Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature.

PURPOSE: To retrospectively summarize the clinical features of acromegaly complicated with fulminant pituitary apoplexy and analyze the prognostic factors to guide early identification and timely treatment of such patients. METHODS: A retrospective analysis was carried out to summarize the clinical manifestations, hormone changes, imaging, treatment and follow-up of ten patients with acromegaly complicated with fulminant pituitary apoplexy admitted to our hospital from February 2013 to September 2021. RESULTS: The mean age of the ten patients (five males and five females) at the time of pituitary apoplexy was 37.1 ± 13.4 years old. There were nine cases with sudden severe headaches and five cases with visual impairment. All patients had pituitary macroadenomas, of which six cases with Knosp grade ≥3. The level of GH/IGF-1 hormone after pituitary apoplexy was lower compared with pre-apoplexy, and 1 patient reached biochemical remission spontaneously. Seven patients underwent transsphenoidal pituitary surgery after apoplexy and one patient was treated with long-acting somatostatin analog. The biochemical remission rate was 37.5% in eight patients immediately after treatment and 50% at the last follow-up. Patients with Knosp grade ≥3 were less likely to achieve biochemical remission than those with Knosp grade <3 (16.7% vs. 100%, p = 0.048), and patients who achieved biochemical remission had a smaller maximum tumor diameter [20.1 (20.1,28.0) mm vs. 44.0 (44.0,60) mm, p = 0.016]. CONCLUSION: Acromegaly complicated with fulminant pituitary apoplexy remains a diagnostic and therapeutic challenge.

[Efficiency of microcystin-LR removal by photocatalysis combined with ferrate oxidation].

This study focused on enhancing photocatalytic degradation of microcystin-LR following the addition of ferrate to the process. The degradation efficiency of ferrate and the photocatalysis was 54% and 63% respectively. However, when ferric or ferrate was added to the photocatalytic process, a significant enhancement in the rate of the photocatalytic degradation was observed and the efficiency can be increased to 73% or 100%. The results demonstrate that relatively low ferrate doses (10 mg/L) are sufficient not only for pre-degradating amount of toxin but also for supplying the Fe3+ enhance the rates of photocatalytic process to destroy the toxin further. At the same time, it indicates the advantage of using ferrate with the photocatalytic system comparing with ferric.