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1.
Eur J Endocrinol ; 181(3): 95-105, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32530258

RESUMO

CONTEXT: Association of central diabetes insipidus (CDI) and pituitary stalk thickening (PST) may have several etiologies (including malignancies) and differential diagnosis remains often difficult. OBJECTIVE: The purpose of this study was to identify which clinical, biochemical or radiological features could help clinicians to make an etiological diagnosis, especially distinguishing neoplastic from non-neoplastic pituitary stalk lesions. DESIGNS AND METHODS: We retrospectively analyzed clinical, biochemical, radiological and histological data of 38 adult patients diagnosed with CDI and PST of proven etiology. RESULTS: Of the 38 pituitary stalk lesions included, 11 (29%) were neoplastic. A histopathological diagnosis was obtained in 22/38 (58%) patients. The three most frequently observed etiologies of PST were neuroinfundibulitis (34%), germinoma (21%) and histiocytosis (18%). Pituitary stalk thickness was larger for neoplastic lesions, particularly germinomas. Male gender and a very young age were statistically associated with a risk of germinoma. At least one anterior pituitary deficit was observed in nearly 60% of patients. Patients with neoplastic PST were more affected by multiple anterior pituitary dysfunction than patients with benign PST. A high serum prolactin level was individually the best predictor of a neoplastic origin (90% sensitivity and 60% specificity for a serum prolactin level 1.27-fold above the normal upper limit (ULN)). CONCLUSION: We confirm a relatively high risk of malignancy in adult patients presenting with the association of CDI and PST. Young age, male gender, a very large thickening of the stalk, multiple anterior pituitary deficits and prolactin above 1.3× ULN increase the likelihood of a neoplastic origin.


Assuntos
Diabetes Insípido Neurogênico/patologia , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Adulto , Fatores Etários , Idoso , Diabetes Insípido Neurogênico/diagnóstico por imagem , Feminino , Germinoma/complicações , Germinoma/patologia , Histiocitose/complicações , Histiocitose/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Prolactina/sangue , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais
2.
J Med Case Rep ; 13(1): 342, 2019 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-31759391

RESUMO

BACKGROUND: Pituitary abscess is a rare condition with nonspecific symptoms that can be delayed. Proper diagnosis needs to occur preoperatively so that the management can be set up accordingly. Accurate diagnosis is challenging because many differential diagnoses can exhibit the same magnetic resonance imaging features. CASE PRESENTATION: We report two cases of pituitary abscess. The first patient was a 66-year-old Arab woman who underwent a surgical procedure for a pituitary macroadenoma and presented 3 months later with chronic headaches and panhypopituitarism. A pituitary abscess was found on the follow-up magnetic resonance imaging. The second patient was a 64-year-old Arab man with no medical history who presented with a chiasmal syndrome with headaches and panhypopituitarism. Brain magnetic resonance imaging showed a heterogeneous pituitary mass that turned out to be a pituitary abscess intraoperatively. These two patients were treated with hormone substitution, endoscopic transsphenoidal drainage, and antibiotherapy, with excellent outcomes. CONCLUSIONS: Pituitary abscess is a rare and serious condition. Preoperative diagnosis can be challenging because of the many existing differential diagnoses upon imaging. Magnetic resonance imaging is the mainstay technique of imaging due to its multimodal nature. These cases demonstrate the variable patterns of a pituitary abscess seen on magnetic resonance imaging and the potential difficulties in achieving an accurate diagnosis preoperatively due to many other conditions potentially exhibiting the same magnetic resonance imaging features.


Assuntos
Abscesso/diagnóstico por imagem , Antibacterianos/uso terapêutico , Drenagem , Endoscopia , Imagem por Ressonância Magnética , Doenças da Hipófise/diagnóstico por imagem , Abscesso/patologia , Abscesso/terapia , Idoso , Terapia Combinada , Descompressão Cirúrgica , Feminino , Cefaleia/diagnóstico por imagem , Terapia de Reposição Hormonal , Humanos , Masculino , Doenças da Hipófise/patologia , Doenças da Hipófise/terapia , Resultado do Tratamento
3.
Pituitary ; 22(5): 514-519, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31401793

