Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

Medical Management of Patients With Brain Tumors.

Pruitt AA

Department of Neurology, University of Pennsylvania, 3 West Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA, amy.pruitt@uphs.upenn.edu.

OPINION STATEMENT: Patients with brain tumors require meticulous attention to medical issues resulting from their disease or its therapy. The following specific issues are the ones most frequently arising in the purview of neurologists: (1) Vasogenic edema: Corticosteroids should be used in divided doses in the minimum amount required to control symptoms and should be tapered as quickly as possible. Some patients may require long-term steroid supplementation, and symptoms of adrenal insufficiency should be investigated with 8 AM: cortisol measurement and treated with appropriate repletion. (2) Seizures: Patients with brain tumors should receive antiepileptic drugs only if they have had seizures, and the drugs should be chosen to minimize cognitive effects and interactions with concurrently administered chemotherapy. Levetiracetam is an excellent choice for patients with partial seizures and is available both orally and parenterally. Lamotrigine is another reasonable choice but requires slow titration. (3) Venous thromboembolism: All brain tumor patients should receive perioperative venous thrombosis prophylaxis with compression boots and enoxaparin or dalteparin. Lifelong treatment with low molecular weight heparinoids or warfarin is required for those developing venous thromboembolism. (4) Other problems: Long-term survivors of brain tumors should be monitored indefinitely for cognitive problems, endocrine dysfunction, and development of secondary neoplasms. Modafinil can improve mood and attention impairments.

Published 10 May 2011 in Curr Treat Options Neurol.
Full-text of this article is available online (may require subscription).

Articles on Addison's Disease published 9 May 2011:

The Role of Abiraterone Acetate in the Management of Prostate Cancer: A Critical Analysis of the Literature.   Eur Urol.

CONTEXT: The development of agents targeting androgen signalling holds promise for men with castration-resistant prostate cancer (CRPC). OBJECTIVE: The emerging role of abiraterone acetate (AA), a novel, orally administered androgen synthesis inhibitor, is critically analysed. EVIDENCE ACQUISITION: Data were acquired from critically important original research published in peer-reviewed literature or presented at conferences conducted by the American Society of Clinical Oncology and the ... [Abstract] [Full-text]

Articles on Addison's Disease published 6 May 2011:

Critical Illness-Related Corticosteroid Insufficiency in Patients with Cirrhosis and Variceal Bleeding.   Clin Gastroenterol Hepatol.

BACKGROUND & AIMS: Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. METHODS: Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and ... [Abstract] [Full-text]

Articles on Addison's Disease published 4 May 2011:

Hormonal disturbances in visceral leishmaniasis (kala-azar).   Am J Trop Med Hyg, 84(5): 668-73.

Abstract. This study presents a cross-sectional analysis of the hormonal alterations of patients with visceral leishmaniasis. The diagnosis was established by the bone marrow aspiration and polymerase chain reaction test. Primary adrenal insufficiency was observed in 45.8% of patients; low aldosterone/renin plasma ratio in 69.4%; low daily urinary aldosterone excretion in 61.1%; and low transtubular potassium gradient in 68.0%. All patients had normal plasma antidiuretic hormone (ADH) ... [Abstract] [Full-text]

Articles on Addison's Disease published 2 May 2011:

Relative Adrenal Insufficiency in the Critical Care Setting: Debunking the Classic Myth.   World J Surg.

BACKGROUND: Classic teaching states that chronic adrenal insufficiency is associated with hyponatremia, hyperkalemia, hypercalcemia, hypoglycemia, and eosinophilia. We hypothesize that these diagnostic markers do not predict relative adrenal insufficiency (RAI) in the critically ill or injured patient. METHODS: Chart review of surgical, trauma, and medical patients admitted over 7 years to a critical care unit was performed to evaluate cortisol levels drawn for suspicion of RAI, which was ... [Abstract] [Full-text]

Articles on Addison's Disease published 20 April 2011:

Primary antiphospholipid antibody syndrome presenting with adrenal insufficiency in a child: case report and review of literature.   Lupus.

A 7-year-old boy presented with adrenal insufficiency. He subsequently developed venous thrombosis in the limbs and was diagnosed with primary antiphospholipid syndrome (PAPS) based on clinical and laboratory parameters. Both adrenals were normal on imaging. He required thrombolysis and anticoagulation. The progressive course of PAPS was controlled with methylprednisolone. There are few reports of PAPS in pediatric patients, and associated adrenal involvement is rare. The unusual presentation, ... [Abstract] [Full-text]

Articles on Addison's Disease published 19 April 2011:

Comparison of low-dose and high-dose cosyntropin stimulation testing in children.   Pediatr Int, 53(2): 175-80.

Background:  There is no consensus among pediatric endocrinologists in using low-dose (LD) versus high-dose (HD) cosyntropin to test for secondary/tertiary adrenal insufficiency. This paper compares LD and HD cosyntropin stimulation testing in children for evaluation of hypothalamic-pituitary-adrenal axis (HPAA) and suggests a new peak cortisol cut-off value for LD stimulation testing to avoid false positivity. Methods:  Data of 36 children receiving LD (1 µg) and HD (249 µg) ... [Abstract] [Full-text]

Articles on Addison's Disease published 18 April 2011:

Clinical and MRI characteristics of acute encephalopathy in congenital adrenal hyperplasia.   J Neurol Sci.

Acute encephalopathy in childhood is frequently associated with common infections, especially in East Asia. Various types have been identified although many cases remain unclassified. Congenital adrenal hyperplasia (CAH) is an autosomal recessive disease presenting impairment of cortisol biosynthesis. We report three CAH children with acute infection-related encephalopathy. They exhibited disturbed consciousness or seizures, which did not improve after glucocorticoid administration, accompanied ... [Abstract] [Full-text]

A young boy with diffuse hyperpigmentation and delayed puberty.   Eur J Pediatr, 170(5): 671-3.

An 18-year-old male patient had presented with diffuse hyperpigmentation after birth and with adrenal insufficiency syndrome since childhood. After puberty, no secondary sexual signs developed. Laboratory examination showed an extremely high concentration of serum triglycerides (9.14 mmol/L) and plasma adrenocorticotropic hormone (>275 pmol/L), however, a low concentration of plasma free cortisone (<25.1-67.6 nmol/L). Abdomen computed tomography detected atrophy of both adrenals glands. [Abstract] [Full-text]

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