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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pituitary metastasis are rare but represent an important differential diagnosis of intrasellar tumorous syndromes. We report one case of intrasellar metastasis of a bronchial adenocarcinoma in a 50 year old woman. Clinical syndrome associated a tumorous syndrome (cephalalgia, bitemporal hemianopsia) and an anterior and posterior hypopituitarism biologically proven. A large intra and suprasellar mass which compressed the optic chiasma and highly enhanced after gadolinium injection was found by nuclear magnetic resonance imaging. The surgical biopsy displayed a pituitary metastasis of a right inferior lobar bronchial adenocarcinoma with bone secondary localizations. Cerebral radiotherapy and corticotherapy allowed recovery of visual loss but did not prevent rapid death. The clinical and radiological features which may evoke an intrasellar metastasis were: the tumorous syndrome associated with or revealed by diabetes insipidus, loss of spontaneous hypersignal of the neurohypophysis in nuclear magnetic resonance imaging, bulking pituitary stalk, bilobar character of the mass which is in favour of rapid cell proliferation, postero-superior extension, lowering of the V3 floor and very strong and homogeneous signal after gadolinium injection.
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PMID:[Diabetes insipidus revealing pituitary metastasis of bronchial carcinoma]. 899 Nov 5

In 1992, we reported a lymphocytic adenohypophysitis (LIH) (Neurol Med Chir). We considered this case unusual in that the case was that of a menopausal female and that it was accompanied with diabetes insipidus as classical lymphocytic adenohypohysitis (LAH). Subsequently, Ahmed reported two cases which presented a similar pathological manifestation, except for necrosis, as did our case and named them "necrotizing infundibulo-hypophysitis." Recently we encountered another similar case, which is reported hereunder. A female, 34 years of age, had suffered from headache, polyuria, and amenorrhea. CT scan showed a pituitary mass, and pituitary tumor was surgically removed transcranially at a local hospital. The pathological examination revealed the findings of chronic inflammation and necrosis. One month after the operation, however, she was an in-patient again under the suspicion of meningitis for fever and, when antibiotic therapy at the local hospital resulted in no improvement, she was referred to our hospital. Endocrinological studies showed low FSH, LH, ACTH and plasma cortisol level. Antibodies of serum to RNP, Sm, mitochondria, nucleus, AChR, and DNA were all negative. Because of an intrasellar mass with suprasellar extension on MRI, transsphenoidal operation was conducted four months after the initial operation. The pathological examination revealed the infiltration of lymphocytes, plasma cells, and foamy macrophages, and necrosis. After this operation, the headache was cured and the patient was discharged. Two months subsequent to the second operation, headache recurred and temporal upper quadrantic anopsia was noted. An enlarged tumor was found, but prednisolone worked to cure the pain and the visual field defect was found to have been remedied. The patient's diabetes insipidus is presently persisting, and she still relies on the use of desmopressin acetate and is still in need of cortisol replacement therapy. Including our cases, ten cases of lymphocytic hypophysitis, not related to pregnancy or delivery but with diabetes insipidus, have been reported. Several clinical and anatomical features distinguish these 10 cases from classical LAH. The classical LAH was predominantly related to pregnancy or delivery. However 6 of 10 cases were male in LIH. LAH related to pregnancy or delivery does not accompany diabetes insipidus, but all reported cases of LIH had a diabetes insipidus. Visual field and/or ocular movement disturbance are LAH's chief complaints (15 out of 25 cases) but visual field disturbance seldom occurs in LIH (1 out of 10 cases). Hypopituitarism is more serious in LAH, and 4 cases became fatal from an adrenal crisis. Anatomically, inflammatory change of LIH is located anterior and posterior to the pituitary gland and extends to the pituitary stalk and, at times, hypothalamus. On the other hand, LAH relates to pregnancy or delivery, the inflammatory change localizes to the adenohypophysis. Ahmed emphasized necrosis, while necrosis was not a prominent histological finding in LIH. Necrosis was noted only in 3 of 10 cases. To be stressed, rather, are the inflammatory changes seen on the neurohypophysis and the pituitary stalk, together with the characteristic diabetes insipidus. We believe, in view of the above, that what Ahmed named necrotizing infundibulo-hypophysitis should be named "LIH with diabetes insipidus." Whereas differential diagnosis is necessary between this said new disorder and the conventional LAH, we advocate that the latter, which is related to pregnancy or parturition but is free from neurohypophysitis be identified as "LAH related to pregnancy or delivery." With respect to treatment, steroid therapy is essential. If the symptoms do not improve, a transsphenoidal operation for diagnosis (LIH and LAH) and decompression (the case of LAH with visual or external ocular movement disturbance) is advisable. However, extensive surgery is not recommended, because per
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PMID:[Lymphocytic infundibulo-hypophysitis with diabetes insipidus as a new clinical entity: a case report and review of the literature]. 902 95