RESUMO

PURPOSE: The 2017 World Health Organization classification of pituitary tumors redefined pituitary null cell adenomas (NCAs) by restricting this diagnostic category to pituitary tumors that are negative for pituitary transcription factors and adenohypophyseal hormones. The clinical behavior of this redefined entity has not been widely studied, and this is a major shortcoming of the classification. This study evaluated the imaging and clinical features of NCAs from two pituitary centers and compared them with those of gonadotroph adenomas (GAs). METHODS: Imaging, pathologic, and clinical characteristics of NCAs and GAs were retrospectively reviewed. Tumor immunohistochemistry was performed to confirm absence of adenohypophyseal hormones and pituitary transcription factor expression. RESULTS: Thirty-one NCAs were compared with 38 GAs. NCAs were more likely to invade the cavernous sinus (15/31 [48%] vs. 5/38 [13%], P = .003) and had a higher proliferative index (i.e., MIB-1 > 3%, 11/31 [35%] vs. 5/38 [13%], P = .04). Gross total resection was less likely in the NCA group (19/31 [61%] vs. 33/38 [87], P = .02). Progression-free survival was worse in the NCA cohort (5-year progression-free survival, 0.70 vs. 1.00; P = .011, by log-rank test). CONCLUSIONS: Compared with GAs, NCAs are more invasive at the time of presentation and have a more aggressive clinical course. This study provides evidence that NCAs represent a distinct clinicopathologic entity with behavior that differs adversely from that of GAs. This may inform clinical decision-making, including frequency of postoperative tumor surveillance and timing of adjunctive treatments.


Assuntos
Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Linfócitos Nulos/patologia , Masculino , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/mortalidade , Doenças da Hipófise/patologia , Neoplasias Hipofisárias/mortalidade , Intervalo Livre de Progressão , Estudos Retrospectivos , Organização Mundial da Saúde
4.
J UOEH ; 41(2): 249-257, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31292372

RESUMO

Here we report a case of a 12-year-old girl who was referred to our department because of marked short stature of more than -5 SD below the median. Although her growth failure began suddenly at 6 years of age, she never had an examination because she had no other symptoms. Brain MRI examination suggested a tumor in the suprasellar region, and endocrine examination revealed combined pituitery hormone deficiency due to the tumor. Before surgery, the supplementation with hydrocortisone and levothyroxine was initiated. The pathological diagnosis of the surgically removed tumor was xanthogranuloma. The pattern of her growth curve showed a growth failure with sudden onset, which is a typical pattern of short stature secondary to pituitary disfunction including growth hormone deficiency associated with brain tumors. This case suggests that growth failure could be the only symptom in pediatric cases with brain tumors. Improved awareness regarding the association of growth failure with brain tumors is needed for earlier diagnosis and treatment. Furthermore, the growth curves should be carefully evaluated in regular health examinations at school.


Assuntos
Estatura , Insuficiência de Crescimento , Transtornos do Crescimento/etiologia , Doenças da Hipófise/complicações , Xantogranuloma Juvenil/complicações , Anormalidades Múltiplas/etiologia , Fatores Etários , Criança , Diagnóstico Precoce , Facies , Feminino , Transtornos do Crescimento/patologia , Transtornos do Crescimento/prevenção & controle , Humanos , Hipotireoidismo/etiologia , Imagem por Ressonância Magnética , Exame Físico , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Doenças da Hipófise/cirurgia , Hormônios Adeno-Hipofisários/deficiência , Instituições Acadêmicas , Índice de Gravidade de Doença , Fator de Transcrição Pit-1/deficiência , Xantogranuloma Juvenil/diagnóstico por imagem , Xantogranuloma Juvenil/patologia , Xantogranuloma Juvenil/cirurgia
5.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289170

RESUMO

Diencephalic syndrome is one of the rare causes of failure to thrive in infants and young children. It is caused by a tumour in diencephalon (thalamus and hypothalamus), characterised by profound emaciation with uniform loss of body weight despite normal or slightly decreased appetite, locomotor hyperactivity, euphoria and visual symptoms. Anaesthetic considerations due to decreased body fat include positioning to avoid pressure necrosis, measures to avoid hypothermia, proper drug dosing, treating electrolyte imbalances and delayed recovery. We report successful anaesthetic management of a child with diencephalic syndrome scheduled for an endoscopic biopsy of suprasellar space occupying lesion under general anaesthesia.


