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1.
Br J Radiol ; 94(1122): 20201311, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33914621

RESUMO

OBJECTIVE: To evaluate the visualization of incidentally imaged normal pituitary gland on three-dimensional (3D) pseudo continuous arterial spin labeling (PCASL) perfusion imaging of the brain. METHODS: Ninety-three patients with a normal pituitary gland who underwent 3D PCASL for suspected brain diseases were retrospectively included. Visualization of the pituitary gland on PCASL cerebral blood flow (CBF) maps was assessed independently by two observers using a three-point grading system: Grade 1, pituitary CBF ≤ CBF of the cerebral white matter (WM); Grade 2, CBF of WM < pituitary CBF ≤ CBF of the cortical gray matter (GM); and Grade 3, CBF of GM < pituitary CBF. The interobserver agreement of visual grading was determined using weighted κ statistic. The associations of visual grades with age, sex, and pituitary volume were assessed using multivariate logistic regression. Pituitary glands were divided equally into three groups (small, medium, and large) according to their volume for categorization. RESULTS: The interobserver agreement for visual rating was excellent (weighted κ = 0.823). Of the 93 cases, Grades 1, 2, and 3 included 17 (18.3%), 41 (44.1%), and 35 cases (37.6%), respectively. Medium and large pituitary volume were significantly associated with Grade 3 visualization (p = 0.0153, OR = 4.8323; 95% CI: 1.3525, 17.2649 and p = 0.0009; OR = 9.0299; 95% CI: 2.4663, 33.0614, respectively), whereas there was no significant association for age or sex. CONCLUSION: The normal pituitary gland is often visualized with higher CBF than cortical GM on 3D PCASL, especially in individuals with larger pituitary volume. ADVANCES IN KNOWLEDGE: Appearance of the normal pituitary gland on 3D PCASL has been documented for the first time.


Assuntos
Encefalopatias/diagnóstico por imagem , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Hipófise/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular , Criança , Meios de Contraste , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos , Valores de Referência , Estudos Retrospectivos , Marcadores de Spin
2.
Medicine (Baltimore) ; 100(10): e25075, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725898

RESUMO

RATIONALE: Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy. PATIENT CONCERNS: We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia. DIAGNOSES: MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM). INTERVENTIONS: The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25µg/day) was given. OUTCOMES: The patient delivered a healthy baby via cesarean section at hospital at 38 + 1 week of gestation. We performed MRI examination regularly and the tumor regressed significantly 8 months postpartum. LESSONS: We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.


Assuntos
Mielinólise Central da Ponte/diagnóstico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Cesárea , Quimioterapia Combinada , Disartria/etiologia , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Hemiplegia/tratamento farmacológico , Hemiplegia/etiologia , Humanos , Hidrocortisona/administração & dosagem , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hiponatremia/etiologia , Imageamento por Ressonância Magnética , Mielinólise Central da Ponte/tratamento farmacológico , Mielinólise Central da Ponte/etiologia , Apoplexia Hipofisária/sangue , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/etiologia , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Gravidez , Terceiro Trimestre da Gravidez , Sódio/administração & dosagem , Tiroxina/administração & dosagem , Resultado do Tratamento , Vômito/tratamento farmacológico , Vômito/etiologia , Adulto Jovem
4.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509867

RESUMO

A man in his early 60s with a medical history of granulomatosis with polyangiitis (GPA) in remission for two decades without maintenance therapy presented with non-specific complaints of profound fatigue and 40-pound weight loss. He was seronegative for antinuclear antibodies and cytoplasmic antineutrophilic antibodies, but erythrocyte sedimentation rate and C reactive protein levels were elevated. Endocrinological testing revealed adrenal insufficiency, hypogonadism, hypothyroidism and diabetes insipidus. An MRI of the head revealed extensive sinonasal inflammation eroding through the floor of the sella turcica and into the pituitary gland and stalk. Biopsy of the sinonasal tissues was inconclusive. On review of his case, a multidisciplinary team diagnosed him with panhypopituitarism secondary to a recurrence of GPA. He responded well to glucocorticoids and methotrexate with marked reduction of pituitary enhancement on imaging and resolution of diabetes insipidus. He will require lifelong testosterone, levothyroxine and glucocorticoids for hormone replacement therapy.


