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1.
Klin Monbl Augenheilkd ; 237(11): 1306-1311, 2020 Nov.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33202463

RESUMO

Pituitary tumours are a common cause of functional impairment and degeneration of the anterior visual pathway. Depending on localization and size, they clinically manifest as initially reversible visual field defects. As part of interdisciplinary tumour management, ophthalmologic examinations are of particular importance concerning diagnostics, indication for tumour resection and documentation of functional surgical results. Based on the relationship between clinical dysfunction and manifest atrophy, together with the patient's age and the duration of symptoms, the ophthalmologist can provide insights into the postoperative visual prognosis. Under good conditions, surgical tumour resection often results in significant improvements to visual fields and acuity. Long-term ophthalmological controls are required in cases of persistent visual loss, radiotherapy or tumour remnants abutting the visual pathway.


Assuntos
Adenoma , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Humanos , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Transtornos da Visão/terapia , Testes de Campo Visual , Campos Visuais
2.
Medicine (Baltimore) ; 99(40): e22619, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019483

RESUMO

RATIONALE: Xanthogranuloma of the sellar region is exceedingly rare, and described in only a handful of case reports. Herein, we present a case of xanthogranuloma of the sellar region to improve our knowledge for the diagnosis and management of this unusual disease. PATIENT CONCERNS: A 50-year-old female presented with the symptoms of intermittent vomiting, occasional head discomfort, and diabetes insipidus of 1 month duration. DIAGNOSES: Magnetic resonance imaging showed a large well-defined, vase-like, heterogeneous mass in the sellar region. The lesion showed mixed signal with hierarchical signal presentation. Fluid-fluid level sign can be found within the lesion. The upper part of the lesion was hyperintense, and the lower part was hypointense on both T1-weighted images and T2-weighted images. The lesion showed no enhancement following the intravenous administration of gadolinium. The normal pituitary tissue was not clearly visible. Optic chiasm was compressed and displaced by the lesion. Initial diagnosis of pituitary macroadenoma with hemorrhage in the sellar region was made before surgery. Final diagnosis of sellar xanthogranuloma was confirmed by histopathological examination after surgical resection. INTERVENTIONS: Gross total resection of the lesion was achieved using the microscope through endonasal transsphenoidal approach. OUTCOMES: The patient recovered well with improved binocular vision and no symptom of diabetes insipidus, and was discharged 5 days after operation. LESSONS: Sellar xanthogranuloma should receive diagnostic consideration for the lesion that is a heterogeneously mixed mass with a degree of T1-weighted images hyperintense in the sellar region.


Assuntos
Diabetes Insípido/etiologia , Granuloma/cirurgia , Sela Túrcica/patologia , Xantomatose/patologia , Xantomatose/cirurgia , Diagnóstico Diferencial , Feminino , Gadolínio/administração & dosagem , Granuloma/patologia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Sela Túrcica/diagnóstico por imagem , Resultado do Tratamento , Vômito/etiologia
3.
Medicine (Baltimore) ; 99(44): e22713, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126308

