Pituitary Adenoma in the Philippines: A Scoping Review on the Treatment Gaps, Challenges, and Current State of Care.

BACKGROUND: Pituitary adenomas are benign brain tumors that impose a heavy burden on patients worldwide. The local burden of disease is yet to be established due to scarcity of data. In line with this, this study aims to present the challenges and gaps in the treatment of pituitary adenomas in the Philippines. METHODS: A scoping review of available relevant literature on epidemiology, clinical experience with treatment, health financing, and healthcare delivery system based on the Preferred Reporting Items for Systematic reviews and Meta-analysis guidelines extension for Scoping Reviews was conducted. RESULTS: The scarcity of updated local clinical data, inequity of distribution of resources, inadequate government support, and lack of affordable diagnostic testing, medications, and neurosurgical procedures are the factors that hinder provision of adequate care of pituitary adenomas in the Philippines. CONCLUSION: There are notable treatment gaps in the management of pituitary adenomas in the Philippines, which may be addressed by strengthening universal healthcare. Strategies to address these gaps were proposed, including improving public-private insurance coverage, increasing manpower, enhancing accessibility to resources, and spreading more awareness.

Ventricular standstill disguised as epilepsy: A case report on Stokes-Adams attacks.

Background: Stokes-Adams attacks presenting as convulsions may be difficult to distinguish from epilepsy. Stokes-Adams Syndrome is a transient abrupt collapse into unconsciousness due to a sudden but pronounced decrease in cardiac output caused by change in heart rate and rhythm, resulting in syncope. Case presentation: We report a patient who presented with multiple convulsive episodes managed as epilepsy, until she was found to have paroxysmal total atrioventricular block. Previously, she had been treated with anti-seizure medications without relief. Ventricular standstill was seen on cardiac monitoring and the convulsive episodes were determined as Stokes-Adams attacks. She underwent percutaneous coronary intervention and has been free of convulsive episodes since. Conclusion: Awareness of distinction between seizures/epilepsy and convulsive syncope is important and may be life-saving. A good clinical history as well as simple non-invasive tests such as electroencephalogram and electrocardiogram are important in establishing correct diagnosis.