Assuntos
Insuficiência Adrenal/diagnóstico , Diabetes Insípido/diagnóstico , Granulomatose com Poliangiite/diagnóstico por imagem , Hipogonadismo/diagnóstico , Hipopituitarismo/diagnóstico , Hipotireoidismo/diagnóstico , Rinite/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Insuficiência Adrenal/tratamento farmacológico , Insuficiência Adrenal/etiologia , Androgênios/uso terapêutico , Diabetes Insípido/etiologia , Fadiga/etiologia , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Granulomatose com Poliangiite/patologia , Terapia de Reposição Hormonal , Humanos , Hipogonadismo/tratamento farmacológico , Hipogonadismo/etiologia , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Hipotireoidismo/tratamento farmacológico , Hipotireoidismo/etiologia , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças da Hipófise , Hipófise/diagnóstico por imagem , Recidiva , Rinite/patologia , Sela Túrcica/diagnóstico por imagem , Sinusite/patologia , Testosterona/uso terapêutico , Tiroxina/uso terapêutico , Perda de Peso
5.
BMC Surg ; 21(1): 58, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485359

RESUMO

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.


Assuntos
Adenoma , Hipófise , Neoplasias Hipofisárias , Base do Crânio , Cirurgia Assistida por Computador , Cirurgia Endoscópica Transanal , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Projetos Piloto , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Cirurgia Endoscópica Transanal/métodos
6.
Vet Radiol Ultrasound ; 62(2): 199-209, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33350547

RESUMO

A recent publication described pathological findings in the pituitary gland incidentally discovered during routine necropsies of the brain of dogs and cats; however, imaging characteristics of these lesions were not reported. Aims of this retrospective, observational study were to characterize MRI variants and incidental lesions in pituitary glands of dogs with no clinical signs of pituitary disease. Cranial MRIs from dogs with no suspicion of pituitary disease, based on history and presenting clinical signs, were retrieved from a veterinary teleradiology database during the period of January 2014 to January 2016. Images were reinterpreted by two observers and pituitary lesions were described based on consensus. A total of 580 scans were evaluated and pituitary lesions were detected in 78 dogs (13.44%). Pituitary cystic lesions were the most common finding and occurred in 31 dogs (5.34%). Of these 31 dogs, the majority (74%) were of toy or brachycephalic breed. Partial or total empty sella lesions were detected in 14 dogs (2.41%), and all of these were small or toy breeds. A significantly increased incidence of the partial empty sella lesion was found in male dogs (P = .034). Pituitary lesions greater than 1 cm occurred rarely (0.69%). There was a significant association between low-field (LF) MRI strength and detection of a partial or total empty sella lesion (P = .0112), and detection of a pituitary lesion greater than 1 cm (P = .0125). A significant difference was present between the MRI field strength (FS) that identified pituitary cysts and the FS that detected an empty sella (P = .0068), with the former being a high FS and the latter a LF strength. The findings from this study indicated that up to 13% of dogs with no presenting clinical signs of pituitary disease may have MRI pituitary lesions.


Assuntos
Doenças do Cão/diagnóstico por imagem , Imageamento por Ressonância Magnética/veterinária , Hipófise/diagnóstico por imagem , Animais , Autopsia/veterinária , Tamanho Corporal , Doenças do Cão/patologia , Cães , Síndrome da Sela Vazia/diagnóstico , Síndrome da Sela Vazia/epidemiologia , Síndrome da Sela Vazia/patologia , Síndrome da Sela Vazia/veterinária , Feminino , Imageamento por Ressonância Magnética/métodos , Masculino , Neoplasias Hipofisárias/veterinária , Estudos Retrospectivos
7.
Clin Imaging ; 69: 145-147, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32731106

RESUMO

A sellar spine is a midline bony spur arising from the ventral aspect of the dorsum sellae. Representing a remnant of the anterior notochord, it is often an incidental finding and thought to be of no clinical significance. However, it has recently been suggested that a potential association may exist between sellar spine and pediatric pituitary endocrinopathies, possibly caused by deformation of the developing pituitary gland by the sellar spine. To our knowledge, this is the first case report demonstrating an association between sellar spine and clinical diabetes insipidus.


