scholarly journals Temozolomide non-responsiveness in aggressive prolactinomas and carcinomas: management and outcomes

2021 ◽  
Author(s):  
Liza Das ◽  
Ashutosh Rai ◽  
Pravin Salunke ◽  
Chirag Kamal Ahuja ◽  
Ashwani Sood ◽  
...  
Keyword(s):  
Literature Review ◽  
Progressive Disease ◽  
Infratemporal Fossa ◽  
Residual Tumour ◽  
Cranial Nerve Involvement ◽  
Recurrent Tumour ◽  
Prior Review ◽  
Giant Prolactinoma ◽  
Male Preponderance ◽  
Overall Mortality

Abstract Purpose Temozolomide is endorsed as the treatment of choice in aggressive or malignant pituitary adenomas. Herein we describe a case of an aggressive prolactinoma which was resistant to temozolomide and performed a literature review of similar non-responsive aggressive prolactinomas. Methods A 40-year-old female presented with a giant prolactinoma which required cabergoline, transsphenoidal surgery and radiotherapy to achieve near-normal prolactin and apparently no residual tumour. A year later, she presented with multiple cranial nerve involvement due to recurrent tumour extending to the infratemporal fossa. She underwent transfrontal surgery, second radiotherapy and was started on temozolomide. Despite 8 cycles of temozolomide (200mg/m 2, 5/28 day cycle), she had progressive disease and ultimately succumbed to the disease. Pubmed/MEDLINE, Google scholar and prior review articles were searched for manuscripts with aggressive prolactinomas who had been treated with temozolomide. Data on demography, duration of therapy and management outcomes were analysed in those with progressive disease. Literature review We identified 94 cases of aggressive/malignant prolactinomas in the literature who had received temozolomide. Progressive disease despite temozolomide was present in 36 cases (38%). There was a male preponderance (65%) and 40% had aggressive prolactinomas while the rest had carcinomas. Patients received a median of 8 cycles (IQR 3.5-11.5) of temozolomide. MGMT immunostaining was negative in 35%. Overall mortality at the time of publication was 40%, at a duration varying from 2 to 20 years from diagnosis. Conclusion Temozolomide resistance in aggressive/malignant prolactinomas is challenging. Progressive disease on optimal temozolomide treatment entails the use of newer agents.

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.

scholarly journals Incidence and Management of Thrombotic and Thromboembolic Complications Following the Superior Cavopulmonary Anastomosis Procedure: A Literature Review

2017 ◽  
Vol 24 (3) ◽  
pp. 405-415 ◽  
Author(s):  
Arnav Agarwal ◽  
Mohammed Firdouse ◽  
Nishaan Brar ◽  
Andy Yang ◽  
Panos Lambiris ◽  
...  
Keyword(s):  
Literature Review ◽  
Cohort Studies ◽  
Secondary Outcome ◽  
Clear Correlation ◽  
Thromboembolic Events ◽  
Bleeding Events ◽  
Cavopulmonary Anastomosis ◽  
Shunt Occlusion ◽  
Retrospective Cohort Studies ◽  
Overall Mortality

The objective of this literature review was to estimate the incidence of thrombosis and thromboembolism associated with the superior cavopulmonary anastomosis (SCPA) procedure and its variants and to examine current thromboprophylaxis regimens utilized. MEDLINE and EMBASE were searched from inception to August 2017 for all prospective and retrospective cohort studies explicitly reporting incidence of thrombosis, thromboembolism, or shunt occlusion in neonates, infants, and children undergoing 1 or more variants of the SCPA procedure. End points included thrombotic events and thromboembolic events (strokes and pulmonary embolisms) as primary outcomes, and overall mortality as a secondary outcome, at the last available follow-up time point. Of 1303 unique references identified, 13 cohort studies were deemed eligible. Reported incidence of thrombosis and thromboembolic events ranged from 0% to 28.0% and from 0% to 12.5%, respectively. Reported incidence of major bleeding events ranged from 0% to 2.9%. Reported overall mortality ranged from 2.5% to 50.5% across studies. Thromboprophylaxis protocols varied across institutions and studies, most commonly involving unfractionated heparin (UFH), warfarin, enoxaparin, acetylsalicylic acid (ASA), or combinations of ASA and warfarin, ASA and low-molecular-weight heparin (LMWH), UFH and LMWH, and UFH and ASA; several studies did not specify a protocol. Due to substantial variability in reported event rates, no clear correlation was identified between prophylaxis protocols and postoperative thrombotic complications. Despite guidance recommending postoperative UFH as standard practice, thromboprophylaxis protocols varied across institutions and studies. More robust trials evaluating different thromboprophylaxis regimens for the management of these patients are warranted.

