scholarly journals First-generation somatostatin ligand receptor treatment in a pregnant patient with a neuroendocrine tumor with liver metastases

2021 ◽  
Vol 2021 ◽  
Author(s):  
Nynne Emilie Hummelshøj ◽  
Gitte Dam ◽  
Lars Henning Pedersen ◽  
Astrid Hjelholt ◽  
Gerda Elisabeth Villadsen
Keyword(s):  
Neuroendocrine Tumor ◽  
First Generation ◽  
Elective Caesarean Section ◽  
Pregnant Patient ◽  
First Trimester ◽  
Neuroendocrine Neoplasms ◽  
List Type ◽  
Long Term Effects ◽  
Healthy Baby ◽  
Disseminated Disease

Summary This rare case describes the course of a pregnancy in a patient with a disseminated small intestinal neuroendocrine tumor. The patient received treatment with first-generation somatostatin ligand receptor (SLR) every 4 weeks and had stable disease for several years before her pregnancy. First-generation SLR treatment was initially paused after detection of the pregnancy. During pregnancy, the patient experienced moderate gastro-intestinal discomfort and fatigue, which was considered predominantly pregnancy related. However, since symptoms could be linked to the patient’s cancer, treatment was resumed after the first trimester. Chromogranin-A measurements remained stable throughout pregnancy and was paralleled by the absence of diarrhea and only minor flushing. She gave birth by elective caesarean section in week 37 to a healthy baby. Subsequent follow up imaging immediately after and 10 months postpartum showed no disease progression. The safety profile of SLR treatment during pregnancy in the context of disseminated neuroendocrine tumors (NET) is discussed. Learning points Neuroendocrine neoplasms (NEN) are rare cancers often occurring in the gastro-intestinal tract or lungs. Many patients with NEN live for several years with disseminated disease. SLR treatment has been given to pregnant patients before; often patients with acromegaly. Pregnancies are reported uneventful. This patient completed an uneventful pregnancy while receiving SLR treatment for disseminated neuroendocrine disease and gave birth to a healthy baby. More research regarding long term effects and safety signals of SLR treatment during pregnancy are much needed.

scholarly journals Treatment of Addison’s disease during pregnancy

2018 ◽  
Vol 2018 ◽  
Author(s):  
Diana Oliveira ◽  
Adriana Lages ◽  
Sandra Paiva ◽  
Francisco Carrilho
Keyword(s):  
Patient Education ◽  
Replacement Therapy ◽  
Addison’S Disease ◽  
Pregnant Patient ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Adrenal Crisis ◽  
Multidisciplinary Teams ◽  
Addison's Disease ◽  
List Type

Summary Addison’s disease, or primary adrenocortical insufficiency, is a long-term, potentially severe, rare endocrine disorder. In pregnancy, it is even rarer. We report the case of a 30-year-old pregnant patient with Addison’s disease, referred to Obstetrics-Endocrinology specialty consult at 14 weeks gestation. She had been to the emergency department of her local hospital various times during the first trimester presenting with a clinical scenario suggestive of glucocorticoid under-replacement (nausea, persistent vomiting and hypotension), but this was interpreted as normal pregnancy symptoms. Hydrocortisone dose was adjusted, and the patient maintained regular follow-up. No complications were reported for the remainder of gestation and delivery. Pregnant patients with Addison’s disease should be monitored during gestation and in the peripartum period by multidisciplinary teams. Adjustments in glucocorticoid and mineralocorticoid replacement therapy are often necessary, and monitoring should be based mainly on clinical findings, which becomes increasingly difficult during pregnancy. Patient education and specialized monitoring are key to avoiding complications from under- or over-replacement therapy in this period. Learning points: An increase in glucocorticoid replacement dose is expected to be necessary during pregnancy in a woman with Addison’s disease. Patient education regarding steroid cover and symptoms of acute adrenal crisis are fundamental. Monitoring in this period is challenging and remains mainly clinical. The increase in hydrocortisone dose often obviates the need to increase fludrocortisone dose.

scholarly journals Octreotide use for rescue of vision in a pregnant patient with acromegaly

2019 ◽  
Vol 2019 ◽  
Author(s):  
Anne Marie Hannon ◽  
Isolda Frizelle ◽  
George Kaar ◽  
Steven J Hunter ◽  
Mark Sherlock ◽  
...  
Keyword(s):  
Post Partum ◽  
Treatment Options ◽  
Elective Caesarean Section ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Pregnant Patient ◽  
Somatostatin Analogue ◽  
Insulin Regimen ◽  
List Type ◽  
In Pregnancy