Assuntos
Diabetes Insípido , Diabetes Mellitus , Neoplasias Hipofisárias , Criança , Diabetes Insípido/etiologia , Humanos , Hipófise/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Coluna Vertebral
8.
Medicine (Baltimore) ; 99(50): e23266, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327247

RESUMO

RATIONALE: Pituitary stalk interruption syndrome (PSIS) is a congenital pituitary anatomical defect. It is characterized by the triad of thin or interrupted pituitary stalk, absent or ectopic posterior lobe, and hypoplastic or aplastic anterior lobe. Moreover, this condition is considered rare. PATIENT CONCERNS: A 23-year-old male patient presented with a history of short stature and hypogonadism. Laboratory assessment revealed low thyroxine, cortisol, and adrenocorticotropic hormone levels, which are consistent with adrenal insufficiency without hypoglycemia. The insulin-induced hypoglycemia tolerance test finding indicated growth hormone (GH) deficiency. Moreover, magnetic resonance imaging revealed an interrupted pituitary stalk, ectopic posterior pituitary, and hypoplastic anterior pituitary. This triad of symptoms was indicative of PSIS. DIAGNOSIS: INTERVENTIONS:: The patient was deficient in adrenaline, thyroxine, gonadal steroid, and GH. Thus, glucocorticoid replacement therapy was initiated, followed by euthyrox, androgen, and human chorionic gonadotropin treatment. Calcium tablets, calcitriol, and alendronate sodium were used for the management of osteoporosis. The patient was 164 cm tall, and his bone age was approximately 15 years old. However, owing to a poor economic condition, the family did not proceed with GH therapy. OUTCOMES: The patient did not present with adrenal or hypothyroidism crisis after receiving poly-hormonal replacement therapy. His secondary sexual characteristics began to develop. However, owing to a short treatment window period, the patient could not receive the required treatment. Hence, whether the patient would have a normal fertility function needs to be confirmed. LESSONS: PSIS is a rare disease with various clinical characteristics. During the neonatal period and infancy, the signs and symptoms of PSIS are often not evident. Therefore, diagnosis is delayed. The early detection of hormone deficiency and treatment initiation can affect both the quality of life and the prognosis of patients with PSIS. Thus, the diagnosis and treatment of this disease must be improved to help patients achieve a better quality of life and to prevent reproductive health problems.


Assuntos
Hipófise/anormalidades , Hormônio Adrenocorticotrópico/deficiência , Teste de Tolerância a Glucose , Transtornos do Crescimento/etiologia , Humanos , Hidrocortisona/deficiência , Hipogonadismo/etiologia , Imageamento por Ressonância Magnética , Masculino , Hipófise/diagnóstico por imagem , Adeno-Hipófise/anormalidades , Neuro-Hipófise/anormalidades , Sistema Hipófise-Suprarrenal , Tiroxina/deficiência , Adulto Jovem
9.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334740

RESUMO

Myasthenia gravis (MG) is a rare and potentially dangerous autoimmune condition, which affects the acetylcholine receptors at the neuromuscular junction of skeletal muscle. MG's diverse symptomatology may readily masquerade as other neurological conditions, posing a diagnostic challenge to clinicians. We describe a 24-year old man who presented to the emergency department with a new onset internuclear ophthalmoplegia. After a series of investigations, we eventually arrived at a diagnosis of MG with pseudointernuclear ophthalmoplegia with an incidentally detected prolactinoma. We explore the literature regarding the pathophysiology of pseudointernuclear ophthalmoplegia, the link between prolactin and autoimmunity and the association between prolactinoma and MG.


Assuntos
Diplopia/etiologia , Miastenia Gravis/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico , Humanos , Achados Incidentais , Masculino , Miastenia Gravis/complicações , Miastenia Gravis/imunologia , Transtornos da Motilidade Ocular/diagnóstico , Hipófise/diagnóstico por imagem , Hipófise/metabolismo , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Prolactina/sangue , Prolactina/metabolismo , Prolactinoma/sangue , Prolactinoma/complicações , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372016

RESUMO

Neurological manifestations of hypothyroidism include peripheral neuropathy and pituitary hyperplasia. However, these associations are rarely encountered during pregnancy. We report a case of a known hypothyroid with very high thyroid stimulating hormone (TSH) values (512 µIU/mL) in the second trimester. At 24 weeks she developed facial palsy and pituitary hyperplasia which responded to a combination of steroids and thyroxine. She had caesarean delivery at 35 weeks and 3 days gestation in view of pre-eclampsia with severe features and was discharged on oral antihypertensives and thyroxine. On follow-up at 5 months, TSH normalised and pituitary hyperplasia showed a greater than 50% reduction in size. To our knowledge, this is the first reported case of facial palsy and pituitary hyperplasia associated with hypothyroidism during pregnancy.