Rapidly progressing giant invasive prolactinoma

2012 ◽  
Vol 126 (8) ◽  
pp. 840-843 ◽  
Author(s):  
R H Care ◽  
V S Sunkaraneni ◽  
J Theaker ◽  
P G Harries
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Neurological Deficit ◽  
Rare Case ◽  
Pituitary Tumours ◽  
Rare Form ◽  
First Report ◽  
Giant Prolactinoma ◽  
Endocrine Disturbance ◽  
Invasive Prolactinoma

AbstractObjective:We report an extremely rare case of a giant invasive prolactinoma presenting as a nasopharyngeal tumour.Method:Case report and literature review regarding giant prolactinoma.Results:Giant prolactinoma is a rare form of prolactinoma which accounts for 0.5–4.4 per cent of all pituitary tumours. It is more common in men and generally presents with symptoms of endocrine disturbance or neurological deficit.Conclusion:To our knowledge, this is the first report of giant prolactinoma presenting with symptoms of sinusitis and nasopharyngeal tumour.

scholarly journals Zdravljenje diseminiranega plazmocitoma na Kliničnem oddelku za hematologijo UKC Ljubljana z avtologno presaditvijo krvotvornih matičnih celic v letih 2014 in 2015.

2016 ◽  
Vol 85 (9) ◽  
Author(s):  
Samo Zver ◽  
Enver Melkić ◽  
Tanja Radevska
Keyword(s):  
Multiple Myeloma ◽  
Partial Response ◽  
Induction Therapy ◽  
Progressive Disease ◽  
Induction Treatment ◽  
Hematopoietic Stem ◽  
Treatment Mortality ◽  
Good Partial Response ◽  
Autologous Hsct ◽  
Overall Mortality

Introduction. In the period from 01.01.2014 to 31.12.2015 at Clinical Department of Hematology, University Medical Centre Ljubljana, we treated 73 multiple myeloma patients with first autologous  hematopoietic stem cell transplantation (HSCT).Methods and results. Age of patients ranged from 27 to 72 years with the median age of 60 years. Induction treatment at the time of diagnosis consisted of: VD (bortezomib, dexamethasone) 60/73 patients (82%), VCD (bortezomib, cyclophosphamide, dexamethasone)  10/73  patients (14%) and VTD (bortezomib, thalidomide, dexamethasone) 3/73 (5%)  patients. As part of induction therapy, patients received from 1 to 9 cycles of treatment. Response to induction therapy prior to HSC(hematopoietic stem cells) collection was as follows: CR(complete remission )7/73(10%), VGPR (very good partial response) 28/73(38%), PR (partial response) 23/ 73(32%), SD (stable disease) 11/73(15%) andPD (progressive disease) 4/73(5%) patients. Response to induction therapy immediately prior to autologous HSCT: CR9/73 (12%), VGPR32/73 (44%), PR17/73(23%), SD 8/73(11%) and PD6/73(8%) patients. Response to induction therapy and the first autologous HSCT at D+100 after HSCT: CR9/67 (13%), VGPR 34/67 (51%), PR 12/67 (18%), SD 3/67 (4 %) and PD 7/67 (10%) patients (in 6 patients data are missing, because they are not mature yet).  With single HSCT 63 patients were treated, while 10 patients received double or second HSCT. The overall mortality of patients treated during the  period from 01.01.2014 to 31.12. 2015 was 6/73 or 8.2%.Conclusions. The treatment of multiple myeloma with autologous HSCT remains the cornerstone of efficiency,as demonstrated by the increasing share of the most desired responses to treatment, ie. CR and VGPR. The treatment mortality rate was within expectation limits.

