Prolactinoma

Prolactinoma is one type of tumor of the pituitary gland. It is almost always non-cancerous. In this case, the pituitary gland overproduces prolactin in the body. There is no known cause. People most affected are under the age of 40. It is more common in women at a younger age; affected men are usually older. Prolcatinoma is rare in children.


Signs and Symptoms

Not everyone with prolactinoma will experience signs and symptoms. The effects are different for men and women, but there are a few that are similar.


Women:

• Irregular menstruation


• Milky discharge from breast when not pregnant or breast feeding
  
• Vaginal dryness noticed during intercourse

Men:

• Erectile dysfunction or impotence


• Loss of body hair


• Enlarged breasts
  

Both:

• Loss of interest in sex


• Headaches


• Infertility


• Low bone density


• Visual Disturbances
  

Women tend to notice symptoms earlier than men, so they rarely experience headaches and visual disturbances. When men detect symptoms, the tumors are usually larger, which leads to those symptoms because of pressure buildup.

Screening

Prolactinoma can be detected in blood tests because of the overproduction of prolactin. CT and MRI images are also helpful.

The above images were found at www.ent.uci.edu/endoscopic_pituitary_tumor.htm

Complications

If untreated, prolcatinoma can lead to vision loss because of pressure on the optic nerve. If the tumor becomes too large, it can effect other hormone productions of the pituitary gland. Women may experience osteoporosis and complications with pregnancy.


Treatment

The two major treatments for prolactinoma are oral medications and surgery. The oral medications given are dopamine agonists bromocriptine and cabergoline. Bromocriptine are more commonly given to women who are wanting or having children because of its proven safety rate. Medications are taken over a long period of time, but if these are ineffective the tumor is usually removed through surgery.

The above images are of a very severe prolactinoma that resulted in death. To find out more about this case, visit

http://www.endotext.org/neuroendo/neuroendo11b/index.html

Sources:

http://www.mayoclinic.com/

Bell's Palsy

If you wake up in the morning and one side of your face is sagging, that might be a bit scary. But, if you are experiencing these symptoms, it could be Bell's Palsy, a condition that usually has a complete recovery.



The symptoms are:

• paralysis on one side of the face
  
• facial droop
  
• difficulty making expressions
  
• pain near or in the ear of affected side
  
• sound louder on affectd side
  
• headache
  
• loss of taste
  
• change in tear and saliva production

So, what causes this? A nerve that controls facial muscles becomes inflamed/swollen and gets piched between bone. That pressure can damage the protective covering of the nerve and interfere in communication between the nerve and facial muscles.

The most common cause is the herpes simlpex virus, but the other viruses that cause chicken pox, shingles, and the Epstein-Barr virus (related to mononucleosis) are also culprits.

Pregnant mothers, diabetics, and those with upper respiratory infections are more at risk.

There are no specific lab tests to confirm diagnosis. Electromyography and CT or MR images are helpful.

Treatment:

Medications for treatment is not always necessary. If something is prescribed, it is most commonly corticosteroids to reduce swelling. Massage and moist heat applications are recommended.

Usually complete recovery is expected within a few months. Complications are rare, but if there is severe damage to the nerve then it may be irreversible. Also, misdirected regrowth of new nerve fibers may cause involuntary contractions.

For more information, please check out the mayoclinic website http://www.mayoclinic.com/

Images found at:

http://www.aurorahealthcare.org/

path.upmc.edu/cases/case112.html

Leigh's Disease

This will be my first of many blogs on pathology, and this one I find particularly depressing.

Leigh's disease (subacute necrotizing encephalomyelopathy) is a progressive neurological disease that degenerates the central nervous system. The sad part is that this rare disease is found in children who are diagnosed between 3 months and 2 years, though there have been few, very rare cases in adults.

Initial symptoms include:

• poor sucking ability
• can't hold head up
• loss of motor skills
• loss of appetite
• vomiting
• irritability
• crying
• seizures

After the disease progresses other symptoms are:

• weakness
• loss of muscle tone
• lactic acid build up in the body and brain that impairs breathing and kidney function
• heart problems

Diagnosis and Treatment:

Diagnosis is usually based on symptoms. There are also tests that show if there is a deficiency in pyruvate dehydrogenase, which would then be treated with a high fat low carb diet. Presence of lactic acidosis is also another symptom. Vitamins such as thiamine are prescribed and well as other medications to treat symptoms.

However, there is no definite cure, and the patients will usually die within 2 years of diagnosis, or by age 6. There have been rare cases of children living into their early teen years. Death is usually from respiratory failure.

In imaging, there are symmetrical patches that are usually on the deep grey matter, but it does not necessarily stay contained there. It is important to image the spinal cord, optic nerve, and peripheral nerve.

Intro

Welcome to my blog spot for CT/MR procedures. In the future I will be posting blogs on pathology that is related to what we are discussing in class at that time. So, please stay tuned for future entries!