The efficacy of dopamine agonist therapy in a young man with a giant prolactinoma: case report

2017 ◽  
Vol 63 (4) ◽  
pp. 231-235
Author(s):  
Alexandr I. Tsiberkin ◽  
Tatiana L. Karonova ◽  
Anna B. Dalmatova ◽  
Elena N. Grineva
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Young Patients ◽  
Young Male ◽  
Serum Prolactin ◽  
Agonist Therapy ◽  
Giant Prolactinoma ◽  
Dopamine Agonist Therapy ◽  
History Of

Prolactinomas are the most common of hormone secreting pituitary adenomas. Patients with prolactinomas generally have a benign prognosis. An algorithm is currently available for managing of this disease. Giant prolactinoma larger than 40 mm with severe invasive growth account for about 2—3% of the prolactin-secreting pituitary adenomas and evidence about management of such patients is limited. This case illustrates progress of a giant prolactin-secreting pituitary adenoma up to 70 mm in young male with a family history of prolactinomas in the absence of the adequate therapy for 8 years after initial diagnosis. After evaluation, it was decided to prescribe medical treatment. Cabergoline therapy started after evaluation appeared to be effective and had lead to significant decrease of serum prolactin level and shrinkage of pituitary adenoma. Described case emphasize the crucial role of identification of hyperprolactinemia among young patients on early stages of the disease. Our observation implies that treatment with dopamine agonists might be effective even in cases with giant prolactinomas.

PTTG has a Dual Role of Promotion-Inhibition in the Development of Pituitary Adenomas

2019 ◽  
Vol 26 (11) ◽  
pp. 800-818
Author(s):  
Zujian Xiong ◽  
Xuejun Li ◽  
Qi Yang
Keyword(s):  
Cell Cycle ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Cell Cycle Progression ◽  
Key Factors ◽  
Cycle Progression ◽  
Sister Chromatids ◽  
Regulation Of Cell Cycle ◽  
Late Stages

Pituitary Tumor Transforming Gene (PTTG) of human is known as a checkpoint gene in the middle and late stages of mitosis, and is also a proto-oncogene that promotes cell cycle progression. In the nucleus, PTTG works as securin in controlling the mid-term segregation of sister chromatids. Overexpression of PTTG, entering the nucleus with the help of PBF in pituitary adenomas, participates in the regulation of cell cycle, interferes with DNA repair, induces genetic instability, transactivates FGF-2 and VEGF and promotes angiogenesis and tumor invasion. Simultaneously, overexpression of PTTG induces tumor cell senescence through the DNA damage pathway, making pituitary adenoma possessing the potential self-limiting ability. To elucidate the mechanism of PTTG in the regulation of pituitary adenomas, we focus on both the positive and negative function of PTTG and find out key factors interacted with PTTG in pituitary adenomas. Furthermore, we discuss other possible mechanisms correlate with PTTG in pituitary adenoma initiation and development and the potential value of PTTG in clinical treatment.

Young Male with Bilateral ICA Dissection: Beyond CADISS Trial

2021 ◽  
pp. 251660852098428
Author(s):  
Vikas Bhatia ◽  
Chirag Jain ◽  
Sucharita Ray ◽  
jay Kumar
Keyword(s):  
Management Strategies ◽  
Young Male ◽  
Acute Onset ◽  
The Body ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke Study ◽  
History Of

Objective: To report a case of young male with stroke and bilateral internal carotid artery (ICA) dissection. Background: Cervical Artery Dissection in Stroke Study trial has provided some insight on management of patients with ICA dissection. However, there is a need to modify the management strategies as per specific clinical scenario. Design/Methods: Case report and literature review. Results: A 45-year-old male presented with 1 month old history of acute onset numbness of right half of the body with slurring of speech. Computed tomography angiography showed complete occlusion of left cervical ICA just beyond origin with presence of fusiform dilatation and spiral flap in right extracranial cervical ICA. The patient was started on antiplatelets and taken for endovascular procedure using 2-mesh-based carotid stents. Patient was discharged after 3 days on antiplatelet therapy. At 1-year follow-up, there were no fresh symptoms. Conclusion: This case emphasizes the role of successful endovascular management of carotid dissection in a young male. These clinical situations may not be fully represented in trials, and a case-based approach is required.

scholarly journals Venipuncture Induced Complex Regional Pain Syndrome Presenting as Inflammatory Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Punit Pruthi ◽  
Pramod Arora ◽  
Manoj Mittal ◽  
Anugrah Nair ◽  
Waqia Sultana
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Inflammatory Arthritis ◽  
Young Male ◽  
Pain Syndrome ◽  
Poor Response ◽  
History Of ◽  
Diagnostic Modalities ◽  
Musculoskeletal Ultrasonography ◽  
The Right