RESUMO

PURPOSE: In this retrospective study, we investigated the status and validity of endoscopic transsphenoidal surgery (eTSS) for pituitary incidentalomas (PIs) as well as the value of basing the indication for surgery on the PI guidelines. METHODS: Patients who underwent eTSS at Fukuoka University Chikushi Hospital between 2012 and 2018 were divided into the PI group and the non-PI group in accordance with the PI guideline of the Endocrine Society and their clinicopathological characteristics and outcomes were compared and analyzed. RESULTS: A total of 59 patients were enrolled, with 35 patients in the PI group and 24 patients in the non-PI group. The diagnoses in the PI group were of non-functioning pituitary adenoma (NFPA) (n = 12, 34%), gonadotropin-producing pituitary adenoma (n = 8, 23%), Rathke cleft cyst (n = 7, 20%), meningioma (n = 4, 11%), and growth hormone-producing pituitary adenoma (n = 3, 9%); those in the non-PI group were of NFPA (n = 6, 25%), gonadotropin-producing pituitary adenoma (n = 3, 13%), Rathke cleft cyst (n = 3, 13%), growth hormone-producing pituitary adenoma (n = 3, 13%), and prolactin producing pituitary adenoma (n = 3, 13%). Regarding the preoperative factors, 1 patient in the PI group with panhypopituitarism was diagnosed with pituitary apoplexy (pure infarction) of an NFPA. The rates of postoperative anterior pituitary hormonal deficiencies (14% vs 46%, P = .015), residual tumor size (2 ±â€Š5 vs 6 ±â€Š7 mm, P = .008), and reoperation (n = 0, 0% vs n = 5, 21%, P = .005) were significantly different between the PI and non-PI groups. CONCLUSIONS: This study showed that, postoperatively, the incidence of anterior pituitary hormonal deficiencies was lower in the PI than in the non-PI group, although it was comparable between the 2 groups before the operation. The patients in the PI group also had smaller residual tumors and a lower risk of reoperation than those in non-PI group. PIs could have a better postoperative clinical outcome than non-PIs when the indication for eTSS is based on preoperative scrutiny according to the PI guidelines and eTSS is performed by an experienced pituitary surgeon. Hence, more aggressive scrutiny and treatment for PIs might be desirable.


Assuntos
Endocrinologia/normas , Endoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Guias de Prática Clínica como Assunto , Adulto , Idoso , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/patologia , Osso Esfenoide/cirurgia , Resultado do Tratamento
4.
PLoS One ; 15(10): e0240016, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002047

RESUMO

Childhood craniopharyngioma is a rare and slow growing brain tumour, often located in the sellar and suprasellar region. It commonly manifests with visual impairment, increased intracranial pressure and hypothalamic and/or pituitary deficiencies. Visual impairment in childhood adversely affects a child's daily functioning and quality of life. We systematically reviewed the literature to provide an extensive overview of the visual function in children with craniopharyngioma at diagnosis in order to estimate the diversity, magnitude and relevance of the problem of visual impairment. Of the 543 potentially relevant articles, 84 studies met our inclusion criteria. Visual impairment at diagnosis was reported in 1041 of 2071 children (50.3%), decreased visual acuity was reported in 546 of 1321 children (41.3%) and visual field defects were reported in 426 of 1111 children (38.3%). Other ophthalmological findings described were fundoscopic (32.5%) and orthoptic abnormalities (12.5%). Variations in ophthalmological testing methods and ophthalmological definitions precluded a meta-analysis. The results of this review confirm the importance of ophthalmological examination in children with craniopharyngioma at diagnosis in order to detect visual impairment and provide adequate support. Future studies should focus on long-term visual follow-up of childhood craniopharyngioma in response to different treatment strategies to provide insight in risks and ways to prevent further loss of vision.


Assuntos
Craniofaringioma/fisiopatologia , Neoplasias Hipofisárias/fisiopatologia , Visão Ocular , Criança , Craniofaringioma/diagnóstico , Humanos , Neoplasias Hipofisárias/diagnóstico , Risco
5.
Mymensingh Med J ; 29(4): 1015-1020, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116111

RESUMO

Hypopituitarism is a rare entity with reported incidence, 4 per 100,000 and about 50% of such patients present with three to five pituitary hormone deficits. A slow onset of symptoms is typical. But, diversified presentations from absence of symptoms to vague clinical features to lethal effects leading to mortality are not uncommon in such disorder. In adults, in such cases symptoms of hypogonadism may be the first noticeable illness for reporting to physicians, but it is often under evaluated or even ignored. Here, we present a case of 40-year-old adult male with panhypopituitarism, who presented with loss of generalized body hair and loss of libido for about last five years but the problem was not evaluated adequately. Later, he developed lethargy, generalized weakness, weight loss and then the underneath cause detected was panhypopituitarism due to pituitary macro adenoma. So, suspicion and hormonal evaluation for hypogonadism would help in early detection and management of progressive hypopituitarism in symptomatic adult patients. Cases of panhypopituitarism need lifelong hormone replacement and follow-up and if pituitary adenoma is present, surgical removal by trans-sphenoidal approach is preferable.