A 15-year-old male was admitted to our hospital with diabetes insipidus, headache and bitemporal hemianopia and a computed tomogram (CT) revealed an intra- and suprasellar tumor. Differential diagnosis between large intra- and suprasellar germinoma and pituitary adenomas is quite difficult based on CT. After comparing our case with past literature of reported cases of intrasellar and suprasellar germinoma, we found that an enhanced mass posterior to the pituitary gland on the midsagittal magnetic resonance imaging (MRI) and absence of the high signal intensity of the posterior lobe on T1-weighted MRI in patients with diabetes insipidus indicated germinoma rather than a pituitary adenoma. Transphenoid approach and appropriate radiotherapeutic management were administered with a good result.
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PMID:Intrasellar and suprasellar germinoma. 926 Apr 68

The majority of cases of central diabetes insipidus are still pathogenetically unclear (idiopathic). Atherosclerotic cholesterol emboli might be partly responsible for some of these idiopathic cases. A 54-year-old woman with known aortic valve stenosis and a history of a transitory ischemic attack presented with sudden-onset polyuria and polydipsia of up to eight l/d, which had started acutely with headaches. She had been treated with lithium for 3 years because of cyclothymic depression. Plasma sodium was in the upper normal range (142-148 mmol/l). Hypertonic saline infusion during lithium therapy revealed a normal threshold of thirst and resetting of vasopressin secretion (osmotic threshold > 300 mosmol/l), whereas vasopressin reserve was normal. Lithium withdrawal led to an even greater delay of vasopressin release upon hypertonic saline infusion (> 310 mosmol/l). Pituitary function tests revealed a normal anterior pituitary function. MR imaging of the hypothalamo-hypophyseal region showed a normal hypothalamic region and a highly intensive neurohypophyseal signal in the T1-weighted image. The patient responded well to desmopressin. We suggest that in this rare case clinical symptoms as well as biochemical findings like impairment of AVP release might be related to a minor structural hypothalamic damage by a vascular lesion, caused, for example, by an atheromatous (cholesterol) embolism in the hypothalamic region responsible for integration of osmoreceptor function and AVP-secretion. The patient's atherosclerosis and aortic stenosis might be responsible for this event.
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PMID:Atherosclerosis, aortic stenosis and sudden onset central diabetes insipidus. 928 11

Craniopharyngioma, often with cystic diliatation, is difficult to resect radically. Fifty patients with huge craniopharyngioma (diameter of tumor was over 5 cm) treated with intratumoral irradiation of radioactive isotopes (32P and 90Y) through CT-guided Leksell stereotactic system are reported. The patients were 2 to 69 years of age with the disease of 1- to 12-year duration. Of the 50 patients, 21 had recurrent tumor after craniotomy, 29 without surgery operation before. All tumors were confirmed pathologically. The major clinical symptoms were as follows: visual field defect, headache, vomiting, diabetes insipidus, hemiplegia and growth retardation in juvenile cases. There was no death or serious complications following the treatment procedure. Partial response (> 50% reduction of tumor size on CT scanning with improvement of symptoms and signs) rate of the treatment was 82.0% at one month and 62.0% at 2 to 7 years after treatment.
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PMID:[Stereotactic intratumoral irradiation of huge craniopharyngioma]. 938 64

Inflammatory lesions of the hypophysis include lymphocytic hypophysitis, pituitary abscess, and granulomatous inflammation, with or without specific infections (i.e., sarcoidosis, mycobacteria). These lesions are known to mimic pituitary neoplasms. We report the clinical and pathologic findings in three patients who underwent transsphenoidal resection for presumed pituitary adenoma. Two were women aged 30 years (one with a 5-month history of headache, the other with a 1-year history of menstrual irregularity) and one was a 12-year-old girl with headache, nausea, and diabetes insipidus. Preoperative endocrinologic studies showed increased prolactin in one patient and normal serum thyroid stimulating hormone and prolactin levels in another. By magnetic resonance imaging (MRI), the first case had a 1.2-cm mass with increased signal on T1 and isointensity on T2, ring enhancement after gadolinium, and lateral deviation of the pituitary stalk. The second patient had a 1.1-cm "cystic" mass seen during magnetic resonance imaging with adjacent bony changes seen during computed tomography. In the third, computed tomography showed a hypodense pituitary mass that enlarged during 1-month observation. At surgery, abnormal soft tissue surrounded liquefied material in the anterior pituitary in all cases. Histologic studies showed fragments of intact normal anterior pituitary with preserved vascular and reticulin network and regions of anterior pituitary infiltrated by foamy histiocytes. Other fragments resembled granulation tissue, and some consisted of acellular debris. Histiocytes were immunoreactive for the macrophage marker CD68 and negative for S-100 and CD1a. Ultrastructurally, the normal adenohypophysis was permeated by lipid-laden macrophages. There were no well-formed granulomas or giant cells, hemosiderin, acid-fast bacilli, or fungi. Serial sections and keratin immunostains failed to identify an epithelial cyst lining or keratin among the debris. We propose the term "xanthomatous hypophysitis" for this lesion.
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PMID:Xanthomatous hypophysitis. 963 Jan 81

