed and the normal pituitary tissue was preserved, allowing fertility restoration.

Impact of Prolactin Hipersecrey on Glucid and Lipid Metabolisms

2019 ◽  
Vol 70 (5) ◽  
pp. 1603-1607
Author(s):  
Elena Ionescu ◽  
Bogdan Virgil Cotoi ◽  
Anca Ganescu
Keyword(s):  
Cranial Nerves ◽  
Pituitary Tumors ◽  
Optic Chiasm ◽  
Anterior Lobe ◽  
Visual Field Defects ◽  
Large Tumor ◽  
Metabolic Complications ◽  
Clinical Onset ◽  
Vision Defects ◽  
Upper Level

Pituitary is a common terrain for the appearance of tumoral changes, representing the origin of about 15% of all intracranial tumors [13]. These tumors are, for the most part, histologically benign, as they arise from hormone secreting cells in the anterior lobe. Therefore, the aim of the paper is to specify the clinical and paraclinical clinical onset characteristics, the evolutionary peculiarities, as well as the metabolic complications secondary to the prolactin hypersecretion. The effects of prolactin-secreting pituitary tumors may occur as a result of mass effects of tumors or even hyperprolactinaemia. Because microadenomas are intrathecal, visual defects may not occur, but headaches occur more often (50%) than normal (27%) [1, 6]. A large tumor that extends beyond the limbs of the turkey can cause headaches and vision defects. The classical presentation is bitemporal hemianopsia due to the compression of the optic chiasm from a tumor that extends to the upper level. If chiasma is prefixed or if the tumor extends posteriorly, compression of a single optical system results in visual field defects similar. The lateral extension in the cavernous sinus can lead to the illness of the oculomotor function involving the cranial nerves III, IV and VI and the branches V1 and V2 of the cranial nerve V, alone or in combinations.

Auricular field nerve stimulation using the NSS-2 BRIDGE® device as an alternative to opioids following kidney donor surgery

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Jacques E. Chelly ◽  
Amy L. Monroe ◽  
Raymond M. Planinsic ◽  
Amit Tevar ◽  
Brittany E. Norton
Keyword(s):  
Enhanced Recovery ◽  
Randomized Study ◽  
Cranial Nerves ◽  
Oral Morphine ◽  
Oral Intake ◽  
Control Group ◽  
Hospital Data ◽  
Kidney Donor ◽  
Post Surgery ◽  
Post Operative Nausea

Abstract Objectives The purpose of this study was to investigate the role that the NSS-2 BRIDGE® device, an auricular field nerve stimulator, may play in reducing opioid requirement and pain in kidney donor surgery. It was not a randomized study. Electrophysiologic studies have demonstrated that the stimulation of the cranial nerves produced by the NSS-2 BRIDGE® device modulates the ascending/descending spinal pain pathways, especially at the level of the limbic system. Methods The design compared the effects of the NSS-2 BRIDGE® device (NSS 2-BRIDGE® device group; n=10) to a control group (n=10). In both groups, the surgery was performed using the same standard enhanced recovery after surgery protocol based on the use of a multimodal analgesic approach. For the active treatment group, the NSS-2 BRIDGE® device was placed in the post anesthesia care unit. The primary endpoint was opioid requirement (oral morphine equivalent, OME in mg) at 24 h post-surgery. Secondary endpoints included pain (0–10), at 24 and 48 h, time to discharge from the recovery room, incidence of post-operative nausea and vomiting at 24 h, time to oral intake, time to ambulation, and time to discharge from the hospital. Data was analyzed using unpaired t-test and presented as mean ± standard deviation. Results Compared to control, the use of the NSS-2 BRIDGE® was associated with a 75.4% reduction in OME (33.6 vs. 8.3 mg; p=0.03) and 41.5% reduction in pain (5 vs. 3.28; p=0.06) at 24 h and a 73.3% difference in pain at 48 h (1.6 ± 1.6 vs. 6.0 ± 2.8; p=0.0004). There was no difference in non-opioid analgesics administration between groups. Conclusions The tolerability of NSS-2 BRIDGE® device was reported by most to be excellent. This study suggests that the NSS-2 BRIDGE® device may represent a complementary approach for controlling postoperative opioid consumption and pain in patients undergoing kidney donation.

