Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Overnight metabolic studies in 39 poorly controlled insulin-treated diabetic patients aged 9 to 66 years showed hypoglycaemia (blood-glucose less than 2 mmol/1) in 22 patients; it lasted 3 h or more in 17. Hypoglycaemic symptoms were very mild or absent, but 19 patients had other features of overtreatment with insulin. These included lethargy, depression, night sweats, morning headaches, fits (3 patients), glycogen-laden hepatomegaly (3), and acquired tolerance to high doses of insulin (mean 1 u/kg/24 h). The best clinical clue to recurrent nocturnal hypoglycaemia was the intermittent occurrence of symptoms, however "mild" and infrequent these appeared to be. Reduction of insulin by a mean of 25% in these patients (without change of species) did not result in loss of overall control; 1 patient with recurrent ketoacidosis was stablished on 40% of his initial dose. It is difficult, sometimes impossible, to achieve good overnight control with conventional once or twice daily insulin therapy. Since patients readily become tolerant of low blood-glucose levels, reliance on urine tests and symptoms of hypoglycaemia as a guide to dosage easily produces a spiral of overtreatment.
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PMID:Unrecognised nocturnal hypoglycaemia in insulin-treated diabetics. 8 75

A boy aged 9 years and 8 months was evaluated for headache and an enlarged sella. His neurological status and visual fields were normal. After injection of radiographic contrast agent, computerized axial tomography showed evidence of an intrasellar tumor. The most striking endocrine abnormalities were growth hormone insufficiency after arginine infusion and after insulin-induced hypoglycemia, and excessively elevated prolactin levels ranging between 1220 ng/ml and 1560 ng/ml. A slightly granulated, acidophilic pituitary adenoma was selectively removed by the trans-sphenoidal approach. The function of the anterior pituitary improved post-operatively. Growth hormone secretion after insulin-induced hypoglycemia returned to normal, and the basal serum prolactin levels decreased, but are still three times higher than normal.
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PMID:Prolactin-producing pituitary adenoma in a 9 year old boy. 21 87

Four episodes of acute left hemiparesis occurred in three pediatric-age, insulin-dependent diabetic patients. Each had a concomitant respiratory tract infection and headache, but no obvious signs of systemic hypoglycemia. No cerebral abnormalities were demonstrated by angiography or computerized tomography. The clinical course was benign, with slow but complete resolution of neurologic abnormalities within 8 to 24 hours of onset, and no further neurologic complaints in a 7- to 16-month follow-up.
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PMID:Acute hemiparesis in juvenile insulin-dependent diabetes mellitus (JIDDM). 57 16

A young diabetic man with recurrent attacks of headache, dizziness, and blurred vision who was originally thought to have episodes of hypoglycaemia, underwent investigation for the possibility of an occlusive cerebrovascular disease; and eventually was operated upon for vertebrobasilar insufficiency. The young age, the degree of occlusive disease, the clinical picture, and the surgical results in this patient on the one hand, and the scanty literature on the other prompted this report.
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PMID:Atherosclerotic occlusive disease of the vertebrobasilar system in young adults and its surgical consideration. 74 31

It is not common to have experienced the nasopharyngeal extension of pituitary adenomas. Recently we have experienced such a case. A man, aged 18, height 168 cm, weight 66 kg, who admitted to the hospital with the complaints of headache, left nasal obstruction, loss of visual acuity and defect of his temporal fields. On examination of both fundi there was primary optic atrophy. At this time large tumor could be seen in the nasopharyngeal cavity. Plain X-ray showed that the pituitary fossa was definitely enlarged and that there was considerable destruction of the sella and the clivus. Definite soft tissue mass could be visualised clearly by tomography. Via transoral and transsphenoidal approach, total removal of the nasopharyngeal tumor and intracapsulary subtotal resection of the tumor were performed. Microscopical examination established the diagnosis of chromophobe adenoma. On postoperative examination of hypothalamopituitary function he had no responces to insulin hypoglycemia and arginine infusion in growth hormone. 60Co irradiation, totally 6,000 rad, was given. Two years postoperatively he showed fairly good deal of improvement of his visual field defect. There was no serious complaints other than visual impairment on the left eye.
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PMID:[Nasopharyngeal extension of a large chromophobe adenoma of the pituitary (author's transl)]. 98 20