Venipuncture is one of the most commonly done medical procedures. We report a unique case of a 23-year-old young male who presented with features suggestive of inflammatory arthritis. The symptoms, which initially started on the right side, also involved the other side after a few weeks. Although the patient’s symptoms and signs were simulating inflammatory arthritis, he had atypical features like poor response to anti-inflammatory medicines and normal laboratory parameters. His musculoskeletal ultrasonography was also not suggestive of arthritis. His history was reviewed and on direct questioning he revealed a history of venipuncture for blood sample withdrawal, done from right antecubital region for routine health check on the day prior to the onset of symptoms. Complex regional pain syndrome was suspected and triple-phase radioisotope bone scan was done which was highly suggestive of this diagnosis. The patient was managed with multidimensional approach and responded very well to the treatment. Complex regional pain syndrome is usually not thought of in the initial differential diagnosis of inflammatory arthritis. In this report we highlight the need to elicit the often overlooked history of trivial trauma like venipuncture, especially in atypical cases of arthritis. Also the role of newer diagnostic modalities in such cases is emphasized.

Parkinson disease psychosis – A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S147-S147
Author(s):  
M.D.C. Ferreira ◽  
S. Varanda ◽  
G. Carneiro ◽  
B. Santos ◽  
Á. Machado
Keyword(s):  
Impulse Control ◽  
Disease Duration ◽  
Motor Symptoms ◽  
Agonist Therapy ◽  
Clozapine Treatment ◽  
Dopamine Agonist Therapy ◽  
Severe Motor ◽  
History Of ◽  
Competing Interest ◽  
Motor Effects

IntroductionPsychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.ObjectivesTo highlight the therapeutic difficulties in PD-related psychosis.MethodsCase description and literature review.ResultsWe report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.ConclusionsClozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Untreated Giant Macroprolactinoma with Chronic Cerebrospinal Fluid Leakage: An Unusual Complication

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Mohamad Nazrulhisham Mad Naser ◽  
Nor Azizah Aziz ◽  
Noor Khairiah A. Karim
Keyword(s):  
Cerebrospinal Fluid ◽  
Dopamine Agonist ◽  
Cerebrospinal Fluid Leak ◽  
Serum Prolactin ◽  
Cerebrospinal Fluid Leakage ◽  
Unusual Complication ◽  
Agonist Therapy ◽  
Fluid Leakage ◽  
Dopamine Agonist Therapy ◽  
Fluid Leak

Macroprolactinoma has the potential to cause base of skull erosion and often extends into the sphenoid sinus. Rapid shrinkage of this invasive tumor following dopamine agonist therapy has been postulated to cause unplugging of the eroded area, leading to cerebrospinal fluid leakage. To the best of our knowledge, the occurrence of spontaneous cerebrospinal fluid leak in treatment-naive prolactinomas is very rare, the majority of which involve undiagnosed macroprolactinomas. We describe here a lady presented late with giant macroprolactinoma, complicated by cerebrospinal fluid leakage. This case raised the dilemma in the management pertaining to the role of either pharmacotherapy or surgical intervention, or combination of both. As she strictly refused surgery, she was treated with bromocriptine which was later changed to cabergoline. On follow-up, there was cessation of cerebrospinal fluid leak, marked reduction of serum prolactin level, and imaging evidence of tumor shrinkage. The majority of patients with medically induced cerebrospinal fluid leakage will require surgical procedures to overcome this complication; however, there are isolated cases of leakage resolution on continuing dopamine agonist therapy while awaiting surgery. The use of dopamine agonist does not necessarily cause worsening of cerebrospinal fluid leakage and instead may produce spontaneous resolution as in this case.

scholarly journals A Case of Schizophrenia in a Young Male Adult with no History of Substance Abuse: Impact of Clinical Pharmacists’ Interventions on Patient Outcome

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mercy N. A. Opare-Addo ◽  
Josephine Mensah ◽  
Grace Owusu Aboagye
Keyword(s):  
Substance Abuse ◽  
Sense Of Self ◽  
Young Male ◽  
Antipsychotic Therapy ◽  
Male Adult ◽  
Clinical Pharmacists ◽  
History Of ◽  
Young Male Adult ◽  
Key Interventions

