A reversible posterior leucoencephalopathy syndrome including blindness caused by preeclampsia.

Complications of (pre)eclampsia may involve multiple systems and organs. Neurological symptoms may occur. Visual symptoms concern up to 25% the of patients with severe preeclampsia and 50% of the patients with eclampsia. An uncommon effect of severe preeclampsia is sudden blindness. Blindness may be part of a clinical and radiological presentation named Posterior Reversible Encephalopathy Syndrome (PRES). PRES may lead to permanent neurological deficit, recurrences or death. We report the case of a 24-year-old Caucasian patient, gravida 5 para 2 who developed preeclampsia and PRES complicated with blindness at 32 weeks of gestation. Optimal care allowed visual symptoms to resolve within 24 hours and a favourable maternal outcome and no long- term sequelae. We describe different causes and manifestations of PRES and highlight the need for immediate care in order to optimize the chance of symptoms reversibility

Etude nationale de la complétude des dossiers médicaux dans les services d'urgence par internet

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Prolactinomas Resistant to Standard Doses of Cabergoline : A multicenter study of 92 patients

Background: Dopamine agonist resistance in prolactinoma is an infrequent phenomenon. Doses of cabergoline (CAB) of up to 2.0 mg/week are usually effective in controlling prolactin (PRL) secretion and reducing tumor size in prolactinomas. The clinical presentation, management, and outcome of patients that are not well controlled by such commonly used doses of CAB-resistant patients are poorly understood. Design and methods: A multicenter retrospective study was designed to collect a large series of resistant prolactinoma patients, defined by uncontrolled hyperprolactinemia on CAB 652.0 mg weekly. Results: Ninety-two patients (50 F, 42 M) were analyzed. At diagnosis, most had macroprolactinomas (82.6%); males were significantly older than females (P=0.0003) and presented with a more aggressive disease. A genetic basis was identified in 12 patients. Thirty-six patients (39.1%) received only medical therapy, most underwent surgery (60.9%, including multiple interventions in 10.9%), and 14.1% received postoperative radiotherapy. Eight patients developed late CAB resistance (8.7%). The median maximal weekly dose of CAB (CAB max/w) was 3.5 mg (2.0-10.5). Despite a higher CABmax/w in patients treated with multimodal therapy (P=0.003 vs exclusive pharmacological treatment), a debulking effect of surgery was shown in 14 patients, with a higher rate of PRL control (P=0.006) and a significant reduction in CAB max/w (P=0.001) postoperatively. At last follow-up (median 88 months), PRL normalization and tumor disappearance were achieved in 28 and 19.9% of the patients respectively, with no significant sex-related difference observed in CABmax/w or disease control. Mortality was 4.8%, with four patients developing aggressive tumors (4.3%) and three a pituitary carcinoma (3.3%). Conclusion: CAB-resistant prolactinomas remain a serious concern. Surgical debulking, newer therapeutic strategies, and early diagnosis of genetic forms could help to improve their outcome

Prolactinomas in Men

Prolactinomas in men have several peculiar features that distinguish them from female PRL-secreting tumors. They occur less frequently in the male gender but are usually larger, more frequently invasive, and more often aggressive than in women. Significantly higher prolactin concentrations are also observed in men as compared to women, especially in the case of macroprolactinoma. Sex differences in tumor behavior largely explain such characteristics, rather than the longer delay in making the diagnosis in men. The reasons for a more aggressive course of prolactinomas in men remain poorly understood, and some hypotheses will be discussed in this chapter. Striking differences also exist in the clinical presentation of prolactinoma. Most women will present with oligomenorrhea, infertility, and/or galactorrhea, while more than half of men initially complain from symptoms of mass effects. Male hypogonadism is often present but neglected, and the male reproductive axis appears to be less sensitive to hyperprolactinemia than the female one. Nonetheless, diagnosis of prolactinoma in men should rely on the same criteria as in women, and a similar therapeutic strategy should be used. Medical management with dopamine agonists (DA) is effective and should always be considered as the first-line therapy, also in men bearing very large and compressive tumors. Transsphenoidal surgery is indicated in patients who are either intolerant or resistant to dopamine agonists or who elect to undergo potential curative surgery. However, most male patients with a macroprolactinoma will require medical treatment to control prolactin hypersecretion after surger