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Thyrotroph pituitary adenomas have been reported to be a rare cause of 'thyroid storms', causing myriad metabolic and autonomic disturbances. In this case, we describe the second reported case in literature of a 'GH storm' in an infarcted somatotroph adenoma. We describe a residual invasive somatotroph macroadenoma that underwent infarction, producing a dramatic elevation in serum GH levels. While infarction of adenomas may in some cases lead to remission, the patient went on to require re-surgery and re-radiation due to growth of the residual viable tumour. 'GH storms' are rare but interesting events that may occur in somatotroph adenomas. Infarction or apoplexy must be considered when managing residual adenomas. [ABSTRACT FROM AUTHOR]

This article, titled "A Multicenter Study of Clinical Outcomes and Volumetric Trends in Microprolactinomas," explores the correlation between prolactin levels, tumor volumes, and clinical outcomes in patients with pituitary microadenomas. The study found that there was no significant correlation between prolactin levels and tumor volume at diagnosis. However, patients with higher tumor volumes tended to have higher prolactin levels. The article also discusses the different treatment options for microprolactinomas, including observation, medical therapy, and surgery. It concludes that tumors with higher prolactin levels may be more likely to undergo medical treatment, while tumors with lower levels may be suitable for surveillance as they tend to shrink over time. The article suggests that an elevated baseline PRL/volume ratio may indicate tumor growth that may require intervention. [Extracted from the article]

This article discusses the feasibility and utility of monitoring intraoperative visual evoked potentials (VEPs) during endoscopic transsphenoidal surgery. The study reviewed 50 patients undergoing this surgery and found that a robust VEP signal was recorded in 73.3% of eyes. The authors recommend using intravenous anesthesia for reliable signal generation and suggest that VEP monitoring may be most helpful during tumor resection near the optic chiasm. The study concludes that intraoperative VEP monitoring is feasible and safe, with no complications or new visual deficits postoperatively. [Extracted from the article]

Objectives Community-acquired pneumonia (CAP) is a significant source of hospital admissions and mortality. Atypical organisms are implicated in up to 40% of cases of CAP diagnoses. We studied the difference in outcomes of severe CAP patients treated with doxycycline versus azithromycin in addition to β-lactam therapy. Patients and methods This was a prospective observational cohort study from March 2020 to July 2022 in a medical ICU (MICU) of an academic quaternary medical center. Adults ≥18 years admitted to the MICU receiving doxycycline or azithromycin in addition to β-lactam therapy for the treatment of CAP were included for analysis. The primary outcomes were in-hospital and 30 day mortality. Secondary outcomes were ICU and hospital length-of-stay, 30 day readmission, days of mechanical ventilation, escalation and duration of antibiotics, adverse effects such as Clostridioides difficile infection and QTc prolongation. Results Sixty-three patients were in the azithromycin group and eighty-six patients in the doxycycline group. Both groups had similar APACHE IV and CURB-65 scores. The mean Charlson Comorbidity Index score was higher for the doxycycline group compared with the azithromycin group (P  = 0.04). There was no statistically significant difference in in-hospital and 30 day mortality between the groups (P  = 0.53, P  = 0.57). There were no significant differences in any of the secondary outcomes. Conclusions MICU patients with severe CAP who received doxycycline versus azithromycin in addition to β-lactam treatment showed no significant differences in outcomes. These data offer support for inclusion of doxycycline as an alternative regimen in current IDSA recommendations. [ABSTRACT FROM AUTHOR]

Byline: Sauradeep. Sarkar, Ari. Chacko Growth hormone (GH) hypersecretion from a pituitary adenoma results in acromegaly, an endocrinological disorder with multiple systemic manifestations that presents several unique challenges in terms [...]

Byline: Ananth. Abraham, Sauradeep. Sarkar, Pavithra. Mannam, Geeta. Chacko, Ari. Chacko Intracranial schwannomas unrelated to cranial nerves are exceedingly rare. Of these, tentorial schwannomas are an even smaller subset with [...]

Byline: Gandham. Jonathan, Sauradeep. Sarkar, Georgene. Singh, Sunithi. Mani, Regi. Thomas, Ari. Chacko Background: Intraoperative cerebrospinal fluid (CSF) leaks are a frequent cause of morbidity in patients undergoing transsphenoidal surgery. [...]

Background: Introduction: Gliomas were previously classified histologically, although now the latest WHO classification incorporates several molecular markers to classify these. Detection of TERT promoter mutations is assuming increased importance due to its relevance to prognostication.Objective: : The aim of this study was to determine the frequency of TERT promoter mutations, association of TERT promoter mutations with other molecular alterations and to assess the role of TERT promoter mutations in overall survival and progression-free survival in relation to histological and molecular glioma subtypes.Materials and Methods: This study analyzed a cohort of 107 adult patients with diffuse gliomas, WHO grades II and III and glioblastoma, by immunohistochemistry for IDH and ATRX mutations, FISH for 1p/19q co-deletions and PCR sequencing for TERT promoter mutation. Further, five glioma molecular sub-groups were derived using three molecular alteration and included the sub-groups with: i) IDH mutations only, ii) IDH and TERT mutations only, iii) IDH and 1p/19q co-deletion only, iv) Triple negative, and v) Triple positive.Results: IDH mutations and 1p/19q co-deletions were individually and significantly associated with an improved progression free (P = 0.001 and P = 0.002, respectively) and overall survival (P = 0.000 and P = 0.005, respectively) in the present cohort of gliomas. TERT promoter mutations occurred frequently in anaplastic oligodendrogliomas (94%), oligodendrogliomas (87.5%) and glioblastomas (54%). Sub-division into molecular sub-groups showed that the triple-positive tumors carried the best prognosis, followed by IDH only, triple negative and finally the TERT mutation only tumors (P < 0.000).Conclusion: : This indicates that sub-classification using these molecular markers separates tumors into prognostically relevant categories. [ABSTRACT FROM AUTHOR]