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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The evidence of the effects of combined oral contraceptives (COCs) on mortality and morbidity is reviewed. All the 11 case-control studies published since 1980 reported and approximate halving of endometrial cancer risk among COC users. The CASH study showed that the protective effect was apparent after 12 months' use, and users had 40% of the risk of non-users after 2 years' use. A study showed that 5 patterns of self-perceived prolonged, heavy, frequent, irregular, or painful bleeding during menstruation were reported less frequently in COC users than in users of other methods. Benign breast disease is rarer, and functional ovarian cysts are less frequent in COC users. Lower-dose preparations may carry a lower risk of myocardial infarction. Smoking possibly potentiates the risk associated with oral contraceptive (OC) use, and it is a major risk factor for myocardial infarction. The Oxford/FPA study found a 2-3-fold increase in incidence of non-haemorrhagic stroke among current OC users. The epidemiologic data on the current risk of venous thromboembolism in relation to OC use are equivocal. New lower dose COCs have a smaller adverse effect on the lipid profile: they cause a smaller increase in low density lipoprotein cholesterol (LDL) and a variable but smaller decrease in high density lipoprotein cholesterol (HDL). The large CASH study, based on 2088 cases, found a significantly elevated relative risk (2.7) of breast cancer, but only in women who had used the OC for at least 11 years. Of 6 case-control studies of hepatocellular carcinoma and OC use published since 1983, all but one showed a large elevated relative risk of around 4-fold. Delayed return of fertility has been observed in nulliparous women 30 who had 2 years; continuous exposure to COCs, although this may not be associated with low-dose, modern OCs. Malignant melanoma, pituitary adenoma, gallbladder disease, and chronic inflammatory bowel disease have been possibly associated with adverse side effects, but results are so far inconclusive.
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PMID:Combined oral contraceptives: risks and benefits. 832 3

Pituitary apoplexy has been reported as a rare complication of combined tests and of TRH administration in prolactinomas. A 54-year-old man with a pituitary macroadenoma had a single injection of 100 micrograms GnRH. Twenty minutes later he complained of increasing headache and vomited. These symptoms settled spontaneously and were attributed to the pharmacological effects of GnRH. Five hours later he was found to be blind and disorientated without spontaneous complaint. Emergency CT showed a large adenoma with central necrosis, consistent with pituitary apoplexy. An urgent surgical decompression was carried out and necrotic haemorrhagic debris removed. Baseline bloods revealed non-pulsatile FSH of 40 U/l with LH 0.3 U/l with no hormonal response to GnRH administration, but the sequence of events strongly suggests a causal relationship between this and pituitary apoplexy. To our knowledge this is the first time that GnRH administration has been associated with pituitary apoplexy of a glycoprotein secreting pituitary adenoma.
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PMID:Pituitary apoplexy and sudden blindness following the administration of gonadotrophin releasing hormone. 782 63

Between 1970 and 1989, 31 patients with a diagnosis of giant pituitary adenoma were referred to the London Regional Cancer Center. Giant pituitary adenoma was defined in terms of extension in excess of 40 mm from the midpoint of the jugum sphenoidale. The diagnosis was made surgically in 30 patients and clinically in one. Tumor extent and dimensions were obtained from operative reports and/or radiological scans computed tomography or magnetic resonance imaging. Mean follow-up was 8 years. Initial treatment consisted of surgery alone (4 patients), radiotherapy alone (2 patients) and combined surgery-radiotherapy (25 patients). One patient underwent a needle biopsy for histological confirmation and was grouped with the radiotherapy alone subset. Four of the six patients who received single modality treatment failed initial treatment (three surgery and one radiation). In contrast only 3 of the 25 patients treated with combined surgery-post-operative radiotherapy progressed despite the fact that all patients had gross residual disease post-operatively and that 43% of these patients received radiotherapy based on the post-operative rather than the pre-operative tumor extent. With subsequent salvage, overall tumor control amongst the 31 patients was 93.5%. Complications in general were minimal although one acromegalic patient sustained a unilateral internal capsular cerebrovascular accident year post treatment. In summary, combined modality treatment with initial surgical debulking followed by radiotherapy in the dose range of 4500-5000 cGy over 25 fractions yields tumor control rates in giant pituitary adenomas similar to those of smaller pituitary adenomas without undue morbidity.
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PMID:Giant pituitary adenomas: role of radiotherapy. 845 86

