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Patient-Reported Outcomes During Pelvic Radiation Therapy: A Secondary Analysis on Sexual Function From NRG-RTOG 1203.
No full textPURPOSE: NRG-RTOG 1203 reported that intensity-modulated radiation therapy (IMRT) reduced patient-reported GI toxicities in patients with cervical/endometrial cancer receiving postoperative RT, compared with 3-dimensional conformal radiation therapy (3DRT). We conducted a secondary analysis of patient-reported sexual function (PR-SF) among treatment groups to identify factors associated with sexual dysfunction.
METHODS AND MATERIALS: Patients on NRG-RTOG 1203 were randomly assigned to 3DRT versus IMRT and completed Patient-Reported Outcomes (PRO)-Common Terminology Criteria for Adverse Events (CTCAE) and FACT-Cx surveys at baseline, week 5 of RT, and at 4-6 weeks, 1 year, and 3 years after RT. Patient responses to FACT-Cx sexual function questions were analyzed. The between-arm frequency and severity of responses and their comparison with PRO-CTCAE GI toxicity were tested using chi-square tests. A repeated-measures logistic regression model was used to determine the impact of clinical and treatment factors on PR-SF.
RESULTS: Two hundred thirty-six patients completed PR-SF questions; 125 (53%) received 3DRT and 111 (47%) IMRT. There were no significant differences in PR-SF between groups (
CONCLUSION: PR-SF was similar between treatment groups. After RT, fear of sex declined and interest in sex improved over time. Women with GI toxicity after RT completion are at risk for worse sexual function
The Silent Tension: A Case of Pheochromocytoma
No full textDescription: Background/Objective: Pheochromocytoma is a rare endocrine disease, with incidence rates per 100 000. Classic findings include hypertension, palpitations, and headaches. Typical signs can be absent in some cases. Case Report: A 51-year-old woman with a history of anxiety with depression on buspirone and aripiprazole presented for follow-up of adrenal nodule. Prior imaging of 2017 showed a nodule 1.1 cm, which had grown to 2.2 cm in 2022. She denied prior history of hypertension and is not on any antihypertensive medications. She has reported episodes of orthostatic hypotension but denies episodes of sweating, palpitations, or chest pain. She reported intermittent headaches but denied cushingoid symptoms. Physical examination showed stable vitals and no abnormalities to palpation or vision. Laboratory results obtained showed a dehydroepiandrosterone sulfate level of 26.6 mcg, total metanephrine level of 1289 mg, urine metanephrine level of 819 mg (greater than 2 times the upper limit), and plasma metanephrine level of \u3e5 times the upper limit (although the medication could induce high levels, this would not induce 5 times the limit). The urine norepinephrine level was 37 mcg, and the urine epinephrine level was 11 mcg. For reference, the normal dehydroepiandrosterone sulfate level in a woman aged 50 to 60 years is 26 to 200 mcg, The normal urine metanephrine level for that same age range is 400 mcg, and the plasma metanephrine level for that same age range is 400 to 600 mcg. The norepinephrine level in urine is 10 to 35 mcg, and the urine epinephrine level is 0 to 20 mcg. Computed tomography of the abdomen with adrenal protocol (HU) showed a right adrenal mass shadowing an absolute washout value of 46.5% and a relative washout value of 27%. An absolute washout of \u3c 60% and relative of \u3c 45% indicate benign adrenal masses. Repeat urine studies continued to slow metanephrine levels greater than 2 times the upper limit. Based on these studies, patients were placed on appropriate alpha- and beta-blocker regimen and referred for surgery. Discussion: Pheochromocytoma is usually observed in patients with hypertension. However, patients can have normal pressures or episodes of orthostatic hypotension. With the advent of routine use of imaging, presymptomatic diagnosis of pheochromocytoma occurs in greater than 60% of patients. Conclusion: For patients with a family history or personal history of hypertension, if cardinal symptoms of pheochromocytoma are absent but mood disorders, diaphoresis, and tachycardia during panic attacks occur, this should prompt imaging and workup for pheochromocytoma. Case Report: Identifying Pheochromocytoma in a woman with normotension, history of anxiety disorder, and episodes of orthostatic hypotension. Discussion: A diagnosis of normotension or hypotension does not rule out pheochromocytoma. Conclusion: With high suspicion for pheochromocytoma, prompt workup should be initiated
Severe Hypocalcemia After Denosumab Treatment Leading to Refractory Ventricular Tachycardia
No full textDescription: Case Report: A 70-year-old man with multiple myeloma developed severe hypocalcemia 1 week after receiving denosumab. Despite calcium supplementation, he developed refractory ventricular tachycardia. Echocardiography showed a preserved ejection fraction, and his calcium levels eventually stabilized after intensive treatment with calcium and vitamin D. Discussion: Denosumab-induced hypocalcemia, though rare, can lead to serious cardiovascular events, including ventricular tachycardia. Prolonged serum denosumab concentrations contribute to persistent hypocalcemia. Early recognition and correction of hypocalcemia are crucial to prevent life-threatening complications. Conclusion: Denosumab-induced hypocalcemia can lead to severe complications like ventricular tachycardia. Early screening, correction of calcium and vitamin D levels, and close monitoring are critical to managing this risk
NAVIGATING A RARE COMPLICATION: THROMBOTIC THROMBOCYTOPENIC PURPURA IN SYSTEMIC LUPUS ERYTHEMATOSUS – A CASE REPORT
No full textStorm-Induced Supply Challenges: A Case of Hurricane-Driven IV Fluid Use and Venous Air Embolism
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The Weekly Assessment of Child Behavior: Psychometric Properties of a Behavior Problem Screening Tool
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