Fibrosarcomas involving the sella turcica are rare lesions and, when encountered, have been associated with previous radiation of a pituitary adenoma. Although primary intracranial fibrosarcomas are well recognized, no case of primary fibrosarcoma of the sella turcica has been reported to date. We describe here a patient who presented with a 2-month history of headache, visual disturbances, and diabetes insipidus. Her past medical history was unremarkable, with no radiation therapy. Magnetic resonance imaging revealed a sellar/suprasellar lesion that at surgery appeared firm in consistency. A radical removal of the mass was performed through a transsphenoidal approach. The patient recovered promptly from the operation and 2 weeks later, given the aggressive histologic appearance of the lesion, underwent gamma knife radiosurgery. Seven months after diagnosis, the patient presented with local tumor recurrence. A subtotal surgical resection was performed, and additional postsurgical treatment is still under consideration. Although most often related to previous radiation of the pituitary gland, primary fibrosarcomas can occur in the sella. This possibility should be suspected in the differential diagnosis of sellar masses that lack the classical characteristics of the much more common pituitary adenomas.
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PMID:Primary fibrosarcoma of the sella unrelated to previous radiation therapy. 964 97

Fifty-six patients with craniopharyngiomas were operated by microsurgical techniques during a 20-year period. Of the 56 patients, 28 were males and 28 were females, with a mean age of 33 years (range 1 to 78 years). Twenty patients (35.7%) were less than 15 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, CT and/or MRI evidence of a decrease in tumor size or tumor disappearance when a patient was discharged from hospital. Ineffectiveness was defined as lack of change in the preoperative clinical status. The mean follow-up period in this study was 6.9 years, with 11 patients monitored. The most common presentation was visual dysfunction (69.6%). 33.9% of the patients presented with headache. The most frequent preoperative finding was a visual field defect, with 55.4% of the patients so affected; 39.5% of patients had preoperative hypothyroidism and 40% had hypoadrenalism. Diabetes insipidus was found preoperatively in 7.1%. Three female patients had amenorrhea. Hydrocephalus was uncommon, being present in only 10.7%. Unruptured aneurysms were found incidentally in 2 cases. A pterional approach was used in 29 patients (52%), a transcallosal approach in 13 (23%), a transcortical approach and a transsphenoidal approaches in 3 (5%), and a lamina terminalis approach in 1 patient. Multiple procedures were required in 8 patients in order to provide significant relief of compressive symptomatology. Overall, 12.5% of the tumors were completely resected. 92.9% of our patients were in remission, 2 had ineffectiveness result, and 2 died of postoperative complications. Except for the completely resected cases, all the other patients underwent radiotherapy postoperatively. The results of this series show that microsurgical management of craniopharyngiomas yields good operative results.
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PMID:Microsurgical management of craniopharyngiomas--outcomes in 56 patients. 965 51

A 56-year-old female presented with idiopathic hypertrophic cranial pachymeningitis manifesting as headache, hypopituitarism, and diabetes insipidus, mimicking lymphocytic hypophysitis. Five months later, she complained of double vision and unusual right facial sensation. The diagnosis was based on magnetic resonance imaging, angiography, and meningeal biopsy via transsphenoidal surgery, and exclusion of other know causes of pachymeningitis. Despite initial response to steroid treatment, her symptoms recurred repeatedly and she became steroid-dependent. Repetition of short-term steroid pulse therapy restrained the deterioration of her condition. The clinical presentation of idiopathic hypertrophic cranial pachymeningitis is variable, and it may develop with signs of adjacent tissue involvement. Resultant secondary hypophysitis must be differentiated from lymphocytic hypophysitis. Initial steroid therapy is effective in improving symptoms, but should be carefully considered since the natural course of this disease seems to be self-limited.
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PMID:Idiopathic hypertrophic cranial pachymeningitis of the cavernous sinus mimicking lymphocytic hypophysitis. 968 25

Pituitary apoplexy is rare and endocrine remission in patients with apopletic secreting pituitary adenomas is even rarer. This study reports on two patients with pituitary macroadenomas (one with Cushing's disease and the other with acromegaly) in whom endocrine remission occurred after apoplexy. The first patient had Cushing's disease and had an ictus of headache and vomiting after which she started a progressive remission of hypercortisolism. A post-apoplexy MRI disclosed persistence of a sellar and supra-sellar mass. She was submitted to transesphenoidal surgery. An hypertensive hemorrhagic cyst was found with no tumor. The second patient had acromegaly. While performing a LHRH-stimulation test he had an ictus of headache, vomiting, no visual loss and appearance of diabetes insipidus. A CT scan disclosed an intrasellar hematoma. Despite the size of the tumor and since there was no visual impairment, this patient was followed up without surgery. Imaging follow-up showed a progressive shrinkage and disappearance of the mass, which was corroborated by endocrine remission. A high rate of recurrence is reported in such patients in the literature. Both patients are being currently followed-up on a long-term basis.
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PMID:[Pituitary apoplexy followed by endocrine remission. Report of two cases]. 975 27


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