A case of pituitary adenoma which had progressed from subclinical pituitary apoplexy to subacute pituitary apoplexy on the occasion of cerebral angiography is reported. A 29-year-old man, complaining of bitemporal hemianopsia, was admitted to our department. Plain skull X-p revealed enlargement and double floor of the sella turcica. No abnormal calcification was revealed. CT demonstrated an isodensity mass with a diameter of 4 x 4 cm, and with ring enhancement in the suprasellar region. The mass extended from the intrasellar region to the suprasellar region and had a signal of high intensity on T1-weighted images. Endocrinological examination revealed hyperprolactinemia with a serum level of 422 ng/ml and normal reaction of anterior pituitary hormones. On 3rd March, digital subtraction angiography with 5F catheter was performed with the patient under sedation. The contrast medium was ioxaglic acid (Hexabrix 320). A volume of 6 ml with a speed of 4 ml per second was injected for the internal carotid angiogram. A total volume of 60 ml was used. Serum saline with 10 unit per ml of heparin sodium was also used for flushing. During angiography, the patient's blood pressure was 125/60-115/60mm Hg. DSA revealed upward displacement of the proximal portion of the anterior cerebral artery, pocket formation, and staining of the tumor capsule. Six hours later, he complained of retroorbital headache. Next morning, he noticed complete lack of left visual acuity. On 7th March, right visual acuity degenerated to blindness. CT revealed that the mass had increased its density. With bifrontal osteoplastic craniotomy, the tumor with marked intratumoral hemorrhage was resected. Its histology was chromophobe adenoma. The patient's right visual acuity improved rapidly. On the occasion of cerebral angiography, we could observe that subclinical pituitary apoplexy deteriorated to subacute pituitary apoplexy. Rosenbaum postulated that injection of contrast media increased intravascular pressure leading to pituitary apoplexy. At present, we cannot postulate increased intravascular pressure with 5F catheter and DSA. We cannot rule out that, with underlying subclinical pituitary apoplexy, hemorrhagic infarction due to contrast media and the anti-coagulate effect of heparin sodium accelerated the intratumoral bleeding. Subclinical pituitary apoplexy is a vulnerable state because of its aggravation to symptomatic apoplexy under mild stress. We emphasize that an operation should be performed as early as possible in the case of subclinical pituitary apoplexy.
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PMID:[A case of pituitary adenoma progressing to pituitary apoplexy on the occasion of cerebral angiography]. 869 76

Pituitary apoplexy is an acute hemorragic or ischemic infarction in pituitary adenomas. The incidence in our series was 6.5%. Clinical diagnosis can often be difficult as the patient is frequently unaware of an existing adenoma (seven out of 11 patients). Therefore, the classic features of the syndrome must be known. They include sudden headaches, impairment of consciousness, endocrinological disturbances and sudden visual deterioration or oculomotor palsies. In this retrospective study from 1987 to 1994 of 14 patients presenting pituitary apoplexy there were 11 cases with visual abnormalities. Oculomotor palsies were more common (82%) than chiasmatic impairment (54.5%) and often revealed pituitary adenoma. CT-Scan and MRI examinations led to diagnosis, and emergency treatment (surgical removal by rhinoseptal approach or less often medical treatment) generally led to a regression of visual disturbances.
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PMID:Ophthalmologic aspects of pituitary apoplexy. 874 54

Obstruction of the internal carotid artery by a pituitary tumor is a rare occurrence, particularly in the absence of pituitary apoplexy. A cas of occlusion of the right internal carotid artery caused by a nonhemorrhagic pituitary adenoma is reported. The patient presented with a 3-month history of headaches and a progressive loss of vision in his right eye, leading to sudden complete right-sided blindness on the day of admission. Except for the visual system, the patient's clinical examination revealed nothing remarkable. There was complete restoration of blood flow in the internal carotid artery after emergency transsphenoidal resection of the tumor was performed. The patient's vision also substantially improved shortly after the surgery. Neurodiagnostic correlation, using various imaging studies, is presented. This cas also demonstrates the importance of using magnetic resonance imaging with and without contrast to demonstrate complete occlusion or thrombosis in the affected vessel.
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PMID:Nonhemorrhagic pituitary macroadenoma producing reversible internal carotid artery occlusion: case report. 884 74