Blood neuroendocrine gene transcripts (NETest) as a diagnostic of pancreatic neuroendocrine tumors and to identify the efficacy of surgical resection.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 631-631
Author(s):  
Stefano Partelli ◽  
Francesca Muffatti ◽  
Valentina Andreasi ◽  
Massimo Falconi ◽  
Irvin Mark Modlin
Keyword(s):  
Progressive Disease ◽  
Residual Disease ◽  
Blood Levels ◽  
R0 Resection ◽  
Recurrence Rates ◽  
Post Surgery ◽  
In Vitro Diagnostic ◽  
Gene Transcripts ◽  
Prospective Longitudinal

631 Background: Surgery is the only treatment for cure of pancreatic neuroendocrine tumours (PNET). There are no effective biomarkers to assess completeness of resection and predict recurrence. The aims of this study were 1) evaluate if blood measurement of neuroendocrine gene transcripts (NETest) were diagnostic of PNET and 2) assess if blood levels correlated with the resection type (R0/ R1/R2). We compared transcript analysis with Chromogranin A (CgA), the current standard of care. Methods: A prospective, longitudinal, single center study (ClinicalTrials.gov ID: NCT03012789) of 30 PNETs. Blood for NETest and CgA were collected preop and on postop day 30 (POD30). Transcript measurement: real-time quantitative reverse transcription PCR and multianalyte algorithmic analysis (NETest) (normal 0-20, > 20 stable and > 40 progressive disease; CgA: (ELISA) (normal < 109mg/ml). Analysis: Student’s t test, Mann-Whitney U test and Fisher’s exact test. Data: mean±SEM. Results: Surgical resections ( n= 30) were: 26 R0, 2 R1, 2 R2. In vitro diagnostic: Preop NETest positive in all 30 (NETest: 38±4) (1005) whereas CgA levels positive (220±66ng/ml) in 9 (30%, p< 0.0001). Surgery R0: ( n= 26): NETest significantly decreased from pre-op of 45±3 to 21±4 ( p< 0.001) at POD30. Post operatively 13 (50%) exhibited an elevated score. One patient (Ki67 18%; extensive nodal involvement) had a score of 80, consistent with residual progressive disease. The remaining 12 had NETest levels of 27 at POD 30. CgA was elevated in 8 (31%) with no decrease at POD30 (154±44ng/ml vs. 109±22ng/ml). R1/R2 ( n= 4): NETest scores unchanged (42±17 vs 46±16) at POD30. CgA levels unchanged (378±332 vs. 753±634ng/ml). Conclusions: The NETest is an accurate in vitro diagnostic biomarker for PNET (100%). After R0 resection NETest decrease indicates the blood test is concordant with tumor removal. Elevated post-resection scores are consistent with residual disease and with reported recurrence rates after pancreatic surgery. CgA exhibited no clinical utility. At 1 month post-surgery, the NETest provides an early indication of high risk recurrence patients who can be stratified for further therapy. Clinical trial information: NCT03012789.

scholarly journals Medical and social characteristics of persons with adverse cardiometabolic risk profile

2012 ◽  
Vol 9 (4) ◽  
pp. 28-33
Author(s):  
M V Avdeeva ◽  
L V Shcheglov ◽  
O M Grigorieva
Keyword(s):  
Risk Factors ◽  
Cardiometabolic Risk ◽  
Fasting Blood Glucose ◽  
Progressive Increase ◽  
Cardiometabolic Risk Factors ◽  
Screening Tests ◽  
Social Characteristics ◽  
Blood Levels ◽  
Unhealthy Lifestyle ◽  
Express Analysis

The study evaluated the effectiveness of screening tests performed on the basis of functioning centers of Health, to identify individuals with cardiometabolic risk factors. Materials and methods: A total of 2007 men (mean age 50,80±16,54 years) were evaluated. The results of physical and psychological tests, express-analysis of functional state of heart via ECG, express-analysis of cholesterol and glucose blood levels, vascular screening, and concentration of carbon monoxide, carboxyhemoglobin and human body composition by bioimpedance were estimated. Results: During the screening we revealed 62.33% men with BMI≥25 kg/m2. BMI≥25 kg/m2 was associated with an increase in the average levels of cholesterol, fasting blood glucose, blood pressure, as well as signs of myocardial electrical instability and autonomic dysfunction. Progressive increase in BMI≥25 kg/m2 was associated with the presence of combined cardiometabolic risk factors and the presence of unhealthy lifestyle behaviors. All patients with a BMI≥25 kg/m2 received individual recommendations about a mode of work, physical activity and diet, and were also invited for group training in «Weight reduction school»

scholarly journals SAT-252 A Rare Case of Crooke’s Adenoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Adeyinka Taiwo ◽  
Marcelo Correia ◽  
Nicole Peyton
Keyword(s):  
Rare Case ◽  
Hormone Replacement ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Pituitary Function ◽  
Csf Leak ◽  
Cell Adenoma ◽  
Post Surgery ◽  
Function Tests ◽  
The Right

