Beneficial Effects of High Doses of Cabergoline in the Treatment of Giant Prolactinoma Resistant to Dopamine Agonists: A Case Report with a 21-Year Follow-Up

2017 ◽  
Vol 89 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Lucas Faria de Castro ◽  
Maria de Fátima  Magalhães Gonzaga ◽  
Luciana Ansaneli Naves ◽  
José Luiz Mendonça ◽  
Benicio Oton de Lima ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Gland ◽  
Prolactin Level ◽  
Dopamine Agonists ◽  
Pubertal Development ◽  
Cystic Degeneration ◽  
Childhood And Adolescence ◽  
Long Term Treatment ◽  
High Doses

Introduction: Prolactinomas are pituitary tumors with a very low prevalence in childhood and adolescence compared to adulthood. This condition is preferentially treated with dopamine agonists. Resistance to these drugs is rare. Case Report: We describe the case of a boy diagnosed with macroadenoma at the age of 9 and followed up for 21 years. He did not fully respond to treatment with dopamine agonists. His initial prolactin level was 2,400 ng/mL (in males, normal values are <16.0 ng/mL) and never normalized. At the last assessment, his prolactin level was 21.5 ng/mL, recorded after 21 years of treatment with the dopamine agonist cabergoline at a dose as high as 4.5 mg per week. Although the prolactin level remained elevated throughout the follow-up period, the patient never presented a low testosterone level and had normal pubertal development. An MRI of the sella turcica showed that the tumor became progressively cystic and disappeared, but a normal pituitary gland was observed. The pituitary gland retained its normal functions despite a partially empty sella. Discussion: Long-term treatment with high doses of cabergoline may cause cystic degeneration of a prolactinoma considered to be resistant to this treatment, but we cannot rule out the possibility that this outcome represents the natural development of the tumor.

CAD/CAM Endocrown Fabrication from a Polymer-Infiltrated Ceramic Network Block for Primary Molar: A Case Report

2016 ◽  
Vol 40 (4) ◽  
pp. 264-268 ◽  
Author(s):  
Mehmet Selim Bilgin ◽  
Ali Erdem ◽  
Mehmet Tanrıver
Keyword(s):  
Case Report ◽  
Computer Aided Design ◽  
Resin Cement ◽  
Primary Tooth ◽  
Primary Molar ◽  
Long Term Treatment ◽  
Computer Aided ◽  
Cad Cam

Objective: The aim of this case report is to describe the treatment of a primary molar with a deep carious lesion by pulpotomy and placement of a ceramic endocrown. Clinical case: A 7-year-old male patient with profound caries in tooth number 85 was referred to our clinic and underwent a pulpotomy. As the final treatment in tooth restoration, placement of an endocrown was planned, because little more than half of the tooth structure remained. After an additional request from the patient's parents for an advanced and prompt restoration, a computer-aided design/computer-aided manufacturing (CAD/CAM) polymer-infiltrated ceramic network (PICN) block was chosen. A three-dimensional model of the arch was obtained after scanning the dental cast, and the endocrown was designed digitally according to the model. When the design was complete, the endocrown was fabricated with a milling machine. Finally, the endocrown was cemented with self-adhesive resin cement. Results: Over the 9-month follow-up period, no pulpal or periradicular pathology was observed on radiographs. Regarding the crown, the marginal fit was excellent, the anatomical form was protected, and no discoloration occurred. Conclusion: During follow-up, the CAD/CAM PICN block endocrown proved to be a good material for the short- to long-term treatment of a primary tooth. However, more clinical cases and follow-up are required to investigate the long-term effects of antagonistic tooth wear.

Advantages of everolimus therapeutic drug monitoring in oncology when drug–drug interaction is suspected: A case report

2020 ◽  
Vol 26 (7) ◽  
pp. 1743-1749 ◽  
Author(s):  
Geoffrey Strobbe ◽  
Diane Pannier ◽  
Ilyes Sakji ◽  
Alexandre Villain ◽  
Frédéric Feutry ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Therapeutic Drug Monitoring ◽  
Drug Interactions ◽  
Drug Monitoring ◽  
Plasma Concentrations ◽  
Response To Treatment ◽  
Therapeutic Drug ◽  
High Doses