Assuntos
Adenoma , Hipogonadismo , Hipopituitarismo , Neoplasias Hipofisárias , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Hipopituitarismo/terapia , Masculino , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia
7.
Praxis (Bern 1994) ; 109(11): 879-887, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32873165

RESUMO

CME: Pituitary Incidentaloma in Adults: Key Knowledge for the General Practice Abstract. Incidentally detected pituitary masses, so-called pituitary incidentalomas, are increasing in frequency as the frequency of performing imaging increases. Evaluation of the imaging from a trained neuroradiologist as well as additional endocrinological and, if necessary, neuroophtalmological studies are part of the initial assessment that drives the treatment decision: in the case of benign small lesions with unremarkable assessment results, follow-up is indicated, whereas potentially malignant lesions or lesions with endocrinological or neuroophtalmological irregularities are usually treated. In borderline cases, interdisciplinary work is beneficial for the determination of the case-specific treatment procedure.


Assuntos
Medicina Geral , Neoplasias Hipofisárias , Adulto , Humanos , Achados Incidentais , Neoplasias Hipofisárias/diagnóstico
8.
Praxis (Bern 1994) ; 109(12): 952-954, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933395

RESUMO

CME/Answers: Pituitary Incidentaloma in Adults: Key Knowledge for the General Practice Abstract. Incidentally detected pituitary masses, so-called pituitary incidentalomas, are increasing in frequency as the frequency of performing imaging increases. Evaluation of the imaging from a trained neuroradiologist as well as additional endocrinological and, if necessary, neuroophtalmological studies are part of the initial assessment that drives the treatment decision: in the case of benign small lesions with unremarkable assessment results, follow-up is indicated, whereas potentially malignant lesions or lesions with endocrinological or neuroophtalmological irregularities are usually treated. In borderline cases, interdisciplinary work is beneficial for the determination of the case-specific treatment procedure.


Assuntos
Medicina Geral , Neoplasias Hipofisárias , Adulto , Medicina de Família e Comunidade , Humanos , Achados Incidentais , Neoplasias Hipofisárias/diagnóstico
9.
Rev Bras Anestesiol ; 70(2): 165-170, 2020.
Artigo em Português | MEDLINE | ID: mdl-32605826

RESUMO

The 2020 pandemic caused by the novel coronavirus, COVID-19, had its headquarters in China. It causes Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and presents a broad spectrum of clinical manifestations, ranging from entirely asymptomatic through severe acute respiratory failure and death. Presuming a significant quantity of ventilator-dependent patients, several institutions strategically delayed elective surgeries. Particularly procedures performed involving the nasal mucosa, such as a transsphenoidal approach of the pituitary gland, considering the tremendous level of viral shedding. Nevertheless, critical cases demand expeditious resolution. Those situations are severe pituitary apoplexy, declining consciousness level, or risk of acute visual loss. This case presents a successful urgent perioperative management of a 47 year-old male COVID-19 positive patient who presented to the Emergency Department with a left frontal headache that culminated with diplopia, left eye ptosis, and left visual acuity loss after 5 days. Transsphenoidal hypophysectomy was uneventfully performed, and the patient was discharged from the hospital on postoperative day four. It additionally describes in detail the University of Mississippi Medical Center airway management algorithm for patients infected with the novel coronavirus who need emergent surgical attention.


Assuntos
Manuseio das Vias Aéreas/métodos , Infecções por Coronavirus/complicações , Neoplasias Hipofisárias/cirurgia , Pneumonia Viral/complicações , Betacoronavirus/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Assistência Perioperatória , Neoplasias Hipofisárias/diagnóstico , Resultado do Tratamento
10.
Eur J Endocrinol ; 183(1): C1-C4, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32487776

