Rosa Cámara Gómez

Tumores hipofisarios no funcionantes: actualización 2012

Non-functioning pituitary adenomas are the most common pituitary macroadenomas in adults, accounting for approximately 14%-28% of all clinically relevant pituitary tumors. They are a heterogeneous group of tumors that cause symptoms by compression and/or hormone deficiencies. The possibility of tumor growth is increased in macroadenomas and solid tumors as compared to microadenomas and cystic tumors. Diagnosis is based on imaging procedures (magnetic resonance imaging), but there are studies reporting promising potential biomarkers. Transsphenoidal surgery remains the first therapeutic option for large tumors with compressive symptoms. There is no evidence that endoscopic procedures improve outcomes, but they decrease morbidity. There is no unanimity in finding prognostic predictors of recurrence. Radiosurgery achieves tumor control and, sometimes, adenoma size reduction. Its adverse effects increase with higher doses and tumor sizes>4cm(3). Drug treatment is of little value. In aggressive non-functioning tumors, temozolomide (TMZ) may be used with caution because no controlled studies are available. TMZ achieves tumor control in 38%-40% of aggressive non-functioning tumors. The optimal treatment regimen and duration have not been defined yet. Lack of response to TMZ after 3 cycles predicts for treatment resistance, but initial response does not ensure optimal mid or long-term results. O6-methylguanine-DNA methyltransferase expression has a limited predictive value of response to treatment with TMZ in aggressive non-functioning tumors. It should therefore not be a determinant factor in selection of patients to be treated with TMZ.

Desnutrición caloricoproteínica grave tras bypass gástrico

La cirugia bariatrica da lugar a una perdida de peso que perdura y mejora las comorbilidades de la obesidad morbida. Pueden darse complicaciones tras ella, la mayoria nutricionales y de caracter leve, pero en algunos casos pueden ser graves y comprometer la vida del paciente. Se presenta el caso de una mujer de 50 anos en quien se desarrollo desnutricion caloricoproteinica grave tras cirugia bariatrica y que preciso que se revirtiera la intervencion. Se discuten los factores que dieron lugar a la desnutricion y las opciones de tratamiento.: Bariatric surgery achieves lasting weight loss and improves the comorbidities associated with morbid obesity. After surgery, patients can develop complications, mainly mild nutritional alterations. However, in some patients, complications can be serious and lifethreatening. We present the case of a 50-year-old woman who developed severe protein-calorie malnutrition after bariatric surgery, which required surgical reversion. The factors leading to malnutrition in this patient and the treatment options are discussed.

Carta científicaApoplejía hipofisaria en gestante con microprolactinoma quísticoPituitary apoplexy in a pregnant woman with cystic microprolactinoma

We report the case of a 37-year-old female patient who two years previously had been diagnosed with a 3-mm cystic microprolactinoma after routine laboratory tests revealed a prolactin level of 68 ng/mL (normal, 2.4--25 ng/mL). The patient had not experienced any prior menstrual changes, galactorrhea, or neurological symptoms. Cabergoline (0.5 mg/week) was administered with a good biochemical response. However, tumor size increased in the first six months of treatment to 7.9 mm × 5 mm × 5 mm, and then remained stable for the following six months. Some months after this last radiographic control, cabergoline was discontinued due to pregnancy, and levothyroxine (50 g/day) was added for secondary hypothyroidism (TSH 1.74 mU/L [normal: 0.35--4.9 mU/L] and free T4 0.65 ng/dL [normal: 0.7--1.5 ng/dL]). The patient attended the emergency room of our hospital at 24 weeks of pregnancy complaining of continuous retroorbital headache and decreased visual acuity in the right eye for approximately 10 days. Pituitary MRI performed based on a clinical suspicion of pituitary apoplexy (PA) showed a cystic pituitary lesion 15 mm × 15 mm × 22 mm in size with serohematic content and an extrasellar component compressing the central portion of the optic chiasm (Fig. 1). The results of a complete blood count, general chemistry, and coagulation tests were normal, and the serum PRL level was 64.5 ng/mL. The ophthalmology department confirmed the decrease in visual acuity in the right eye (0.4/1), and also detected inferior temporal quadrantanopia in the same eye. Treatment was restarted with dopamine agonists (bromocriptine 2.5 mg/day), and surgery was decided in agreement with the neurosurgery department and based

Apoplejía hipofisaria en gestante con microprolactinoma quístico

We report the case of a 37-year-old female patient who two years previously had been diagnosed with a 3-mm cystic microprolactinoma after routine laboratory tests revealed a prolactin level of 68 ng/mL (normal, 2.4--25 ng/mL). The patient had not experienced any prior menstrual changes, galactorrhea, or neurological symptoms. Cabergoline (0.5 mg/week) was administered with a good biochemical response. However, tumor size increased in the first six months of treatment to 7.9 mm × 5 mm × 5 mm, and then remained stable for the following six months. Some months after this last radiographic control, cabergoline was discontinued due to pregnancy, and levothyroxine (50 g/day) was added for secondary hypothyroidism (TSH 1.74 mU/L [normal: 0.35--4.9 mU/L] and free T4 0.65 ng/dL [normal: 0.7--1.5 ng/dL]). The patient attended the emergency room of our hospital at 24 weeks of pregnancy complaining of continuous retroorbital headache and decreased visual acuity in the right eye for approximately 10 days. Pituitary MRI performed based on a clinical suspicion of pituitary apoplexy (PA) showed a cystic pituitary lesion 15 mm × 15 mm × 22 mm in size with serohematic content and an extrasellar component compressing the central portion of the optic chiasm (Fig. 1). The results of a complete blood count, general chemistry, and coagulation tests were normal, and the serum PRL level was 64.5 ng/mL. The ophthalmology department confirmed the decrease in visual acuity in the right eye (0.4/1), and also detected inferior temporal quadrantanopia in the same eye. Treatment was restarted with dopamine agonists (bromocriptine 2.5 mg/day), and surgery was decided in agreement with the neurosurgery department and based