Abstract:: Glucagon like peptide- 1 receptor analogs (GLP-1RAs) are incretin mimetics with potent glucose-dependent insulinotropic action that translates to glycemic control in people with type-2 diabetes mellitus (T2DM). These agents potentially have the ability to stimulate proliferation or prevent apoptosis of pancreatic β-cells, induce weight-loss and provide vascular benefits in patients with T2DM. Newer GLP-1RA, semaglutide has shown robust reduction in HbA1c up to 1.5 - 1.8%. However individual differences do exist between the different GLP-1RAs, in terms of efficacy, pharmacokinetics, tolerability, and vascular protection. The potential of vascular protection offered by newer anti-diabetic agents has generated a lot of excitement in the field of diabetes, and to a large extent is now driving treatment decisions. So far, six cardiovascular outcome trials of GLP-1 RAs have been published, analyzing lixisenatide (ELIXA), liraglutide (LEADER), semaglutide (SUSTAIN-6), long-acting exenatide (EXSCEL), dulaglutide (REWIND), and oral semaglutide (PIONEER 6) with a follow-up duration of 2-4 years. LEADER, REWIND and SUSTAIN-6 trials have demonstrated reduction in rates of major adverse cardiovascular events with active GLP-1 RA treatment but ELIXA, PIONEER 6 and EXSCEL have been neutral. In this review, we discuss the available evidence from randomized controlled trials (RCTs) analyzing the cardiovascular effects of various GLP-1 RAs with the aim of comparing individual drugs. We have also summarized the general aspects of GLP-1RAs that can be applied in clinical practice.
Prolactinomas are the most common type of pituitary adenomas. Macroprolactinoma is the name used for tumors when their size exceeds 1 cm and giant prolactinomas are those that exceeds 4 cm. Females are more commonly reported to have microprolactinomas with female-to-male ratio of 20:1, on the contrary macroprolactinomas are usually diagnosed in men aged 20-50 years with a reported male-to-female ratio of 9:1. We are presenting the case of a 63-year-old female with history of cataracts and hypertension who presented with complaints of progressive decrease in vision in both of her eyes (right greater than left) for several months and declining night vision without headache. Her only other symptoms were tiredness and cold intolerance. A detailed visual exam led to the findings of bitemporal hemianopsia and possible right optic neuropathy. Her neurological exam otherwise was intact. Subsequently contrast magnetic resonance imaging (MRI) of the brain showed a large sellar and suprasellar mass measuring greater than 10 cm x 6 cm in size invading right cavernous sinus, surrounding vessels and compressing optic chiasm with extension into the right temporal lobe, left frontal lobe and subfalcine shift to the right. Laboratory studies indicated elevated prolactin level of 4932 ng/mL (2.8 - 29.2 ng/mL) consistent with prolactinoma. Pituitary hormone function testing revealed suppressed gonadotropins, subnormal ACTH stimulation test and central hypothyroidism. She was started on medical therapy with cabergoline. At one month follow-up, serum prolactin level significantly decreased to 136.2 ng/mL but the size of the mass did not significantly decrease on follow up brain MRI. Patient currently wants to try medical management alone. Conclusion: Macroprolactinomas measuring >4 cm are rare, accounting for only 1–5% of all prolactinomas and are more commonly seen in men, however they can be seen in postmenopausal women as well. Headaches and visual field disturbances are common presenting symptoms due to compressive effect and warrant further investigation with MRI of the brain. Medical therapy alone can sometimes suffice and surgery is a second line option as it confers morbidity risks.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.