Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 51-year-old man presented with a pituitary apoplexy with symptoms and signs predominantly of meningitis. Later on, hydrocephalus and an empty sella were disclosed. It is likely that the empty sella and the hydrocephalus were both caused by the adenoma necrosis. Based on this case and cases reported in the literature, it is suggested that concomitant presence of an empty sella and hydrocephalus results from necrosis in a pre-existing pituitary adenoma.
 ...
PMID:Adult hydrocephalus and the empty sella. 650 33

A 25-year-old woman presented with decreased level of consciousness, bilateral papilledema, and bitemporal hemianopsia. While receiving oxacillin prophylaxis, she underwent ventriculostomy and a transsphenoidal approach for the removal of a growth hormone- and prolactin-secreting adenoma of the pituitary. Within 4 days, fewer, symptoms of meningitis, and marked cerebrospinal fluid (CSF) pleocytosis developed, associated with many large Gram-positive rods in the CSF, subsequently identified as Bacillus cereus. This case emphasizes the potential for Bacillus species to cause serious disease following surgery, including meningitis after intracranial surgery. Meningitis may be severe, and organisms are often resistant to standard surgical prophylactic regimens, which might include penicillin or cephalosporin derivatives. Isolation of Bacillus species from the CSF requires evaluation; these organisms should not be dismissed as contaminants or "non-pathogens," particularly when isolated from CSF of patients who have recently undergone neurosurgical procedures.
 ...
PMID:Fulminant postsurgical Bacillus cereus meningitis: case report. 679 27

Giant invasive pituitary adenomas are rare tumors that have been reported to extensively involve the cranial base, as well as other intra- and extra-cranial structures, making surgical resection by traditional approaches impossible. We report two cases, each of a giant invasive adenoma involving the entire length of the clivus and adjacent structures that was resected via a transfacial approach with excellent results. Both tumors were in middle-aged men; one was nonsecreting, and the other secreted follicle-stimulating hormone alpha-subunit. Most previously reported giant invasive adenomas have been prolactinomas. Both tumors were resected via a transfacial approach that incorporated an osteoplastic maxillotomy with palatal division and a posterior pharyngeal incision that provided exposure from the suprasellar region to C2. Both of the patients received postoperative radiation and have done very well. Their cosmetic results were excellent. The complications included postoperative meningitis in one patient and a nasal voice in the other. The transfacial approach provides excellent access for this type of extensive midline tumor requiring resection from the suprasellar region down to the foramen magnum.
 ...
PMID:Resection of giant invasive pituitary tumors through a transfacial approach: technical case report. 750 Nov 26

Streptococcus bovis is an uncommon cause of meningitis and subdural empyema. We report one case each of meningitis and subdural empyema in which S. bovis biotype II was isolated from both the spinal fluid and blood. In one case, the organisms were seen on a gram-stained preparation of cerebrospinal fluid. The first patient presented with gastrointestinal symptoms of unknown etiology, was immunosuppressed, and recovered. The second patient presented with syncope, developed a subdural empyema, and died; at autopsy, a colonic adenoma was found. A review of the English-language literature revealed only 14 previously reported cases of meningitis due to S. bovis and no cases of subdural empyema due to S. bovis. These cases indicate the importance of complete laboratory identification of specific organisms and confirm the need for a thorough neurological examination and search for underlying gastrointestinal disease in cases of S. bovis infection.
 ...
PMID:Streptococcus bovis infection of the central nervous system: report of two cases and review. 935 95

The results of transnasal transsphenoidal surgery of pituitary adenomas were retrospectively analyzed in a group of 42 patients, 22 females and 20 males, aged 19-70, of average age 43 years. Histopathological examination showed null-cell adenomas in 4, growth-cell in 11, prolactin-cell in 3, adrenocorticotropin-cell in 6, plurihormonal adenomas in 6, craniopharingeoma in 1, metastasis of pulmonary carcinoma in 1, pituitary abscess in 1, and normal pituitary tissue in 9 cases, respectively. Out of 30 patients with adenomas, 21 had macro (> 1 cm) and 9 had microadenomas (< 1 cm). Cerebrospinal fluid leakage (8.7%) and meningitis (6.5%) were the most frequent postoperative complications. There was no operative mortality. Full adenoma recurrence (clinical, hormonal, and radiological) was found in 3, clinical and hormonal in 3, hormonal and radiological in 1, and radiological in 2 patients, respectively. The repeated transsphenoidal surgery was performed in 4 patients. The transnasal transsphenoidal approach is the procedure of choice for surgical treatment pituitary adenomas.
 ...
PMID:[Transnasal transsphenoidal approach to pituitary adenomas]. 1064 51

