Friday, July 20, 2012

Magic Conference: Managing Medications and Aftercare of Treatments

MEETING NOTES : Dr. Salvatori, 2


Meeting Created: July 20, 2012 1:33 PM

Lombard


Managing Medications and Aftercare of Treatments



It is crucial to monitor your treatments and aftercare of treatments when living with a pituitary
disorder. Dr. Salvatori will discuss the importance of these issues so you will be aware of how
to manage your pituitary disorder. A simple diagnosis does not mean that medications may be
altered or changed in the future. This segment will assist you with information on how to
manage your future. 


Usually prolactinoma easier to treat


Therapy

  • Larger the tumor, less likely surgery will work
  • Medications, dopaminergic drugs
  • Shrinkage on meds
Bromocriptine, cabergoline.  Cabergoline: take less often, works better, fewer side effects.  Heart valve abnormalities in Parkinson's patients but they take 20-40 times as much, also Pergolide.

Acromegaly...

Cushing's:
Don't switch labs! Stay with the same lab for all testing, if possible
Minnie G., pitituitary apoplexy? Carney Complex?

Hypopituitary
  • Take glucocorticoids
  • THS is not useful blood test to diagnose
  • Testosterone or estrogen
  • Growth Hormone
Circadian rhythm
  • Cortisol dosage
  • Most patients are over treated
  • No test tells right dose
  • Use the lowest dose that keeps you going
  • Always increase for illness
  • Always get a flu shot at the beginning of the season
Growth Hormone Deficiency
OTC growth hormone no good

GH deficiency:
  • Cholesterol
  • Osteoporosis
  • Diminished quality of life
Tips:
  • No long term studies
  • Not for cancer patients
  • Maybe need for more cortisol, thyroid hormone
  • Serum IGF-1 monitored bi-annually
Secondary hypothyroidism
  • Several weeks for improvement
  • Twice a year testing
  • Do not rely on TSH
  • Wide range of normal
  • He sees no advantage to "natural" preparations, variable by batch (armour)
  • "Wilson syndrome" does not exist
  • Because someone wrote a book doesn't make it true...
Diabetes Insipidus (DI)

DDVAP, nasal spray lasts longer
All should have a period during the 24 hours when DDVAP has worn off. 
Brain can only expand 8%

Q&A

Correlation cortisol and blood pressure

ERs not giving steroids even with medic alert bracelet and letters from doctor.
Solu-cortef, troubles getting it in the ER
Take 5-20 mg pills if you can keep it down.
Shouldn't need an emergency kit unless far from hospital
Doctor meeting patient at ER, or calls attending
Rectal version for steroids?




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