Naslov
From tramadol side effects to pituitary macroadenoma

Autori
Lekić, Ivan ; Degmečić, Dunja ; Bačun, Tatjana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, znanstveni

Skup
International Translational Medicine Congress of Students and Young Physicians

Mjesto i datum
Osijek, Hrvatska, 07.02.2019. - 08.02.2019

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
tramadol ; headache ; nonfunctioning pituitary adenoma ; hypopituitarism ; pituitary apoplexy

Sažetak
Introduction: Tramadol is an opioid analgesic drug used in treating medium to moderately severe pain and has a reduced risk of developing addiction in chronic use. Very common side effects (> 1 out of 10) are nausea, fatigue and drowsiness, while frequent side effects (1-10 in 100) are vomiting, headache, stiffness, dry mouth, sweating and mood swings. The pituitary tumors represent 10% of the central nervous system tumors and are most often dysfunctional. These are mostly adenomas. Due to their size, can exert pressure on healthy pituitary tissue and cause hypopituitarism as well as surrounding structures that can cause vision disorders, appearance of field vision and headache. If cancerous apoplexy occurs, headaches, nausea, fatigue and disorientation can suddenly occur. Case report: Patient is a 72-year-old male with type 2 diabetes, arterial hypertension, angina pectoris, and vitamin B12 deficiency and that had previously suffered a left knee injury and is therefore occasionally receiving nonsteroidal anti-rheumatics. The day before admission he took a tramadol / paracetamol tablet for planned housework. After a few hours there was general weakness, nausea and headaches, which led to the drug taking. After physical effort, headaches were amplified, he felt weakness, fatigue, vomited several times, and was referred to an internist emergency room. The clinical finding was normal. Since more than 12 hours had past after the drug had been taken, the patients symphtoms remain the same, a neurologist was instructed. Patient noticed loss of eye sight on right eye. An urgent head CT scan was performed, showing hyper-dense tumor formation of 31x20x22 mm, caudally inserted into the sphenoid sinus, cranial to the hypothalamus area, suppressing optical chiasma and partially expanding into the left cavernous sinus, which is pointing to the pituitary adenoma or meningioma. During the endocrinologic examination the patient was adynamic, pale skin and with visible mucous membranes, scarce hairiness, hypotensive and was subfebrile. An urgent MR scan of pituitary gland was performed, patient was diagnosed with pituitary macroadenoma. In emergency laboratory findings there was a decrease in cortisol values (58.6 nmol / l) with a normal value of fT4 and TSH. The next day, in regular findings there were lower values of LH and testosterone with ACTH below normal, indicating secondary hypochorticism and hypogonadism. Patient received the replenishment of hydrocortisone 100 mg four times and adequate hydration, with a gradual dose reduction. Patient was moved to a neurosurgery clinic where he was successfully operated where surgery confirmed the diagnosis of pituitary macroadenoma. Conclusion: When the patient is treated with tramadol or similar opioid drug in which there are assumptions of side effects, and if they are not receding within the time needed for drugs elimination it needs to be examined for other causes including pituitary adenoma or possible adenoma apoplexy.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti, Kliničke medicinske znanosti

POVEZANOST RADA