Assuntos
Paralisia Facial/etiologia , Hipotireoidismo/complicações , Hipotireoidismo/patologia , Hipófise/patologia , Complicações na Gravidez/patologia , Corticosteroides/uso terapêutico , Adulto , Anti-Hipertensivos/uso terapêutico , Cesárea , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Terapia de Reposição Hormonal , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/etiologia , Imageamento por Ressonância Magnética , Hipófise/diagnóstico por imagem , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/cirurgia , Gravidez , Segundo Trimestre da Gravidez , Tireotropina/sangue , Tiroxina/administração & dosagem
11.
Zhonghua Nan Ke Xue ; 26(8): 736-739, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-33377737

RESUMO

Objective: To present a case of Rathke's cleft cyst (RCC) in a middle-aged man complaining of depression and review the relevant literature. METHODS: A 51-year-old man firstly visited the outpatient clinic of neurology in our hospital due to 4 years of low mood. The patient was found normal in physical and thyroid function laboratory examinations and achieved a total score of 19 in Hamilton Depression Scale, which indicated depression. After failure to respond to antidepressant medication, the patient again came to the clinic of andrology and was found with sexual dysfunction and aspermia. With the serum FSH, LH, PRL, T and fasting blood glucose levels of 0.88 IU/L, 0.25 IU/L, 30.8 nmol/L, <0.24 nmol/L and 3.9 nmol/L respectively, it was considered to be a case of hypogonadotropic hypogonadism. Pituitary MRI indicated RCC but the adreno-cortico-tropic hormone and growth hormone were normal. All the data obtained led to the final diagnosis of RCC, acquired hypogonadotropic hypogonadism, depression and acquired aspermia and therefore the patient was referred to the department of neurosurgery and underwent navigation- and endoscopy-guided microsurgical resection of the Rathke cleft cyst via the nasopharynx and sella region in 2018. RESULTS: RCC was pathologically confirmed postoperatively. At 3 months after surgery, the patient was found with a serum T level of 0.72 nmol/L and received the testosterone replacement therapy. After 3 months of treatment, the serum T was increased to 10.3 nmol/L, the patient's symptoms of depression, hyposexuality and sexual dysfunction were significantly improved, and a little semen was observed in the ejaculate. CONCLUSIONS: RCC is one of causes of hypogonadism in middle-aged men, causing the clinical symptoms mainly by pressing the pituitary gland and inducing gonadotropin deficiency. It is hard for RCC patients with depression and sexual dysfunction to restore gonadotropin to normal even after surgical removal of the cyst and therefore testosterone replacement therapy is necessitated postoperatively.


Assuntos
Cistos do Sistema Nervoso Central/diagnóstico , Depressão/etiologia , Hipogonadismo/etiologia , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/patologia
12.
Radiol Clin North Am ; 58(6): 1115-1133, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33040852

RESUMO

The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neuroimagem/métodos , Hipófise/anatomia & histologia , Hipófise/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Feminino , Humanos , Masculino , Doenças da Hipófise/diagnóstico por imagem , Doenças da Hipófise/patologia , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Sela Túrcica/patologia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
13.
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 , Imageamento 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
14.
Pediatr Hematol Oncol ; 37(5): 438-444, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32299275

RESUMO

Involvement of the pituitary gland by leukemic infiltration is exceedingly rare. Here, we describe a very late recurrence of B-cell acute lymphoblastic leukemia masquerading as a pituitary tumor and review the literature for previously reported cases. Our female patient presented 13 years after completion of therapy for B-ALL with headache, amenorrhea, galactorrhea and a pituitary mass. Subsequent studies revealed recurrence of her leukemia, and the pituitary lesion resolved after induction chemotherapy. Our case highlights the importance of considering leukemic infiltrate in the differential diagnosis of pituitary mass, particularly in a patient with a history of hematologic malignancy, sparing unnecessary surgical intervention and informing endocrine evaluation. In addition, the case also highlights difficulties with characterizing this recurrence as a very late relapse or clonal evolution of the original leukemia.


