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Biomedical subjects

A Leal-Cerro

Publications and source records attributed to A Leal-Cerro.

At least 37 records · Page 2Linked to original sources
PubMed1993

Clinical use of octreotide in unresectable meningiomas. A report of three cases.

Unresectable meningioma is the cause of a serious clinical problem, for whom no satisfactory mode of treatment is currently available. Meningiomas are known to have receptors for diverse hormones. In this sense, somatostatin receptors were found in every meningioma specimen studied in a recent report. In addition, somatostatin has been able to inhibit meningioma cell proliferation in vitro. A brief report of clinical use of somatostatin long-life analogue octreoctide upon three patients diagnosed of unresectable meningioma is here presented. Doses used were gradually increased up to 1000, 900 and 1500 micrograms/24 h during 16, 6 and 7 weeks, respectively. There was an almost perfect tolerance to the drug (in one case a mild and transient abdominal discomfort and diarrhea could be observed). An important alleviation of headaches in 2 cases, and a transient but objective improvement in ocular movements and signs in 1 case were noticed. No change (neither growth nor shrinkage) was observed by CT scan at the end of treatment course in the three cases studied. In 1 case a partial resection was performed and tissue specimen was found to contain somatostatin receptors. Although in our very limited experience no brilliant results are presented, duration of treatment or doses used could have been insufficient. Data herein presented seem to support recently reported findings in which no growth inhibition of meningioma cells cultured in vitro by adding octreoctide to the medium was observed. So, in our opinion, clinical use of octreoctide on unresectable meningioma deserves further experience, that must be carried out with great caution.

Adult↗
PubMed1991

Acromegalic cardiopathy improves after treatment with increasing doses of octreotide.

The aim of this study was to assess the effects a long-acting somatostatin analogue (octreotide) had on the heart function of acromegalic patients. Five patients fulfilling clinical criteria of active acromegaly without symptoms of heart dysfunction, were treated with increased doses of octreotide (300, 600, 900, 1,200 and 1,500 micrograms/daily) over a period of six months. Growth hormone (GH) profiles were carried out during each different dose of octreotide. M-Mode, two dimensional and Doppler echocardiographic evaluation were performed both before and after treatment. Although the GH levels of all patients dropped after each increment of the octreotide, the responses were not homogeneous. Six months after the onset of treatment, echocardiographic studies revealed a significant reduction in the interventricular septum thickness (IVST) (p less than 0.05) and Doppler analyses showed an increase in the early diastolic transmitral flow velocity (p less than 0.05). Our results indicate that octreotide is capable of reversing acromegalic cardiopathy, since it not only reduces GH levels to within normal limits but improves left ventricular hypertrophy and distensibility without modifying contractility.

Acromegaly↗
PubMed1991

[Results of trans-sphenoidal surgery for the treatment of acromegaly].

UNLABELLED: During the past 17 years (1972-89) 55 transsphenoidal surgery (TSS) interventions were performed in our Hospital in 53 cases of acromagaly (2 cases underwent surgery twice). RESULTS: 22 were cured (40%); 15 partial efficacy (27%) and 18 negative efficacy (33%). Mean GH values (ngr/ml) before surgery were: Cured cases 15.8 + 12.9 (p = 0.0015). Basal GH values above 40 ngr/ml obscure the prognosis of TSS in acromegaly. Cure was perfectly achieved in smaller size hypophysis adenomas (Hardy Grade land 11 in CT scan). The complications in the early post-surgery were rare and transient. Chronic sequelae due to TSS occurred in 7 cases (13.5%), as complete or partial anterior hypophysis failure. TSS is the treatment of choice of acromegaly in our environment, however a significant number of cases do not achieve cure and need to complete treatment with hypophyseal radiotherapy.

Acromegaly↗
PubMed1990

[Treatment of macroprolactinomas with delayed bromocriptine. Effectiveness of a single intramuscular injection].

The aim of the present study was to evaluate the effectiveness and tolerance of a new pharmaceutical preparation of long acting bromocryptine (bromocryptine depot of L.A.), characterized by the slow release of bromocryptine during 4 or 6 weeks after a deep intramuscular injection. It was administered to 9 patients with macroprolactinoma, 7 of which had visual abnormalities. The tolerance of the drug was excellent, and only one patient had nausea within the first 24 hours. In all cases, PRL values fell between 40% and 97%. All patients with visual abnormalities, including 2 patients with cranial nerve palsy (IIIth and VIIth pairs) returned to normal or improved. In the CT controls carried out after 4 weeks of therapy a reduction in tumor size was observed in 7 of 9 patients. Two patients were operated through the transesphenoidal route, PRL being demonstrated in the immunohistochemical study of the resected specimen. Subsequently, all patients received oral bromocryptine therapy with perfect tolerance. The results show that parenteral long acting bromocryptine is an effective, well tolerated and convenient way to start the therapy of macroprolactinoma, even when severe visual abnormalities are present.

Adolescent↗
PubMed1990

Effect of enhancement of endogenous cholinergic tone with pyridostigmine on growth hormone (GH) responses to GH-releasing hormone in patients with Cushing's syndrome.

