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Temozolomide-Induced Shrinkage of Invasive Pituitary Adenoma in Patient with Nelson's Syndrome: A Case Report and Review of the Literature.

Kurowska M, Nowakowski A, Zieliński G, Malicka J, Tarach JS, Maksymowicz M, Denew P - Case Rep Endocrinol (2015)

Bottom Line: Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time.Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Medical University of Lublin, Lublin, Poland.

ABSTRACT
Introduction. Invasive tumours in Nelson's syndrome need aggressive therapy. Recent reports have documented the efficacy of temozolomide (TMZ) in the treatment of adenomas resistant to conventional management. Objective. The review of the literature concerning TMZ treatment of atypical corticotroph adenomas and a case study of 56-year-old woman who developed Nelson's syndrome. Treatment Proceeding. The patient with Cushing's disease underwent transsphenoidal adenomectomy followed by a 27-month-long period of remission. Due to a regrowth of the tumor, she underwent two reoperations followed by stereotactic radiotherapy. Because of treatment failures, bilateral adrenalectomy was performed. Then she developed Nelson's syndrome. A fourth transsphenoidal adenomectomy was performed, but there was a rapid recurrence. Five months later, she underwent a right frontotemporal craniotomy. Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time. Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement. To date, this is the first case of invasive corticotroph adenoma in Nelson's syndrome treated with temozolomide in Poland. Conclusion. In our opinion, temozolomide can be an effective treatment option of invasive adenomas in Nelson's syndrome.

No MeSH data available.


Related in: MedlinePlus

The assessment of tumour size (A, B) based on the MRI picture. The tumour volume (C) was measured using the computer program OsiriX. Frontal (A, C) and sagittal (B) scans.
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fig4: The assessment of tumour size (A, B) based on the MRI picture. The tumour volume (C) was measured using the computer program OsiriX. Frontal (A, C) and sagittal (B) scans.

Mentions: When the TMZ treatment started, the patient complained about recurrent headaches and blindness of the right eye (earlier, after the neurosurgery, she had light sensitivity and could see the contours of objects). MRI scans performed before TMZ therapy are presented in Figure 4. Initial maximal tumour dimensions were 3.441 × 3.916 cm in frontal (Figure 4(a): (A)) and 5.132 × 3.332 cm (Figure 4(a): (B)) in sagittal images and its volume was 16.2 mL (Figure 4(a): (C)).


Temozolomide-Induced Shrinkage of Invasive Pituitary Adenoma in Patient with Nelson's Syndrome: A Case Report and Review of the Literature.

Kurowska M, Nowakowski A, Zieliński G, Malicka J, Tarach JS, Maksymowicz M, Denew P - Case Rep Endocrinol (2015)

The assessment of tumour size (A, B) based on the MRI picture. The tumour volume (C) was measured using the computer program OsiriX. Frontal (A, C) and sagittal (B) scans.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4499620&req=5

fig4: The assessment of tumour size (A, B) based on the MRI picture. The tumour volume (C) was measured using the computer program OsiriX. Frontal (A, C) and sagittal (B) scans.
Mentions: When the TMZ treatment started, the patient complained about recurrent headaches and blindness of the right eye (earlier, after the neurosurgery, she had light sensitivity and could see the contours of objects). MRI scans performed before TMZ therapy are presented in Figure 4. Initial maximal tumour dimensions were 3.441 × 3.916 cm in frontal (Figure 4(a): (A)) and 5.132 × 3.332 cm (Figure 4(a): (B)) in sagittal images and its volume was 16.2 mL (Figure 4(a): (C)).

Bottom Line: Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time.Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, Medical University of Lublin, Lublin, Poland.

ABSTRACT
Introduction. Invasive tumours in Nelson's syndrome need aggressive therapy. Recent reports have documented the efficacy of temozolomide (TMZ) in the treatment of adenomas resistant to conventional management. Objective. The review of the literature concerning TMZ treatment of atypical corticotroph adenomas and a case study of 56-year-old woman who developed Nelson's syndrome. Treatment Proceeding. The patient with Cushing's disease underwent transsphenoidal adenomectomy followed by a 27-month-long period of remission. Due to a regrowth of the tumor, she underwent two reoperations followed by stereotactic radiotherapy. Because of treatment failures, bilateral adrenalectomy was performed. Then she developed Nelson's syndrome. A fourth transsphenoidal adenomectomy was performed, but there was a rapid recurrence. Five months later, she underwent a right frontotemporal craniotomy. Due to a rapid regrowth of the tumour, the patient did not receive gamma-knife therapy and was treated with cabergoline and somatostatin analogue for some time. Only TMZ therapy resulted in marked clinical, biochemical, and radiological improvement. To date, this is the first case of invasive corticotroph adenoma in Nelson's syndrome treated with temozolomide in Poland. Conclusion. In our opinion, temozolomide can be an effective treatment option of invasive adenomas in Nelson's syndrome.

No MeSH data available.


Related in: MedlinePlus