Summary Pregnancy in acromegaly is rare and generally safe, but tumour expansion may occur. Managing tumour expansion during pregnancy is complex, due to the potential complications of surgery and side effects of anti-tumoural medication. A 32-year-old woman was diagnosed with acromegaly at 11-week gestation. She had a large macroadenoma invading the suprasellar cistern. She developed bitemporal hemianopia at 20-week gestation. She declined surgery and was commenced on 100 µg subcutaneous octreotide tds, with normalisation of her visual fields after 2 weeks of therapy. She had a further deterioration in her visual fields at 24-week gestation, which responded to an increase in subcutaneous octreotide to 150 µg tds. Her vision remained stable for the remainder of the pregnancy. She was diagnosed with gestational diabetes at 14/40 and was commenced on basal bolus insulin regimen at 22/40 gestation. She otherwise had no obstetric complications. Foetal growth continued along the 50th centile throughout pregnancy. She underwent an elective caesarean section at 34/40, foetal weight was 3.2 kg at birth with an APGAR score of 9. The neonate was examined by an experienced neonatologist and there were no congenital abnormalities identified. She opted not to breastfeed and she is menstruating regularly post-partum. She was commenced on octreotide LAR 40 mg and referred for surgery. At last follow-up, 2 years post-partum, the infant has been developing normally. In conclusion, our case describes a first presentation of acromegaly in pregnancy and rescue of visual field loss with somatostatin analogue therapy. Learning points: Tumour expansion may occur in acromegaly during pregnancy. Treatment options for tumour expansion in pregnancy include both medical and surgical options. Somatostatin analogues may be a viable medical alternative to surgery in patients with tumour expansion during pregnancy.

scholarly journals Antibiotics at birth and later antibiotic courses: effects on gut microbiota

2021 ◽  
Author(s):  
Sofia Ainonen ◽  
Mysore V Tejesvi ◽  
Md. Rayhan Mahmud ◽  
Niko Paalanne ◽  
Tytti Pokka ◽  
...  
Keyword(s):  
Gut Microbiota ◽  
Control Group ◽  
List Type ◽  
Antibiotic Exposure ◽  
Microbiota Composition ◽  
Long Term Effects ◽  
The Impact ◽  
Antibiotic Courses ◽  
Gut Microbiota Composition

Abstract Background Intrapartum antibiotic prophylaxis (IAP) is widely used, but the evidence of the long-term effects on the gut microbiota and subsequent health of children is limited. Here, we compared the impacts of perinatal antibiotic exposure and later courses of antibiotic courses on gut microbiota. Methods This was a prospective, controlled cohort study among 100 vaginally delivered infants with different perinatal antibiotic exposures: control (27), IAP (27), postnatal antibiotics (24), and IAP and postnatal antibiotics (22). At 1 year of age, we performed next-generation sequencing of the bacterial 16S ribosomal RNA gene of fecal samples. Results Exposure to the perinatal antibiotics had a clear impact on the gut microbiota. The abundance of the Bacteroidetes phylum was significantly higher in the control group, whereas the relative abundance of Escherichia coli was significantly lower in the control group. The impact of the perinatal antibiotics on the gut microbiota composition was greater than exposure to later courses of antibiotics (28% of participants). Conclusions Perinatal antibiotic exposure had a marked impact on the gut microbiota at the age of 1 year. The timing of the antibiotic exposure appears to be the critical factor for the changes observed in the gut microbiota. Impact Infants are commonly exposed to IAP and postnatal antibiotics, and later to courses of antibiotics during the first year of life. Perinatal antibiotics have been associated with an altered gut microbiota during the first months of life, whereas the evidence regarding the long-term impact is more limited. Perinatal antibiotic exposure had a marked impact on the infant’s gut microbiota at 1 year of age. Impact of the perinatal antibiotics on the gut microbiota composition was greater than that of the later courses of antibiotics at the age of 1 year.

scholarly journals Ultrasound Evaluation of Pregnancy in the First Trimester

2010 ◽  
Vol 4 (1) ◽  
pp. 17-28 ◽  
Author(s):  
George M Graham
Keyword(s):  
Early Pregnancy ◽  
First Trimester ◽  
Transvaginal Sonography ◽  
List Type ◽  
Intrauterine Pregnancy ◽  
Ultrasound Evaluation ◽  
Early Pregnancy Failure ◽  
Ultrasound Findings ◽  
Ultrasound Technology ◽  
First Trimester Ultrasound