Side effects of octreotide may be local, biochemical, gastroenterological, or endocrinological. Local pain at the injection site occurs frequently, but rarely lasts more than 15 minutes and often resolves with continued therapy and may be improved if the vial is warmed prior to injection. No long-term hematological or biochemical abnormalities have been described. Despite initial diarrhea in some patients, no change in circulating fat-soluble vitamins has been consistently reported. Antibodies to octreotide have been described, but are rare. Abdominal pain or diarrhea can occur at the beginning of therapy. These symptoms rarely persist and are minimal if the injections are timed between meals, but this may increase the incidence of gallstones. Gallstones occur with increased frequency. Gastritis has been described as being an invariable consequence of long-term treatment with octreotide. We have found the incidence to be increased in patients on octreotide, but this is not invariable. Hypoglycemia may be exacerbated in some patients with insulinoma because of glucagon suppression. Small numbers of patients on octreotide for acromegaly have developed hypoglycemic. Conversely, carbohydrate tolerance may temporarily worsen because of insulin suppression and rarely oral hypoglycemia drug therapy may become necessary. Most frequently, carbohydrate tolerance does not deteriorate. In some patients with acromegaly, pituitary tumor size may continue to increase despite continued therapy. Last, there is the theoretical risk of addiction to a compound which may act through opiate receptors and considerably alleviates headache in some patients with pituitary tumor. Overall, despite the multiplicity of theoretical side effects, the majority of patients tolerate octreotide well, with no serious untoward effects.
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PMID:Proceedings of the discussion, "Tolerability and safety of Sandostatin". 151 39

We studied escalating doses of recombinant human interleukin-1 beta (IL-1 beta) alone and after a myelosuppressive dose of 5-fluorouracil (5-FU) in patients with gastrointestinal cancer. Transient neutropenia, monocytopenia, and lymphocytopenia were observed followed by a 1.3- to 6.0-fold (mean, 3.46-fold) dose-dependent neutrophil leukocytosis (P less than .00001) on the days of IL-1 beta administration. Increases in platelet counts were observed at a median of 14 days (range, 6 to 23) after IL-1 beta administration. Transient hypoglycemia, rebound hyperglycemia, elevations in serum cortisol, and C-reactive protein were observed. Side effects included fever, rigors, and headache in the majority of patients. Hypotension was observed in three of five patients at the highest dose level (0.1 micrograms/kg) and was dose-limiting. Fewer days of neutropenia were noted after 5-FU plus IL-1 beta than after 5-FU alone; however, this difference did not reach statistical significance. These data show that IL-1 beta has stimulatory effects in human hematopoiesis.
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PMID:A phase I trial of recombinant human interleukin-1 beta alone and in combination with myelosuppressive doses of 5-fluorouracil in patients with gastrointestinal cancer. 188 14

