Steroid dependent optic neuritis

It has been recommended in the current Clinical Practice Guidelines (2011) by the Endocrine Society - a professional, international medical organization in the field of endocrinology and metabolism - that all patients with pituitary incidentalomas undergo a complete medical history and physical examination , laboratory evaluations to screen for hormone hypersecretion and for hypopituitarism . If the lesion is in close proximity to the optic nerves or optic chiasm , a visual field examination should be performed. For those with incidentalomas which do not require surgical removal, follow up clinical assessments and neuroimaging should be performed as well follow-up visual field examinations for incidentalomas that abut or compress the optic nerve and chiasm and follow-up endocrine testing for macroincidentalomas. [37]

Persons who are on drugs which suppress the immune system are more susceptible to infections than healthy individuals. Chicken pox and measles , for example, can have a more serious or even fatal course in non-immune children or adults on corticosteroids. In such children or adults who have not had these diseases particular care should be taken to avoid exposure. How the dose, route and duration of corticosteroid administration affects the risk of developing a disseminated infection is not known. The contribution of the underlying disease and/or prior corticosteroid treatment to the risk is also not known. If exposed, to chicken pox, prophylaxis with varicella zoster immune globulin (VZIG) may be indicated. If exposed to measles, prophylaxis with pooled intramuscular immunoglobulin (IG) may be indicated. (See the respective package inserts for complete VZIG and IG prescribing information.) If chicken pox develops, treatment with antiviral agents may be considered. Similarly, corticosteroids should be used with great care in patients with known or suspected Strongyloides (threadworm) infestation. In such patients, corticosteroid-induced immunosuppression may lead to Strongyloides hyperinfection and dissemination with widespread larval migration, often accompanied by severe enterocolitis and potentially fatal gram-negative septicemia .

Caution must be exercised in interpreting test findings. In patients with Cushing's disease, endogenous ACTH and cortisol production should be suppressed with high-dose (8-mg) dexamethasone, but the test lacks specificity, a clear cutoff value and diagnostic accuracy. 3 , 6 , 19 , 24 , 25 In fact, the pretest probability of finding a pituitary cause for ACTH-dependent Cushing's syndrome (85 to 90 percent) may exceed the diagnostic accuracy of the test. 4 , 25 Microadenomas are more likely to demonstrate high-dose dexamethasone suppression than macroadenomas (92 versus 56 percent in one study). 26

Steroid dependent optic neuritis

steroid dependent optic neuritis


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