Schizophrenia is a chronic and severe mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behaviour. This report presents the role of clinical pharmacists in the management of a patient diagnosed with schizophrenia with symptoms of paranoia. A gainfully employed young African male adult reported to be roaming around town moving from one bank to another was arrested. The patient was referred to the psychiatric unit of a hospital and diagnosed with schizophrenia. Key interventions offered included rapid tranquilization, electroconvulsive therapy, and psychotherapy. Medications administered to the patient while on admission included IV diazepam, IM haloperidol, IV Ketamine, IM flupentixol, olanzapine tablets, and trihexyphenidyl tablets. Issues raised by clinical pharmacists during the patient’s admission included need for alternative medication for rapid tranquilization, need for initial investigations and documentation of the patient’s vitals, initiation of antipsychotic therapy without initial monitoring and screening for substance abuse, inappropriate dose at initiation of antipsychotic medications, untreated indication, and incidence of missed doses. Interventions by the clinical pharmacists contributed to improvement in the patient’s symptoms prior to hospital discharge. The case proves that it is critical for clinical pharmacists to be involved in the multidisciplinary team during management of patients with psychosis.

The rapid diagnosis of sensitivity or resistance to dopamine agonists with depot bromocriptine

1987 ◽  
Vol 116 (2) ◽  
pp. 275-281 ◽  
Author(s):  
A. Grossman ◽  
J. A. H. Wass ◽  
M. Besser
Keyword(s):  
Dopamine Agonists ◽  
Oral Therapy ◽  
Adverse Reactions ◽  
Rapid Diagnosis ◽  
Serum Prolactin ◽  
Agonist Therapy ◽  
Dopamine Infusion ◽  
Dopamine Agonist Therapy ◽  
Oral Doses ◽  
Higher Doses

Abstract. Some patients with hyperprolactinaemia are unable to tolerate even low doses of oral bromocriptine. In such cases, it is difficult to predict whether serum prolactin might be normalized if higher doses could be tolerated, or whether true resistance to bromocriptine is present. We have investigated 8 such patients who were subjected to a dopamine infusion (4 μg/kg per min for 4 h), followed by an injection of 50 mg of depot bromocriptine on a separate occasion. Serum prolactin was normalized in 4 patients during dopamine, and in 6 patients 12–48 h following depot bromocriptine. The 2 patients who failed to respond to depot bromocriptine also failed to respond to high oral doses of bromocriptine, while the remaining 6 patients were successfully transferred to oral bromocriptine without adverse reactions after the depot preparation was administered, and with a normalization of serum prolactin. It is concluded that depot bromocriptine may represent a better predictor of true unresponsiveness to dopamine agonist therapy than a dopamine infusion, and may also allow for initiation onto oral therapy of previously intolerant patients.

scholarly journals Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Nagham Saeed Jafar ◽  
Warkaa Al Shamkhani ◽  
Sunil Roy Thottuvelil Narayanan ◽  
Anil Kumar Rajappan
Keyword(s):  
Cardiac Sarcoidosis ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Young Patients ◽  
Young Male ◽  
Pulmonary Involvement ◽  
Av Block ◽  
History Of ◽  
Exercise Induced ◽  
Cardiac Manifestations

Cardiac sarcoidosis is a major cause of death in patients with systemic sarcoidosis. Cardiac manifestations are seen in 2.3% of the patients. Atrioventricular (AV) block is one of the common manifestations of cardiac sarcoidosis. Other presentations of cardiac involvement include congestive heart failure, ventricular arrhythmias, and sudden cardiac death. The presence of AV block in young patients should raise the suspicion of sarcoidosis. AV block may be the only manifestation and patients may not have clinical evidence of pulmonary involvement. Here we describe a young male presented with exercise induced AV block rapidly progressing to complete heart block with recurrent syncope needing urgent pacemaker implantation. Factors that suggested an infiltrative process included his young age, rapidly progressive conduction abnormalities in the ECG in the absence of coronary disease, and previous history of cutaneous sarcoidosis.

scholarly journals High prevalence of AIP gene mutations following focused screening in young patients with sporadic pituitary macroadenomas

2011 ◽  
Vol 165 (4) ◽  
pp. 509-515 ◽  
Author(s):  
Maria A Tichomirowa ◽  
Anne Barlier ◽  
Adrian F Daly ◽  
Marie-Lise Jaffrain-Rea ◽  
Cristina Ronchi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Pediatric Patients ◽  
Young Patients ◽  
Gene Mutations ◽  
Clinical Analysis ◽  
Clinical Genetic ◽  
Interacting Protein ◽  
Aip Gene ◽  
Pituitary Macroadenomas