Assuntos
Anestesia/métodos , Diencéfalo/patologia , Doenças Hipotalâmicas/patologia , Doenças da Hipófise/patologia , Anestésicos/administração & dosagem , Biópsia , Criança , Insuficiência de Crescimento/etiologia , Humanos , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças Hipotalâmicas/metabolismo , Unidades de Terapia Intensiva Pediátrica/normas , Cuidados Intraoperatórios , Masculino , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Cuidados Pré-Operatórios , Prognóstico , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/métodos
6.
Endocr Pract ; 25(9): 926-934, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31170366

RESUMO

Objective: A significant ambiguity still remains about which patient deserves a magnetic resonance imaging (MRI) scan of the pituitary during evaluation of hypogonadotropic hypogonadism (HH) in men. Methods: Retrospective case series of 175 men with HH referred over 6 years. Results: A total of 49.7% of men had total testosterone (TT) levels lower than the Endocrine Society threshold of 5.2 nmol/L. One-hundred forty-two patients (81.2%) had normal appearance of pituitary MRI, whereas others had different spectrum of abnormalities (empty sella [n = 16], macroadenoma [n = 8], microadenoma [n = 8], and pituitary cyst [n = 1]). In men with TT in the lowest quartile, MRI pituitary findings were not significantly different from men in the remaining quartiles (P = .50). Patients with raised prolactin had higher number of abnormal MRI findings (38.9% vs. 13.7%; P = .0014) and adenomatous lesions (macro and micro) (27.8% vs. 4.3%; P = .01) in comparison to men with normal prolactin. The prolactin levels (median [interquartile range]) were highest in men with macroadenomas in both groups (9,950 [915]; P = .007 and 300 [68.0] mU/L; P = .02, respectively), with concomitant lower levels of other pituitary hormones. Multivariate logistic regression showed an association of abnormal pituitary MRI with insulin-like growth factor 1 (IGF-1) standard deviation score (SDS) (odds ratio [OR], 1.78 [95% confidence interval (CI), 1.15 to 2.77]; P = .009) and prolactin (OR, 1.00 [95% CI, 1.00 to 1.03]; P = .01). Conclusion: MRI of the pituitary is not warranted in all patients with HH, as the yield of identifiable abnormalities is quite low. Anatomic lesions are likely to be present only when low levels of TT (<5.2 nmol/L) are found concomitantly with high levels of prolactin and/or low IGF-1 SDS. Abbreviations: CI = confidence interval; FT4 = free thyroxine; GH = growth hormone; HH = hypogonadotropic hypogonadism; IGF-1 = insulin-like growth factor; LH = luteinizing hormone; MRI = magnetic resonance imaging; OR = odds ratio; SDS = standard deviation score; TSH = thyroid-stimulating hormone; TT = total testosterone.


Assuntos
Hipogonadismo , Doenças da Hipófise , Humanos , Imagem por Ressonância Magnética , Doenças da Hipófise/diagnóstico por imagem , Hipófise , Estudos Retrospectivos , Testosterona
7.
Rheumatol Int ; 39(8): 1467-1476, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203400

RESUMO

GPA with pituitary involvement is a rare condition which is prone to be misdiagnosed. The aim of this study was to summarize clinical features of pituitary involvement in GPA and facilitate early diagnosis. Twelve GPA patients were retrospectively analyzed at a single hospital between 2000 and 2017. A literature review was conducted to compare previous findings with our clinical results. The incidence rate of pituitary involvement in GPA was 3.9% (12/304) without sexual predilection. Other impairments included ear, nose and throat (n = 12), oculi (n = 10), lung (n = 6), meninges (n = 4), kidney (n = 3), and skin (n = 2). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with lung or kidney involvement (n = 6/6), while ANCA were negative in almost all patients without lung or kidney involvement (n = 5/6). Endocrine abnormalities included central diabetes insipidus (CDI, n = 11/12) hypogonadotropic hypogonadism (n = 6/11), adrenocorticotropic hormone deficiency (n = 4/7), thyroid-stimulating hormone deficiency (n = 5/11), and growth hormone deficiency (n = 3/9). Enlarged pituitary gland (n = 6), absence of posterior hyperintense signal on T1-weighed images (n = 11) and hypertrophic cranial pachymeningitis (n = 4) were common radiological manifestations. After treatment, nine patients experienced remission but one died. Pituitary images of 3/4 patients showed size of pituitary lesions decreased. CDI was not alleviated and hypopituitarism remained in two patients. Pituitary involvement in GPA can occur at any time throughout the course of disease, including at the initial presentation. GPA could not be excluded based on negative-ANCA in patients with pituitary abnormality alone. CDI and hypogonadotropic hypogonadism are dominant endocrine abnormalities. Systemic diseases may alleviate and pituitary images may improve after treatment, though the recovery of pituitary function is rare.


