RESUMO
A 55-year-old woman presented with headache, dizziness, and decreased visual acuity. Magnetic resonance imaging revealed a sellar mass with sphenoid sinus extension. The result of hormone showed an obviously high prolactin (815 ng/mL). The mass was resected and diagnosed with aspergillosis pathologically. Postoperatively, the level of prolactin dramatically decreased, and the patient received medical treatment with voriconazole and caspofungin. During a 6-month follow-up, the patient's headache and dizziness disappeared, and visual acuity improved. Therefore, aspergillus sellar abscess could result in hyperprolactinemia and should be considered in the differential diagnosis of a sellar mass, even in immunocompetent patients. A combination of surgery and antifungal therapy could reduce the hyperprolactinemia and improve symptoms.
Assuntos
Abscesso/diagnóstico , Antifúngicos/uso terapêutico , Aspergillus/isolamento & purificação , Drenagem/métodos , Hospedeiro Imunocomprometido , Hipófise/microbiologia , Neoplasias Hipofisárias/diagnóstico , Abscesso/microbiologia , Abscesso/terapia , Aspergilose/diagnóstico , Aspergilose/microbiologia , Aspergilose/terapia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Hipófise/cirurgia , Tomografia Computadorizada por Raios XRESUMO
Pituitary abscesses occurring in pre-existing pituitary pathology like Rathke's cleft cyst or adenomas (secondary pituitary abscesses) are rare and of unclear etiology. While surgery and antibiotics have been effective in some cases reported to date, leading to the suggestion that secondary pituitary abscesses are mostly indolent, we investigated the hypothesis that infected adenomas, given their propensity to invade the paranasal sinuses and subarachnoid space, could carry a worse prognosis than uninfected adenomas or secondary abscesses forming in other pituitary pathologies. We identified infected adenomas from our center through retrospective review. Given the rarity of this diagnosis at any single center, we also reviewed published cases of secondary pituitary abscesses occurring in pituitary adenomas to look for common features. Twenty-three cases (19 from the literature and four from our center) of infected adenomas were identified. The mean age at presentation was 46 years, with 65 % male. The most common presenting symptoms were visual disturbances (83 %) and headache (65 %), followed by infectious signs like fever (39 %) and meningitis (26 %). The sphenoidal sinus was the most common site of extrasellar invasion. While good outcome occurred in 74 % of patients, and most achieved vision improvement, the mortality was 26 %. Patients with infected pituitary adenomas commonly present with visual disturbances and headache, with symptoms of infection also occurring. Surgery and antibiotics are indicated for these lesions. While the infection is more indolent than other intracranial abscesses, it is associated with high mortality even after prompt operation and antibiotic treatment.
Assuntos
Abscesso Encefálico/complicações , Hipófise/patologia , Neoplasias Hipofisárias/complicações , Seio Esfenoidal/patologia , Adulto , Idoso , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hipófise/microbiologia , Hipófise/cirurgia , Neoplasias Hipofisárias/microbiologia , Neoplasias Hipofisárias/cirurgia , Prognóstico , Seio Esfenoidal/microbiologia , Seio Esfenoidal/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Pituitary aspergillosis is a very rare disease, documented in only 12 cases. Although seen in both immunocompetent and immunocompromised patients, serious invasive sequelae, such as meningoencephalitis and death, have been noted in immunocompromised patients. Immunocompromised patients are susceptible and require complex multidisciplinary care to contain the spread of infection and maximize outcomes. This is the first case report, to our knowledge, of pituitary aspergillosis in the setting of an organ transplant. A 68-year-old woman presented with cephalgia, left temporal hemianopsia, and ptosis. Non-contrast magnetic resonance imaging of the head revealed a sellar mass, which was believed to be a benign pituitary adenoma. She underwent trans-sphenoidal resection, and subsequent histopathologic examination showed aspergillosis. She was subsequently started on voriconazole. On postoperative day 3, she developed a left anterior cerebral artery ischemic stroke, likely from Aspergillus angioinvasion and occlusion. Her mental status declined further and she died when care was withdrawn.