BackgroundAryl hydrocarbon receptor interacting protein (AIP) mutations (AIPmut) cause aggressive pituitary adenomas in young patients, usually in the setting of familial isolated pituitary adenomas. The prevalence of AIPmut among sporadic pituitary adenoma patients appears to be low; studies have not addressed prevalence in the most clinically relevant population. Hence, we undertook an international, multicenter, prospective genetic, and clinical analysis at 21 tertiary referral endocrine departments.MethodsWe included 163 sporadic pituitary macroadenoma patients irrespective of clinical phenotype diagnosed at <30 years of age.ResultsOverall, 19/163 (11.7%) patients had germline AIPmut; a further nine patients had sequence changes of uncertain significance or polymorphisms. AIPmut were identified in 8/39 (20.5%) pediatric patients. Ten AIPmut were identified in 11/83 (13.3%) sporadic somatotropinoma patients, in 7/61 (11.5%) prolactinoma patients, and in 1/16 non-functioning pituitary adenoma patients. Large genetic deletions were not seen using multiplex ligation-dependent probe amplification. Familial screening was possible in the relatives of seven patients with AIPmut and carriers were found in six of the seven families. In total, pituitary adenomas were diagnosed in 2/21 AIPmut-screened carriers; both had asymptomatic microadenomas.ConclusionGermline AIPmut occur in 11.7% of patients <30 years with sporadic pituitary macroadenomas and in 20.5% of pediatric patients. AIPmut mutation testing in this population should be considered in order to optimize clinical genetic investigation and management.

scholarly journals Delayed presentation of late-onset cerebrospinal fluid rhinorrhoea following dopamine agonist therapy for giant prolactinoma

2014 ◽  
Vol 2014 ◽  
Author(s):  
J K Prague ◽  
C L Ward ◽  
O G Mustafa ◽  
B C Whitelaw ◽  
A King ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Dopamine Agonist ◽  
Surgical Repair ◽  
Proliferation Index ◽  
Serum Prolactin ◽  
List Type ◽  
Agonist Therapy ◽  
Conventional Radiotherapy ◽  
Dopamine Agonist Therapy ◽  
Csf Rhinorrhoea

Summary Therapeutic shrinkage of prolactinomas with dopamine agonists achieves clinical benefit but can expose fistulae that have arisen as a result of bony erosion of the sella floor and anterior skull base by the invasive tumour, resulting in the potential development of cerebrospinal fluid (CSF) rhinorrhoea, meningitis, and rarely pneumocephalus. Onset of symptoms is typically within 4 months of commencing therapy. The management is typically surgical repair via an endoscopic transnasal transsphenoidal approach. A 23-year-old man presented to the Emergency Department with acute left limb weakness and intermittent headaches. Visual fields were full to confrontation. Immediate computed tomography and subsequent magnetic resonance imaging (MRI), demonstrated a 5 cm lobular/cystic mass invading the right cavernous sinus, displacing and compressing the midbrain, with destruction of the bony sella. He was referred to the regional pituitary multidisciplinary team (MDT). Serum prolactin was 159 455 mIU/l (7514.37 ng/ml) (normal ranges 100–410 mIU/l (4.72–19.34 ng/ml)). Cabergoline was commenced causing dramatic reduction in tumour size and resolution of neurological symptoms. Further dose titrations were required as the prolactin level plateaued and significant residual tumour remained. After 13 months of treatment, he developed continuous daily rhinorrhea, and on presenting to his general practitioner was referred to an otolaryngologist. When next seen in the routine regional pituitary clinic six-months later he was admitted for urgent surgical repair. Histology confirmed a prolactinoma with a low proliferation index of 2% (Ki-67 antibody). In view of partial cabergoline resistance he completed a course of conventional radiotherapy. Nine months after treatment the serum prolactin had fallen to 621 mIU/l, and 12 months after an MRI showed reduced tumour volume. Learning points CSF rhinorrhoea occurred 13 months after the initiation of cabergoline, suggesting a need for vigilance throughout therapy. Dedicated bony imaging should be reviewed early in the patient pathway to assess the potential risk of CSF rhinorrhoea after initiation of dopamine agonist therapy. There was a significant delay before this complication was brought to the attention of the regional pituitary MDT, with associated risk whilst left untreated. This demonstrates a need for patients and healthcare professionals to be educated about early recognition and management of this complication to facilitate timely and appropriate referral to the MDT for specialist advice and management. We changed our nurse-led patient education programme as a result of this case. Having developed partial cabergoline resistance and CSF rhinorrhoea, an excellent therapeutic response was achieved with conventional radiotherapy after limited surgery.

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