A 45 year old woman with hirsutism was found to have classic biochemical features of ACTH dependent Cushing's disease, with partial cortisol suppression in response to dexamethasone. As no pituitary adenoma could be visualised by CT or MRI, she proceeded to bilateral simultaneous inferior petrosal sinus sampling before possible surgery. During the course of this procedure she had a stroke affecting the brainstem at the level of the pontocerebellar junction. This complication of petrosal sinus sampling has been previously described but is not widely recognised; the procedure should only be undertaken when results of less invasive tests are equivocal.
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PMID:A neurological complication of inferior petrosal sinus sampling during investigation for Cushing's disease: a case report. 915 15

A 68-year-old man with coronary artery disease was admitted for chest pain and ventricular tachycardia. After electric cardioversion, therapeutic heparinization was started for myocardial ischemia and nontransmural infarction. On day 3, headache and fever developed, followed by an altered sensorium and hyponatremia. Infectious etiology for the fever was excluded, and results of computed tomography of the brain were normal. Later magnetic resonance imaging (Day 10) demonstrated a pituitary macroadenoma with hemorrhage. Treatment for panhypopituitarism with stress-dose steroids stabilized the patient, and the fever and hyponatremia resolved. Transsphenoidal resection of the pituitary adenoma was performed without incident. This is the first reported case of pituitary apoplexy after heparin anticoagulation for acute myocardial infarction, although chronic anticoagulation in other settings has been reported as a precipitant of apoplexy. The uncommon presentation of a "central" fever and confusion in a patient with previously undiagnosed adenoma posed a diagnostic challenge. Subtle presentations of panhypopituitarism, knowledge of which should lead to suspicion and early diagnosis of pituitary apoplexy, will prevent anticoagulant-induced central nervous system catastrophes and potential fatalities.
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PMID:Heparin therapy for myocardial infarction: an unusual trigger for pituitary apoplexy. 936 41

A case of pituitary apoplexy occurring after Gd-DTPA-administration for contrast enhanced MRI in a patient with an hGH-producing macro-adenoma is presented. Within days the initially increased hGH level fell to the normal range, the oral glucose tolerance test (OGTT) showed a normal suppression of hGH and complete anterior pituitary insufficiency developed. At this time repeated MRI suggested a haemorrhagic infarction of the macro-adenoma. Fourteen months later re-examination confirmed spontaneous cure of the acromegaly, improvement of adenopituitary function and shrinkage of the sellar content. The causal linkage between the pituitary adenoma apoplexy and Gd-DTPA-administration is unclear. It might be due to contrast induced blood pressure and endothelial permeability changes, possibly promoted by pre-existing diabetes mellitus associated vasculopathy.
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PMID:Pituitary apoplexy with spontaneous cure of acromegaly and its possible relation to Gd-DTPA-administration. 940 63

Treatment of prostatic cancer with GnRH agonist is a medical alternative to surgical castration, although hyperstimulation of the tumor can occur. We describe an unusual unwanted effect of such a treatment which unmasked a clinically silent gonadotroph adenoma. A 62-year-old man developed after the first injection of leuprorelin-depot a sudden intracranial hypertension, which was related to apoplexy of an unknown pituitary adenoma. Its gonadotroph origin was recognized after surgery by immunocytochemistry. Retrospectively, the tumor was shown to secrete in vivo both FSH and LH when on therapy with the agonist, demonstrating the lack of desensitization. Testosterone levels were also markedly and sustainly high when on therapy, a particularly unwanted effect in prostatic cancer. As gonadotroph adenomas occur in men in the same age group as prostatic cancer, the question is raised whether hormonal testing and pituitary imaging should be performed before starting a therapy with GnRH agonist in men.
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PMID:Pituitary apoplexy of a gonadotroph adenoma following gonadotrophin releasing hormone agonist therapy for prostatic cancer. 941 12


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