scholarly journals Multimodal Non-Surgical Treatments of Aggressive Pituitary Tumors

2021 ◽  
Vol 12 ◽  
Author(s):  
Tae Nakano-Tateno ◽  
Kheng Joe Lau ◽  
Justin Wang ◽  
Cailin McMahon ◽  
Yasuhiko Kawakami ◽  
...  
Keyword(s):  
Treatment Options ◽  
Somatostatin Receptor ◽  
Pituitary Tumors ◽  
Peptide Receptor Radionuclide Therapy ◽  
Current Treatment ◽  
Chemotherapeutic Drugs ◽  
Clinical Level ◽  
Medical Therapies ◽  
Surgical Treatments

Up to 35% of aggressive pituitary tumors recur and significantly affect mortality and quality of life. Management can be challenging and often requires multimodal treatment. Current treatment options, including surgery, conventional medical therapies such as dopamine agonists, somatostatin receptor agonists and radiotherapy, often fail to inhibit pituitary tumor growth. Recently, anti-tumor effects of chemotherapeutic drugs such as Temozolomide, Capecitabine, and Everolimus, as well as peptide receptor radionuclide therapy on aggressive pituitary tumors have been increasingly investigated and yield mixed, although sometimes promising, outcomes. The purpose of this review is to provide thorough information on non-surgical medical therapies and their efficacies and used protocols for aggressive pituitary adenomas from pre-clinical level to clinical use.

scholarly journals Expert Opinion on the Management of Non-Alcoholic Fatty Liver Disease (NAFLD) in the Middle East with a Focus on the Use of Silymarin

2021 ◽  
Vol 12 (2) ◽  
pp. 155-165
Author(s):  
Ahmed Hashem ◽  
Yogesh Shastri ◽  
Malfi Al Otaibi ◽  
Elwin Buchel ◽  
Hussam Saleh ◽  
...  
Keyword(s):  
Liver Disease ◽  
Middle East ◽  
Fatty Liver Disease ◽  
Expert Panel ◽  
Treatment Options ◽  
Current Treatment ◽  
Alcoholic Fatty Liver ◽  
Liver Disease Progression ◽  
Alcoholic Fatty Liver Disease

Non-alcoholic fatty disease (NAFLD) is amongst the leading causes of chronic liver disease worldwide. The prevalence of NAFLD in the Middle East is 32%, similar to that observed worldwide. The clinicians in this region face several challenges in diagnosing and treating patients with NAFLD. Additionally, there are no national or regional guidelines to address the concerns faced with current treatment options. Silymarin, derived from milk thistle, provides a rational and clinically proven approach to hepatoprotection. This article focuses on addressing regional diagnostic challenges and provides clear guidance and potential solutions for the use of Silymarin in the treatment of NAFLD in the Middle East. Both clinical and preclinical studies have highlighted the efficiency of Silymarin in managing NAFLD by reducing liver disease progression and improving patient symptoms and quality of life, alongside being safe and well tolerated. An expert panel of professionals from the Middle East convened to establish a set of regional-specific diagnostics. A consensus was established to aid general physicians to address the diagnostic challenges in the region. In conclusion, Silymarin can be considered beneficial in treating NAFLD and should be initiated as early as possible and continued as long as necessary.

Outcomes of peptide receptor radionuclide therapy (PRRT) in metastatic grade 3 neuroendocrine tumors (NETs).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15694-e15694
Author(s):  
Mei Sim Lung ◽  
Michael Hofman ◽  
Grace Kong ◽  
Sue-Ping Thang ◽  
Michael Michael ◽  
...  
Keyword(s):  
Treatment Option ◽  
Treatment Options ◽  
Somatostatin Receptor ◽  
Peptide Receptor Radionuclide Therapy ◽  
Receptor Expression ◽  
Unknown Primary ◽  
Receptor Imaging ◽  
Ki 67 ◽  
Prior Chemotherapy ◽  
Platinum Based Chemotherapy

