ECE2007 Poster Presentations (1) (659 abstracts)
Medial cerebral artery occlusion 25 years after cranial radiation therapy in acromegaly
Pietro Maffei 1 , Chiara Martini 1 , Martina Barban 1 , Marta Carli 1 , Renzo Manara 2 , Massimo Scanarini 3 , Renzo Mazzarotto 4 , Giorgio Meneghetti 5 , Carla Menegazzo 1 , Roberto Mioni 1 , Eugenio De Carlo 1 , Roberto Vettor 1 & Nicola Sicolo 1
1Department of Medical and Surgical Sciences, Padua, Italy; 2Department of Neuroradiology, Padua, Italy; 3Department of Neurosurgery, Padua, Italy; 4Department of Radiotherapy, Padua, Italy; 5Department of Neurology, Padua, Italy.
Introduction: Epidemiological studies indicate that patients with acromegaly have increased mortality rates for cardiovascular and cerebrovascular disease (CVD). Potentials risk factors for increased CVD include hypopituitarism and cranial radiation therapy (CRT).
Case Report: A 43-year-old acromegalic woman was admitted because of worsening headache, left lower facial numbness and left arm weakness. Two weeks later she developed a central palsy of the left 7th cranial nerve. Past medical history was remarkable for gigantism-acromegaly which was diagnosed at age 17. At that time a pituitary macroadenoma was partially removed by transsphenoidal surgery and few months later she underwent conventional radiation therapy (two-fields, 50 Gy, 25 sessions). The patient’s current medications were estroprogestin (since age 18), L-thyroxin (since age 39) and cortisone (since age 42). GH deficiency was also diagnosed (IGF-I 70 ug/L). Finally, a prothrombin mutation (G20210A) was discovered in family members including the patient.
Results: On examination there were a left lower facial palsy and bilateral cutaneous brownish of temporal regions. Laboratory investigations were uneventful for homocysteine, glucose and lipid metabolism. Thyroid and adrenal glands were regularly replaced. Intensive general (EKG; BP values; echocardiogram; 24-h Holter EKG; chest X-ray; abdominal US) and neurological study (carotid US; transcranial US; EEG; CT; MRI; MR-angiography; CT-angiography) disclosed several ischemic lesions of right parietal lobe, lenticular nucleus, anterior limb of internal capsule and occlusion of right medial cerebral artery near its origin. The diameter of right carotid artery was also reduced. Post-radiotherapy brain damage was visible by MRI. Atrial septal defect was excluded. The patient was treated with aspirin plus low dose heparin s.c. and neurological disturbances relieved completely.
Discussion: Life-long follow-up of acromegalic patients receiving CRT is essential so that early diagnosis of radiation-induced vascular damage can be made. In this particular context, treatment and monitoring of cerebrovascular thrombosis remain almost empiric.
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