Abstract BACKGROUND: Crooke’s cell adenoma is a rare variant of ACTH-secreting corticotroph adenomas (&lt;1%). These are aggressive macroadenomas and usually invade the cavernous sinus producing visual symptoms. Clinical Case: A 48-year old male presented with acute right eye and right temple pain, and diplopia that started 6 days prior. Past medical history included hypertension, type 2 diabetes, hyperlipidemia, traumatic brain injury, CSF leak with bacterial meningitis s/p sphenoid repair and palsy of the right III, V and VI cranial nerves. Head CT showed a 1.9 x 2.1 x 1.5 cm soft tissue-density mass medial to the right cavernous carotid artery extending into the sphenoid sinus. There was expansile bony change to the floor and right dorsum of the sella. The mass showed mild contrast enhancement and abutted the superior orbital fissure. A brain MRI was not obtained due to history of a left cochlear implant. He did not have any cushingoid features on exam. Neuro-ophthalmology exam revealed, severe sixth cranial nerve palsy, bilateral optic disc pallor and a mild right superotemporal visual field defect. Pre-operative pituitary function tests revealed ACTH 103 pg/ml (7–63), cortisol 14 ug/dl (6.0–18.4), FSH 2.7 mIU/ml (1.5–12.4), LH 3.8 mIU/ml (1.7–8.6), prolactin 17.6 ng/ml (4–15.2), total testosterone 175 ng/dl (249–836), TSH 1.10 uIU/ml (0.27–4.20), free T4 0.67ng/dl (0.8–1.8) and IGF-1 208 ng/ml (69–224). He underwent successful endoscopic trans-sphenoidal resection of a 4.2 x 2.5 x 0.5 cm mass. Pathology revealed hyaline deposits in the cytoplasm and perinuclear cytokeratin in more than 50% of the adrenocorticotroph cells consistent with Crooke’s cell adenoma. Post-operatively, his right eye pain and abduction deficit improved, and diplopia returned to baseline. He was placed on a short hydrocortisone taper. Due to high risk of recurrence, he received 54Gy in 30 fractions to the sella. Six and 12-month follow-up head CTs revealed stable residual enhancing tissue. Pituitary function tests done 9 months post-surgery were normal and no hormone replacement was needed. He was clinically stable 12 months after surgery. Conclusion: We described a rare case of invasive Crooke’s cell pituitary adenoma with visual disturbances that was managed with resection and radiotherapy. The patient remained free of recurrence 1 year later. However, lifetime surveillance is necessary due to high incidence of recurrence. Reference: 1. Crooke’s Cell Tumors of the Pituitary. Neurosurgery, Volume 76, Issue 5, May 2015, Pages 616–22

Phenylketonuria: Implications of Initial Serum Phenylalanine Levels on Cognitive Development

1988 ◽  
Vol 63 (1) ◽  
pp. 135-142 ◽  
Author(s):  
A. Barclay ◽  
O. Walton
Keyword(s):  
Cognitive Development ◽  
Age At Onset ◽  
Blood Levels ◽  
Dietary Control ◽  
Biochemical Control ◽  
Phenylalanine Level ◽  
Initiation Of Therapy ◽  
Serum Phenylalanine

This study investigated influences of diagnostic phenylalanines, age at initiation of diet, and dietary control, separately and in combination, on cognitive development for 29 phenylketonuric children (17 boys and 12 girls) who ranged in age from 1 to 1,184 days. Initial serum phenylalanine concentrations and age at initiation of therapy were significantly related to cognitive development, whereas neither dietary and biochemical control relative to blood levels of phenylalanine or for these variables in combination exerted a statistically significant effect on measures of functioning. The interaction between initial serum phenylalanine level and age at onset of diet did reach nearly significant proportions, suggesting that the relation between diagnostic phenylalanines and subsequent cognitive development in the phenylketonuric population warrants further study. Despite an approximately 13-point decrease in IQs between initial (1 yr.) and most recent measurements (3 yr.), all 29 children were functioning in the normal or near-normal intellectual range at the most recent testing.