Assuntos
Antifúngicos/administração & dosagem , Aspergilose/diagnóstico , Infarto da Artéria Cerebral Anterior/complicações , Transplante de Rim/efeitos adversos , Doenças da Hipófise/diagnóstico , Voriconazol/administração & dosagem , Idoso , Aspergilose/complicações , Aspergilose/tratamento farmacológico , Aspergilose/cirurgia , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Evolução Fatal , Feminino , Humanos , Hifas , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Infarto da Artéria Cerebral Anterior/diagnóstico , Infarto da Artéria Cerebral Anterior/microbiologia , Doenças da Hipófise/complicações , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/cirurgia , Hipófise/microbiologia , Esporos FúngicosRESUMO
INTRODUCTION: The aim of this study was to investigate the potency of LH suppression and the uterotrophic effects of quercetin, a flavonoid widely present in our diet which in vitro has been shown to posses estrogenic properties. METHODS: Fifty-nine female Sprague-Dawley (SD) rats were ovariectomized (ovx) and fed with soy-free rodent chow with the addition of quercetin or estradiol-3 benzoate (E2B). Quercetin was added to the rodent chow at the dose of 200mg/kg (n=12) and 1000 mg/kg (n=11) which on average corresponded to 3.55 mg and 18.42 mg per animal per day, respectively, and E2B at the dose of 4.3mg/kg (n=12) or 17.3mg/kg (n=12) which corresponded to 0.07 mg and 0.20 mg per animal per day, respectively. The control group (n=12) received soy-free chow only. After three months of treatment, animals were sacrificed and using real time RT-PCR, pituitary LHbeta and uterine insulin like growth factor (IGF)-1, progesterone receptor (PR) and complement 3 protein (C3) mRNA levels were measured. Additionally, the in vitro binding capacity of quercetin with a porcine cytosolic ER preparation was evaluated. RESULTS: In contrast to E2B, dietary quercetin did not decrease pituitary LH expression, had no effects on uterine weight and uterine expression of estrogen regulated genes. The binding capacity of quercetin with the ERs was also 35000-fold lower compared with 17beta-estradiol (E2). CONCLUSION: Our study shows that quercetin does not show any estrogenic effects in the pituitary and the uterus of the ovx SD rats.
Assuntos
Antioxidantes/farmacologia , Anticoncepcionais/farmacologia , Estradiol/análogos & derivados , Flavonoides/farmacologia , Hormônio Luteinizante/metabolismo , Hipófise/efeitos dos fármacos , Quercetina/farmacologia , Receptores de Estrogênio/efeitos dos fármacos , Útero/efeitos dos fármacos , Animais , Dieta , Estradiol/farmacologia , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/metabolismo , Hormônio Luteinizante/sangue , Ovariectomia , Hipófise/microbiologia , RNA Mensageiro/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Receptores de Estrogênio/metabolismo , Útero/metabolismoAssuntos
Aspergillus , Abscesso Encefálico/patologia , Infecções Fúngicas do Sistema Nervoso Central/patologia , Neuroaspergilose/patologia , Hipófise/microbiologia , Adulto , Antifúngicos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Humanos , Masculino , Neuroaspergilose/tratamento farmacológico , Neuroaspergilose/microbiologia , Hipófise/patologia , Pirimidinas/uso terapêutico , Resultado do Tratamento , Triazóis/uso terapêutico , VoriconazolRESUMO
RATIONALE: The transsphenoidal surgical (TS) approach to sellar masses is the preferred surgical route in most cases. Secondary pituitary abscess (PA) following TS is an extremely rare but serious postoperative complication with potentially high disability and mortality. PATIENT CONCERNS: We describe an uncommon case of secondary PA in a 42-year-old woman, who underwent uncomplicated transsphenoidal procedures without cerebrospinal fluid leak, to treat primary Rathke cleft cyst. Without obvious cause, the patient suffered recurrent meningitis with complaints of headache, hyperpyrexia, and chills from 1 month after the operation. DIAGNOSIS: There were no significant imaging findings until a new rim-enhancement lesion was seen in the sellar region on magnetic resonance imaging during the 6th episode of meningitis 11 months after the initial surgery. A diagnosis of secondary PA was considered; INTERVENTIONS:: Therefore, she underwent a 2nd TS with pus evacuation and antibiotic treatment. OUTCOMES: She improved remarkably and had no recurrence of symptoms during the 9-month follow-up. LESSONS: Our aim was to present this rare case and discuss the most likely etiologies and preventive measures for this condition. In patients with recurrent meningitis but dormant imaging manifestations after TS, the possibility of secondary PA should considered. Adequate surgical drainage with microbiology-guided antibiotic therapy is the 1st choice for treatment.