Assuntos
Infiltração Leucêmica/diagnóstico , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/patologia , Diagnóstico Diferencial , Feminino , Galactorreia/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Hipófise/diagnóstico por imagem , Prolactina/sangue , Recidiva , Tireotropina/sangue , Adulto Jovem
15.
Radiology ; 295(3): 640-648, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32286194

RESUMO

Background Astronauts on long-duration spaceflight missions may develop changes in ocular structure and function, which can persist for years after the return to normal gravity. Chronic exposure to elevated intracranial pressure during spaceflight is hypothesized to be a contributing factor, however, the etiologic causes remain unknown. Purpose To investigate the intracranial effects of microgravity by measuring combined changes in intracranial volumetric parameters, pituitary morphologic structure, and aqueductal cerebrospinal fluid (CSF) hydrodynamics relative to spaceflight and to establish a comprehensive model of recovery after return to Earth. Materials and Methods This prospective longitudinal MRI study enrolled astronauts with planned long-duration spaceflight. Measures were conducted before spaceflight followed by 1, 30, 90, 180, and 360 days after landing. Intracranial volumetry and aqueductal CSF hydrodynamics (CSF peak-to-peak velocity amplitude and aqueductal stroke volume) were quantified for each phase. Qualitative and quantitative changes in pre- to postflight (day 1) pituitary morphologic structure were determined. Statistical analysis included separate mixed-effects models per dependent variable with repeated observations over time. Results Eleven astronauts (mean age, 45 years ± 5 [standard deviation]; 10 men) showed increased mean volumes in the brain (28 mL; P < .001), white matter (26 mL; P < .001), mean lateral ventricles (2.2 mL; P < .001), and mean summated brain and CSF (33 mL; P < .001) at postflight day 1 with corresponding increases in mean aqueductal stroke volume (14.6 µL; P = .045) and mean CSF peak-to-peak velocity magnitude (2.2 cm/sec; P = .01). Summated mean brain and CSF volumes remained increased at 360 days after spaceflight (28 mL; P < .001). Qualitatively, six of 11 (55%) astronauts developed or showed exacerbated pituitary dome depression compared with baseline. Average midline pituitary height decreased from 5.9 to 5.3 mm (P < .001). Conclusion Long-duration spaceflight was associated with increased pituitary deformation, augmented aqueductal cerebrospinal fluid (CSF) hydrodynamics, and expansion of summated brain and CSF volumes. Summated brain and CSF volumetric expansion persisted up to 1 year into recovery, suggesting permanent alteration. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Lev in this issue.


Assuntos
Astronautas , Encéfalo/diagnóstico por imagem , Pressão do Líquido Cefalorraquidiano/fisiologia , Pressão Intracraniana/fisiologia , Imageamento por Ressonância Magnética , Voo Espacial , Simulação de Ausência de Peso , Adulto , Aqueduto do Mesencéfalo/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Estudos Prospectivos
16.
Eur J Radiol ; 126: 108931, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32146344

RESUMO

PURPOSE: Tumor consistency is a critical factor in surgical planning that influences ease of resection and risk of operative morbidity. The ability of MRI to predict tumor consistency tumor consistency has been shown to increase with higher field strength. The present study examined the utility of 7 T (7 T) MRI in predicting the tumor consistency of pituitary adenomas. METHOD: Fifteen patients with pituitary adenomas were preoperatively scanned at 7 T MRI. Regions of interest were drawn around lesions for voxel-based signal intensity (SI) analysis. The percentage of tumor voxels with intensity higher than local gray matter was calculated on T2-weighted imaging. A single neurosurgeon rated tumor firmness for all patients. Histopathological analysis was performed. Radiological tumor features were correlated with intraoperative tumor consistency measurements and histopathology. RESULTS: Tumors rated as 'soft' intraoperatively were hyperintense to local gray matter on T2-weighted imaging. 'Firm' tumors were hypointense to local gray matter. There was no significant difference in SI ratio between soft and firm tumors (p = 0.098). Soft tumors had a significantly higher percentage of tumor voxels greater than local gray matter compared to firm tumors (p = 0.035, Cohen's D-effect size = 1.208). Soft tumors had higher vascularity than firm tumors, p = 0.015. CONCLUSIONS: The signal and contrast advantage conferred by 7 T MRI may provide valuable preoperative information regarding pituitary tumor consistency and physiology. The use of granular, voxel-based analysis maximizes the potential afforded by the high resolution of 7 T imaging, and may be a valuable method of predicting consistency of pituitary adenoma.