Growth hormone (GH) secretion in patients with Cushing's syndrome is diminished to all the stimuli tested so far but the precise mechanisms through which this occurs are unknown. In order to investigate whether increased somatostatinergic tone might be responsible for this alteration, we studied the effect of pyridostigmine (120 mg p.o. at -60 min), which activates cholinergic synapses and thus suppresses hypothalamic somatostatin release on GH responses to GHRH (100 micrograms, i.v. at 0 min), in six patients with Cushing's syndrome. We found that while pyridostigmine markedly potentiated GH responses to GHRH, in all the normal subjects tested (n = 12), neither GHRH alone nor GHRH plus pyridostigmine elicited any increase in GH secretion in any of the patients with Cushing's syndrome. This suggests that chronic glucocorticoid excess induces marked alterations in the hypothalamic control of GH secretion.

Adult↗
PubMed1990

Evaluation of the pituitary-adrenal axis before, during and after pituitary adenomectomy. Is perioperative glucocorticoid therapy necessary?

Under the supposition that ACTH secretion will be compromised by surgical trauma, patients with pituitary adenomas undergoing transsphenoidal adenomectomy are frequently given corticoids, even though this therapy is controversial. We studied 10 patients with pituitary adenomas whose adrenocortical function was sufficient prior to surgery. The ACTH and cortisol levels rose significantly during surgery in all of these patients. Five patients completed a two-year postoperative follow-up period and their ACTH and cortisol values remained within normal limits. It may be that patients undergoing transsphenoidal surgery for pituitary adenomas do not need perioperative glucocorticoid treatment, since the hypophyseal-adrenal axis does retain its integrity.

Adenoma↗
PubMed1989

Arterial hypertension as a complication of prolonged ketoconazole treatment.

Two of 14 patients with Cushing's syndrome treated on a long-term basis with ketoconazole developed sustained hypertension. In both cases normal plasma and urinary free cortisol levels had been achieved following ketoconazole therapy, yet continuous blood pressure monitoring demonstrated hypertension 31 (patient 1) and 52 weeks (patient 2) after treatment. In patient 1, plasma levels of deoxycorticosterone and 11-deoxycortisol were elevated. In patient 2, in addition to an increase in both deoxycorticosterone and 11-deoxycortisol levels, plasma aldosterone values were raised, with a concomitant suppression of renin levels. Our findings show that long-term treatment with high doses of ketoconazole may induce enzyme blockade leading to mineralocorticoid-related hypertension.

Adolescent↗
PubMed1989

Rapid improvement of visual defects with parenteral depot-bromocriptine in a patient with a non-functioning pituitary adenoma.

The management of non-functioning pituitary adenomas with bromocriptine is controversial, and surgical treatment is usually prescribed when the visual field is affected. Here we report, what we believe to be the first case of a patient with a non-functioning pituitary adenoma who experienced normalization of visual field defects and a substantial improvement in visual acuity after the parenteral administration of depot-bromocriptine. The patient's tolerance to the drug was excellent. The results of the immunohistochemical study of the surgically removed tumor were negative for PRL, GH, LH, FSH, TSH and ACTH. In our opinion, the use of depot-bromocriptine may represent an alternative to surgery in patients with non-functioning pituitary adenomas associated with visual lesions.

Adenoma↗
PubMed1989

In vitro effects of ketoconazole on corticotrope cell morphology and ACTH secretion of two pituitary adenomas removed from patients with Nelson's syndrome.

The direct effects of ketoconazole on the secretion of ACTH by human pituitary adenoma cells from 2 patient with Nelson's syndrome were studied in vitro. Stereologically quantified, intracellular changes affect the surface density of the endoplasmic reticulum (it decreased by 73%), the volume density of the secretion granules (it decreased by 49%), and the volume density of lysosomes (it decreased by 67%). The hormone released in the culture medium decreased depending on the doses of ketoconazole used; 10 mumol/l decreased ACTH levels by 31%. These data show that ketoconazole induce marked changes on corticotrope morphology and ACTH secretion in pituitary cells obtained from patients with Nelson's syndrome.

Adenoma↗
PubMed1988

Contrasting features of insulin dependent diabetes mellitus associated with neuroectodermal defects and classical insulin dependent diabetes mellitus.

The Wolfram, or DIDMOAD, syndrome is a rare congenital disease that is associated with diabetes insipidus, insulin dependent diabetes mellitus of an early onset, bilateral optic atrophy and deafness. Urological disorders are usually present as well. We have studied nine patients belonging to five different families. All of the family members were HLA typed (including DR), and islet cell as well as antinuclear antibody determinations were carried out. Although individuals with insulin dependent diabetes mellitus are very prone to have either HLA-DR3 or -DR4 antigens, none of our patients had DR3 antigens and only one was DR4 positive. On the other hand, three of our patients were typed as HLA-DR2 positive. This antigen is uncommon in classical insulin dependent diabetes. In one of the families, the affected siblings did not share the same HLA haplotype. Islet cell and antinuclear antibodies were not found in any of the cases and six of the patients had a small, but significant, insulin secretory reserve. On the basis of some of the clinical features it was also possible to further distinguish between the DIDMOAD syndrome and the classical insulin dependent diabetes mellitus. The differences encountered between classical and DIDMOAD insulin dependent diabetes mellitus--the presence/absence of HLA linkage, HLA-DR2, -DR3 and -DR4 associations, islet cell or antinuclear antibodies, the tendency to ketosis and diabetic retinopathy--indicate that their etiopathogenies are triggered by distinct mechanisms.

Adolescent↗