ABSTRACT
Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs. However secondary resistance to dopamine agonists therapy has also been described in patients who were initially responsive to treatment, either with Cabergoline or Bromocriptine but later develop dopamine agonist resistance, with elevated prolactin levels and sometimes an enlarging tumor volume several years afterwards. We report a case of a male patient with prolactinoma who developed drug resistance 13 months after initial dopamine agonist therapy.
ABSTRACT
Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas. Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs. However secondary resistance to dopamine agonists therapy has also been described in patients who were initially responsive to treatment, either with Cabergoline or Bromocriptine but later develop dopamine agonist resistance, with elevated prolactin levels and sometimes an enlarging tumor volume several years afterwards. We report a case of a male patient with prolactinoma who developed drug resistance 13 months after initial dopamine agonist therapy.
Subject(s)
Dopamine Agonists/therapeutic use , Ergolines/therapeutic use , Pituitary Neoplasms/drug therapy , Prolactinoma/drug therapy , Adult , Cabergoline , Dopamine Agonists/administration & dosage , Drug Resistance , Ergolines/administration & dosage , Humans , Male , Pituitary Neoplasms/pathology , Prolactinoma/pathology , Time FactorsABSTRACT
A 54-year-old woman came to our endocrinology clinics presenting with upper and lower extremity paresthesia, salt cravings, episodes of hypotension, fatigue and a long term history of depression. Physical exam was unremarkable. Cervical and brain MRI ordered by her neurologist three years ago revealed sella and pituitary normal in size, stable very small 3 mm pituitary incidentaloma and mild disc bulging. Basal pituitary hormonal screening showed low cortisol and ACTH levels. Insulin Tolerance Test and Glucagon Stimulation Test confirmed secondary ACTH deficiency with concomitant GH deficiency. In spite of medical counseling the patient refused glucocorticoid replacement. Due to the non-specific symptoms of this condition it remains a challenge to be diagnosed by clinicians. In conclusion: Our case shows that hormonal deficiencies may occur in small tumors less than 6 mm.
Subject(s)
Adenoma/metabolism , Adrenocorticotropic Hormone/deficiency , Human Growth Hormone/deficiency , Hydrocortisone/deficiency , Hypopituitarism/diagnosis , Pituitary Neoplasms/metabolism , Adenoma/pathology , Adrenocorticotropic Hormone/metabolism , Female , Glucagon , Human Growth Hormone/metabolism , Humans , Hydrocortisone/metabolism , Hypopituitarism/etiology , Hypopituitarism/physiopathology , Incidental Findings , Magnetic Resonance Imaging , Middle Aged , Pituitary Neoplasms/pathology , Pituitary-Adrenal System/physiopathology , Symptom Assessment , Treatment Refusal , Tumor BurdenABSTRACT
Pasteurella multocida a small gram-negative coccobacilli is primarily found as normal flora of cats and dogs. These organisms can cause a variety of infections in humans, usually the result of scratches, bites and licks by percutaneous inoculation of the organism. Most cases of septic arthritis involve a cat or dog bite distal to the involved joint without direct penetrating injury to the joint. On scenarios were Pasteurella infection is suspected within a prosthetic joint, aggressive surgical debridement and/or removal of the prosthesis with intravenous antibiotics is recommended. Prosthetic joint infections secondary to animal bites are an extremely rare complication and few cases have been reported in the literature. This is a case report of a patient that suffered a cat's bite of his right prosthetic knee and against all odd was able to save it without surgical intervention.
Subject(s)
Arthritis, Infectious/etiology , Arthroplasty, Replacement, Knee , Pasteurella Infections/etiology , Pasteurella multocida/isolation & purification , Postoperative Complications/etiology , Wound Infection/etiology , Aged , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Ampicillin/therapeutic use , Animals , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/microbiology , Arthritis, Infectious/surgery , Bites and Stings/complications , Bites and Stings/microbiology , Cats/microbiology , Combined Modality Therapy , Debridement , Humans , Male , Mouth/microbiology , Osteoarthritis, Knee/surgery , Pasteurella Infections/drug therapy , Pasteurella Infections/microbiology , Pasteurella Infections/surgery , Postoperative Complications/drug therapy , Postoperative Complications/microbiology , Postoperative Complications/surgery , Prosthesis-Related Infections/diagnosis , Sulbactam/therapeutic use , Surgical Wound Infection/diagnosis , Wound Infection/drug therapy , Wound Infection/microbiology , Wound Infection/surgeryABSTRACT
Systemic lupus erythematosus is a chronic inflammatory autoimmune disease characterized by autoantibodies specific for highly conserved nuclear antigens, such as double-stranded DNA, histones and ribonuclear proteins. The course of the disease is unpredictable and nine times more common in females. Among the neurological manifestations of collagen vascular diseases is the most commonly recognized and better studied disease. Central nervous system lupus is a serious and potentially treatable illness presenting as difficult diagnostic challenge. This is a case report of a patient that suffered central nervous system manifestations of severe active lupus. Early recognition of this entity is essential to expedite appropriate to treatment and avoid future complications.
