Prolactinoma: a condition associated with hypoadiponectinemia.

Prolactinomas are prolactin-secreting neoplasias accounting for 40% of the pituitary adenomas. Much is known about the effects of prolactinomas on the reproductive system, but few data are yet available regarding their induced changes on metabolism. This study was aimed at evaluating patients with prolactinomas for insulin resistance and adiponectinemia. Forty patients with prolactinoma were allocated to 2 different groups according to disease control: 20 with uncontrolled disease (UPRL) and 20 with controlled disease in the last 6 months (CPRL). Forty healthy individuals (CG) matched for age, sex, and body mass index were taken as controls. Patients with prolactinoma were compared both as a one group and according to disease control with CG. All subjects were evaluated for waist/hip ratio (WHR), blood pressure, lipid profile, fasting glucose, homeostasis assessment model of insulin resistance (HOMAIR), and adiponectin. Patients with prolactinomas (UPRL+CPRL) showed higher insulin (p<0.05) and HOMAIR (p<0.05), alongside with lower adiponectin levels (p<0.01) than matched controls. When UPRL was compared to CPRL and CG, UPRL was disclosed as a subgroup of significant altered metabolic profile as related to WHR (p<0.01 for comparisons), high-density lipoprotein cholesterol (p<0.05 for comparisons), triglycerides (p<0.05 for comparisons), HOMAIR (p<0.05 and p<0.01, respectively), and adiponectin (p<0.01 for comparisons). All these metabolic abnormalities, except hypoadiponectinemia (p<0.01), were not observed in CPRL. These data suggest that prolactinomas are associated with hypoadiponectinemia, which is further exacerbated in uncontrolled patients when insulin resistance is also prominent.

October 2000: a 47 year old man with long-standing progressive tetraparesis.

A 47-year-old man with a six-month history of progressive tetraparesis and sphincter disturbances developed tetraplegy after two years and died. A cervical MRI revealed an ill-defined, enhancing lesion from C1 to C6, internally attached to the dura mater and compressing the spinal cord. At necropsy, eight whitish nodes and diffuse thickening of the dura mater from C1 to C6 were found. Histological studies revealed multiple en plaque lymphoplasmacyte-rich meningiomas. The radiologic and pathologic aspects of lymphoplasmacyte-rich meningioma are reviewed and the atypical features of this case, such as macroscopic appearance and the histological variant, are described.

[An en bloc cranio-orbitozygomatic approach: surgical technique and results]. / Acesso crânio-orbitozigomático em flape único. Técnica cirúrgica e resultados.

An en bloc cranio-orbitozygomatic approach is described. This technique was applied in seven patients (five basilar artery aneurysms, a trigeminal neuroma, a meningioma of the lesser sphenoid wing). The follow-up period ranged from 3 to 50 months. The patients were retrospectively analyzed from the cosmetic point of view, and submitted to computerized tomography with three dimensional and multiplanar reconstructions. The access provided a wider operative field with a shorter distance to the pathology and possibility of increased angulation of the microscope. The aneurysms could be clipped and the tumors completely removed in all cases. A frontalis muscle paralysis occurred in two cases, as well as a temporalis muscle atrophy in another two patients. There were no enophthalmos or bone flap displacements. The surgical technique is simple and do not require drills, electric saws and mini-plates.

Morphometric study of the neurons in the medial mammillary nucleus in acute and chronic Wernicke's encephalopathy.

A morphometric study was made of the neurons in the medial mammillary nucleus from 25 cases of Wernicke's encephalopathy (WE) and from 15 other cases (control group) in which hepatic or brain disease was excluded and the risk factors associated with WE were not present. The whole area of the mammillary body was also measured in all cases from both groups. The cases of WE were divided into acute and chronic. A highly significant reduction in the area of the mammillary body was noted in the chronic WE group, when compared to the control and acute WE cases. Although no significant differences were detected between the three groups with regard to the total number of neurons of medial mammillary nucleus, cell density was significantly higher in the chronic WE group, when compared to the control and acute WE cases. A significant reduction was noted in the nuclear volume of the neurons in the chronic cases of WE, when compared to the acute WE cases. The positive correlation between the area of the mammillary body and the nuclear volume of the neurons in the medial mammillary nucleus was highly significant for the WE group and significant for the control and chronic WE groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Ischemic and hemorrhagic necrosis of the pons with anatomical location similar to that of central pontine myelinolysis in a chronic alcoholic patient.

An autopsied case of recent ischemic and hemorrhagic necrosis of the pons is reported, in which the anatomical site of the lesion is similar to that observed in central pontine myelinolysis. The patient, a 46-year-old woman, was a chronic alcoholic who had been treated with large quantities of physiological saline and glucose solution at 5% during a period of nine days before death. On the fifth day of treatment she developed hypernatremia, which persisted for three days. From hyperglycemia on the day of admission, her serum glucose levels subsequently dropped to normal values and then rose again on the day of death. Examination of the brain revealed recent ischemic and hemorrhagic necrosis affecting the central portion of the upper two thirds of the pontine basis, in triangular, bilaterally symmetrical pattern, and extending into the tegmentum. There was no evidence of demyelination or degradation products of the myelin. No vascular alterations or thrombi were identified in the pontine vessels surrounding the lesion. The differential diagnosis of pontine infarct, central pontine myelinolysis, and Duret's hemorrhage is discussed. In analysing the possible etiology and pathogenesis of the lesion, it is suggested that osmotic vascular injuries induced by fluctuating levels of serum sodium and glucose may lead to edema and demyelination similar to that observed in central pontine myelinolysis and, rarely, to necrosis and hemorrhage, as in the present case.