RESUMO

Acromegaly is a debilitating and disfiguring chronic disease, which occurs in both sexes at any age, associated with multiple comorbidities and increased mortality. It is typically caused by a GH-secreting pituitary adenoma that promotes exposure of body tissues to increased concentrations of GH and IGF-I. The diagnosis of acromegaly is still made very late in a substantial number of patients when the disease is already in advanced stages. An epidemiological study from Sweden has elegantly demonstrated that the longer the diagnostic delay in acromegaly, the higher the number of comorbidities. Moreover, about 25% of the Swedish patients had 10 years or more of diagnostic delay and in this group mortality rate was significantly increased. These results reinforce the importance of shortening the latency period between disease onset, diagnosis and treatment to improve patient outcomes. This commentary article discusses strategies to be embraced by the endocrine community to allow early identification of acromegaly among public and health professionals, as internists, primary care clinicians, different specialists and dentists are the first point of contact for most of the patients. We emphasize that acromegaly should be presented as a sporadic, rather than rare, insidious disease, meaning that there is a considerable chance for health professionals to see a patient with acromegaly throughout their careers. The motto 'you must know it to think of it' is advocated in awareness efforts to reduce time to diagnosis, which results in lower rates of morbidity and mortality and might positively impact healthcare costs.


Assuntos
Acromegalia/diagnóstico , Acromegalia/epidemiologia , Neoplasias Hipofisárias/complicações , Acromegalia/etiologia , Diagnóstico Tardio , Feminino , Humanos , Masculino , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia
11.
Eur J Endocrinol ; 183(1): G17-G23, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32369770

RESUMO

Patients with pituitary tumours, ensuing hormonal abnormalities and mass effects are usually followed in multidisciplinary pituitary clinics and can represent a management challenge even during the times of non-pandemic. The COVID-19 pandemic has put on hold routine medical care for hundreds of millions of patients around the globe, while many pituitary patients' evaluations cannot be delayed for too long. Furthermore, the majority of patients with pituitary tumours have co-morbidities potentially impacting the course and management of COVID-19 (e.g. hypopituitarism, diabetes mellitus, hypertension, obesity and cardiovascular disease). Here, we summarize some of the diagnostic and management dilemmas encountered, and provide guidance on safe and as effective as possible delivery of care in the COVID-19 era. We also attempt to address how pituitary services should be remodelled in the event of similar crises, while maintaining or even improving patient outcomes. Regular review of these recommendations and further adjustments are needed, depending on the evolution of the COVID-19 pandemic status. We consider that the utilization of successful models of pituitary multidisciplinary care implemented during the COVID-19 pandemic should continue after the crisis is over by using the valuable and exceptional experience gained during these challenging times.


Assuntos
Adenoma/terapia , Antineoplásicos Hormonais/uso terapêutico , Infecções por Coronavirus , Agonistas de Dopamina/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias , Apoplexia Hipofisária/terapia , Neoplasias Hipofisárias/terapia , Pneumonia Viral , Adenoma/diagnóstico , Cabergolina/uso terapêutico , Gerenciamento Clínico , Terapia de Reposição Hormonal , Hormônio do Crescimento Humano/análogos & derivados , Hormônio do Crescimento Humano/uso terapêutico , Humanos , Octreotida/uso terapêutico , Peptídeos Cíclicos/uso terapêutico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Guias de Prática Clínica como Assunto , Radioterapia , Somatostatina/análogos & derivados , Somatostatina/uso terapêutico , Telemedicina , Fatores de Tempo , Testes de Campo Visual
12.
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 , Imagem por Ressonância Magnética , Hipófise/diagnóstico por imagem , Prolactina/sangue , Recidiva , Tireotropina/sangue , Adulto Jovem
13.
Medicina (B Aires) ; 80(2): 181-184, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32282328

RESUMO

Most pituitary adenomas are sporadic, but 3-5% can occur in a family and hereditary context. This is the case of multiple endocrine neoplasia type 1 (MEN1), Carney complex (CNC) and familial isolated pituitary adenomas (FIPA). FIPA is an infrequent condition that occurs in a family context, not associated with MEN type1 or CNC. FIPA kindred can be homogeneous (all adenomas affected in the family having the same tumor phenotype) or heterogeneous (different tumor phenotypes in the affected members). We describe a Congolese family in which two sisters and a cousin were diagnosed with a prolactinoma (homogenous FIPA) at the ages of 29, 32 and 40 years, respectively. The patients presented with macroadenomas at the time of diagnosis, non-invasive tumors and good biological response to cabergoline treatment (maximum dose of 1.5 mg/weekly). Of these two sisters, one went through a pregnancy without complications. Because no MEN1 and CNC clinical and biochemical features were detected during the 12-year follow-up, these genes were not investigated. The genetic analysis of the aryl hydrocarbon receptor interacting protein (AIP) was normal. As nearly 80% of patients with FIPA do not have a mutation in the AIP gene, future studies in these families are required to identify other affected genes involved in their physiopathology.


