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- Assistant Professor, Weill Cornell Medicine-Qatar [1]
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- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar E-mail: [email protected] [1]
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar [1]
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar [1]
- Diabetes and Endocrine Department, Hamad Medical Corporation, Doha, Qatar Email: [email protected] [1]
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Successful medical management of a pituitary macroadenoma with features of resistant acromegaly and hyperprolactinemia using pasireotide
Background: The somatostatin analog pasireotide is used for the treatment of acromegaly after the failure of surgery and/or first-line medical treatment.
Case Presentation: A 48-year-old male reported that during a workup for obesity in his home country hyperprolactinemia was diagnosed and a 3.5 × 3.5 cm pituitary macroadenoma was identified on pituitary MRI. He received cabergoline for 6 months; then he was lost to follow-up. He presented at our Endocrine clinic 2 years later for treatment of obesity (BMI 49.5 kg/m2). Biochemical workup revealed that in addition to hyperprolactinemia (7237 [normal: 85–323 mIU/L) he had acromegaly evident by elevated insulin-like growth factor 1 (IGF-1) level (450 [normal: 88–210 µg/L]) and a positive growth hormone suppression test secondary hypothyroidism and secondary hypogonadism. Pituitary MRI showed that the adenoma encased parts of the left and right internal carotid arteries and encroached on the optic chiasm. Surgical excision was therefore not feasible. He was treated with cabergoline and later long-acting release (LAR) octreotide. Prolactin levels were reduced with cabergoline but IGF-1 levels did not respond to octreotide and it was discontinued. The patient abandoned radiotherapy after two sessions. He was started on LAR pasireotide 40 mg every 4 weeks and continued on cabergoline 0.5 mg per week. His biochemical response was dramatic with a near normalization of IGF-1 levels in 3 months. After 6 months from starting pasireotide we increased cabergoline dose from 0.5 mg/week to 3 mg/week. Three months later IGF-1 level was normalized. The patient developed type 2 diabetes as a side effect of pasireotide; however this was well-controlled with medications.
Conclusions: The case suggests that pasireotide can provide marked biochemical improvement in acromegaly after the failure of both cabergoline monotherapy and cabergoline plus octreotide. This further confirms a potentially efficacious treatment regimen in treatment-resistant acromegaly with hyperprolactinemia.
Science of quality improvement – from vision to reality: Experience from a leading academic healthcare center in Qatar
Quality improvement and patient safety are cornerstones to the delivery of effective patient care. The introduction of a quality improvement curriculum for medical students and trainee physicians can have a significant effect on their understanding of the science of improvement and its role in improving the quality of healthcare delivery and patient safety. The article describes the development and implementation of a quality improvement curriculum for trainee physicians in the department of internal medicine at a tertiary care center in Qatar through online training courses workshops didactic activities and trainee-led quality improvement projects.
Demographics, clinical characteristics, and recurrence rate of patients with primary spontaneous pneumothorax at a tertiary care center in Qatar
Introduction: Primary spontaneous pneumothorax (PSP) is a common medical emergency. Its treatment includes simple observation needle thoracentesis pleural catheter video-assisted thoracoscopy (VATS) and open surgery. We aimed to establish the demographic clinical characteristics and 12-month recurrence rate of patients with PSP in four hospitals of the Hamad Medical Corporation Qatar.
Materials and methods: We conducted a retrospective analysis of patients >14 years old who were admitted with PSP from January 1 2017 to December 31 2019. The patients were followed up for 12 months for the recurrence of PSP.
Results: Out of 246 patients enrolled in this study 223 (90.7%) were males and 23 (9.3%) were females. Their mean age was 29.1 ± 9.59 years and their mean body mass index (BMI) was 21.7 ± 4.22 kg/m2. Of these 123 (51.2%) patients were smokers. Chest pain was the most common presenting complaint (82.5%). A total of 59 (23.98%) patients had a small pneumothorax whereas 187 (76.01%) patients had a large pneumothorax.
Among the patients with small pneumothorax 16 (28.33%) were managed through observation alone 2 (3.33%) required needle aspiration 15 (25%) required pleural catheter insertion and 26 (44.06%) underwent surgical intervention for management. Out of 187 patients with large pneumothorax 16 (8.6%) were managed through observation 7 (3.76%) required needle aspiration 73 (38.1%) required pleural catheter insertion and 91 (48.6%) underwent surgery.
During the 12-month follow-up 58 patients were lost to follow-up and 5 patients (5/188; 2.66%) presented with a recurrence of PSP. Out of 108 patients who underwent VATS 2 (1.85%) had a recurrence of PSP.
Conclusion: PSP is more common in males than in females with a tendency for younger age onset. The recurrence rate of PSP in our study was 2.66%. Furthermore the recurrence rate in our patients who underwent VATS was 1.85%. Prospective studies are warranted to compare the success rates of different treatment interventions.