Orbital Cellulitis

Orbital Cellulitis:  An infection of the soft tissue that makes up the eyelids, eyebrow, and the cheek surrounding the eye itself. It has the potential to be very harmful and affect vision.
Causes: 
     Bacteria (Haemophilus influenzae) from a sinus infection.
     Staphylococcus aureus, Streptococcus pneumoniae, and/or beta-hemolytic streptococci.
     Bug bites, stye, or recent eyelid surgery.
     Seek medical attention immediately.
Symptoms: 
     Painful swelling of upper and lower eyelids, possible spreading into the cheek and eyebrow.
     Proptosis or exophthalmos (bulging eyes).
     Eye pain with movement.
     Difficulty moving the eyes.
     Fever-102 or higher.
     Discomfort.
     Shiny red or purple eyelids.
Tests:
     Blood cultures.
     CBC.
     Spinal tap in extreme cases of kids.
     Sinus x-rays and surrounding areas.
     CT or MRI of orbits and sinuses.
     Culture of throat and eye drainage.
     Throat culture.
Treatment:
     Hospitalization with IV antibiotics.
     Surgery may be necessary to drain the abscess or relieve the pressure.
     Infection may become increasingly worse very quickly. Close, frequent (every few hours) monitoring must performed.
Prognosis:  Complete recovery with prompt treatment.
Possible Complications:
     Cavernous sinus thrombosis:  A blood clot in the cavernous sinus at the base of the brain which returns deoxygenated blood to the heart from the brain.
     Hearing Loss.
     Septicemia.
     Meningitis.
     Optic nerve damage or loss of vision.
Contact Physician Immediately If:
     Swelling of eyelids along with a fever.
Prevention:
     Early treatment of sinus infections, dental infections, and other infections.
     Receiving the HiB vaccine will also help prevent orbital cellulitis.
References:
Garrity, J. (2008, September). Preseptal and orbital cellulitis. Retrieved from http://www.merckmanuals.com
Orbital cellulitis and cavernous sinus thrombosis. (2009, February 23). Retrieved from http://www.allina.com
U. S. National Library of Medicine, National Institutes of Health. (2011). Orbital cellulitis. Bethesda, MD, http://www.nlm.nih.gov

 

PROLACTINOMA

Pituitary Gland: "Master Gland." Important in regulating growth and development, metabolism, and reproduction.

Prolactinoma:  The most common type of pituitary adenoma. Based on postmortem autopsies, 25% of U.S. population have a small pituitary tumor. A benign tumor of the pituitary gland causing an excessive amount of the hormone prolactin (natural hormone that aids in mild production) to be secreted. Symptoms develop when the tumor grows, putting pressure on the surrounding tissues. Hyperprolactinemia is the condition when prolactin increases in the bloodstream.

Function:  Signals growth of breast tissue during pregnancy. Post pregnancy, the levels decrease unless the mother breastfeeds.

Symptoms Caused by Prolactinoma: 
     Women:  Ovulation interference, irregular menstrual cycles, and possible infertility. Non-pregnant, non-breastfeeding women may develop breastmilk. Decrease in sex drive may occur. Vaginal dryness may cause painful intercourse.
     Men:  Impotence most common. Often do not go to doctor until headache and vision problems develop.

Diagnosis: 
     Blood test:  detect elevated prolactin levels.
     MRI:  best test to detect and measure prolactinomas due to its sensitivity. Repeated periodically to monitor progression and effects of therapy.
     CT:  sometimes used, but not as effective as MRI.

Post-Diagnosis Tests:
     Comprehensive eye exam.    
Goals of Treatment: 
     Return of normal prolactin secretion.
     Reduction in tumor size.
     Restore normal vision.
     Restore normal function on the pituitary gland.

Treatment:
     Medications first, surgery considered if medications not tolerated or effective.
     Medications may be used in conjunction with surgery and/or radiation therapy.   
Medications:  Dopamine mimicking medications that inhibit prolactin secretion.
     Parlodel
     Dostinex

Surgical Treatment:  A very delicate surgery (performed by a neurosurgeon) involving an opening into the brain to access the tumor. This is often done by going through the roof of the mouth through the sphenoid sinus. Outcome highly depends on skill of surgeon, size of the tumor,  and prolactin level.

Prognosis:  With medications, sexual function and fertility will return.

References:

Ferry, R. Prolactinoma (pituitary tumor). (n.d) retrieved March 20, 2011, from MedicineNet.com Web Site: http://www.medicinenet.com/

Hurley, D. & K. Ho (2004). Pituitary disease in adults. retrieved March 20, 2011, from The Medical Journal of Australia Web Site: http://www.mja.com.au

Prolactin producing pituitary tumor. (n.d) retrieved March 20, 2011, from Health Resources Web Site: http://www.health-res.com/

Prolactinoma. (April, 2009). retrieved March 20, 2011, from lookforadiagnosis.com Web Site: http://www.lookforadiagnosis.com/

Prolactinoma. (2011). retrieved March 20, 2011, from University of Michigan Health System Web Site: http://www.med.umich.edu/



Coronal Image Prolactinoma

  

Sagittal Image Prolactinoma