Hypopituitarism following a direct bullet injury to the pituitary. A case report.

A 29-year old man was referred for hypogonadism. At 14 years of age he was struck by a gun bullet in the head, receiving a frontomedial open fracture with leakage of cerebral tissue. The bullet could not be extracted at the operation. At 16 years of age he noticed a stop of pubertal development, weight gain and a fall in visus on the left eye. The clinical examination and the endocrinological data (low F-T4 and F-T3; low plasma cortisol and testosterone; normal plasma prolactin; sub-normal pituitary response to intravenous administration of insulin, GnRH, TRH and GRF) demonstrated that the patient was hypopituitaric. A radiological skull X-ray showed that the bullet was lodged in the sellar and parasellar region. This seems to be the seventh case of hypopituitarism following a direct injury to the pituitary region described in the literature so far.

[Hyperbaric oxygen therapy in the treatment of benign intracranial hypertension. Follow-up of a preliminary study]. / L'ossigenoterapia iperbarica nel trattamento della ipertensione endocranica benigna. Follow-up di uno studio preliminare.

Preliminary experience of hyperbaric oxygen (HBO) in the treatment of benign intracranial hypertension (BIH) is reported. Fifty-three patients with BIH were observed. They were treated with antiedema non steroid drugs plus rachicentesis, with steroid drugs plus rachicentesis, with lumbar peritoneal shunt and only 8 with HBO. Each patient underwent HBO with 100% oxygen at 2 atmospheres absolute a day for 15 days. In all patients a gradual disappearance of signs and symptoms of elevated intracranial pressure was observed. No lasting effect of treatment were seen after concluding therapy. The effect of HBO in the treatment of BIH has not yet been clarified, but the results can encourage further experience and studies.

[Angioma of the Gasserian ganglion. Morphological and histogenetic considerations on a case]. / Angioma del ganglio di Gasser. Considerazioni morfologiche ed istogenetiche su di un caso.

A cavernous haemangioma of the Gasserian ganglion in a 37-year-old man is presented. It is the third reported case of cavernoma in this region, where infrequently tumors develop. Carotid angiogram shows a network of neoformed vessels in the middle cranial fossa. The hypotheses about the malformative origin of this tumor and the differential diagnosis toward other highly vascularized meningeal tumors are discussed.

[Further considerations on epilepsy in the follow-up of patients subjected to surgery for intracranial pathology]. / Ulteriori considerazioni sull'epilessia nel follow-up di soggetti operati per patologia intracranica.

A retrospective study has been carried out on a pool of 210 pts. suffering from various intracranial lesions (tumours, abscesses, vascular malformations, hydrocephalus), submitted to neurosurgical operation. The main evidences of our investigation are: both early and tardive seizures are observed only related to supratentorial pathology, mainly to tumours; pts. with seizures before the operation present a major incidence of postoperative epilepsy; and pts. with early seizures have more often also late epilepsy. The Authors relate this evidence to a factor of individual predisposition; pharmacological prophylaxis can be really effective in reducing postoperative epilepsy.

Change in circadian cortisol rhythmicity in patients with intracranial tumour.

To verify the influence of intracranial expanding processes on circadian cortisol rhythm, we studied its occurrence in 10 normal subjects, in 5 patients with extrasellar tumour, and in 3 patients with intracranial haematoma. All patients were tested every 4 h. Cortisol was measured by RIA. A cosine function was fitted to the data by mean cosinor method to evidence any rhythm and its parameters. A significant circadian rhythm was detected in the normal subjects with acrophase at 07.55 (07.15-08.25). The patients with extrasellar tumour and those with intracranial haematoma showed a lack of circadian rhythmicity due to a significant increase of cortisol levels at 20.00 and at 00.00, respectively. Our results suggest that study of the cortisol rhythm is useful, especially when an extrasellar tumour is suspected.