7 research outputs found

    Ectopic Acromegaly Secondary to Bronchial Tumor; a Case Report of Rare Occurrence.

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    Introduction: Acromegaly is caused due to the unregulated and sustained overproduction of growth hormone (GH). The majority of the cases are caused by autonomous secretion of GH from anterior pituitary tumors. Nonetheless, in less than 1 % of the cases, the cause of autonomous secretion is secondary to ectopic growth hormone-releasing hormone (GHRH) production. Bronchial carcinoids are the most common cause of ectopic GHRH production. Case description:  A 32-year-old female presented to the clinic with a history of cough, hemoptysis, and undocumented weight loss for four years. Initial workup showed a large right main stem endobronchial mass. Transbronchial biopsy of the mass revealed a grade I neuroendocrine tumor (NET). During NET workup, a large sellar mass was incidentally found on cross-sectional imaging. The hormonal profile revealed markedly elevated insulin-like growth factor -1 (IGF-1) and mildly raised prolactin. The MRI Brain study revealed pituitary macroadenoma measuring 2 cm x 1.2 cm x 1.5 cm. The patient underwent bronchial carcinoid tumor resection, which led to normalization of serum IGF-1 and growth hormone response to an oral glucose tolerance test. Subsequent MRI brain revealed complete resolution of previously noted sellar mass. Practical implications:  This case highlights the importance of differentiating acromegaly secondary to pituitary adenoma and ectopic acromegaly. This case emphasizes the importance of keeping rare entities in the differential while assessing patients with pituitary macroadenoma

    Myasthenia Gravis Mimicking Third Cranial Nerve Palsy: a Case Report

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    Background: The most common pituitary adenoma presentation is a visual field defect and inappropriate pituitary hormone secretion. The compression of the optic chiasma causes visual impairment. Large pituitary adenomas can rarely cause diplopia and ptosis secondary to adenoma's lateral extension into the cavernous sinus. Myasthenia gravis (MG) is an autoimmune disorder involving neuromuscular junctions. It is characterized by skeletal muscle fatigability, commonly involving extraocular muscles, face, and limbs. It is estimated that 75% of MG patients present with ptosis and diplopia. The association of MG with pituitary adenoma is very rare. Case Description: A 30-year-old lady presented with headache, diplopia, and ptosis of the left eye for two months. She was diagnosed with acromegaly secondary to pituitary adenoma. Ptosis is a rare presenting feature in pituitary adenoma. Her case was discussed in a multidisciplinary meeting, and the consensus was that her ptosis is likely secondary to pituitary adenoma, which was involving the left cavernous sinus. She underwent transsphenoidal resection of pituitary macro adenoma. Three weeks post-surgery, she developed bilateral ptosis, dysarthria, dysphonia, which was diagnosed as myasthenia gravis. Clinical implications: Ptosis is a rare manifestation of pituitary adenoma. Nonetheless, pituitary tumor patients presenting with ptosis should be evaluated for the neuromuscular disorder. A high index of suspicion is required for early diagnosis and prompt treatment of myasthenia gravis

    Dopamine-Agonist Induced Cerebrospinal Fluid Rhinorrhea; a Case Report

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    Introduction: Prolactinomas are the most common pituitary adenomas. Medical therapy with dopamine agonists (DA) is the mainstay of treatment and rarely requires surgical manipulation. Patients may rarely present with cerebrospinal fluid (CSF) rhinorrhea after starting therapy with DA in case of massive or invasive prolactinomas. Case Description: We present a case of a 29-year-old lady with invasive prolactinoma who presented with CSF rhinorrhea after a month of starting bromocriptine therapy with the development of meningitis and warranting early surgical repair. Practical Implications: Patients with macroprolactinoma should be closely monitored initially after starting on dopamine agonists to avoid life-threatening complications

    Prevalence of behavioural and psychological problems in working children

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    OBJECTIVE: To determine the prevalence and screen the nature and types of behavioural and psychological problems among working children in Karachi. METHODS: A cross sectional study was conducted in three urban squatter settlements of Karachi from May to June 2006, targeting working children aged 11-16 years. Behavioural Problems of these children were estimated by using the self reported Urdu version of the Strengths and Difficulty Questionnaire. The results were cross-tabulated using SPSS 13.0 with the identified risk-factors. RESULTS: Out of a total of 225 respondents, 94.2% (n = 212) males and 5.8% (n = 13) females, the prevalence of Behavioural Problems among working children was found to be 9.8%. Peer problems were most prevalent (16.9%) seconded by Conduct problems (16.7%). Adverse family environment and work environment were closely associated with Behavioural Problems in these children. CONCLUSION: Our study reinforces the need for measures to improve the environment of the children and prevent the psychological and behavioural problems associated with working children. Gradual, long-term policies are required to decrease the need for working children, though sudden abolishment would cause more detrimental effects

    Treatment of Ipilimumab Induced Graves’ Disease in a Patient with Metastatic Melanoma

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    Objective. Thyroid disease has been reported among the endocrinopathies that can occur after treatment with ipilimumab. Graves’ disease, however, has been rarely reported with this medication. Here we report a case of Graves’ disease diagnosed after initiation of ipilimumab in a patient with melanoma. Methods. We present the clinical presentation and management course of this patient followed by a related literature review. Results. A 67-year-old male with metastatic melanoma was started on ipilimumab. He developed hyperthyroidism after two doses of ipilimumab. The cause of hyperthyroidism was determined to be Graves’ disease. Ipilimumab was held and the patient was started on methimazole with return to euthyroid status. Ipilimumab was resumed and the patient continued methimazole during the course of ipilimumab therapy, with controlled hyperthyroidism. Restaging studies following four cycles of ipilimumab showed complete response in the lungs, with residual melanoma in the neck. The patient then underwent total thyroidectomy and left neck dissection as a definitive treatment for both hyperthyroidism and residual melanoma. Conclusion. Graves’ disease can develop after starting ipilimumab and methimazole can be an effective treatment. For patients whose hyperthyroidism is well-controlled on methimazole, ipilimumab may be resumed with close monitoring

    Case Report Treatment of Ipilimumab Induced Graves' Disease in a Patient with Metastatic Melanoma

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    Objective. Thyroid disease has been reported among the endocrinopathies that can occur after treatment with ipilimumab. Graves' disease, however, has been rarely reported with this medication. Here we report a case of Graves' disease diagnosed after initiation of ipilimumab in a patient with melanoma. Methods. We present the clinical presentation and management course of this patient followed by a related literature review. Results. A 67-year-old male with metastatic melanoma was started on ipilimumab. He developed hyperthyroidism after two doses of ipilimumab. The cause of hyperthyroidism was determined to be Graves' disease. Ipilimumab was held and the patient was started on methimazole with return to euthyroid status. Ipilimumab was resumed and the patient continued methimazole during the course of ipilimumab therapy, with controlled hyperthyroidism. Restaging studies following four cycles of ipilimumab showed complete response in the lungs, with residual melanoma in the neck. The patient then underwent total thyroidectomy and left neck dissection as a definitive treatment for both hyperthyroidism and residual melanoma. Conclusion. Graves' disease can develop after starting ipilimumab and methimazole can be an effective treatment. For patients whose hyperthyroidism is well-controlled on methimazole, ipilimumab may be resumed with close monitoring
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