Clivus-involved immunoglobulin G4 related hypertrophic pachymeningitis mimicking meningioma: A case report.

BACKGROUND: Immunoglobulin G4 related disease (IgG4-RD) is a fibroinflammatory disease with markedly elevated serum IgG4 levels and fibrous tissue proliferation, accompanied by numerous plasma cells. IgG4 related hypertrophic pachymeningitis (IgG4-RHP) is relatively rare and indistinguishable from other phymatoid diseases before the operation. The risk of long-term immunosuppression needs to be balanced with disease activity. CASE SUMMARY: A 40-year-old man presented with headache and bilateral abducent paralysis. He was also diagnosed with pulmonary tuberculosis 10 years ago and was on regular treatment for the same. Before the operation and steroid therapy, the patient was suspected of having tubercular meningitis at a local hospital. A clivus lesion was found via brain magnetic resonance imaging (MRI) at this presentation. He was preliminarily diagnosed with meningioma and underwent Gamma Knife Surgery. Transnasal endoscopic resection was performed to treat deterioration of nerve function. Postoperative pathologic examination suggested IgG4-RD. Moreover, the serum IgG4 was elevated at 1.90 g/L (reference range: 0.035-1.500 g/L). After steroid therapy for 2 mo, the lesion size diminished on MRI, and the function of bilateral abducent nerves recovered. CONCLUSION: IgG4-RHP is relatively rare and indistinguishable before the operation. Elevated serum IgG4 levels and imaging examination help in the diagnosis of IgG4-RHP. Surgery is necessary when lesions progress and patients start to develop cranial nerve function deficit.

[Pituitary functional recovery and hormone replacement therapy of patients with pituitary adenoma surgery].

OBJECTIVE: To study the pituitary functional recovery of patients with pituitary adenoma surgery and to identify appropriate dosages of hormone replacement for those patients. METHODS: Serum hormone levels of 187 patients with pituitary adenoma were detected before and after surgery. RESULTS: The lowest serum hormone levels were detected on the 3rd day after surgery (P < 0.05). The hormone levels were partly recovered on the 30th day (P < 0.05) and continued to rise to a relatively high level on the 90th day and one year after surgery (P < 0.05). Patients with older ages were more likely to suffer from hypopituitarism and had less satisfying recovery (P < 0.05) than their younger counterparts. The dosages of Euthyrox and Prednisone that were needed for hormone replacement therapy reached a relatively stable level on the 90th day after surgery (P < 0.05). CONCLUSION: Most patients with pituitary adenoma experienced hypopituitarism shortly after surgery, especially for the elderly who recovered more slowly. Low dosage of hormone replacement therapy based on their symptoms can help the patients reach a stable level of hormone within three months. As a result, the 90th day after surgery can be regarded as a cut-off time for measuring functional recovery of glandula pituitaria.

[Effects of bromocriptine on the treatment of prolactinomas in male patients and its influences on their sexual function].

OBJECTIVE: To explore the effect of bromocriptine in the treatment of male patients with prolactinoma and its impacts on their sexual function. METHODS: The clinical data of 29 male patients with prolactinomas treated with Bromocriptine were analysed, International Index of Erectile Function-5 (IIEF-5) was used to assess the sexual function of married patients before and after the treatment of Bromocriptine. RESULTS: The main clinical symptoms of male patients with prolactinomas were sexual dysfunction, headache and hypopsia, which were released significantly at 6 months after Bromocriptine therapy, with the decrease of serum prolactin (PRL) level (P < 0.05) and the improvement of basal testosterone (T) level (P < 0.05). The total normalization rate of PRL was 82.8%, and total effective rate of Bromocriptine therapy was 100%. According to the assessment of IIEF-5, all the male patients had their sexual function improved in various degree. CONCLUSION: Bromocriptine can improve the clinical symptoms of male patients with prolactinoma and their sexual function.