Assuntos
Abscesso Encefálico/etiologia , Meningites Bacterianas/etiologia , Doenças da Hipófise/etiologia , Complicações Pós-Operatórias/etiologia , Seio Esfenoidal/cirurgia , Adulto , Abscesso Encefálico/microbiologia , Cistos do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Doenças da Hipófise/microbiologia , Hipófise/microbiologia , Hipófise/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/microbiologiaRESUMO
Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.
Assuntos
Abscesso Encefálico/diagnóstico por imagem , Doenças da Hipófise/diagnóstico , Hipófise/microbiologia , Antibacterianos/administração & dosagem , Antibacterianos/urina , Antiprotozoários/administração & dosagem , Antiprotozoários/uso terapêutico , Abscesso Encefálico/patologia , Abscesso Encefálico/cirurgia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Humanos , Hidrocortisona/uso terapêutico , Hipopituitarismo/complicações , Hipopituitarismo/tratamento farmacológico , Imageamento por Ressonância Magnética/métodos , Masculino , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Doenças da Hipófise/microbiologia , Hipófise/patologia , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Adulto JovemRESUMO
Functional interactions between neuroendocrine and immune systems are mediated by similar ligands and receptors, which establish a bi-directional communication that is relevant for homeostasis. We investigated herein the hypothalamus-pituitary-adrenal (HPA) axis in mice acutely infected by Trypanosoma cruzi, the causative agent of Chagas' disease. Parasites were seen in the adrenal gland, whereas T. cruzi specific PCR gene amplification product was found in both adrenal and pituitary glands of infected mice. Histological and immunohistochemical analyses of pituitary and adrenal glands of infected animals revealed several alterations including vascular stasis, upregulation of the extracellular matrix proteins fibronectin and laminin, as well as T cell and macrophage infiltration. Functionally, we detected a decrease in CRH and an increase in corticosterone contents, in hypothalamus and serum respectively. In contrast, we did not find significant changes in the amounts of ACTH in sera of infected animals, whereas the serum levels of the glucocorticoid-stimulating cytokine, IL-6 (interleukin-6), were increased as compared to controls. When we analyzed the effects of T. cruzi in ACTH-producing AtT-20 cell line, infected cultures presented lower levels of ACTH and pro-opiomelanocortin production when compared to controls. In these cells we observed a strong phosphorylation of STAT-3, together with an increased synthesis of IL-6, suppressor of cytokine signaling 3 (SOCS-3) and inhibitor of activated STAT-3 (PIAS-3), which could explain the partial blockage of ACTH production. In conclusion, our data reveal that the HPA axis is altered during acute T. cruzi infection, suggesting direct and indirect influences of the parasite in the endocrine homeostasis.
Assuntos
Doença de Chagas/fisiopatologia , Sistema Hipotálamo-Hipofisário/microbiologia , Sistema Hipófise-Suprarrenal/microbiologia , Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/fisiologia , Hormônio Adrenocorticotrópico/análise , Hormônio Adrenocorticotrópico/metabolismo , Animais , Corticosterona/análise , Corticosterona/metabolismo , Hormônio Liberador da Corticotropina/análise , Hormônio Liberador da Corticotropina/metabolismo , Sistema Hipotálamo-Hipofisário/fisiologia , Hipotálamo/microbiologia , Hipotálamo/fisiologia , Immunoblotting , Imuno-Histoquímica , Interleucina-6/análise , Interleucina-6/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Hipófise/microbiologia , Hipófise/fisiologia , Sistema Hipófise-Suprarrenal/metabolismo , Proteínas Inibidoras de STAT Ativados/análise , Proteínas Inibidoras de STAT Ativados/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fator de Transcrição STAT3/análise , Fator de Transcrição STAT3/metabolismo , Proteína 3 Supressora da Sinalização de Citocinas , Proteínas Supressoras da Sinalização de Citocina/análise , Proteínas Supressoras da Sinalização de Citocina/metabolismo , Trypanosoma cruziRESUMO
Pituitary abscess is a rare disease, but one with potentially high mortality and morbidity. We present a 46-year-old man with progressive visual disturbance and general malaise for 1 year. Endocrine studies revealed hypopituitarism, and magnetic resonance imaging revealed a pituitary lesion with suprasellar extension. We attempted to excise the lesion using a transsphenoidal approach, but pus in the pituitary fossa was found at operation, and no tumour was identified. The culture yielded coagulase-negative Staphylococcus. Antibiotics were administered for 3 weeks, and the patient made a good postoperative recovery. He required life-long hormone replacement therapy. After one and a half years of follow-up, he was well and had no evidence of focal or systemic infection. We review the literature regarding pituitary abscess and discuss the appropriate treatment and possible pathological mechanism.
