Presentation
We report the case of a patient who underwent remote pituitary irradiation for a prolactinoma and then presented decades later with hypercalcemia of unknown cause. [ncbi.nlm.nih.gov]
Psychiatrical
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Anger
Anger, B. V. A. Low-Beer and C. B. [cancerres.aacrjournals.org]
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Fear
The largest series re ported a 1.5% risk of visual impairment not attributable to other recognized ophthalmologic causes (18), and most modern series report risk Although there is fear of temporal lobe damage from radiation passing through normal tissues [78stepshealth.us]
Urogenital
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Secondary Amenorrhea
Secondary amenorrhea or lack of pubertal progression was found in 5 other cases. GH deficiency was associated with gonadotropin deficiency in 9 of these 10 cases. [ncbi.nlm.nih.gov]
Workup
X-Ray
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Cardiomegaly on Chest X-ray
At the final follow-up 6 patients had cardiomegaly on chest X-ray and echocardiographs (10 patients) were abnormal in every case. All 11 patients had evidence of complete or partial anterior hypopituitarism. [ncbi.nlm.nih.gov]
Serum
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Calcium Decreased
Skeletal mass (total body calcium) decreased into the range observed in osteoporosis in several patients. Trabecular bone mass, as reflected by the Singh Index, was consistently reduced, and two patients had vertebral compression fractures. [ncbi.nlm.nih.gov]
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Kluver-Bucy Syndrome
Progressive late delayed postirradiation encephalopathy with Kluver-Bucy syndrome. Serial MRI and clinicopathologic studies. Clin Neurol Neurosurg 1995;97:264–268. Google Scholar 54. Kleinschmidt-DeMaters BK. [link.springer.com]
Treatment
She also had a remission in 3 months and the treatment was continued for one year, requiring no further treatment. [ncbi.nlm.nih.gov]
Prognosis
Surgical removal has a guardedly favorable prognosis, but long-term follow-up is required. [skullbaseinstitute.com]
No statistically significant variables influenced prognosis in this study. 2 A 2009 study by Erridge et al. reported the progression-free survival rate of 385 patients treated with RT to be 97% at 10 years, and 96% at 20 years. [appliedradiationoncology.com]
These tumors have a poor prognosis because of their intrinsic resistance to treatment and the difficulty of using aggressive therapies in previously irradiated patients. In our patient, further radiotherapy could not be administered safely. [omicsonline.org]
Etiology
Although the etiology of Cushing's disease is controversial, current evidence suggests that most cases result from ACTH-producing pituitary tumors. [ncbi.nlm.nih.gov]
Etiology Most cases occur sporadically. Some cases ( 5% ) have a genetic/familial association. [amboss.com]
Extensive biochemical investigation, autoimmune markers assessment and imaging investigations including lumbar puncture failed to disclose an underlying etiology. Contrast-enhanced MRI revealed evidence of optic neuropathy (Figures 1 and 2). [hormones.gr]
Epidemiology
The irradiated cohort consisted of 167 patients treated at the Donner Pavilion (Lawrence Berkeley Laboratory, University of California, Berkeley), and the comparison cohort was the population evaluated in the Wisconsin Epidemiologic Study of Diabetic [ncbi.nlm.nih.gov]
Epidemiology Pituitary adenomas account for about 15% of primary intracranial tumors. Peak incidence : 35–60 years Prevalence : 80 cases per 100,000 individuals References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Jump to navigation Jump to search Pituitary Adenoma Epidemiology [ edit ] Comprise 10% of intracranial tumors On autopsy found in 5-25% Male:female 1:1 Majority present between 30-50 years old Genetic predisposition in MEN-1 Benign histologically Nonsecretory [en.wikibooks.org]
Etxabe J, Vazquez JA, 1994 Morbidity and mortality in Cushing’s disease: an epidemiological approach. Clin Endocrinol (Oxf) 40: 479-484. 2. Mampalam TJ, Tyrrell JB,Wilson CB, 1988 Transsphenoidal microsurgery for Cushing disease. [hormones.gr]
Pathophysiology
Multiple endocrine neoplasia type 1 Carney syndrome Isolated familial acromegaly References: [2] Pathophysiology Pituitary adenomas are well circumscribed, intrasellar tumors with monomorphic, polygonal cells arranged in sheets or cords without any connective [amboss.com]
Study Group of the Italian Society of Endocrinology on the Pathophysiology of the Hypothalamic-Pituitary-Adrenal Axis. J Clin Endocrinol Metab 1999;84(2):440-448. [cushings.org]
The pathophysiology, prevention and treatment of radiation-induced optic neuropathy, including the efficacy of hyperbaric oxygen therapy are reviewed. [hormones.gr]
Giustina A and Veldhuis JD (1998) Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. Endocr Rev 19 : 717–797 59. [nature.com]
Prevention
No satisfactory therapy is currently available for this grave complication but proper safeguards can prevent it. [ncbi.nlm.nih.gov]