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MD, MNAMS, DM (Endo) Consultant Endocrinologist Fortis Hospital, Belle Vue Clinic, Kolkata & Research Scientist Dept. of Endocrinology, IPGME&R, Kolkata In Favour of Radiotherapy
Orbital fibroblasts in the endomysium & perimysium of extraocular muscles- are the primary target Retroorbital preadepocyte fibroblast-like cell- are the primary target T-cell mediated
Immunosuppresion Glucocorticoids Cyclosporine, Cyclophosphamide, Azathioprine, Plasmapheresis External Beam Radiotherapy
Mechanism Clonogenic death Apoptotic death Radiation induced death of Inflammatory cells, lymphocytes Reduction in muscle swelling Local Effect (restricted to the orbit only)
Stanford- 311 pts % had soft tissue responses, 58% complete response Peterson IA et al. Int J Radiat Oncol Biol Phys 1990; 19:259–264. France- 199 pts % complete response vs 48% partial response Beckendorf V et al. Int J Radiat Oncol Biol Phys 1999; 43:805–815.
56 pts- (vs Prednisone)- Response rate similar (~50%)- Side effects more in Prednisone & Radiotherapy better tolerated Prummel MF, et al. Lancet 1993; 342:949– pts (vs placebo- sham radiation)- 60% vs 31% response rate. Motility improved 82% vs 20%. Mourits MP, et al. Lancet 2000; 355:1505–1509.
Generalised Effect !! Relapse after withdrawal !! Side effects !!
Acne Adrenal insufficiency Arthralgia Avascular necrosis of the hip Cataracts Cushingoid features Diabetes Depression Easy bruisability Fluid retention Glaucoma Headache Hirsutism Hypertension Immunosuppression Increased appetite Irregular heartbeat Loss of libido Menstrual irregularities Mood disturbance Oral rash Osteoporosis Paresthesias Poor wound healing Proximal myopathy Skin rash Stomach ulcers Weakness Weight gain
Availability- only in tertiary care centres Expertise- scarce
Cataracts (dosimetric errors/ high dose) Retinopathy (DM increased risk) Radiation induced tumor (1.2%) Kinyoun JL, et al. Arch Ophthalmol 1984; 102:1473–1476. Snijders-Keilholz A, et al. Radiother Oncol 1996; 38:69–71.
1 ADRENOCORTICOSTEROIDS Major categories of action: Glucocorticoids: affecting intermediary metabolism & resistance to stress Mineralocorticoids: regulation.
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Author(s): Seetha Monrad, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Noncommercial–Share.
CORTICOSTEROIDS(aka glucocorticosteroids/steroids) class of chemicals that includes steroid hormones naturally produced in the adrenal cortex of vertebrates.adrenal.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 72 Glucocorticoids in Nonendocrine Disorders.
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Collection of glands that secrete hormones directly into the bloodstream. › Adrenal glands, parathyroid glands, pancreas, pineal gland, pituitary.
Cushing’s Syndrome. This patient had Ectopic ACTH Syndrome Non-pituitary tumor secreting either ACTH or CRH causing bilateral adrenal hyperplasia excess.
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