Assuntos
Granulomatose com Poliangiite , Doenças da Hipófise , Adulto , Anticorpos Anticitoplasma de Neutrófilos/sangue , Biomarcadores/sangue , Biópsia , Desamino Arginina Vasopressina/uso terapêutico , Feminino , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Terapia de Reposição Hormonal , Hormônios/sangue , Humanos , Imunossupressores/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/patologia , Indução de Remissão , Estudos Retrospectivos , Tiroxina/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
8.
Indian J Pediatr ; 86(10): 939-951, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30887222

RESUMO

Short stature in children is a diagnostic challenge to the physician. Bone age assessment can be done using various methods. The causes of short stature are variable; often leading to a series of investigations. The endocrine conditions have typical imaging features. This chapter provides a short overview of the methods of bone age estimation, and imaging findings and algorithmic approach towards a child with short stature.


Assuntos
Determinação da Idade pelo Esqueleto/métodos , Diagnóstico por Imagem/métodos , Transtornos do Crescimento/diagnóstico por imagem , Algoritmos , Criança , Síndrome de Cushing/diagnóstico por imagem , Síndrome de Cushing/patologia , Doenças do Sistema Endócrino/diagnóstico por imagem , Doenças do Sistema Endócrino/patologia , Glioma/diagnóstico por imagem , Glioma/patologia , Transtornos do Crescimento/patologia , Hamartoma/diagnóstico por imagem , Hamartoma/patologia , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/patologia , Humanos , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/patologia , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças Hipotalâmicas/patologia , Hipotireoidismo/diagnóstico por imagem , Hipotireoidismo/patologia , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Hormônios Hipofisários , Puberdade Precoce/diagnóstico por imagem , Puberdade Precoce/patologia
11.
Acta Radiol ; 60(2): 213-220, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29792041

RESUMO

BACKGROUND: Conventional magnetic resonance imaging (MRI) is adversely affected by thick slices, small intersection gaps, and the partial volume effect, leading to the missed diagnosis or misdiagnosis of pituitary micro-lesions. PURPOSE: To evaluate the diagnostic yield of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-T2 SPACE) sequences compared with a standard MRI protocol for the diagnosis of pituitary micro-lesions. MATERIAL AND METHODS: The MRI findings of 664 patients with clinically suspected pituitary lesions were retrospectively analyzed. All patients underwent coronal 3D-T2 SPACE sequences followed by T1-weighted (T1W) imaging. Conventional scanning sequences included coronal and sagittal T1W imaging and post-contrast enhanced coronal and sagittal T1 imaging. All images were independently evaluated by two experienced neuroradiologists. The inter-observer agreement was analyzed using kappa statistics. RESULTS: Compared with conventional sequences, there was an increase in diagnostic confidence of 60.3% for the diagnosis of pituitary micro-lesions with the addition of 3D-T2 SPACE sequences. The lesion conspicuity scores of combined conventional and 3D-T2 SPACE sequences were significantly higher than those of conventional imaging (z = -6.403, P < 0.01) and 3D-T2 SPACE sequences (z = -4.243, P < 0.01). In addition, the inter-observer agreement of 3D-T2 SPACE sequences was good (κ = 0.826). CONCLUSION: Combined with routine sequences, post-contrast enhanced 3D-T2 SPACE sequences effectively improve diagnostic confidence in the diagnosis of pituitary micro-lesions. Post-contrast enhanced 3D-T2 SPACE is suitable for detecting pico-adenomas, micro-lesions adjacent to the cavernous sinuses or sellar floor, lesions between the anterior and posterior lobes, and lesions with early phase enhancement.


