General seizures revealing macro-adenomas secreting prolactin or prolactin and growth hormone in men

Chentli, F.; Akkache, Lina; Daffeur, Katia; Azzoug, S.

doi:10.4103/2230-8210.131185

Cited by 7 publications

(10 citation statements)

References 11 publications

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“…In agreement with many researchers, we noted that appealing signs were visual loss and/or neurological complications including epilepsy,[ 36 37 ] memory troubles[ 38 39 ] and meningitis. [ 40 41 ] Psychiatric problems noted in some of our cases are also reported by others.…”

Section: Discussionsupporting

confidence: 92%

Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

Chentli

Azzoug

Daffeur

et al. 2015

Indian J Endocr Metab

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Introduction:Prolactinomas are less frequent, but more invasive in males. Giant ones (≥4 cm) are extremely rare in literature. Their neurological, psychiatric and endocrine complications are life threatening. Our aim was to report the largest mono center series in order to analyze their frequency, their characteristics, and their complications.Subjects and Methods:All patients had clinical examination, hormonal, ophthalmological, and radiological assessment based on computed tomography scan and cerebral magnetic resonance imaging. Positive diagnosis was based on clinical symptoms, high prolactin ± immunohistochemy study. Mixed adenomas were excluded by hormonal exploration and immunohistochemy. For those who received medical treatment only, a reduction in tumor size was considered a supplementary positive point for the diagnosis.Results:Among 154 male prolactinomas seen between 1987 and 2013, we observed 44 giant tumors (28.5%). Median age = 36 years, and 38.3% were under 30. Median tumor height = 53.95 mm (40–130) and median prolactin = 15,715 ng/ml (n < 20). Solid and cystic aspect ± calcifications was observed in 25%. 42 had cavernous sinuses invasion. Other invasions were: Posterior= 65.9%, anterior= 63.6%, temporal= 15.9% and frontal = 9%. For endocrine complications: Hypogonadism = 98.4%, thyrotroph and corticotroph deficits were seen in respectively 34%, and 32%. Posterior pituitary insufficiency was observed in one case. For ophthalmological complications: Optic atrophy = 46%, Ptosis = 6.8%, diplopia/strabismus = 4.5%. Neurological complications were: Memory loss and/or unconsciousness = 18.2%, epilepsy = 15.9%, frontal syndrome = 9% and obstructive hydrocephalus = 6.8%.Conclusion:Giant prolactinomas account for 28% in our population. Severe neurological complications are frequent. But, obstructive hydrocephalus is rare, which argues for a slow progression.

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Section: Discussionsupporting

confidence: 92%

Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

Chentli

Azzoug

Daffeur

et al. 2015

Indian J Endocr Metab

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“…Interestingly, neurologic diseases present on initial admission, most commonly epilepsy and convulsions, were predictive of readmission after transsphenoidal pituitary surgery. Seizures are relatively rare in patients with pituitary tumors, but can occur with large tumors that invade the suprasellar area . Few studies exist regarding epilepsy in the context of pituitary tumors, with seizures present in 8.9% to 20% of patients .…”

Section: Discussionmentioning

confidence: 99%

“…Seizures are relatively rare in patients with pituitary tumors, but can occur with large tumors that invade the suprasellar area . Few studies exist regarding epilepsy in the context of pituitary tumors, with seizures present in 8.9% to 20% of patients . Furthermore, for large tumors inciting an epileptic focus, surgery would be strongly considered for management because these are often recalcitrant to antiepileptic medications .…”

Section: Discussionmentioning

confidence: 99%

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Rizvi

Ferrandino

Luu

et al. 2018

Int Forum Allergy Rhinol

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Background:Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission a er transsphenoidal pituitary surgery. Methods:The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital-level characteristics were compared for patients with and without unplanned 30-day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study. Results:A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmi ed patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.Conclusion: Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients. C 2018 ARS-AAOA, LLC.

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“…Both patients in this report presented with new onset seizure disorders presenting as status epilepticus. Seizures are rare in people with pituitary adenoma as they account for only 4% of all intracranial tumors causing seizures ( 9 ). They typically occur when the tumor invades the suprasellar area due to mass effect on the brain in large pituitary adenomas ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…Seizures are rare in people with pituitary adenoma as they account for only 4% of all intracranial tumors causing seizures ( 9 ). They typically occur when the tumor invades the suprasellar area due to mass effect on the brain in large pituitary adenomas ( 9 ). The mechanism by which status epilepticus may occur in patients with pituitary macroadenoma is by local effect and hormone dysfunction ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Status epilepticus and diabetes ketoacidosis: uncommon clinical presentations of acromegaly

Chamba

Amour²,

Sadiq

et al. 2021

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Acromegaly is a rare disease caused by hypersecretion of the growth hormone (GH). Most cases are caused by either pituitary microadenoma or macroadenoma. The GH producing tumors present with clinical manifestations of acromegaly due to excessive GH secretion or symptoms resulting from mass effects of the enlarging tumor. The physical changes are usually slow and, therefore, recognition of the disease is delayed. These adenomas are never malignant but can have significant morbidity and mortality. A subgroup of patients with acromegaly present with severe hyperglycemia resulting in diabetic ketoacidosis (DKA) which requires insulin. Rarely are pituitary tumors responsible for generalized convulsions except when they are too large. We hereby present two cases, the first is that of a 26-year-old female who presented with new onset status epilepticus, DKA with a 1-year history of diabetes mellitus (DM). On examination, she had clinical features of acromegaly. The second case is that of a 34-year-old female who presented with new onset status epilepticus, hyperglycemia with a history of recently diagnosed DM, and features of gigantism. In both cases, their diagnosis was confirmed by elevated serum GH and later by elevated insulin-like growth factor type 1 levels, and CT of the head demonstrating large pituitary macroadenoma. The importance of clinical history and examination, as well as investigations is vital in the recognition of acromegaly. The prognosis of acromegalic patients depends on early clinical recognition and tumor size reduction by either medical or surgical therapy. Learning points Conditions such as status epilepticus and DKA may be clinical presentations in patients presenting with acromegaly. Seizures are rare in people with pituitary adenoma and typically occur when the tumor invades the suprasellar area due to mass effect on the brain. This article shows how best we were able to manage the acromegaly complications in a low resource setting. Hyperprolactinemia in acromegaly may be due to disruption of the normal dopaminergic inhibition of prolactin secretion due to mass effect of the macroadenoma, and around 25% of GH-secreting adenomas co-secrete prolactin.

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General seizures revealing macro-adenomas secreting prolactin or prolactin and growth hormone in men

Cited by 7 publications

References 11 publications

Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

Neurological, psychiatric, ophthalmological, and endocrine complications in giant male prolactinomas: An observational study in Algerian population

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Status epilepticus and diabetes ketoacidosis: uncommon clinical presentations of acromegaly

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