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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A rare case of a pituitary adenoma found in association with a symptomatic Rathke's cleft cyst in a 34-year-old women presenting with headaches, visual symptoms, and amenorrhea is described. The diagnostic evaluation and operative treatment of these coincident lesions are discussed.
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PMID:Symptomatic Rathke's cleft cyst with pituitary adenoma: case report. 405 3

The authors described a case of primary intracranial endodermal sinus tumor (EST), and presented a review of 24 reported cases. From the middle of December 1981, this 15-year-old boy experienced progressive diplopia. At the other hospital, partial removal of the intrasellar tumor was performed by a left frontotemporal craniotomy approximately 2 months after the onset of symptoms. The histological diagnosis was suspected to be a pituitary adenoma, and thereafter, 60Co irradiation was carried out for about a month. On June 5th. 1982, the patient was admitted to the Kochi Medical School Hospital, because of increasing headache with diplopia, hoarseness, dysphagia and limitation of tongue movement. On admission, he had a small stature for his age with moderate diabetes insipidus. Neurological examination showed left abducens, glossopharyngeal and vagal nerve palsies in addition to bitemporal hemianopsia. CT scans revealed a heterogenously enhanced high density mass lesion behind the dorsum sellae with an extension from the upper clivus to the sphenoid sinus. Cerebral angiograms showed posterior displacement of the basilar artery. In the endocrinological examination, panhypopituitarism was recognized with a high level of serum alfa-fetoprotein (AFP). While, serum carcinoembryonic antigen (CEA) and human chorionic gonadotropin (HCG) were in normal range. On July 1st. 1982, a left suboccipital craniectomy was performed. The tumor existed mainly in the extradural space along the clivus, and only a small intradural portion of the tumor was excited.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Primary intracranial endodermal sinus tumor with a skull base extension--a case report]. 620 69

We studied the dopaminergic control of TSH secretion in a patient with hyperthyroidism due to a TSH-secreting pituitary adenoma. A 34-yr-old previously thyroidectomized woman had mild clinical hyperthyroidism and a diffuse goiter without exophthalmos. She complained of headaches and had bitemporal hemianopsia. Serum T4 and T3 by RIA were elevated, and TSH was 112 microU/ml (normal range, 1.1-7.2). The alpha-subunit to TSH molar ratio was 1.7 (normal, less than 1), as reported in other patients with tumoral TSH hypersecretion. After TRH, a marked increase in TSH occurred. There was no evidence of pituitary deficiency. Skull x-rays and computerized axial tomography revealed an intrasellar tumor with suprasellar extension. Selective transsphenoidal adenomectomy was performed, and a pituitary tumor was removed. The tumor was almost entirely composed of cells reactive with antihuman beta TSH serum by indirect immunofluorescence. A unique feature of this patient was the marked increase in TSH levels after L-dopa administration. To our knowledge, this paradoxical response has never been reported previously in such patients. Using [3H]domperidone as ligand, dopaminergic receptors were demonstrated in the membranes of the adenomatous thyrotroph cells. The reason for the paradoxical response of TSH to dopaminergic agents is not known.
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PMID:Paradoxical response of thyrotropin to L-dopa and presence of dopaminergic receptors in a thyrotropin-secreting pituitary adenoma. 643 Sep 50

During a systematic study of women with idiopathic galactorrhea, we observed several patients with normal random serum prolactin (PRL) levels and normal menses, but abnormal sellar tomograms characteristic of a pituitary adenoma. To test the hypothesis that these women might have intermittent PRL hypersecretion, we studied PRL secretion by sampling blood every half hour for 24 h in 10 patients and for 17.5 h in another, and compared the findings to those of a group of 5 normal women. The mean 24-h PRL of the 10 patients (16.8 +/- 7.8 ng/ml; mean +/- SD) was not significantly different from that of the normal women (13.6 +/- 3.2 ng/ml), and each patient showed a normal sleep-associated PRL increment. Three individuals exhibited an abnormally elevated 24-h PRL (greater than 20 ng/ml). Increased PRL secretion occurred primarily at night or in the afternoon. Thyrotropin releasing hormone (TRH) administration caused normal or exaggerated PRL responses in all patients tested. High resolution CT scanning of two of the hypersecretors suggested a microadenoma in one case. In another case whose PRL was normal over 17.5 h, transsphenoidal surgery, carried out because of the tomographic findings and the symptom of headaches, demonstrated a 5-mm chromophobe adenoma that did not contain PRL by immunohistochemistry. Postoperatively the galactorrhea persisted. We conclude that most women with galactorrhea, normal PRL, normal menses, and abnormal tomograms have normal PRL secretion. However, a minority of patients with this syndrome do demonstrate intermittent PRL hypersecretion. The etiology of intermittent PRL hypersecretion and its relevance to galactorrhea have not been determined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Twenty-four-hour prolactin secretory patterns in women with galactorrhea, normal menses, normal random prolacting levels and abnormal sellar tomograms. 643 70