Assuntos
Abscesso Encefálico/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Doenças da Hipófise/diagnóstico , Hipófise/microbiologia , Hipófise/patologia , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Terapia de Reposição Hormonal , Humanos , Hipopituitarismo/microbiologia , Hipopituitarismo/fisiopatologia , Hipopituitarismo/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Doenças da Hipófise/tratamento farmacológico , Doenças da Hipófise/microbiologia , Hipófise/fisiopatologia , Sela Túrcica/microbiologia , Sela Túrcica/patologia , Sela Túrcica/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/patologia , Transtornos da Visão/fisiopatologiaRESUMO
A 36-year-old man with no history of immunosuppression presented with diabetes insipidus, but no other hormonal disturbances. Magnetic resonance imaging of the brain revealed an enhanced mass in the pituitary stalk appearing as a thickened pituitary stalk. The mass lesion was completely removed through the right optico-carotid space. Histological examination showed epithelioid cell granuloma with caseous necrosis, which strongly suggested mycobacterial infection. However, acid-fast staining detected no bacteria. Polymerase chain reaction (PCR) examinations of the gastric juice and cerebrospinal fluid for tuberculosis were negative. Nested PCR and deoxyribonucleic acid (DNA) sequencing of the DNA from the surgical specimen disclosed Mycobacterium tokaiense DNA sequences. This rare case of pituitary stalk granuloma caused by M. tokaiense shows that if the surgical specimen contains caseous necrosis, nested PCR and DNA sequencing are useful methods to identify mycobacterial infection.
Assuntos
Granuloma/microbiologia , Granuloma/patologia , Infecções por Mycobacterium/complicações , Micobactérias não Tuberculosas/isolamento & purificação , Doenças da Hipófise/microbiologia , Hipófise/microbiologia , Adulto , Infecções do Sistema Nervoso Central/diagnóstico , Infecções do Sistema Nervoso Central/genética , Infecções do Sistema Nervoso Central/microbiologia , Granuloma/genética , Humanos , Masculino , Infecções por Mycobacterium/genética , Infecções por Mycobacterium/patologia , Necrose/patologia , Micobactérias não Tuberculosas/genética , Doenças da Hipófise/genética , Doenças da Hipófise/patologia , Hipófise/patologia , Reação em Cadeia da PolimeraseRESUMO
Although reovirus infection may lead to changes in endocrine function in vivo, little is known about the precise interaction of reovirus with endocrine cells. In this study we have examined the effects of reovirus infection on two types of endocrine cells, GH4C1 cells and RINm5F cells. Both type 1 reovirus and type 3 reovirus infect the two cells lines and appear to grow equally well. Viral replication occurred within the first 24 h following infection after which viral titers remained stable for 3 days. By 48-72 h after viral infection, substantial cytopathic effects were noted in RINm5F cells infected with both type 1 and type 3 reovirus. In GH4C1 cells, type 3 reovirus was most effective in producing cell death, and type 1 reovirus was significantly less cytotoxic despite a similar viral titer. Only type 1 reovirus caused a specific inhibition of overall protein and DNA synthesis, and this occurred only in the RINm5F cells. Over the time course studied, GH4C1 cells successfully infected with type 1 reovirus demonstrated no cytopathic effects, and only minimal alterations in cellular function were noted. Intracellular insulin content and insulin secretion, a "luxury function" of the RINm5F cells, were also surprisingly well maintained in the first 48 h after viral infection. In addition, virally infected cells were able to respond to glyceraldehyde, an insulin secretagogue, although the response appeared to be somewhat blunted compared to that of control cells. These results suggest that viral infection of endocrine cells results in specific alterations that depend on the nature of the infecting virus. In addition, the cellular environment of the host cell may be an important determinant in the outcome of viral infection.
