cosyntropin and Brain-Neoplasms

Glucocorticoids are the main drug used to control vasogenic edema in patients with brain tumor. Rapid GC tapering may not only decompensate intracranial pressure, but also unmask SAI, and some symptoms of SAI can be mistakenly attributable to increased intracranial pressure or side effects of chemotherapy and radiation therapy.. The University of Virginia Neuro-Oncology Database was reviewed from February 2002 to January 2006, and 5 neuro-oncology patients with clinical and laboratory evidence of SAI were identified.. In our experience, 1% of neuro-oncology patients treated with GC developed SAI. Symptoms resembled increased intracranial pressure or side effects of antineoplastic treatment.. A healthy index of suspicion for this complication and use of pharmacologic testing will help avert misattribution of symptoms of SAI and its deleterious consequences.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Aged; Brain Edema; Brain Neoplasms; Causality; Cosyntropin; Drug Administration Schedule; Female; Glucocorticoids; Humans; Hypothalamo-Hypophyseal System; Intracranial Hypertension; Male; Middle Aged; Patient Selection; Substance Withdrawal Syndrome

Tetracosactide is known to be used in brain tumours, but its action is difficult to evaluate clearly. Tetracosactide exerts analgesic, anti-emetic and anti-inflammatory effects and it reduces the oedema surrounding brain tumours. It is this latter effect which we have studied. We used a technetium-labelled cerebral marker, 99mTc HMPAO (Ceretec), and found that this functional exploration not only detects the presence of a brain tumour, but also measures regional cerebral blood flow. This marker is mainly used in intracerebral vascular diseases. Since february 1990, eighteen patients suffering from malignant brain tumour with pronounced perilesional oedema were selected and treated with tetracosactide for two days. With the help of 99mTc HMPAO scintigraphy the oedema was quantified, and the results obtained were interpreted. The initial results of this clinical experiment indicate that the phenomena observed were due to improved vascularization of the healthy peritumoral areas with resorption of oedema. This was a consequence of the direct tetracosactide action, and the higher the dose of this compound, the clearer its action.

Topics: Adult; Aged; Brain; Brain Edema; Brain Neoplasms; Cosyntropin; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Time Factors; Tomography, X-Ray Computed

Topics: Adrenocorticotropic Hormone; Adult; Brain Neoplasms; Cosyntropin; Female; Humans; Lymphoma, Non-Hodgkin; Tomography, X-Ray Computed

Topics: Adrenocorticotropic Hormone; Adult; Brain; Brain Neoplasms; Cosyntropin; Glioblastoma; Humans; Male; Necrosis; Radiotherapy