Pleomorphic Adenoma of the Infratemporal Fossa: Case Report and Literature Review

2010 ◽  
Vol 120 (S4) ◽  
pp. S151-S151 ◽  
Author(s):  
Lowell E. Gurey ◽  
Christopher D. Brook ◽  
Steven M. Parnes
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Pleomorphic Adenoma ◽  
Infratemporal Fossa

scholarly journals Glomus Faciale Tumors: A Report of 3 Cases and Literature Review

2017 ◽  
Vol 96 (3) ◽  
pp. E7-E12 ◽  
Author(s):  
Sahar Nadimi ◽  
John P. Leonetti ◽  
Sam J. Marzo ◽  
Douglas E. Anderson ◽  
Gulrez Mahmood ◽  
...  
Keyword(s):  
Literature Review ◽  
Facial Nerve ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infratemporal Fossa ◽  
Tertiary Care ◽  
Tumor Resection ◽  
Case Series ◽  
Management Options ◽  
Complete Tumor

Our objectives in reporting this case series are to familiarize readers with the rare occurrence of paragangliomas originating along the facial nerve and to provide a literature review. We describe 3 such cases that occurred at our tertiary care academic medical center. Two women and 1 man presented with a tumor adjacent to the vertical segment of the facial nerve. The first patient, a 48-year-old woman, presented with what appeared to be a parotid tumor at the stylomastoid foramen; she underwent a parotidectomy, transmastoid facial nerve decompression, and a shave biopsy of the tumor. The second patient, a 66-year-old man, underwent surgery via a postauricular infratemporal fossa approach, and a complete tumor resection was achieved. The third patient, a 56-year-old woman, presented with a middle ear mass; she underwent complete tumor removal through a transmastoid transcanal approach. All 3 patients exhibited normal facial nerve function both before and after surgery. Paragangliomas of the facial nerve are extremely rare, and their signs and symptoms are unlike those of any other temporal bone glomus tumors. Management options include surgical resection, radiologic surveillance, and radiotherapy. The facial nerve can be spared in selected cases.

scholarly journals Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
K. Seejore ◽  
S. A. Alavi ◽  
S. M. Pearson ◽  
J. M. W. Robins ◽  
B. Alromhain ◽  
...  
Keyword(s):  
Tumour Volume ◽  
Tumour Resection ◽  
Pituitary Hormone ◽  
Residual Tumour ◽  
Repeat Surgery ◽  
Recurrent Tumour ◽  
Tertiary Centre ◽  
Before And After ◽  
Treatment Naïve ◽  
Pituitary Macroadenomas

Abstract Background Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. Methods Data from patients who underwent endoscopic TSS for a NFPMA (2009–2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. Results Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). Conclusion Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.

scholarly journals 749. Impact of Infectious Disease Consultation in Patients with Candidemia: A Retrospective study, Systematic Literature Review and Meta-analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S421-S422
Author(s):  
Takaaki Kobayashi ◽  
Alexandre Marra ◽  
Marin L Schweizer ◽  
Patrick Ten Eyck ◽  
Chaorong Wu ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Care Hospital ◽  
Inclusion Criteria ◽  
Research Support ◽  
Infectious Disease Consultation ◽  
The Impact ◽  
Overall Mortality

Abstract Background Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia. Methods We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. All patients aged ≥18 years with blood cultures positive for Candida species were included. We only included the first episode of candidemia. Exclusion criteria were death or transfer to the palliative care unit within 48 hours from the time cultures became positive. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five publication-databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia. The study protocol has been submitted to the International Prospective Register for Systematic Reviews (PROSPERO) database (ID 156939) on April 2020. Results A total of 151 patients at our institution met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Our systematic literature review returned 216 reports, of which, 13 studies including ours fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Mortality numbers were available in 10 studies. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% and 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral (61%; 790/1279 and 21%; 273/1304, P < 0.001), echocardiogram (54%; 662/1219 and 28%; 369/1296, P < 0.001), and central line removal (78%; 830/1069 and 61%; 686/1116, P < 0.02) were performed more frequently among patients receiving IDC. Overall mortality Conclusion This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with a lower mortality and should be standard of care in all patients with candidemia. Disclosures Dimitrios Farmakiotis, MD, Astellas (Grant/Research Support) Paul Auwaerter, Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant) Daniel Diekema, bioMerieux, Inc (Grant/Research Support)JMI Laboratories (Consultant)

Sign in / Sign up

Export Citation Format

Share Document