Authors:Schürmeyer; Thomas H., Galling, Britta Abstract: Objective Therapeutic options for persistent acromegaly after surgery include another surgical approach, radiotherapy, medical therapy or a combination of these procedures. We describe a patient with persistent acromegaly despite heavy pre-treatment who was in need of a simplified mode of effective therapy.Methods In a 45-year old patient after transsphenoidal pituitary surgery followed by linear accelerator irradiation of the residual tumor two years later acromegaly could not be controlled by a tolerable dosage of intramuscular octreotide LAR. For professional reasons the patient requested a simplified mode of treatment.Results In order to improve efficacy and treatment convenience, we combined subcutaneous injections of lanreotide up to 120 mg monthly performed by the patient’s spouse and of pegvisomant 80 mg weekly conducted by the patient himself. This therapy was well tolerated and satisfactory endocrine control was achieved. Magnetic resonance imaging did not show any remaining tumor within a year. 5 years following surgery and 3 years following irradiation pegvisomant could be stopped and levels of insulin growth factor 1 and growth hormone remained in the normal range. The interval of lanreotide given subcutaneously by the patient’s spouse could be extended stepwise and somatostatin analog treatment was terminated after 7.5 years when the patient was cured.Conclusions Excessive growth hormone secretion persisting after pituitary surgery and irradiation can be controlled in a convenient way for the patient with acromegaly by combining monthly lanreotide and weekly pegvisomant injections, if monotherapy with a somatostatin analog fails. Citation: Exp Clin Endocrinol Diabetes Rep 2018; 05: e9-e12 PubDate: 2018-06-11T00:00:00+01:00 DOI: 10.1055/a-0630-0412 Issue No:Vol. 05, No. 01 (2018)
Authors:Thrasher; Bradly J., Whitham, Jennifer, Law, Jennifer Abstract: We present a case of declining cardiac function in a patient with Friedreich's Ataxia, however, her worsening cardiac function was not related to her chronic disease. Her declining cardiac function was associated with hypothyroidism that was initially overlooked. The purpose of this article is to remind physicians of the role that thyroid hormone has in cardiac function and overall health. Autoimmune hypothyroidism is a common condition, and physicians should consider screening thyroid function in any patient with poor or worsening cardiac function. Citation: Exp Clin Endocrinol Diabetes Rep 2018; 05: e6-e8 PubDate: 2018-03-20T00:00:00+0100 DOI: 10.1055/s-0043-109432 Issue No:Vol. 05, No. 01 (2018)
Authors:Calissendorff; Jan, Christofer Juhlin, Carl Abstract: Lymphocytic adrenal medullitis (LAM) denote the histological finding of lymphocytic infiltrates in the adrenal medulla, a rare phenomenon that previously has been deemed asymptomatic and linked to autopsy findings in patients with type I diabetes. We describe the finding of LAM in a 66-year old female presenting with hyperaldosteronism and a 17 mm lesion in the right adrenal gland. The patient displayed secondary hypertension as well as intermittently occurring exaggerated hypertensive episodes with systolic peaks above 220 mm Hg. Preoperative catecholamine screening was negative, diminishing the possibility of a pheochromocytoma. Unilateral adrenalectomy was performed, and histology revealed an aldosterone producing adrenocortical adenoma. No signs of adrenomedullary hyperplasia or pheochromocytoma were found; however, prominent B- and T-lymphocytic infiltrates were observed across the medulla. The inflammation was almost absent in the surrounding adrenocortical tissue. Postoperatively, the patient remained hypertensive, but without paroxysmal excessive blood pressure elevations. A review of our pathology records between the years 2000 to present time as well as focused histopathological re-examination of 40 cases revealed no signs of LAM in any adrenal gland investigated, confirming the occurrence in living patients as exceedingly rare. This is the first report of LAM in a living patient, with a possible clinical association to intermittent episodes of markedly increased blood pressure not commonly seen in patients with hyperaldosteronism. A coupling between LAM and exaggerated hypertensive episodes cannot be ruled out. Citation: Exp Clin Endocrinol Diabetes Rep 2018; 05: e1-e5 PubDate: 2018-01-22T00:00:00+0100 DOI: 10.1055/s-0043-122492 Issue No:Vol. 05, No. 01 (2018)
Open Access journal
[233 journals]