Assuntos
Adenoma/diagnóstico por imagem , Adenoma/patologia , Imageamento por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Adenoma/cirurgia , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/patologia , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos
17.
Clin Imaging ; 64: 24-28, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32217423

RESUMO

PURPOSE: To systematically evaluate the sella morphology and pituitary gland height on brain MRI of Chiari II malformation (C2M) patients to understand the observed high incidence of apparent enlargement of the pituitary gland. METHODS: Brain MRIs of C2M patients at a single tertiary care adult institution were retrospectively reviewed. We also evaluated two age and gender-matched control groups-patients with normal brain MRI (C1 group) and chronic ventricular shunts (C2 group). The heights of tuberculum sella, dorsum sella, and pituitary gland were measured and compared. The presence or absence of dural thickening was noted. RESULTS: 21 patients were included in each group. In C2M group, a pituitary adenoma was suggested on 24% of the MRIs. The dorsum sella was significantly smaller in the C2M group (4.8 mm) compared to both the C1 group (7.4 mm, p < 0.001) and the C2 group (7.1 mm, p < 0.001). The pituitary gland was also larger in the cranial-caudal dimension in C2M group (8.6 mm) as compared to both the C1 group (6.6 mm, p < 0.01) and the C2 group (6.0 mm, p < 0.001). One C2M patient with a pituitary gland<10 mm was suggested to have a pituitary adenoma on outside MRI, although a normal pituitary gland was seen on pathology. CONCLUSION: C2M patients have shallow sella which can accentuate the pituitary gland height. The mean pituitary height was larger in C2M patients, but no functional pituitary pathology was present. It is important to consider sella morphology when evaluating the pituitary gland of C2M patients to avoid unnecessary medical and surgical interventions.


Assuntos
Malformação de Arnold-Chiari/diagnóstico por imagem , Hipófise/anatomia & histologia , Adulto , Feminino , Humanos , Hipertrofia/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hipófise/diagnóstico por imagem , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Sela Túrcica/patologia , Adulto Jovem
18.
Vet Radiol Ultrasound ; 61(3): 322-328, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32170792

RESUMO

The aim of this retrospective reference interval observational study was to determine the mensuration of the pituitary gland (hypophysis cerebri) by analyzing CT studies in rabbits without clinical evidence of pituitary disease or central neurologic signs. Though diseases of the rabbit pituitary gland are uncommon, the pituitary gland is essential in regulation of the rabbit's endocrine system, as in other species. Currently, there are minimal published studies that detail the rabbit head anatomy on cross-sectional imaging, and even less specifically examining the pituitary gland. The pituitary gland was measured by one observer at a single time point from transverse and reconstructed sagittal CT images in a soft-tissue algorithm in 62 rabbits for a total of 66 rabbit head CT studies. The rabbits ranged from 0.84 to 14 years in age (mean ± SD: 5.46 ± 3.05 years) and 0.92 to 4.95 kg in weight (2.21 ± 0.83 kg). Linear pituitary measurements were performed using electronic calipers. The mean ± SD pituitary height was 4.22 ± 0.57 mm, width was 4.48 ± 0.71 mm, and length was 6.02 ± 0.70 mm. The pituitary gland height-to-brain area ratio was 1.10 ± 0.16 mm-1 , which is much higher than the values reported in normal dogs and cats. The age, weight, and sex of the rabbits were not found to have a significant impact on pituitary gland mensuration. These measurements could be useful as a reference range for future rabbit head CT studies and to rule out pituitary enlargement or disease when evaluating rabbit pituitary glands.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Hipófise/diagnóstico por imagem , Coelhos/anatomia & histologia , Tomografia Computadorizada por Raios X/veterinária , Animais , Feminino , Masculino , Valores de Referência , Estudos Retrospectivos
19.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(3): 194-204, mar. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-188148