Abstract Improvements in ultrasound technology, including transvaginal sonography and higher frequency probes, have led to a better understanding of early pregnancy development. These advances and the increasing availability of ultrasound allow women to have an earlier and more accurate assessment of their pregnancy. First trimester sonographic signs have been identified that can be used to reassure women that their pregnancy is progressing normally or counsel them that their pregnancy will fail. In addition, first trimester ultrasound can accurately predict the type of twinning in multiple gestations, allowing for appropriate counseling and management. Objectives Know the first trimester ultrasound findings of a normal intrauterine pregnancy Understand the ultrasound findings that diagnose an early pregnancy failure Know the ultrasound criteria used to diagnose a multifetal gestation

scholarly journals Gingival Inflammation in the Presence of Bacterial Plaque in Women in the First and Second Trimester of Pregnancy

2020 ◽  
Vol 2 (1) ◽  
pp. 46-52
Author(s):  
Juan Daniel Argüello Torres ◽  
Geoconda Luzardo
Keyword(s):  
Oral Hygiene ◽  
Pregnant Patient ◽  
First Trimester ◽  
Hormonal Changes ◽  
Second Trimester ◽  
Gingival Inflammation ◽  
Plaque Control ◽  
Bacterial Plaque ◽  
Transversal Study ◽  
Oral Hygiene Habits

Problem: Pregnancy hormonal changes in addition to the low control of the dental plaque generate gingivitis during the first and second trimester of the pregnancy. Objective: This study’s objective was to identify the levels of gingival inflammation having place in the first and second trimester of the pregnancy in relation to a low plaque control. Materials and Methods: This was an analytic descriptive transversal study in which 73 pregnant women that went to their monthly check to the “Centro de Salud Ministerial del Cantón Samborondón” during June and July of the year 2014 were tested. 32 of them were on their first trimester and the 41 left, on their second trimester of pregnancy. They were tested by the recollection in a document of information about their oral hygiene habits, oral hygiene indices, gingival inflammation and the presence of bacterial plaque. Results: 100% of the woman had gingivitis, from which 69.86% presented a moderate type (30.14% in the first and 39.73% in the second trimester). In the oral hygiene examination, 76.71% obtained a regular grade, from which 38.36% showed up in both trimesters. Finally, we found bacterial plaque in 67% of the patients with a range between 50.1-75%, being the 30% in the first and the 37% in the second trimester of pregnancy. Conclusion: It was found gingival inflammation in presence of bacteria plaque in every pregnant patient, showing a slightly higher intensity in the second trimester of pregnancy.

Giant Primary Neuroendocrine Neoplasms of the Liver: Report of 2 Cases With Molecular Characterization

2019 ◽  
Vol 27 (8) ◽  
pp. 893-899
Author(s):  
Laura G. Pastrián ◽  
Ignacio Ruz-Caracuel ◽  
Raul S. Gonzalez
Keyword(s):  
World Health Organization ◽  
Neuroendocrine Tumor ◽  
Large Cell ◽  
The Other ◽  
World Health ◽  
Neuroendocrine Neoplasms ◽  
Molecular Testing ◽  
Well Differentiated ◽  
Grade 3 ◽  
Health Organization

Primary neuroendocrine neoplasms of the liver have occasionally been reported in the liver, though many reports do not convincingly exclude metastases. In this article, we report 2 “giant” hepatic neuroendocrine lesions without evidence of a primary elsewhere after clinical workup. One occurred in a 21-year-old male; the lesion was a large cell neuroendocrine carcinoma measuring 24 cm. The patient died of disease in 10 months. The other occurred in a 25-year-old patient, was 18 cm wide, and was diagnosed as a well-differentiated neuroendocrine tumor, World Health Organization grade 3. The patient died of disease after 30 months. Molecular testing demonstrated only the presence of TP53 mutations in common. These cases expand our knowledge of seemingly primary neuroendocrine neoplasms of the liver, in particular, giant cases measuring more than 8 cm. Guidelines for clinical workup and therapy for these lesions remain unclear, but future thorough workup of such cases is necessary for specific characterization.

scholarly journals Anticoagulation for the Pregnant Patient with a Mechanical Heart Valve, No Perfect Therapy: Review of Guidelines for Anticoagulation in the Pregnant Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Aaron Richardson ◽  
Stuart Shah ◽  
Ciel Harris ◽  
Garry McCulloch ◽  
Patrick Antoun
Keyword(s):  
Heart Valve ◽  
Thrombotic Event ◽  
Alternative Therapy ◽  
Mechanical Heart Valve ◽  
Mechanical Valve ◽  
Pregnant Patient ◽  
First Trimester ◽  
Subsequent Pregnancy ◽  
Mechanical Valves ◽  
Increased Risk