Cushing's disease is almost always due to ACTH hypersecretion by a pituitary adenoma. Surgical excision is the only curative treatment. MRI together with ACTH assay in the inferior petrous sinus provides the diagnosis and localization in 80% of cases. Surgery should be wide in all cases, going beyond the limits of the adenoma visible on the MRI. Total or subtotal antihypophysectomy may be indicated if the imaging is negative and no lateralization can be determined from ACTH assays. In case of therapeutic failure, reoperation must be proposed early. A 5-year follow-up is required before the definitive results of surgery can be assessed. Cure is evaluated on the basis of postoperative cortisol levels (<3 - 5 g/dl). Initially, the rate of remission varies from 70 to 85%. Success after a second operation is to the order of 80 to 90%. The surgical risk for ACTH adenomas is higher than for other secreting adenomas (CSF fistulae, meningitis, thromboembolism, visual disorders), certainly due, in part to subtotal or total antihypophysectomy.
 ...
PMID:[Surgical strategy in Cushing's disease]. 1097 Sep 49

An endoscopic endonasal transsphenoidal approach to the sella was performed in 100 consecutive patients, with a follow up from 3 to 55 months: 57 females and 43 males, age ranging from 14 and 70 years. 76 cases pituitary adenomas: 22 were acromegaly (7 microadenomas and 15 macroadenomas); 21 null cell adenomas (3 microadenomas and 18 macroadenomas); 19 Cushing disease (11 microadenomas and 8 macroadenomas), 10 prolactinomas (6 microadenomas and 4 macroadenomas), and 4 LH adenomas (4 macroadenomas). In this serie, remission was achieved in 44.8% for macroadenomas, 60% for acromegaly, 27.7% for null cell adenoma, 50% for Cushing disease, 50% for prolactinomas and 50% for LH adenomas, and 81.4% for microadenomas 85% for acromegaly, 100% for null cell adenoma, 81.8% for Cushing disease, 66% for prolactinoma. We had also four craniopharyngiomas, four sphenoidal mucocele, three sphenoidal aspergillus, one Rathke cyst, one hypophysitis, one cavernous aneurysm, one encefalocele, one intrasellar meningioma, one intrasellar tuberculoma and a sphenoid fibrous dysplasia. In this series we also had six fistulas of the anterior base that were completely cured. We had a mortality of 2, one null cell giant adenoma in a 57 years old man and another patient, 38 years old, with a giant craniopharyngioma. The morbidity was: two cured meningitis, three cured fistulas, and two permanent diabetes insipidus. Endoscopic endonasal transsphenoidal surgery in this series resulted with comparable surgical outcomes to conventional microscopic transsphenoidal surgery. The advantages of this technique have been represented by an easier access to the lesion, better visualisation and increased illumination of the surgical sites, microdissection of the tumor with maximum preservation of the pituitary function, and reduction of hospitalization times and coasts. The main limits have been the reduction of field depth, constant need of manual control of the endoscope, and required experience of the endoscope technique.
 ...
PMID:[Transnasal endoscopic surgery of the sellar region: study of the first 100 cases]. 1459 92

Rathke's cleft cysts are rare benign lesions requiring surgical treatment when they become symptomatic. Transsphenoidal surgery is the recommended therapy due to its efficacy and safety. However, whether the optimal surgical strategy is simple drainage and biopsy or cyst wall resection remains controversial. We report a single center's experience of a series of 14 Rathke's cleft cysts treated with transsphenoidal resection of the cyst wall. Postoperatively, there was no cerebrospinal fluid rhinorrhea. The complications included permanent diabetes insipidus, hypocortisolism (including a patient with a coexisting adrenocorticotropic hormone-secreting adenoma), sinusitis and a case of meningitis and intrasellar abscess, one year post-surgery. Visual impairment and headache resolved in all cases. Pituitary dysfunction was restored only in patients with hyperprolactinemia and Cushing's disease. During the follow-up period (median 29 months) there was no recurrence requiring re-operation. According to our experience, the aggressive approach is associated with good surgical results and with low complication and recurrence rates.
 ...
PMID:Treatment of Rathke's cleft cysts: experience at a single centre. 1936 83

Meningitis due to Streptococcus pneumoniae is a rare complication of trans-sphenoidal surgery. We present the case of a patient who developed pneumococcal meningitis with associated bacteraemia after elective endoscopic trans-sphenoidal resection of a pituitary macro-adenoma. After initial treatment with ceftriaxone and dexamethasone, the patient made a good recovery and dexamethasone was discontinued. Two days later the patient's condition deteriorated rapidly, presenting focal and diffuse neurological deficits. Cerebral MRI revealed widespread punctate ischaemic-type lesions affecting both anterior and posterior vascular territories bilaterally and involving features consistent with cerebral vasculitis. Antibiotic treatment was broadened to include meropenem and dexamethasone was restarted, but the patient remained in a comatose state and died 14 days later. Steroid treatment may play a dual role in this poorly characterised infectious complication of trans-sphenoidal pituitary surgery. This possibility is discussed and the options for prophylaxis are reviewed.
 ...
PMID:Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited. 2313 30

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms.
 ...
PMID:Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy? 2472 69


<< Previous 1 2 3 Next >>