Assuntos
Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Doenças da Hipófise/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/patologia , Estudos Retrospectivos
13.
J Pediatr Endocrinol Metab ; 31(11): 1267-1271, 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30367806

RESUMO

Background Pituitary cysts have been speculated to cause endocrinopathies. We sought to describe the prevalence and volumetry of pituitary cysts in patients with growth hormone deficiency (GHD) and idiopathic short stature (ISS). Methods Six hundred and eighteen children evaluated for growth failure at the Division of Pediatric Endocrinology at New York Medical College between the years 2002 and 2012, who underwent GH stimulation testing and had a brain magnetic resonance imaging (MRI) prior to initiating GH treatment were randomly selected to be a part of this study. High resolution MRI was used to evaluate the pituitary gland for size and the presence of a cyst. Cyst prevalence, cyst volume and percentage of the gland occupied by the cyst (POGO) were documented. Results Fifty-six patients had a cyst, giving an overall prevalence of 9.1%. The prevalence of cysts in GHD patients compared to ISS patients was not significant (13.5% vs. 5.7%, p=0.46). Mean cyst volume was greater in GHD patients than ISS patients (62.0 mm3 vs. 29.4 mm3, p=0.01). POGO for GHD patients was significantly greater (p=0.003) than for ISS patients (15.3%±12.8 vs. 7.1%±8.0). Observers were blinded to patient groups. Conclusions GHD patients had a significantly greater volume and POGO compared to ISS patients. This raises the question of whether cysts are implicated in the pathology of growth failure.


Assuntos
Cistos/epidemiologia , Transtornos do Crescimento/epidemiologia , Hormônio do Crescimento Humano/deficiência , Hipopituitarismo/epidemiologia , Doenças da Hipófise/epidemiologia , Hipófise/patologia , Adolescente , Criança , Cistos/diagnóstico por imagem , Cistos/patologia , Feminino , Transtornos do Crescimento/diagnóstico por imagem , Transtornos do Crescimento/patologia , Humanos , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/patologia , Imagem por Ressonância Magnética , Masculino , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Hipófise/diagnóstico por imagem , Prevalência
14.
J Neurol Sci ; 395: 153-158, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30321796

RESUMO

INTRODUCTION: Current literature is poor with respect to well conducted prospective studies of hypothalamic pituitary axis (HPA) dysfunction in tubercular meningitis (TBM). As hormonal deficiencies are associated with poor clinical outcome in various neurological and non-neurological disorders, we prospectively evaluated the hypothalamic pituitary axis (HPA) dysfunction in TBM. PATIENTS AND METHODS: Present study included newly diagnosed drug naive TBM patients (n = 63) at a tertiary care centre in Northern India. All patients underwent detailed clinical, radiological evaluation (Gadolinium enhanced magnetic resonance imaging of brain) and HPA hormonal profiles (electrochemiluminescence assay) both at initial presentation and at six month follow up. All the data was recorded on a predesigned proforma. RESULTS: 77.8% patients had definite and 22.2% had highly probable TBM. 84.2% of patients had pituitary hormonal abnormalities at presentation. These included hyperprolactinemia (49.2%), secondary adrenal deficiency (42.9%), secondary hypogonadism (38.1%) and central hypothyroidism (9.5%). At follow up, 42.1% patients had HPA abnormalities [hyperprolactinemia (13.2%), secondary hypogonadism (15.8%), secondary adrenal deficiency (10.5%) and central hypothyroidism (10.5%)]. On multivariate logistic regression analysis, secondary hypocortisolism (Odd ratio: 4.042; 95% CI = 1.074-15.22; P = .039) was associated with poor outcome in TBM. CONCLUSION: Abnormalities of HPA are common in TBM. Patients with TBM should be evaluated for dysfunction of HPA and treated accordingly.


Assuntos
Doenças Hipotalâmicas/sangue , Doenças Hipotalâmicas/diagnóstico por imagem , Doenças da Hipófise/sangue , Doenças da Hipófise/diagnóstico por imagem , Tuberculose Meníngea/sangue , Tuberculose Meníngea/diagnóstico por imagem , Adulto , Antituberculosos/uso terapêutico , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Encéfalo/diagnóstico por imagem , Feminino , Seguimentos , Hormônios/sangue , Humanos , Doenças Hipotalâmicas/complicações , Índia , Masculino , Doenças da Hipófise/complicações , Estudos Prospectivos , Centros de Atenção Terciária , Resultado do Tratamento , Tuberculose Meníngea/complicações , Tuberculose Meníngea/tratamento farmacológico
15.
Pituitary ; 21(6): 605-614, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30276501

RESUMO

BACKGROUND: The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk's (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis. AIM: To present the various causes of PSL-their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology. METHOD: A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32 ± 4.2 years (range 6-67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010-2018. RESULTS: Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown. CONCLUSION: Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.