RESUMO

Background: Dopamine agonists (DA) are the first-line therapy in prolactinomas, but they fail to decrease prolactin (PRL) levels and/or tumor size in some of these tumors, which are labeled as resistant prolactinomas (RP). To date, risk factors for DA resistance are not fully understood and management of DA-RP is not well established. Methods: We retrospectively recorded clinical, biochemical and radiological features, as well as management and outcome, of all cabergoline (CAB)-RP attended at the Endocrinology department of a tertiary hospital between 1995 and 2016. CAB resistance was defined as the failure to normalize PRL (biochemical resistance, BR) or reduce tumor size by at least 50% (morphological resistance, MR) with a CAB dose up to 2 mg/week (or 3 mg/week in cases where lower doses were not tested) for at least 3 months. Results: Ten CAB-RP were found. The mean age of the cohort was 30.6 years and 50% of subjects were male. The average tumor size was 1.78 cm (80% macroadenomas). The mean maximal dose of CAB was 3.8 mg/week. Five patients showed isolated MR, four combined MR + BR and only one isolated BR. MR patients were more often males and older than MR + BR patients. Transsphenoidal surgery achieved normalization of PRL and/or disappearance of tumor in three of seven patients. At the end of follow up all patients had controlled PRL levels (with or without CAB) and most of them bore a visible although stable tumor. Conclusions: Isolated MR and combined MR + BR are the most frequent patterns of DA resistance whereas isolated BR seems to be uncommon. Our data support a high tumor size but not male gender as a risk factor for DA resistance


Contexto: Los agonistas dopaminérgicos (AD) son el tratamiento de elección de los prolactinomas, pero en algunos casos no logran normalizar los niveles de prolactina (PRL) o disminuir el tamaño del tumor, y estos casos se etiquetan como prolactinomas resistentes (PR). Los factores de riesgo de resistencia a los AD y el manejo de los PR no están bien establecidos. Métodos: Analizamos retrospectivamente las características clínicas, bioquímicas y radiológicas, así como el manejo y evolución de los PR a cabergolina (CAB) atendidos en el departamento de Endocrinología de un hospital terciario entre 1995 y 2016. La resistencia a CAB se definió como persistencia de PRL elevada (resistencia bioquímica, RB) o reducción tumoral inferior al 50% (resistencia morfológica, RM) tras al menos 3 meses de tratamiento con una dosis de CAB de hasta 2 mg/semana (o 3 mg/semana en los casos que no recibieron dosis inferiores) Resultados: Se incluyeron 10 pacientes, edad media 30.6 años, 50% varones. El tamaño medio del tumor fue 1.78 cm (80% macroadenomas) y la dosis máxima media de CAB 3.8 mg/semana. Cinco pacientes presentaron RM aislada, cuatro RM + RB y uno RB aislada. La prevalencia de sexo masculino y la edad fueron superiores en el grupo RM comparado con el grupo RM + RB. La cirugía transesfenoidal logró normalización de PRL y/o desaparición del tumor en tres de siete pacientes. Al final del seguimiento la PRL era normal (con o sin CAB) en todos los casos y la mayoría presentaba un tumor visible de tamaño estable. Conclusiones: la RM aislada y la RM+RB combinadas son los patrones más frecuentes de resistencia a los AD. Nuestros datos apoyan la asociación del tamaño tumoral pero no del sexo masculino con la resistencia a los AD


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Prolactinoma/tratamento farmacológico , Cabergolina/administração & dosagem , Prolactinoma/diagnóstico , Prolactina/efeitos dos fármacos , Resistencia a Medicamentos Antineoplásicos/efeitos dos fármacos , Fatores de Risco , Estudos Retrospectivos , Prolactinoma/patologia , Prolactinoma/cirurgia , Hipófise/diagnóstico por imagem , Hipófise/patologia , Hipogonadismo/etiologia
20.
J Clin Neurosci ; 73: 48-50, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32070673

RESUMO

Cerebral spinal fluid (CSF) leak is a significant complication in pituitary surgery, increasing both patient morbidity and mortality. In a recent publication, Campero et al. observed worse postoperative prognosis and increased risk of intraoperative CSF leak in patients with reduced sellar barrier thickness. The objective of this study was to analyze the association between sellar barrier thickness and intraoperative CSF leak in older individuals. A retrospective review was conducted of 44 transsphenoidal surgery resections for pituitary adenomas, 24 microscopic and 20 purely endoscopic procedures. Presence of intraoperative CSF fistula was significantly greater in patients with weak sellar barrier (thickness under 1 mm), compared to strong sellar barrier (52.94% vs 3.70% p < 0.0001, respectively). Application of this novel concept may help improve surgical technique selection as well as predict risk of intraoperative CSF leak and need for eventual use of flaps for reconstruction.


Assuntos
Adenoma/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico por imagem , Sela Túrcica/diagnóstico por imagem , Adenoma/cirurgia , Idoso , Vazamento de Líquido Cefalorraquidiano/etiologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Neuroendoscopia/efeitos adversos , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos
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