e15694 Background:Grade 3 (G3) NETs have a poor prognosis and limited treatment options (usually chemotherapy). PRRT is a potential treatment option if all sites of disease demonstrate high uptake on somatostatin-receptor imaging (SSRI). We retrospectively evaluated the efficacy of PRRT in G3 NETs. Methods: We reviewed records of patients with metastatic G3 NETs (Ki-67 > 20%) who received PRRT at our institution. Patients were treated with up to 5 cycles of PRRT, predominantly 177Lu-DOTA-octreotate. Further maintenance PRRT was administered upon progression if deemed suitable on SSRI. Radio-sensitizing chemotherapy was administered unless contra-indicated. Kaplan-Meier estimate was used to determine median overall survival (OS) and median time to new treatment/death (TNTD) defined from start of PRRT. Subgroup-analysis was performed for patients with Ki67 < 55% and ≥55%. Results: 26 patients with metastatic G3 NET received PRRT; 22 combined with chemotherapy (capecitabine/temozolomide (n = 12), 5-fluorouracil or capecitabine (n = 8), other (n = 2)). 58% were male. The median age was 62 (range 16-78 years). 61% had pancreatic NET, 19% small bowel, 8% lung, 8% unknown primary, 4% rectal. 77% had received at least one line of prior chemotherapy. 54% received prior platinum-based chemotherapy. Median follow-up was 33 months (range 8-83 months). Patients received a median of 4 cycles of PRRT (range 1-15). The estimated median OS from start of PRRT was 18 months: for Ki-67 < 55% (n = 21), 20 months; and Ki-67≥ 55% (n = 5), 9 months. The estimated median TNTD was 12 months: for Ki-67 < 55%, 16 months; and Ki-67≥55%, 4 months. 31% of patients were alive without a change in treatment modality following PRRT. Conclusions: In thispoor prognosis G3 NET cohort of whom 77% had received prior chemotherapy, a median OS of 18 months from start of PRRT is encouraging and warrants further study. PRRT is a promising treatment option for patients with G3 NET with high somatostatin-receptor expression selected by SSRI.

scholarly journals Functioning Pituitary Adenomas – Current Treatment Options and Emerging Medical Therapies

2019 ◽  
Vol 15 (1) ◽  
pp. 30 ◽  
Author(s):  
Elena V Varlamov ◽  
Shirley McCartney ◽  
Maria Fleseriu ◽  
◽  
◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Treatment Options ◽  
Current Treatment ◽  
Medical Therapies

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: The burden of Cushing's disease: clinical and health-related quality of life aspects

2012 ◽  
Vol 167 (3) ◽  
pp. 311-326 ◽  
Author(s):  
R A Feelders ◽  
S J Pulgar ◽  
A Kempel ◽  
A M Pereira
Keyword(s):  
Quality Of Life ◽  
Cushing’S Disease ◽  
Treatment Options ◽  
Current Treatment ◽  
Cushing's Disease ◽  
Health Related Quality ◽  
Time To Diagnosis ◽  
Related Quality ◽  
Health Related

ObjectiveCushing's disease (CD) is a rare endocrine disorder characterized by excess secretion of ACTH due to a pituitary adenoma. Current treatment options are limited and may pose additional risks. A literature review was conducted to assess the holistic burden of CD.DesignStudies published in English were evaluated to address questions regarding the epidemiology of CD, time to diagnosis, health-related quality of life (HRQoL), treatment outcomes, mortality, prevalence of comorbidities at diagnosis, and reversibility of comorbidities following the treatment.MethodsA two-stage literature search was performed in Medline, EMBASE, and Science Citation Index, using keywords related to the epidemiology, treatment, and outcomes of CD: i) articles published from 2000 to 2012 were identified and ii) an additional hand search (all years) was conducted on the basis of bibliography of identified articles.ResultsAt the time of diagnosis, 58–85% of patients have hypertension, 32–41% are obese, 20–47% have diabetes mellitus, 50–81% have major depression, 31–50% have osteoporosis, and 38–71% have dyslipidemia. Remission rates following transsphenoidal surgery (TSS) are high when performed by expert pituitary surgeons (rates of 65–90%), but the potential for relapse remains (rates of 5–36%). Although some complications can be partially reversed, time to reversal can take years. The HRQoL of patients with CD also remains severely compromised after remission.ConclusionsThese findings highlight the significant burden associated with CD. As current treatment options may not fully reverse the burden of chronic hypercortisolism, there is a need for both improved diagnostic tools to reduce the time to diagnosis and effective therapy, particularly a targeted medical therapy.