Introduction Drug interactions involving everolimus are fairly well known because of its common use, primarily as an immunosuppressant. Several recommendations regarding therapeutic drug monitoring are also available for the use of everolimus-based immunosuppression regimens. However, everolimus use in oncology differs substantially, particularly because of the high doses involved. Therapeutic drug monitoring, although sometimes necessary, is not recommended as a routine in oncology. Thus, it was deemed inapplicable due to the lack of clear recommendations. Case report Here, we present a case where a patient was prescribed everolimus for renal cell carcinoma. The patient benefitted from a pharmaceutical consultation prior to treatment initiation, and a drug interaction with verapamil was suspected. Management and outcome: Therapeutic drug monitoring of everolimus was proposed. Based on the everolimus values reported in the literature, trough plasma concentration in the patient was greatly increased. The patient was then diagnosed with grade 4 oral mucositis, thereby requiring temporary suspension of everolimus treatment. Management of adverse effects was performed through multiple medicated mouthwashes. Discussion Therapeutic drug monitoring for everolimus is important for potential drug interactions or the occurrence of severe adverse events. In such cases, dose adjustments should be managed according to everolimus plasma concentrations. Clear oncological recommendations regarding plasma everolimus thresholds are required for a successful follow-up of the patient’s condition and to ensure adequate response to treatment.

Idiopathic Recurrent Catatonia Needs Maintenance Lorazepam: Case Report and Review

2007 ◽  
Vol 41 (7) ◽  
pp. 625-627 ◽  
Author(s):  
Narayana Manjunatha ◽  
Sahoo Saddichha ◽  
Christoday R.-J. Khess
Keyword(s):  
Case Report ◽  
Mood Disorders ◽  
Term Treatment ◽  
Down Regulation ◽  
Gaba A ◽  
Periodic Catatonia ◽  
Long Term Treatment ◽  
History Of ◽  
High Doses

Objectives: Catatonia as a phenomenon has been well described with either a schizophrenic illness, severe mood disorders or periodic catatonia disorder. We aim to report a patient who had recurrent catatonia that responded to and required lorazepam for maintenance. Methods: We describe the case of a 28 year old woman who had a history of recurrent catatonia that was unresponsive to most anti-psychotics, but who responded to high doses of lorazepam and needed long-term lorazepam for maintenance. Results and Conclusion: Our patient met the criteria for a diagnosis of idiopathic catatonic disorder. Response to lorazepam suggests that a certain group of patients may require long-term treatment with lorazepam, especially those who may have down-regulation of GABA-A receptors.

Ambroxol chaperone therapy for Gaucher disease type I-associated liver cirrhosis and portal hypertension: a case report

2021 ◽  
Vol 21 ◽  
Author(s):  
Peng Zhang ◽  
Mei-Fang Zheng ◽  
Shi-Yuan Cui ◽  
Wei Zhang ◽  
Run-Ping Gao
Keyword(s):  
Liver Cirrhosis ◽  
Case Report ◽  
Portal Hypertension ◽  
Gaucher Disease ◽  
Liver Stiffness ◽  
Ultrasound Elastography ◽  
High Dose ◽  
Type I ◽  
Long Term Treatment

Background: Gaucher disease (GD) is a rare autosomal recessive inherited disease caused by the deficiency of glucocerebrosidase and characterized by a broad spectrum of clinical manifestations, including hepatosplenomegaly, bone infiltration, and cytopenia. Moreover, it is even involved in the central nervous system. GD is classified into three phenotypes on the ground of neurologic involvement: type 1 (GD1), the commonly adult-onset, non-neuropathic variant; type 2 (GD2), the acute neuropathic form; and type 3 (GD3), the severe chronic neuro-visceral form. Recently, several studies have shown a promising outcome of ambroxol chaperone therapy for the treatment of GD, but its therapeutic role in GD1-associated liver cirrhosis and portal hypertension was not verified. Case presentation: A 36-year-old male patient was admitted for esophageal varices lasting for one year with a 34-year history of liver and spleen enlargement. The patient was diagnosed with GD1 with cirrhosis and portal hypertension based on the identification of Gaucher cells and advanced fibrosis in the liver biopsy tissue and two known pathogenic mutations on the glucocerebrosidase (GBA) gene. The patient received 660 mg/d of ambroxol for up to two years. At his six-month follow-up, the patient exhibited a remarkable increase in GBA activity (+35.5%) and decrease in liver stiffness (-19.5%) and portal vein diameter (-41.2%) as examined by ultrasound elastography and computer tomography, respectively. At two-year follow-up, the liver stiffness was further reduced (-55.5%) in comparison with untreated patients. Conclusion: This case report suggests that long-term treatment with high dose ambroxol may play a role in the reduction of hepatic fibrosis in GD1.

