ergoline and Abdominal-Pain

We report the management of spontaneous ovarian hyperstimulation syndrome in a 23-year-old patient, diagnosed at 8 gestational weeks, in a context of moderate hypothyroidism. The etiology of spontaneous ovarian hyperstimulation syndrome should seek hypersecretion of glycoprotein hormones (hCG, TSH, FSH and LH) and/or mutation of FSH and LH receptors. It will eliminate an incipient ovarian neoplasia. The laparoscopic exploration can be done if diagnosis doubt persists. A diagnostic algorithm can be proposed.

Topics: Abdominal Pain; Adrenal Cortex Hormones; Adult; Cabergoline; Chorionic Gonadotropin; Ergolines; Female; Fibrinolytic Agents; Follicle Stimulating Hormone; Gestational Age; Graves Disease; Humans; Hypothyroidism; Luteinizing Hormone; Ovarian Hyperstimulation Syndrome; Pregnancy; Pregnancy Complications; Thyroidectomy; Thyrotropin

Dopamine agonists are effective in some patients with acromegaly and in this condition treatment is considered to be chronic. We describe two acromegalic patients who responded adequately to the long-acting dopamine agonist cabergoline, but surprisingly maintained normal GH and IGF-I levels once therapy was discontinued after 42 and 76 months because of possibly related side effects. A 32-year-old woman with mild acromegaly (IGF-I: 423 microg/l, GH after OGTT: 2.5 microg/l, adenoma 4 mm) was treated with cabergoline as primary therapy and reached safe GH levels (2 microg/l or less) and normal IGF-I levels with 3.5 mg cabergoline weekly. After 42 months of therapy the patient experienced a progressive decrease of libido, which she attributed to the intake of cabergoline. After stopping medication, serum levels of GH and IGF-I remained normal during the following 2.5 years. A 53-year-old man with moderate acromegaly (serum IGF-I: 547 microg/l, GH after OGTT: 5.9 microg/l, adenoma 7 mm) preferred cabergoline as primary therapy. Serum GH levels below 2 microg/l and normal levels of IGF-I were obtained with 3.5 mg cabergoline weekly. When the patient experienced severe stomach pains after 76 months of treatment, cabergoline was held responsible and discontinued. Serum GH and IGF-I did not increase again and stayed at the same level during a follow-up of 5.5 years. These two cases demonstrate that acromegalic patients with a good response to cabergoline may occasionally remain in remission after stopping therapy. This phenomenon has previously only been described in patients with a prolactinoma.

Topics: Abdominal Pain; Acromegaly; Adult; Biomarkers; Cabergoline; Dopamine Agonists; Drug Administration Schedule; Ergolines; Female; Human Growth Hormone; Humans; Insulin-Like Growth Factor I; Libido; Male; Middle Aged; Secondary Prevention; Time Factors; Treatment Outcome

We report a case of hepatolithiasis (intrahepatic stone) complicated by gram-negative sepsis in a 37 year old male with acromegaly being treated with octreotide. As a child, he had suffered a traumatic injury to his liver requiring the surgical repair of a laceration. This is the first reported case of hepatolithiasis during octreotide therapy. Gallstones and bile sludge are common side effects of octreotide therapy but rarely become symptomatic or require treatment. Hepatolithiasis is uncommon in western countries but is quite prevalent in East Asia and is often associated with a predisposing condition that causes intrahepatic bile stasis (eg. bile duct stricture). In addition to its known effect on gallbladder stasis, octreotide alters bile acid composition and may thus hasten intrahepatic sludge and stone formation. Extra caution should be taken in using octreotide or its long-acting analog in patients otherwise predisposed to intrahepatic bile stasis.

Topics: Abdominal Pain; Acromegaly; Adenoma; Adult; Anti-Bacterial Agents; Bile Ducts, Intrahepatic; Bilirubin; Cabergoline; Chemical and Drug Induced Liver Injury; Cholangiopancreatography, Endoscopic Retrograde; Cholelithiasis; Cholesterol; Ergolines; Gram-Negative Bacterial Infections; Hepatectomy; Humans; Insulin-Like Growth Factor I; Liver; Liver Diseases; Male; Octreotide; Pituitary Neoplasms; Postoperative Complications; Sepsis; Surgical Wound Infection