Heart valve replacement with a mechanical valve requires lifelong anticoagulation. Guidelines currently recommend using a vitamin K antagonist (VKA) such as warfarin. Given the teratogenic effects of VKAs, it is often favorable to switch to heparin-derived therapies in pregnant patients since they do not cross the placenta. However, these therapies are known to be less effective anticoagulants subjecting the pregnant patient to a higher chance of a thrombotic event. Guidelines currently recommend pregnant women requiring more than 5 mg a day of warfarin be switched to alternative therapy during the first trimester. This case report highlights a patient who was switched to alternative therapy during her first pregnancy and suffered a devastating cerebrovascular accident (CVA). Further complicating her situation was during a subsequent pregnancy; this patient continued warfarin use during the first trimester and experienced multiple transient ischemic attacks (TIAs). This case highlights the increased risk of thrombotic events in pregnant patients with mechanical valves. It also highlights the difficulty of providing appropriate anticoagulation for the pregnant patient who has experienced thrombotic events on multiple anticoagulants.

scholarly journals Platelet-derived factors impair placental chorionic gonadotropin beta-subunit synthesis

2019 ◽  
Vol 98 (2) ◽  
pp. 193-207
Author(s):  
Désirée Forstner ◽  
Sabine Maninger ◽  
Olivia Nonn ◽  
Jacqueline Guettler ◽  
Gerit Moser ◽  
...  
Keyword(s):  
Chorionic Gonadotropin ◽  
Morphological Differentiation ◽  
First Trimester ◽  
Trophoblast Cell ◽  
Beta Subunit ◽  
Bewo Cell ◽  
Intracellular Camp ◽  
Type I ◽  
List Type ◽  
Maternal Fetal Interface

Abstract During histiotrophic nutrition of the embryo, maternal platelets may be the first circulating maternal cells that find their way into the placental intervillous space through narrow intertrophoblastic gaps within the plugs of spiral arteries. Activation of platelets at the maternal-fetal interface can influence trophoblast behavior and has been implicated in serious pregnancy pathologies. Here, we show that platelet-derived factors impaired expression and secretion of the human chorionic gonadotropin beta-subunit (βhCG) in human first trimester placental explants and the trophoblast cell line BeWo. Impaired βhCG synthesis was not the consequence of hampered morphological differentiation, as assessed by analysis of differentiation-associated genes and electron microscopy. Platelet-derived factors did not affect intracellular cAMP levels and phosphorylation of CREB, but activated Smad3 and its downstream-target plasminogen activator inhibitor (PAI)-1 in forskolin-induced BeWo cell differentiation. While TGF-β type I receptor inhibitor SB431542 did not restore impaired βhCG production in response to platelet-derived factors, Smad3 inhibitor SIS3 interfered with CREB activation, suggesting an interaction of cAMP/CREB and Smad3 signaling. Sequestration of transcription co-activators CBP/p300, known to bind both CREB and Smad3, may limit βhCG production, since CBP/p300 inhibitor C646 significantly restricted its forskolin-induced upregulation. In conclusion, our study suggests that degranulation of maternal platelets at the early maternal-fetal interface can impair placental βhCG production, without substantially affecting morphological and biochemical differentiation of villous trophoblasts. Key messages Maternal platelets can be detected on the surface of the placental villi and in intercellular gaps of trophoblast cell columns from gestational week 5 onwards. Platelet-derived factors impair hCG synthesis in human first trimester placenta. Platelet-derived factors activate Smad3 in trophoblasts. Smad3 inhibitor SIS3 interferes with forskolin-induced CREB signaling. Sequestration of CBP/p300 by activated Smad3 may limit placental hCG production.

First trimester three-dimensional ultrasonographic diagnosis of diastrophic dysplasia: a case report and review of the literature

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Ozgur Ozyuncu ◽  
Mert Turgal ◽  
Aslihan Yazicioglu
Keyword(s):  
Genetic Disorder ◽  
Three Dimensional ◽  
Pregnant Patient ◽  
First Trimester ◽  
Nuchal Translucency ◽  
3D Ultrasound ◽  
Review Of The Literature ◽  
Diastrophic Dysplasia ◽  
First Trimester Scan ◽  
Increased Nuchal Translucency

AbstractDiastrophic dysplasia is a rare genetic disorder characterized by short limbs and deformities of several joints occurring in conjunction with xyphoscoliosis, distinctive abduction of the first metacarpals (hitchhiker thumbs). A 28-year-old pregnant patient was referred due to detection of increased nuchal translucency at the first-trimester scan. We describe a case of diastrophic dysplasia diagnosed by two- and three-dimensional ultrasound and termination of pregnancy at 13 weeks of gestation. This case is the first report in the literature in which 3D ultrasound was used in diagnosis of diastrophic dysplasia as early as the 13th week of pregnancy. We think that prenatal diagnosis of diastrophic dysplasia can be possible even at first trimester.

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