Evaluation of pulmonary side effects in prolactinoma patients treated with cabergoline

Introduction: Cabergoline (CAB) is the most used dopamine agonist in the treatment of prolactinomas. Studies related to the treatment of Parkinson’s disease have shown that dopamine agonists can lead to fibrotic syndromes affecting the heart and the lung. The aim of this study was to evaluate the possible pulmonary side effects of CAB in prolactinoma patients. Material and methods: Chest X-ray imaging and pulmonary function parameters like forced vital capacity (FVC), total lung capacity (TLC), and diffusion capacity for carbon monoxide (DLCO) were evaluated in 73 prolactinoma patients. The cumulative dose of CAB and the total duration of CAB use were also calculated, and all data were reviewed retrospectively. Results: The median cumulative CAB dose was 192 mg, and the median duration of CAB use was 64 months. Only 13 patients (17%) among this cohort had abnormal DLCO results that could be an indirect sign of pulmonary fibrosis. These abnormal DLCO results were found not to be associated with cumulative CAB dose in these 13 patients. Conclusions: CAB appears to be safe in terms of pulmonary functions with a median cumulative dose of 192 mg in prolactinoma patients

Hyponatremia as the presenting manifestation of Sheehan's syndrome in elderly patients

Background and aims: Hyponatremia is not a disease in itself, but a manifestation of a variety of disorders and side-effects of diuretics; alternatively, it may be the only manifestation of hypopituitarism or hypothyroidism. In our experience, diagnosis of hypopituitarism in hyponatremic patients is often overlooked, especially in the elderly. Methods: We report here data from five elderly multiparous women (mean age 69 yr; range 62-78 yr) with a post history of complicated delivery, in whom initial symptoms were due to hyponatremia (serum sodium less than 128 mEq/L) who went undiagnosed and untreated for a long time (up to 42 years) after the initial event. Results: Initial hormonal levels indicated hypopituitarism, and magnetic resonance imaging led to diagnosis of empty sella in all patients, so that they were diagnosed as suffering from Sheehan's syndrome (SS). The occurrence of sodium and water disorders associated with SS depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions which also play a role in sodium and water balance. In these patients, clinical condition and hyponatremia improved rapidly after glucocorticoid substitution. L-thyroxine was appropriately substituted subsequently. Conclusions: We suggest that, especially in elderly patients, much more attention should be paid to patients' past history. Early recognition of severe hyponatremia due to hypopituitarism with adrenal insufficiency is critical, and treatment with hydrocortisone results in safe and improved quality of life

Optimal effective doses of cabergoline and bromocriptine and valvular leasions in men with prolactinomas

OBJECTIVES: Prolactinoma is the most common pituitary adenoma, and dopamine agonists( BRC, and CAB) is the primary therapy. Recently, the increased prevalance of cardiac valvular disease in patients treated with DAs for Parkinson's disease has raised concerns about the safety of this drug in patients with prolactinoma. CAB and pergolide are frequently reported to cause valvulopathy, there are very few studies showing this side effect in BRC administiration which has less potent agonism of 5-HT2B receptors. Male patients who are known to have higher prevalance of macroadenomas compared to women. The dosage of DAs administered were rarely evaluated

Association Between Skin Tags and Colonic Polyps in Patients with Acromegaly

The high prevalence of colonic polyps in acromegalic patients is well known. Colonic adenomatous polyps may be precursor lesions for colorectal carcinoma. Skin tags are generally benign skin growths, but it has been reported that there is a correlation between skin tags and colonic polyposis in acromeglic patients. We evaluated association between colonic polyps and skin tags in twenty-five acromegalic patients. The aged over 70, previous colonic disease or polyps, rectal bleeding, positive family history for colon disease and smoking were exclusion criterians in the study. Colonoscopy was performed in all patients and colonic polyps were found in ten of them. Skin tags were detected in eight of ten patients with colonic polyps. The specificity and sensitivity of the presence of polyps with skin tags was high However Fisher's exact test was not statistically significant. As a conclusion, colonoscopy should be performed in all acromegalic patients especially in those with skin tags

Disease Activity May Not Affect the Prognosis of Coexisting Thyroid Cancer in Acromegalic Patients

Acromegaly is known to be associated with high incidence of malignancies probably due to the mitogenic effects of IGF-1. Differentiated thyroid cancer (DTC) is reported to be one of the most frequent malignancies associated with acromegaly. But there is no data about the clinical course of DTC in acromegalic patients. In this study, we evaluated the course of DTC in 14 acromegalic patients retrospectively. Fourteen papillary thyroid cancer patients without acromegaly, who were matched with the acromegalic patient group for age, gender and properties of thyroid cancer, were investigated as the control group. We identified no change in the course and treatment responses of DTC in association with the acromegaly activity, gender, age and disease duration, and all patients were found to be in remission for DTC at the time of investigation. Retrospective analysis of this cohort suggests that the activity of acromegaly may not affect the treatment responses and prognosis of coexisting DTC

Expression of Ki-67, p53 and vascular endothelial growth factor (VEGF) concomitantly in growth hormone-secreting pituitary adenomas; which one has a role in tumor behavior?

OBJECTIVE: In many pituitary tumor, immunohistochemical studies have been shown to be correlated with different aspects of tumor behavior. There is no study up to date in which markers of Ki-67, p53, VEGF were evaluated concomitantly in GH-secreting adenomas. This study aims to determine which marker has a major role in tumor behavior and whether these markers have a cut-off value to distinguish invasive adenoma from non-invasive pituitary adenoma

THE EFFECTS OF CARVEDILOL ON LEFT VENTRICULAR FUNCTIONS AND ARRHYTHMIAS IN PATIENTS WITH SEVERE CARDIAC FAILURE

Objective: Arrhythmia are seen frequently in patients with heart failure (HF). Carvedilol which has both beta-blocker and alfa-blocker properties has led to new expectations in the treatment of HF. Our aim is to explore the effect of carvedilol on left ventricular (LV) function and development of arrhythmia in patients with HF

Differences in risk factors for acute coronary syndromes between men and women

Objective - The aim of this study is to evaluate the presence of risk factors for coronary heart diseases in men and women in our population

Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers

Differentiated thyroid carcinomas are the most common malignancies of endocrine organs. Metastases to cervical lymph nodes occur in 20-50 % of cases. Recurrence and survival rates are closely related to the type of surgery performed. High-resolution ultrasonography (USG) is a sensitive imaging method used to detect occult lymph node metastases in patients with thyroid cancer. We evaluated how intraoperative USG affected surgical success. This was a retrospective study comparing two groups of patients with thyroid carcinoma who underwent cervical lymph node dissection. A total of 101 patients (33 males and 68 females) were included. Group 1 included 53 patients who underwent surgery with intraoperative USG guidance. Group 2 included 48 patients who underwent surgery without the use of USG. All patients were followed up (mean 23 months; range 5-44 months) with thyroglobulin measurements and USG evaluations. Group 1 (intraoperative USG) had a residual/recurrent tumor rate of 1.9 % (1/53 patients). Group 2 had a residual/recurrent tumor rate of 12.5 % (6/48 patients). A statistically significant difference appeared between the residual/recurrent tumor rates in Groups 1 and 2 (p < 0.05). In addition to its classical use in diagnosis and follow-up, intraoperative use of high-resolution USG can improve surgical success and may decrease the number of residual/recurrent tumors encountered during follow-up