To better understand and treat painful conditions, one needs to identify the cause, discover the source, and develop knowledge of peripheral and central pain transmission; headaches are no exception. The development of appropriate animal models is important. Accordingly, we have reviewed the anatomy, neurochemistry, electrophysiology, and pharmacology of the trigeminovascular system in experimental animals and emphasized whenever possible the relevance of this final common pathway to migraine, cluster, and other headache syndromes in humans. For example, based on recent anatomic dissections, the pericarotid cavernous sinus plexus was suggested as an important focus to investigate cluster headache pathophysiology. This plexus is an anatomic point of convergence for the nerves giving rise to the signs of sympathetic and parasympathetic activity and sensory symptoms that develop in cluster patients. As in other nociceptive systems, trigeminovascular axons assume at least two important roles. One concerns the transmission of nociceptive information. Electrophysiologic evidence supports the trigeminal nucleus caudalis as an important site for the convergence of visceral (vessel) and somatic (forehead) inputs to mediate the referral of vascular pain to superficial tissues. A second important role concerns the initiation of local increases in blood flow and enhanced protein permeability (sterile inflammation) via the axonal release of vasoactive neuropeptides. Plasma extravasation develops within the dura mater following trigeminal stimulation. Extravasation can be blocked by the administration of ergot alkaloids or sumatriptan, a new serotonin-like agonist, and a prejunctional (neuronal) mechanism of action for these drugs (such as blockade of release) was suggested based on experimental evidence. Whether vasoconstriction also relates to the therapeutic efficacy remains to be determined. As in other organ systems, real or threatened tissue injury provides an important stimulus for depolarizing sensory fibers. The stimulus may come from external conditions such as reduced blood flow or hypoglycemia. The brain may also possess intrinsic neuronal mechanisms by which nociceptors may be synthesized (e.g., glutamate-induced neurotoxicity, seizures). Molecules of relevance include bradykinin, prostaglandins, leukotrienes, and potassium. Experimental evidence was presented demonstrating that the trigeminal nerve mediates hyperemia within cortical gray matter by axon-reflex like mechanisms. An important role for this nerve was established during the hyperemic period of recirculation after ischemia or during severe hypertension above the limits of autoregulation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Basic mechanisms in vascular headache. 217 82

The authors report a case of recurrent pituitary adenoma, which changed its endocrinological function from GH producing to non-functioning. A 37-year-old woman was admitted to our hospital complaining of headaches, amenorrhea and acromegalic features. Skull X-rays showed marked ballooning of the sella turcica and mild thickening of the calvarium. X-rays of the hands and feet revealed moderate acromegalic changes. On pneumoventriculography, the tumor elevated the floor of the third ventricle. The serum GH level was 29.3 ng/ml, which did not respond to insulin induced hypoglycemia. Radical removal of the tumor was performed through a right frontal craniotomy. Histologically, it was diagnosed as a pituitary eosinophilic adenoma. Immunostains revealed the presence of many GH positive cells in the adenoma. Since the post-operative GH levels were still high (12-16 ng/ml), irradiation to the sellar region was carried out. The serum GH concentration gradually decreased to the normal level in one year after the irradiation. At that time no sellar tumor could be found on CT scans. The patient had been well for six years until she noticed hearing impairment of her right ear. She was re-admitted about seven years after the first admission because of cerebellar ataxia and hearing loss. CT scans revealed a recurrent tumor extending from the sellar region to the right cerebello-pontine angle. Serum GH levels on admission were within normal range (3-4 ng/ml). The tumor was partially removed by suboccipital craniectomy. Pathologically, the tumor was reported as a pituitary chromophobe adenoma. With immunostains, no GH positive cells could be found in the adenoma.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of growth hormone-producing adenoma presenting as a non-functioning tumor at recurrence]. 301 91

An 11-year-old male presented with a 2-year history of headache and lethargy. Serum PRL was elevated at 14,000 mU/l and computerized tomography showed a pituitary macroadenoma. Visual fields and fundi were normal and the testes showed early pubertal changes. There was normal responsiveness of serum cortisol but absence of GH response to hypoglycaemia. After bromocriptine therapy for 4 months serum PRL had fallen to 90 mU/l and the tumour was not visible on repeat computerized tomography. After 7 months treatment, repeat pituitary function testing showed restoration of GH response to hypoglycaemia. Treatment with bromocriptine was continued and there was spontaneous progression of normal puberty; the serum testosterone continued to rise, and height maintained the 50th centile. Bromocriptine therapy should be considered as initial therapy in the management of prolactinomas in prepubertal patients.
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PMID:Normal growth and pubertal development during bromocriptine treatment for a prolactin-secreting pituitary macroadenoma. 366 15


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