Assuntos
Hipófise/diagnóstico por imagem , Hipófise/patologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Adulto Jovem
16.
Eur Urol Focus ; 4(3): 338-347, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-30327281

RESUMO

Imaging can benefit clinicians in evaluating men with infertility or sexual dysfunction by giving an overview of a patient's overall clinical condition before undertaking an invasive procedure. An understanding of the limitations and advantages of image modalities used in clinical practice will ensure that clinicians can optimize patient care with imaging when necessary. PATIENT SUMMARY: The objective of this article was to review the current literature on imaging modalities used for the diagnosis and management of male infertility and sexual dysfunction. An understanding of the advantages and limitations of these imaging modalities will ensure that clinicians can optimize patient care with imaging when necessary.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Disfunção Erétil/diagnóstico por imagem , Infertilidade Masculina/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Ultrassom Focalizado Transretal de Alta Intensidade/métodos , Criptorquidismo/complicações , Criptorquidismo/diagnóstico por imagem , Ductos Ejaculatórios/anormalidades , Ductos Ejaculatórios/diagnóstico por imagem , Disfunção Erétil/epidemiologia , Humanos , Hiperprolactinemia/complicações , Hiperprolactinemia/diagnóstico por imagem , Hiperprolactinemia/patologia , Sistema Hipotálamo-Hipofisário/anormalidades , Sistema Hipotálamo-Hipofisário/diagnóstico por imagem , Infertilidade Masculina/epidemiologia , Infertilidade Masculina/etiologia , Síndrome de Kallmann/complicações , Síndrome de Kallmann/diagnóstico por imagem , Masculino , Doenças Urogenitais Masculinas/complicações , Doenças Urogenitais Masculinas/diagnóstico por imagem , Induração Peniana/complicações , Induração Peniana/diagnóstico por imagem , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico por imagem , Escroto/anormalidades , Escroto/diagnóstico por imagem , Varicocele/complicações , Varicocele/diagnóstico por imagem , Ducto Deferente/anormalidades , Ducto Deferente/diagnóstico por imagem
17.
J Pediatr Endocrinol Metab ; 31(10): 1161-1164, 2018 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-30205655

RESUMO

Background Xanthogranuloma of the sellar region is a rare entity. Its pathology is controversial and it is difficult to strictly differentiate it from craniopharyngioma or Rathke's cyst. Case presentation We report a case of xanthogranuloma accompanied by growth hormone deficiency in an 11-year-old girl. She did not show any other pituitary hormone deficiency or neurological symptoms before operation. The preoperative diagnosis was craniopharyngioma, but histological findings showed small areas of epithelium. Thus, the final diagnosis was xanthogranuloma. Xanthogranuloma is an important cause of growth delay. We reviewed 16 cases reported after 2000, and included our case, of xanthogranuloma in children. Conclusions Endocrinological symptoms are often regarded as one of the few apparent symptoms in xanthogranuloma compared with craniopharyngioma. Therefore, we should follow up carefully and accumulate cases.


Assuntos
Hormônio do Crescimento Humano/deficiência , Hipopituitarismo/patologia , Doenças da Hipófise/patologia , Xantogranuloma Juvenil/patologia , Criança , Feminino , Humanos , Hipopituitarismo/diagnóstico por imagem , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico por imagem , Xantogranuloma Juvenil/complicações , Xantogranuloma Juvenil/diagnóstico por imagem
18.
Rev. argent. radiol ; 82(3): 124-130, set. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-977273

RESUMO

Los síndromes de neoplasia endocrina múltiple (MEN), incluyen una serie de enfermedades con alteraciones genéticas que se caracterizan por la presencia de tumores que afectan a dos o más glándulas endocrinas. Son síndromes con una herencia autosómica dominante e incluyen tres patrones: MEN 1 (síndrome de Wermer), MEN 2 (que incluye MEN 2A o síndrome de Sipple y MEN 2B o síndrome de Wagenmann-Froboese) y MEN 4. Los adenomas paratiroideos y el carcinoma medular tiroideo, son los tumores más frecuentes del MEN tipo 1 y 2 respectivamente. Esos síndromes son más comunes en pacientes jóvenes, con patología de afectación bilateral, múltiple o multifocal y, sobre todo, en pacientes con antecedentes familiares. Es necesario el trabajo en equipo de endocrinólogos, cirujanos, oncólogos y radiólogos para optimizar el tratamiento de esos pacientes.