Assuntos
Adenoma/genética , Adenoma Hipofisário Secretor de Hormônio do Crescimento , Neoplasias Hipofisárias/genética , Adenoma/diagnóstico , Adulto , Feminino , Humanos , Espectroscopia de Ressonância Magnética , Neoplasia Endócrina Múltipla Tipo 1/genética , Mutação , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/genética , Neoplasias Hipofisárias/diagnóstico
14.
Best Pract Res Clin Endocrinol Metab ; 34(2): 101382, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32139169

RESUMO

Pituitary surgery is the first-line treatment for patients with Cushing's disease. For patients who are not considered candidates for pituitary surgery, pituitary radiation and bilateral adrenalectomy are further treatment alternatives. Not all patients are cured with pituitary surgery, and a substantial number of patients develop recurrence, sometimes many years after an apparently successful treatment. The same applies to patients treated with radiotherapy. Far from all patients are cured, and in many cases the disease recurs. Bilateral adrenalectomy, although always curative, causes chronic adrenal insufficiency and the remaining pituitary tumour can continue to grow and cause symptoms due to pressure on adjacent tissues, a phenomenon called Nelson's syndrome. In this paper the rate of recurrence of hypercortisolism, as well as the rate of development of Nelson's syndrome, following treatment of patients with Cushing's syndrome, will be reviewed. The aim of the paper is also to summarize clinical and biochemical factors that are associated with recurrence of hypercortisolism and how the patients should be monitored following treatment.


Assuntos
Biomarcadores/análise , Síndrome de Cushing/diagnóstico , Síndrome de Cushing/terapia , Diagnóstico por Imagem/métodos , Técnicas de Diagnóstico Endócrino , Monitorização Fisiológica/métodos , Doença de Addison/diagnóstico , Doença de Addison/epidemiologia , Doença de Addison/etiologia , Doença de Addison/terapia , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/epidemiologia , Adenoma/terapia , Adrenalectomia/efeitos adversos , Síndrome de Cushing/epidemiologia , Síndrome de Cushing/patologia , Humanos , Síndrome de Nelson/diagnóstico , Síndrome de Nelson/epidemiologia , Síndrome de Nelson/etiologia , Síndrome de Nelson/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/epidemiologia , Neoplasias Hipofisárias/terapia , Recidiva
17.
World Neurosurg ; 138: 27-34, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32081821

RESUMO

BACKGROUND: Xanthomatous hypophysitis (XH) is the rarest histologic type of primary hypophysitis. It is nonlymphocytic and characterized by an infiltration of the pituitary gland by lipid-laden histiocytes and macrophages. The clinical and radiologic features overlap heavily with pituitary adenomas and are prone to misdiagnosis. We describe a rare case of XH recurrence at 1 year, treated surgically. Moreover, we provide an updated review of the literature to further elucidate useful management and detection strategies. CASE DESCRIPTION: A 45-year-old woman presented with a history of menstrual irregularity for 9 months, amenorrhea, galactorrhea, and headache for 2 months duration. Preoperative endocrinologic studies showed increased prolactin levels. Magnetic resonance imaging of the sella showed a cystic lesion with suprasellar extension suggestive of a pituitary adenoma. The patient underwent transsphenoidal resection, showing a thick yellowish colloidal material. Histopathology showed necrotic tissue with no definitive diagnosis and no identified microorganisms. At 2 months after surgery, prolactin levels and menstrual cycle normalized. At 1 year after surgery, her menstrual cycle again became irregular. Repeat magnetic resonance imaging showed a recurrent mass and a second transsphenoidal resection was undertaken. Repeat histopathology was consistent with XH. The patient is 9 years postoperative and is doing well without evidence of recurrence. CONCLUSIONS: XH presents similarly to nonfunctional adenomas and diagnosis remains difficult without surgical pathology, requiring meticulous immunohistochemistry to prevent misdiagnosis. Thus, XH should be considered as a rare cause in the differential of disease of the sellar region. Management can parallel that of pituitary neoplasm, with a focus on radiosurgery, re-resection, and high-dose steroids.