As an unusual complication of bromocriptine treatment for prolactinoma, CSF rhinorrhea has been reported in the relevant literature. The authors, on the contrary, experienced cessation of CSF rhinorrhea during bromocriptine treatment. A 37-year-old man with invasive prolactinoma underwent a frontal craniotomy for removal of pituitary adenoma on February 2, 1978. Postoperative CT showed residual adenoma within the sella and the sphenoid sinus. Postoperative irradiation was started on February 27 and given in a total dose of 5,000 rad. On March 30, 1979, the patient noticed clear fluid dropping out of his nostrils, the fluid contained glucose and CSF rhinorrhea was suspected. The CSF rhinorrhea was considered due to the regrowth of adenoma in the paranasal sinuses. On June 27, 1979, the patient developed headache together with fever and CSF rhinorrhea. On examination, the patient was drowsy and showed marked nucheal rigidity. Under the diagnosis of meningitis caused by CSF rhinorrhea antiseptic chemotherapy was started. Hypocycloidal tomogram showed extensive destruction of the sella and a soft density mass in the sphenoid and the ethmoid sinuses. CT also showed intrasphenoidal and lateral extension of the adenoma. To repair of the CSF leak, transsphenoidal surgery was performed on August 2, 1979 when the patient was in favorable condition. The sphenoid sinus was full of adenoma and it was removed, however, the exact location of the CSF leak could not be identified. The sphenoid sinus was packed with muscle tissue. Bromocriptine treatment was postoperatively started with 5 mg per day on August 25, 1979. The patient sustained CSF rhinorrhea which was decreased by lumbar drainage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cessation of cerebrospinal fluid rhinorrhea by bromocriptine treatment of a patient with invasive prolactinoma]. 646 39

A 54-year-old man with a long-lasting left-sided headache and biochemical evidence of hyperprolactinemia was found to have a large chromophobe pituitary adenoma, which concurred with a granulomatous hypophysitis. The mechanism of the inflammatory reaction is discussed and the immunohistochemical and ultrastructural findings of this hitherto undescribed combination of lesions are presented.
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PMID:Prolactinoma coexistent with granulomatous hypophysitis. 665 Jan 39

The patient presented with poor vision (particularly OS) which had declined progressively over ten years. He had had bifrontal headaches over the past two years. Examination and visual field testing showed optic atrophy and a bitemporal hemianopia. Procedures leading to the diagnosis of pituitary adenoma are discussed, as are treatment modalities and association of pituitary adenomas with other entities.
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PMID:Endocrinological associations of pituitary tumors. 699 35

A 64-year-old woman had received radiotherapy, following surgery of a chromophobe pituitary adenoma. Six years after irradiation she began to complain of headache and dementia. Right vertebrogram demonstrated a right temporal mass lesion, stenosis and dilatation of middle cerebral artery and posterior, communicating artery in the field of irradiation. CT scan showed the irregular low density area at the right temporal region, and the irregular enhancement after an intravenous injection of contrast medium was seen at the small part of affected area. From these findings, radiation necrosis at the right temporal lobe was diagnosed. As vascular changes of the main cerebral arteries due to radiation are rare, we discussed on them from ever reported literature.
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PMID:[A case of radiation necrosis with vascular changes on main cerebral arteries (author's transl)]. 709 75

Three cases of the secondary empty sella syndrome were reported. Case 1. A 57-year-old female was admitted to our clinic because of recurrent visual disturbance. Fourteen years previously a pituitary adenoma was diagnosed and two courses of radiation therapy was given elsewhere, the total dosage being unknown. Pneumoencephalography revealed air collection in the sellar cavity. Exploratory craniotomy demonstrated an empty sella with downward migration of the optic nerve and chiasm. Case 2. A 40-year-old female was readmitted to our clinic for possible recurrent pituitary adenoma. Three years previously she underwent transsphenoidal surgery and postoperative radiation therapy with a tumor dose of 6,400 rad. She had headache and visual disturbance. Pneumoencephalography showed air extension into the sellar cavity. Case 3. A 50-year-old female was readmitted to our clinic because of general prostration and headache. Ten years previously she received transsphenoidal surgery and postoperative radiation therapy with a tumor dose of 6,650 rad for a pituitary adenoma. Endocrine evaluation revealed a hypopituitarism. Pneumoencephalography showed air extension into the sellar cavity. The etiology of secondary empty sella has not been clarified yet, although the primary empty sella has been considered to result from incomplete development of the diaphragma sellae. We consider that the most important factor should be present in the diaphragma itself. It is conceivable that the diaphragma sellae becomes weak due to 1) compression by the tumor, 2) mechanical injury during operation, 3) radiation effect. Then, these preceding factors might bring about herniation of the optic nerve and chiasm with the diaphragma sellae into the sellar cavity. Therefore, we propose that early diagnosis of pituitary tumor should be important, and that careful packing of the sellar floor at transsphenoidal surgery should be essential to prevent occurrence of the secondary empty sella syndrome.
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PMID:[Secondary empty sella syndrome: report of three cases and review of the literature]. 715 93

The occurrence of hemorrhage from pituitary adenoma (so-called "pituitary apoplexy") was investigated in a consecutive series of 560 cases operated on during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. These patients were analyzed in terms of age, sex, symptoms and signs, size of tumor, hormonal function, and histological types of adenomas, and computerized tomography findings. In 90 cases (16.6%), hematoma or old bloody fluid was verified within the tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 patients, 42 (7.5%) showed no evidence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one patients (9.1%) had definite histories of an acute episode that suggested sudden bleeding (symptomatic hemorrhage: pituitary apoplexy). Thirty-eight patients (6.8%) had a major attack manifested by disturbances of consciousness, hemiparesis, loss of vision, or ocular palsy. In two acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was one case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 symptomatic patients (2.3%) developed a minor attack which included headache, nausea, vomiting, and vertigo. Bleeding from pituitary adenomas was not statistically correlated with any of the following factors: sex, hormonal function of adenomas, and histological types, but it was correlated with age. The number of asymptomatic cases in the third decade was significantly greater than that of the whole group of pituitary adenoma patients in the same decade. The present investigation revealed that the incidence of pituitary apoplexy was unexpectedly high: a major attack in 6.8% of pituitary adenoma patients, a minor attack in 2.3%, and asymptomatic hemorrhage in 7.5% of the cases. This risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.
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PMID:Pituitary apoplexy: its incidence and clinical significance. 725 41


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