Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transferred to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma

The Prevalence of Orthostatic Hypotension in Type 2 Diabetes Mellitus Patients in a Diabetic Clinic in Enugu South-East Nigeria

BACKGROUND: Orthostatic Hypotension is a serious and common complication of diabetes mellitus.AIMS: To determine the prevalence and risk factors of Orthostatic Hypotension in type 2 diabetic patients in a diabetes mellitus clinic in Enugu South-East Nigeria.METHOD AND MATERIALS: A structured questionnaire was administered to the eligible and consenting seventy type 2 diabetes mellitus patients.The supine and erect blood pressures of each patient were recorded. The patients with Orthostatic Hypotension were compared with those withoutOrthostatic Hypotension for different clinical and biochemical parameters.STATISTICAL ANALYSIS USED: The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 software. Odds ratio was calculated for the presence of Orthostatic Hypotension amongst thevariables and p-value <0.05 was considered statistically significant.RESULTS: The prevalence of Orthostatic Hypotension in type 2 diabetic patients was 23.3%. Orthostatic Hypotension had statistically significant association with the presence of peripheral neuropathy, retinopathyand proteinuria.CONCLUSIONS: Orthostatic Hypotension is a common complication in type 2 diabetes mellitus patients seen at Enugu. It is recommended thatmeasurement of erect and supine blood pressures should be part of the standard care of type 2 diabetic patients.  KEY WORDS: Prevalence, orthostatic, hypotension, Enugu, Nigeri

Respiratory symptoms and ventilatory function tests in Nigerians with HIV infection

Background: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. Methods: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV 1 ), FEV 1 /FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. Results: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200cells/μl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. Conclusions: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated