We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory response to medications that are usually effective in idiopathic cluster headache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treatment with cabergoline, the patient remains asymptomatic. Symptomatic cluster headache should be suspected when the clinical features of the headache are atypical. By inducing vascular mechanisms, the parasellar lesion may have played a role in initiating the cluster headache.Key words: cluster headache, pituitary adenoma, macroprolactinoma Abbreviation: CH cluster headache ( Headache 2001;41:723-725) Cluster headache (CH) is a disease with a typical periodic pain pattern. The diagnostic criteria are based on clinical features and the temporal pattern. In primary CH, neuroradiological investigations should not demonstrate any pathological or morphological lesion in the central or peripheral nervous system. Like other vascular headaches, CH is presumed to develop from pathophysiological events, which ultimately activate the trigeminovascular system. 1 Several reports have described the association of clusterlike headache with structural neurological disturbances (Table). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] We report the occurrence of clusterlike headache in a patient with a pituitary adenoma. The neurological examination was normal, but both neuroradiological and endocrine investigations revealed the presence of a pituitary prolactinoma. CASE HISTORYA 30-year-old man presented with complaints of recurrent headache of 2 years' duration. The pain was severe, sharp, and invariably in the left eye and periorbital region, and usually lasted less than 120 minutes. The attacks were associated with ipsilateral lacrimation, rhinorrhea, injection of conjunctiva, ptosis, and miosis. The pain was never associated with nausea or vomiting and did not increase with Valsalva maneuver. The pain never awakened the patient. Initially, the attacks occurred sporadically, once a day for a period of 20 days, and then he was asymptomatic for a couple of months. The frequency increased in the previous 6 months to three or more episodes per day without any temporal pattern. Because analgesic treatment was not effective and the clinical characteristics had changed, he decided to consult a specialist. The initial neurological examination was normal. There were no signs of cranial nerve involvement. The patient was started on verapamil and given zolmitriptan for pain crises. A cranial computed tomography scan showed a parasellar and suprasellar tumor with left extension into the cavernous sinus. Magnetic resonance imaging (MRI) again demonstrated a left-sided adenoma with cavernous sinus invasion (Figure). His prolactin level was 4759 ng/mL,

Introduction. Malnutrition and weight loss in cancer patients is a common problem that affects the prognosis of the disease. In the case of CRC, malnutrition rates range between 30 and 60%. Objectives. Description of the preoperative nutritional status of patients diagnosed with colorectal neoplasia who will undergo surgery. Materials and Methods. A prospective observational study is performed. Results. Of 234 patients studied, we observed that 139 (59%) had some degree of nutritional risk. Of all of them, 44.9% (N = 47) had 1-2 points according to MUST and 25% (N = 27) had more than 2 points. No differences were found when studying nutritional risk according to the location of the neoplasm. It was observed that 2.15% of the patients were underweight, 51% overweight, and 23% obese. 19.4% of patients lost less than 5 kg in the 3–6 months prior to diagnosis, 20.7% lost between 5 and 10 kg, and 2.1% lost more than 10 kg. In asymptomatic patients, the weight loss was lower than in symptomatic patients, loss <5 kg, 8.2% vs. 22.8%, and loss 5–10 kg, 16.2% vs. 29.3%, with a value of p = 0.016 . 5% (N = 7) of the patients had hypoalbuminemia record. 16.5% (N = 23) had some degree of prealbumin deficiency and 20.9% (N = 29) of hypoproteinemia. Symptomatic patients had more frequent analytical alterations, 1-2 altered parameters in 48.8% (N = 20) of asymptomatic vs. 61.2% (N = 22) in the symptomatic, p = 0.049 .