AYURVEDIC MANAGEMENT OF PARTIAL EMPTY SELLA SYNDROME: A CASE REPORT

2021 ◽  
Vol 12 (4) ◽  
pp. 15-18
Author(s):  
Eswara M P Sarma ◽  
Arathi P K
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Pituitary Gland ◽  
Sella Turcica ◽  
Marked Change ◽  
Empty Sella ◽  
Empty Sella Syndrome ◽  
Lukewarm Water

Empty Sella Syndrome is a disorder that involves the presence of Cerebro-spinal fluid in Sella turcica in an excess amount. In empty Sella syndrome the Sella turcica is either partially filled with cerebrospinal fluid and an atrophied pituitary gland lying in the floor of the Sella (Partial Empty Sella Syndrome) or filled with cerebrospinal fluid which pushes the pituitary gland into a side of Sella turcica resulting in non-visualization of the gland. (Completely empty Sella). A 37-year-old female diagnosed with partial empty Sella syndrome was managed with Pathyakshadhatryadi kashayam 15 ml twice daily in empty stomach with 45 ml lukewarm water, Rasnadi choornam tailam application, mahatraiphala ghritam 10 ml at night after food, Kshirabala 7 Avarti tailam pratimarsha nasyam. After completion of the treatment, there was considerable relief in the primary complaint of the patient which was a recurrent headache and the follow up MRI showed a marked change in the condition. This case report highlights the role of Ayurveda in the management of partial empty Sella syndrome and sheds light for further study on the same.

scholarly journals Biotin-Thiamine-Responsive Basal Ganglia Disease: Case Report and Follow-Up of a Patient With Poor Compliance

2018 ◽  
Vol 5 ◽  
pp. 2329048X1877321 ◽  
Author(s):  
Muneera A. Alabdulqader ◽  
Sumayah Al Hajjaj
Keyword(s):  
Case Report ◽  
Basal Ganglia ◽  
Lower Limb ◽  
Gradual Improvement ◽  
Unsteady Gait ◽  
Disease Case ◽  
The Family ◽  
Basal Ganglia Disease ◽  
High Doses

Background: Biotin-thiamine-responsive basal ganglia disease (BTBGD) is a rare treatable autosomal recessive neurometabolic disorder characterized by progressive encephalopathy that eventually leads to severe disability and death if not treated with biotin and thiamine supplements. Objectives: We aimed to determine the optimal management of BTBGD presenting in acute encephalopathic episodes. Method: Case report. Results: An 8-year-old girl born to consanguineous parents was diagnosed with BTBGD at the age of 3 years after presenting with acute encephalopathy and ataxia. The patient was treated with biotin and thiamine, and the family was instructed to continue these medications for life. When she was 7 years old, her supplements were stopped for 2 weeks for social reasons. Afterward, the patient began to have tremor in both hands and an unsteady gait. The family then resumed the medications at the usual dosages. However, the patient remained symptomatic. The patient was admitted with acute BTBGD because of discontinuation of medications. The patient’s condition was then managed with high doses of intravenous thiamine and oral biotin. She showed gradual improvement after 48 hours. She was then discharged home 1 week later with residual mild upper and lower limb tremor, as well as right lower limb dystonia. Further follow-up showed a good neurological condition with no apparent long-term sequel. The family was further educated about the importance of strict compliance. Conclusion: Patients with BTBGD should remain on lifelong treatment with thiamine and biotin. For those who present with acute relapse, we recommend inpatient treatment with high doses of intravenous thiamine and oral biotin. Further clinical research is required to determine the optimal doses and durations.