Surgical Management of Cavernous Malformations Involving the Cranial Nerves

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 352-357 ◽  
Author(s):  
Vivek R. Deshmukh ◽  
Felipe C. Albuquerque ◽  
Joseph M. Zabramski ◽  
Robert F. Spetzler
Keyword(s):  
Cranial Nerves ◽  
Surgical Techniques ◽  
Optic Chiasm ◽  
Symptom Improvement ◽  
Subtotal Resection ◽  
Cavernous Malformations ◽  
Male Patients ◽  
Acute Hearing Loss ◽  
Age Range ◽  
Specific Symptoms

Abstract OBJECTIVE To analyze the indications and techniques pertinent to the treatment of cranial nerve (CN) cavernous malformations (CMs). METHODS CN CMs are lesions isolated to the CNs. CMs affecting the optic nerve (CN II), oculomotor nerve (CN III), facial/vestibulocochlear complex (CN VII and CN VIII), and hypoglossal nerve (CN XII) have been described. The records for six patients were reviewed with respect to lesion location, symptoms, surgical approach, and therapeutic considerations. This is the largest series of CMs isolated to CNs reported to date. RESULTS Three female patients and three male patients (age range, 28–76 yr; mean age, 41 yr) presented with six CN lesions; four lesions involved the optic chiasm and two involved CN VII and CN VIII. The patients with chiasmatic lesions presented with acute visual deterioration. Both patients with CN VII/CN VIII lesions exhibited acute hearing loss. The level of deterioration suggested CM hemorrhage. Orbitozygomatic craniotomies were performed for chiasmatic lesions, and retrosigmoid craniotomies were performed for cerebellopontine angle lesions. All patients experienced symptom improvement after surgery. One chiasmatic lesion recurred after 2 years and required resection. CONCLUSION CN CMs present with site-specific symptoms and require complex surgical techniques for resection. These lesions are frequently symptomatic, because of the eloquence of the tissue of origin. Therefore, all CN CMs should be resected. Subtotal resection uniformly results in disease and symptom recurrence. CN CMs can be resected safely, with preservation of CN function.

scholarly journals Differences and Similarities in Neuropathy in Type 1 and 2 Diabetes: A Systematic Review

2021 ◽  
Vol 11 (3) ◽  
pp. 230
Author(s):  
Mar Sempere-Bigorra ◽  
Iván Julián-Rochina ◽  
Omar Cauli
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Nervous System ◽  
Screening Tests ◽  
Cardiac Autonomic Neuropathy ◽  
Blood Levels ◽  
Diabetic Patients ◽  
Diabetes Patients

Background: Diabetic neuropathy is defined as the dysfunction of the peripheral nervous system in diabetic patients. It is considered a microvascular complication of diabetes mellitus. Its presence is associated with increased morbidity and mortality. Although several studies have found alterations at somatic motor, sensory levels and at the level of autonomic nervous system in diabetic patients, there is not a systematic approach regarding the differences in neuropathy between the major variants of diabetes, e.g., type 1 and 2 diabetes at both neurological and molecular level. Data sources: we systematically (Medline, Scopus, and Cochrane databases) evaluated the literature related to the difference of neuropathy in type 1 and 2 diabetes, differences in molecular biomarkers. Study characteristics: seventeen articles were selected based on pre-defined eligibility criteria. Conclusions: both superficial sensitivity (primarily thermal sensitivity to cold) and deep sensitivity (such as vibratory sensitivity), have been reported mainly in type 2 diabetes. Cardiac autonomic neuropathy is one of the diabetic complications with the greatest impact at a clinical level but is nevertheless one of the most underdiagnosed. While for type 1 diabetes patients most neuropathy alterations have been reported for the Valsalva maneuver and for the lying-to-standing test, for type 2 diabetes patients, alterations have been reported for deep-breathing test and the Valsalva test. In addition, there is a greater sympathetic than parasympathetic impairment, as indicated by the screening tests for autonomic cardiac neuropathy. Regarding subclinical inflammation markers, patients with type 2 diabetes showed higher blood levels of inflammatory markers such as high-sensitivity C-reactive protein, proinflammatory cytokines IL-6, IL-18, soluble cell adhesion molecules and E-selectin and ICAM-1, than in type 1 diabetes patients. By contrast, the blood levels of adiponectin, an adipocyte-derived protein with multiple paracrine and endocrine activities (anti-inflammatory, insulin-sensitizing and proangiogenic effects) are higher in type 1 than in type 2 diabetic patients. This review provides new insights into the clinical differences in type 1 and 2 diabetes and provide future directions in this research field.

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