Management of bladder, bowel, and sexual dysfunction

2015 ◽  
pp. 281-313 ◽  
Author(s):  
Ulrich Mehnert
Keyword(s):  
Sexual Dysfunction ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Bowel Function ◽  
Current Treatment ◽  
Major Surgery ◽  
Therapeutic Principles ◽  
Treatment Knowledge ◽  
Treatment Concepts

This chapter provides an overview of the pathophysiological basis of bladder, bowel, and sexual dysfunction, relevant therapy principles, and treatment options. These dysfunctions are frequent sequelae of neurotrauma and neurodegenerative diseases that require adequate management and treatment. Knowledge of basic neurophysiological and pathophysiological processes involved is important for understanding and interpretation of clinical symptoms and findings and for understanding current treatment concepts. Treatment is mandatory and therapy options range from simple conservative measures to major surgery. The main therapeutic principles include protection of kidney function, reduction of urinary and/or faecal incontinence, independent management of bladder and bowel function, ability to sustain a satisfactory sexual relationship, fertility support, and improvement of quality of life. To comply with such principles and to select, initiate, maintain, and eventually adapt the ‘optimal’ treatment regimen for each patient requires a specialized multidisciplinary team.

scholarly journals Post Stroke Pain: Identification, Assessment, and Therapy

2015 ◽  
Vol 39 (3-4) ◽  
pp. 190-201 ◽  
Author(s):  
Rebecca A. Harrison ◽  
Thalia S. Field
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Current Treatment ◽  
Best Interests ◽  
Common Complication ◽  
Post Stroke ◽  
Pain Syndromes ◽  
And Function

Background: Pain is a common complication after stroke and is associated with the presence of depression, cognitive dysfunction, and impaired quality of life. It remains underdiagnosed and undertreated, despite evidence that effective treatment of pain may improve function and quality of life. Summary: We provide an overview of the means for clinical assessment and risk factors for the development of post-stroke pain, then review the newest available literature regarding the commonest post-stroke pain syndromes, including central post-stroke pain, complex regional pain syndrome, musculoskeletal pain including shoulder subluxation, spasticity-related pain, and post-stroke headache, as well as the available epidemiology and current treatment options. Key Messages: In the best interests of optimizing quality of life and function after stroke, clinicians should be aware of pain as a common complication after stroke, identify those patients at highest risk, directly inquire as to the presence and characteristics of pain, and should be aware of the options for treatment for the various pain syndromes.

scholarly journals Treatment options for lower-risk myelodysplastic syndromes. Where are we now?

2021 ◽  
Vol 12 ◽  
pp. 204062072098664
Author(s):  
Virginia O. Volpe ◽  
Rami S. Komrokji
Keyword(s):  
Myelodysplastic Syndromes ◽  
Bone Marrow Failure ◽  
Treatment Options ◽  
Current Treatment ◽  
Transfusion Independence ◽  
First Line Therapy ◽  
Ring Sideroblasts ◽  
Choice Of Therapy ◽  
Significant Mortality

Myelodysplastic syndromes (MDS) are a spectrum of clonal stem-cell disorders characterized clinically by bone-marrow failure. Resultant cytopenias are responsible for significant mortality and decreased quality of life in patients with MDS. In patients with low-risk MDS (LR-MDS), anemia is the most common cytopenia and erythropoiesis-stimulating agents (ESA) are usually used as first-line therapy. Those patients who become refractory to ESA have a poor survival. Available treatment options such as lenalidomide, hypomethylating agents, and immunosuppressive therapy can provide some hematologic response among selected subsets of patients, however durable responses are limited, and these agents can carry significant adverse effects. Chronic transfusions help to alleviate symptoms of anemia but still carry risks associated with transfusion and iron overload. Luspatercept, recently approved for those LR-MDS with ring sideroblasts refractory to ESA, was found to have an improvement in transfusion independence with a well-tolerated safety profile. While anemia is the most common cytopenia, thrombocytopenia and neutropenia management is challenging and the co-occurrence of these cytopenias with anemia may dictate the choice of therapy. In this article, we review LR-MDS and discuss the optimal use of current treatment options and explore new therapeutic options on the horizon.

scholarly journals Treatment of Refractory Postural Tachycardia Syndrome with Subcutaneous Octreotide Delivered Using an Insulin Pump

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Khan ◽  
Jing Ouyang ◽  
Karen Perkins ◽  
John Somauroo ◽  
Franklin Joseph
Keyword(s):  
Insulin Pump ◽  
Orthostatic Intolerance ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Current Treatment ◽  
Postural Tachycardia Syndrome ◽  
Treatment Regimens ◽  
Postural Tachycardia ◽  
Novel Treatment

Postural Tachycardia Syndrome (PoTS) represents a disorder of the autonomic nervous system that results in symptoms of orthostatic intolerance. Despite having a severe impact on the patient’s quality of life, the current treatment options for PoTS are based on limited evidence. Subsequently, this results in clinicians having to utilise a variety of treatment regimens in the hope of successfully providing symptomatic relief. However, the options available for PoTS are not without significant side effects that can worsen an already debilitating condition. Our cases provide a further novel treatment option for clinicians to consider in PoTS refractory to established treatments.

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