Gynecomastia induced by trazodone: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S640-S640 ◽  
Author(s):  
M.D. Sánchez García ◽  
A. Gómez Peinado ◽  
P. Cano Ruiz ◽  
S. Cañas Fraile
Keyword(s):  
Case Report ◽  
Depressive Symptoms ◽  
Prolactin Level ◽  
Psychiatric Clinic ◽  
Receptor Stimulation ◽  
Normal Limits ◽  
Patient Reported ◽  
Rare Side Effect ◽  
Competing Interest

IntroductionTrazodone is a heterocyclic antidepressant that exerts its effect via the inhibition of selective serotonin reuptake and the antagonism of 5-HT2A and 5-HT2 C receptors. Antidepressant-induced gynecomastia and galactorrhea and increases in prolactin levels have rarely been reported.Case reportA 73-year-old man presented to the psychiatric clinic with depressive symptoms and insomnia that was the reason that his GP introduced paroxetine 20 mg/day three months before. One month later because the insomnia persisted, trazodone (100 mg/day) was added to the treatment. At a 2-month follow-up, the patient reported improvement in depressive symptoms but also presented gynecomastia on the left side that is non-tender on palpation. No other medications were noted. Laboratory testing was within normal limits, with the exception of on elevated prolactin level (38.2 ng/mL). Ultrasonography indicated normal results. Treatment included the tapering and discontinuation of trazodone with continued paroxetine therapy. Lorazepam was initiated for the treatment of insomnia. Two weeks later, the prolactin level was 13.1 ng/mL and gynecomastia was practically resolved. Lorazepam was initiated for the treatment of insomnia.ConclusionsEffects of trazodone on PRL are unclear, there is one study reported that trazodone increases the PRL level, and another one reported that trazodone reduces them, in our case, the trazodone use led to hyperprolactinemia via hypothalamic postsynaptic receptor stimulation and it should be remembered that gynecomastia and galactorrhea may appear as a rare side effect of trazodone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals MRI follow-up is unnecessary in patients with macroprolactinomas and long-term normal prolactin levels on dopamine agonist treatment

2017 ◽  
Vol 176 (3) ◽  
pp. 323-328 ◽  
Author(s):  
J Eroukhmanoff ◽  
I Tejedor ◽  
I Potorac ◽  
T Cuny ◽  
J F Bonneville ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Prolactin Level ◽  
Dopamine Agonists ◽  
Tumor Volume ◽  
Line Treatment ◽  
First Line ◽  
Retrospective Multicenter Study ◽  
First Line Treatment

Objective Both antitumor and antisecretory efficacies of dopamine agonists (DA) make them the first-line treatment of macroprolactinomas. However, there is no guideline for MRI follow-up once prolactin is controlled. The aim of our study was to determine whether a regular MRI follow-up was necessary in patients with long-term normal prolactin levels under DA. Patients and methods We conducted a retrospective multicenter study (Marseille, Paris La Pitie Salpetriere and Nancy, France; Liege, Belgium) including patients with macroprolactinomas (largest diameter: >10 mm and baseline prolactin level: >100 ng/mL) treated by dopamine agonists, and regularly followed (pituitary MRI and prolactin levels) during at least 48 months once normal prolactin level was obtained. Results In total, 115 patients were included (63 men and 52 women; mean age at diagnosis: 36.3 years). Mean baseline prolactin level was 2224 ± 6839 ng/mL. No significant increase of tumor volume was observed during the follow-up. Of the 21 patients (18%) who presented asymptomatic hemorrhagic changes of the macroprolactinoma on MRI, 2 had a tumor increase (2 and 7 mm in the largest size). Both were treated by cabergoline (1 mg/week) with normal prolactin levels obtained for 6 and 24 months. For both patients, no further growth was observed on MRI during follow-up at the same dose of cabergoline. Conclusion No significant increase of tumor size was observed in our patients with controlled prolactin levels on DA. MRI follow-up thus appears unnecessary in patients with biologically controlled macroprolactinomas.

Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

2011 ◽  
Vol 21 (1) ◽  
pp. 11-21 ◽  
Author(s):  
Farzan Irani ◽  
Rodney Gabel
Keyword(s):  
Case Report ◽  
Therapeutic Intervention ◽  
Intensive Therapy ◽  
Positive Outcome ◽  
Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

1608: Long-Term Treatment with High Doses of Sildenafil Does Not Up-Regulate the Levels of Phosphodiesterase 5 (Pde5) in the Rat Penis

2004 ◽  
Vol 171 (4S) ◽  
pp. 424-424 ◽  
Author(s):  
Monica G. Ferrini ◽  
Eliane G. Valente ◽  
Jacob Rajfer ◽  
Nestor F. Gonzalez-Cadavid
Keyword(s):  
Term Treatment ◽  
Long Term Treatment ◽  
High Doses ◽  
Phosphodiesterase 5
Sign in / Sign up

Export Citation Format

Share Document