Multiple endocrine neoplasia (MEN) encompasses a serial of familial genetically disorders in wich tumors simultaneusly occur in two or more endocrine organs. MEN síndromes are autosomal-dominant disorders categorized into three main patterns: MEN 1 (Wermer syndrome), MEN 2 (includes MEN 2A o Sipple syndrome and MEN 2B o Wagenmann-Froboese syndrome) and MEN 4. Parathyroid adenomas and medullary thyroid carcinoma are the most frecuent tumors in MEN 1 and MEN 2 respectively. These entities will be suspected in younger patients, bilateral, multiple or multifocal disease and, specially, in patients with family background. Cooperation between endocrinologist, surgeons, oncologists and radiologists is pivotal for optimizing patient treatment.


Assuntos
Humanos , Neoplasia Endócrina Múltipla/diagnóstico por imagem , Neoplasia Endócrina Múltipla Tipo 2b/diagnóstico por imagem , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico por imagem , Neoplasia Endócrina Múltipla Tipo 1/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias das Paratireoides/diagnóstico por imagem , Doenças da Hipófise/complicações , Doenças da Hipófise/diagnóstico por imagem , Neoplasia Endócrina Múltipla/complicações , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias do Córtex Suprarrenal/diagnóstico por imagem , Carcinoma Adrenocortical/diagnóstico por imagem , Hiperparatireoidismo Primário/diagnóstico por imagem
19.
World Neurosurg ; 117: 11-14, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29886298

RESUMO

BACKGROUND: Persisting embryonal infundibular recess (PEIR) is a rare anomaly of the third ventricular floor, with only 10 cases having been reported to date. Accurate imaging diagnosis of this entity is essential to avoid unnecessary surgery and its associated morbidity. The following case is presented to emphasize its recognition in the differential diagnosis of pituitary cystic lesions. CASE DESCRIPTION: A 38-year-old woman was referred for evaluation of a pituitary cystic mass. Magnetic resonance imaging (MRI) revealed a 10.2-mm cystic mass in an enlarged sella turcica. Three-dimensional high-resolution MRI using constructive interference in steady-state sequence clearly delineated a communicating tract between the third ventricle and the sellar cyst through pituitary stalk. A final diagnosis of PEIR was made. The patient was managed successfully with conservative treatment, and the lesion was in a stationary condition over a 5-year follow-up period. CONCLUSIONS: This is the first case report demonstrating imaging features of PEIR in 3-dimensional high-resolution MRI. Although PEIR is a rare anomaly, imaging diagnosis of this entity is important because confusion with other pituitary cystic lesions and the attempt of surgical removal may lead to serious complications.


Assuntos
Doenças da Hipófise/diagnóstico por imagem , Terceiro Ventrículo/anormalidades , Terceiro Ventrículo/diagnóstico por imagem , Adulto , Tratamento Conservador , Cistos/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem
20.
J Coll Physicians Surg Pak ; 28(6): S97-S98, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29866234

RESUMO

Tuberculosis rarely involves the hypothalamo-pituitary region and constitutes only 1% of the lesions involving the sellar and/or suprasellar region. Coleman and Meredith first reported pituitary tuberculosis in 1940, and only a handful of cases have been reported ever since. It may manifest as a chiasmal syndrome due to compression of the optic chiasm or as hypopituitarism due to pituitary destruction. It has a characteristic radiological appearance and can mimic a pituitary adenoma. Diagnostic procedures, such as trans-sphenoidal biopsy, are crucial for accurate diagnosis. We report a case of a 32-year male, who presented with complaints of headache and decreased visual acuity for the past 6 months. Eye examination revealed bitemporal hemianopsia. Brain MRI scan showed a mass in the sella with features suggestive of pituitary adenoma. Transcranial resection of the mass was performed; histopathology of the excised mass proved it to be a pituitary tuberculoma.


Assuntos
Cefaleia/etiologia , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética/métodos , Quiasma Óptico/diagnóstico por imagem , Doenças da Hipófise/diagnóstico por imagem , Hipófise/diagnóstico por imagem , Tuberculoma/diagnóstico por imagem , Adulto , Antituberculosos/uso terapêutico , Craniotomia , Terapia de Reposição Hormonal , Humanos , Hipopituitarismo/terapia , Masculino , Quiasma Óptico/irrigação sanguínea , Doenças da Hipófise/complicações , Hipófise/cirurgia , Tuberculoma/complicações , Tuberculoma/tratamento farmacológico , Tuberculoma/cirurgia , Transtornos da Visão/etiologia
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