Assuntos
Adenoma/diagnóstico , Hipofisite/diagnóstico , Hipofisite/patologia , Neoplasias Hipofisárias/diagnóstico , Xantomatose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hipofisite/cirurgia , Pessoa de Meia-Idade , Recidiva , Xantomatose/patologia , Xantomatose/cirurgia
18.
BMC Neurol ; 20(1): 56, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32061247

RESUMO

BACKGROUND: Craniopharyngiomas are defined by the WHO as "benign" tumours, but their location and surgical treatment may be associated with major complications, one being chemical meningitis. Although rare, especially in children, it should be taken into account when worrying symptoms appear after surgery. CASE PRESENTATION: The aim of this study is to present the case of chemical meningitis in a 7-year-old girl. She was admitted to the Department of Neurology with the following symptoms: headache, vomiting and balance disorders. Brain magnetic resonance imaging showed a tumour in the sellar and suprasellar region, which was diagnosed as a craniopharyngioma. Due to acute hydrocephalus the patient underwent emergency surgery. Conventional surgery was preceded by an endocrinological consultation to determine pituitary hormone levels. The first 6 days post-surgery, during which the patient started substitution therapy for pituitary insufficiency, were uneventful but on the seventh day she presented with seizures, fever, severe headache, weakness, irritability, stiffening of the neck and a gradual degradation of consciousness. This clinical presentation suggested meningitis, which was confirmed by examination of cerebrospinal fluid. CONCLUSIONS: The conventional and/or endoscopic resection of a craniopharyngioma poses a risk of postoperative complications in the form of chemical meningitis. Although this is a rare occurrence in children with craniopharyngioma, physicians should be aware of this complication and its clinical presentation as it may facilitate earlier diagnosis, appropriate treatment and a faster recovery of their patients.


Assuntos
Craniofaringioma/complicações , Meningite/etiologia , Neoplasias Hipofisárias/complicações , Criança , Craniofaringioma/cirurgia , Feminino , Cefaleia/etiologia , Humanos , Hidrocefalia/cirurgia , Hipopituitarismo/etiologia , Imagem por Ressonância Magnética/métodos , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
20.
Sci Rep ; 10(1): 1334, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992791

RESUMO

The diagnosis of various histological subtypes of pituitary tumors is made using serum based hormone panel test. However, certain subtypes secrete more than one hormone, making the diagnosis ambiguous. Here, we performed 1H-NMR based metabolomic analysis of serum and whole-blood from luteinizing/follicle-stimulating (LH/FSH)-secreting (n = 24), prolactinomas (n = 14), and non-functional (NF) (n = 9) tumors. We found elevated levels of betahydroxybutyrate (BHB) in serum and whole-blood (WB) of prolactinomas (0.481 ± 0.211/0.329 ± 0.228 mM in serum/WB), but it was statistically significant (p ≤ 0.0033, Bonferroni correction) only in serum when compared with LH/FSH-secreting tumor patients (0.269 ± 0.139/0.167 ± 0.113 mM in serum/WB). Phenylalanine in NF tumors was found to be elevated in both serum and WB when compared with prolactinomas but it met the statistical significance criteria (p ≤ 0.0028) only in the serum. Alanine (p ≤ 0.011), tyrosine (p ≤ 0.014) and formate (p ≤ 0.011) were also elevated in NF tumors but none showed statistically significance when compared with prolactinomas. Quantification of BHB and the above amino acids in the circulation may aid in the development of blood-based in vitro diagnostic methods which can supplement the currently used serum hormone panel in the diagnosis of various subtypes of pituitary tumors.


Assuntos
Ácido 3-Hidroxibutírico/sangue , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/sangue , Prolactinoma/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Curva ROC
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