Assuntos
Ilhotas Pancreáticas/metabolismo , Hipófise/metabolismo , Infecções por Reoviridae/metabolismo , Animais , Linhagem Celular , DNA/biossíntese , Insulina/metabolismo , Secreção de Insulina , Ilhotas Pancreáticas/microbiologia , Leucina/metabolismo , Hipófise/microbiologia , Biossíntese de Proteínas , Reoviridae/crescimento & desenvolvimentoRESUMO
A one-week-old Brown Swiss calf had fractures of the metaphyseal regions of the left femur and right tibia, and a generalised, severe derangement of osteogenesis. Alternating zones of sclerosis and radiolucency in the metaphysis of all the long bones was visible radiographically. A histopathological examination revealed a segmental disruption of trabecular modelling, with subsequent fracture. Immunohistochemistry using a monoclonal antibody for bovine viral diarrhoea (BVD) virus revealed abundant viral antigen in the pituitary gland, hypothalamus and thyroid gland. Intestinal tissue was positive on fluorescent antibody testing for the virus. The lesions indicate that transplacental infection with BVD virus can result in severe skeletal abnormalities and fractures.
Assuntos
Osso e Ossos/anormalidades , Doença das Mucosas por Vírus da Diarreia Viral Bovina/complicações , Bovinos/lesões , Fraturas do Fêmur/veterinária , Fraturas da Tíbia/veterinária , Animais , Antígenos Virais/análise , Densidade Óssea , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Doença das Mucosas por Vírus da Diarreia Viral Bovina/congênito , Vírus da Diarreia Viral Bovina/imunologia , Vírus da Diarreia Viral Bovina/isolamento & purificação , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/etiologia , Hipotálamo/microbiologia , Imuno-Histoquímica , Rim/microbiologia , Hipófise/microbiologia , Radiografia , Glândula Tireoide/microbiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologiaRESUMO
Hypopituitarism often remains unrecognized due to subtle clinical manifestations. Anterior pituitary hormone deficiencies may present as isolated or multiple and may be transient or permanent. Traumatic brain injury (TBI) is recognized as a risk factor for hypopituitarism, most frequently presenting with isolated growth hormone deficiency (GHD). Data analysis shows that about 15% of patients with TBI have some degree of hypopituitarism which if not recognized may be mistakenly ascribed to persistent neurologic injury and cognitive impairment. Identification of predictors for hypopituitarism after TBI is important, one of them being the severity of TBI. The mechanisms involve lesions in the hypothalamic-pituitary axis and inflammatory changes in the central nervous system (CNS). With time, hypopituitarism after TBI may progress or reverse. Cranial irradiation is another important risk factor for hypopituitarism. Deficiencies in anterior pituitary hormone secretion (partial or complete) occur following radiation damage to the hypothalamic-pituitary region, the severity and frequency of which correlate with the total radiation dose delivered to the region and the length of follow-up. These radiation-induced hormone deficiencies are irreversible and progressive. Despite numerous case reports, the incidence of hypothalamic-pituitary dysfunction following infectious diseases of the CNS has been underestimated. Hypopituitarism usually relates to the severity of the disease, type of causative agent (bacterial, TBC, fungal, or viral) and primary localization of the infection. Unrecognized hypopituitarism may be misdiagnosed as postencephalitic syndrome, while the presence of a sellar mass with suprasellar extension may be misdiagnosed as pituitary macroadenoma in a patient with pituitary abscess which is potentially a life-threatening disease.
Assuntos
Lesões Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/diagnóstico , Irradiação Craniana/efeitos adversos , Hipopituitarismo/diagnóstico , Animais , Lesões Encefálicas/complicações , Lesões Encefálicas/metabolismo , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/metabolismo , Humanos , Hipopituitarismo/etiologia , Hipopituitarismo/metabolismo , Hipotálamo/metabolismo , Hipotálamo/microbiologia , Hipotálamo/patologia , Hipófise/metabolismo , Hipófise/microbiologia , Hipófise/patologia , Fatores de RiscoAssuntos
Adenoma Hipofisário Secretor de Hormônio do Crescimento/patologia , Hipófise/patologia , Neoplasias Hipofisárias/patologia , Sela Túrcica/patologia , Tuberculose do Sistema Nervoso Central/patologia , Acromegalia/etiologia , Acromegalia/fisiopatologia , Adulto , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/metabolismo , DNA Bacteriano/análise , DNA Bacteriano/genética , Encefalite/microbiologia , Encefalite/patologia , Encefalite/fisiopatologia , Feminino , Hormônio do Crescimento/metabolismo , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Mycobacterium tuberculosis/genética , Procedimentos Neurocirúrgicos , Hipófise/microbiologia , Hipófise/fisiopatologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/fisiopatologia , Reação em Cadeia da Polimerase/métodos , Tuberculose do Sistema Nervoso Central/complicações , Tuberculose do Sistema Nervoso Central/fisiopatologiaRESUMO
El absceso hipofisario es un proceso infeccioso dentro de la silla turca, infrecuente, grave y de difícil diagnóstico debido a sintomatología variada e inespecífica. Presentamos 3 casos clínicos de abscesos hipofisarios, teniendo en común la presencia de lesiones preexistentes. Todos fueron intervenidos quirúrgicamente, 2 pacientes resultaron ser abscesos asépticos y en un paciente se aisló Aspergillus capsulatum. Presentaron buena evolución con el tratamiento médico pero con secuelas de hipopituitarismo. Es muy importante tener en cuenta el absceso hipofisario entre los diagnósticos diferenciales de las masas que se localicen en esa región debido a que el diagnóstico oportuno y el tratamiento correcto son relevantes para el pronóstico de estos pacientes.
Pituitary abscess is due to a severe and uncommon infection in the sella. It is difficult to diagnose due to varied and non-specific symptoms. A report is presented of 3 cases of pituitary abscess, which had the presence of pre-existing injuries in common. All were subjected to surgery, with aseptic abscesses found in 2 patients, and Aspergillus capsulatum was isolated in 1 patient. They showed good progress with medical treatment, but with sequelae of hypopituitarism. It is very important to consider the pituitary abscess in the differential diagnosis of the masses that are located in that region, as a timely diagnosis and proper treatment can be important for the prognosis of these patients.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipófise/patologia , Imageamento por Ressonância Magnética , Hipófise/microbiologia , Hipófise/diagnóstico por imagem , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Abscesso/cirurgiaRESUMO
The authors report a 36-year-old male who presented with headache and hypopituitarism, and MRI revealed a ring enhancing lesion with pituitary stalk thickening. During follow-up, he presented with recurrent pyogenic meningitis with persistence of the lesion, therefore a diagnosis of pituitary abscess was considered. He underwent trans-sphenoidal surgery (TSS) with evacuation of pus and received antibiotic treatment for the same. After this he remarkably improved and had no recurrence of symptoms. He is on levothyroxine, glucocorticoids and testosterone replacement therapy for his respective hormone deficits.
Assuntos
Abscesso/complicações , Abscesso/diagnóstico , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/etiologia , Hipófise , Abscesso/microbiologia , Abscesso/terapia , Adulto , Antibacterianos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/terapia , Hipófise/microbiologia , RecidivaAssuntos
Viroses/fisiopatologia , Animais , Doença Crônica , Hormônio do Crescimento/biossíntese , Hormônios/biossíntese , Humanos , Vírus da Coriomeningite Linfocítica/patogenicidade , Neurotransmissores/biossíntese , Hipófise/microbiologia , Fatores de Tempo , Proteínas Virais/metabolismo , Viroses/imunologiaRESUMO
The utility of diffusion-weighted imaging (DWI) for the diagnosis of intracranial abscesses has already been established. However, the use of DWI for pituitary abscesses has not been previously reported. We present a case of postoperative pituitary abscess in which T1-weighted and T2-weighted magnetic resonance imaging (MRI) revealed a supra-sellar cystic mass, with the cyst contents showing high intensity on DWI. This case suggests that DWI is useful for the diagnosis of pituitary abscesses.
Assuntos
Abscesso Encefálico/patologia , Doenças da Hipófise/patologia , Hipófise/patologia , Complicações Pós-Operatórias/patologia , Idoso , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/cirurgia , Imagem de Difusão por Ressonância Magnética , Gadolínio , Humanos , Masculino , Procedimentos Neurocirúrgicos , Doenças da Hipófise/microbiologia , Doenças da Hipófise/cirurgia , Hipófise/microbiologia , Hipófise/cirurgia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgia , Infecções por Pseudomonas/patologia , Compostos RadiofarmacêuticosRESUMO
Lymphocytic choriomeningitis virus (LCMV) Armstrong caused disordered growth and glucose metabolism secondary to growth hormone deficiency in infected C3H/St mice. In contrast, LCMV strain WE replicated in fewer growth hormone-producing cells, failed to disrupt growth hormone synthesis, and did not cause growth hormone-induced disease in infected, matched controls. The generation of genetic reassortant viruses between the virulent strain of LCMV:Armstrong and the avirulent strain, LCMV:WE, is reported. Using such reassortants and both parental strains of virus in C3H/St mice, the perturbation of growth hormone synthesis was clearly mapped to the S RNA segment of LCMV:ARM.