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

Five cases, four histologically proved, or hamartoma of the tuber cinereum and hypothalamus in children (age range: 2--12 years) are reported. Three cases had pubertas praecox, and in all of these the hamartoma was located in the basal cistern between the chiasm and pons, and had a collar button shape and size typical of hamartoma of the tuber cinereum. In the third case, which presented with headache, a huge calcified mass in the suprasellar region was initially thought to be craniopharyngioma. The fourth case had a hamartoma within the substance of the hypothalamus and presented with hyponatremia and temporal lobe seizures.
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PMID:Radiologic findings of hamartomas of the tuber cinereum and hypothalamus. 66 60

A female case of precocious puberty associated with HCG-producing ectopic pinealoma was reported. The patient, a 5-year-old girl, was referred to the hospital because of headache and choked discs. Physical examination revealed normal physical growth with breast enlargement. Endocrinological study revealed a high plasma HCG concentration of 1192 ng/ml with a normal FSH level. None of HCG, LH and FSH did respond to the LH-RH test. A partial resection of the tumor and an external X-ray irradiation relieved the symptoms and breast enlargement subsided with a remarkable decrease in the plasma HCG level. Histological examination revealed two-cell-pattern pinealoma and electron microscopic findings showed abundant secretory granules in the dark cells. HCG content in the tumor was as high was 400 ng/mg of acetone dried tumor tissue, but no FSH was detectable. Hitherto, all of the reported cases of precocious puberty associated with pineal tumors have been exclusively boys. A normal level of plasma FSH concentration with a somewhat elevated prolactin level might be a contributory factor for the development of precocial sexual development in the present case.
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PMID:A female case of the HCG-producing ectopic pinealoma associated with precocious puberty. 99 33

TSH tumors are associated with both hypothyroid and hyperthyroid states. The proposed mechanism of thyrotroph secretion is illustrated in Figure 8. Pituitary enlargement in hypothyroidism is usually due to reactive hyperplasia and correlates with the degree of TSH elevation. Although this often translates to long-standing hypothyroidism and severe symptoms, this is not always the case. Patients may be asymptomatic or present with other endocrine syndromes. Children may have precocious puberty, and adults may have amenorrhea or decreased libido. One important message to remember is that whenever a patient has evidence of a pituitary tumor, a serum T4 and TSH level must be obtained. The dramatic reduction in pituitary size and resolution of endocrine dysfunction with thyroid hormone is gratifying. Thyrotropinomas producing thyrotoxicosis are autonomous tumors. Given their infrequent occurrence, one could question the cost effectiveness of ordering a serum TSH on all new patients with hyperthyroidism. Features that might favor the possibility of there being a tumor include male sex, headaches, visual impairment, and the absence of ophthalmopathy. Unfortunately, these are not reliable clinical features to suggest the presence of this disorder, and the diagnosis requires a serum TSH determination. Fortunately, the newer assays available are able to provide the sensitivity needed. Therapy should be aimed at the pituitary gland, but currently it is less than optimal. Surgery with or without external irradiation offers the best prognosis and, hopefully, will yield better results when cases are identified earlier. Medical therapy to suppress TSH is still in its infancy. More effective agents will hopefully be discovered in the near future.
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PMID:Thyrotropin-secreting pituitary tumors. 331 2

Detection of an intraventricular or intratumoral fat-fluid level on the plain craniograms has been known as a characteristic sign indicating the presence of intracranial teratomatous tumors. On CT scans, however, only thirteen cases have been previously reported to be found an intraventricular and/or subarachnoid free fat associated with spontaneous ruptures of these tumors. We reported a case of pineal teratoma with intraventricular free-fat seen on CT scans. A nine-year-old male with precocious puberty was admitted to our hospital complaining a moderate nonpulsatile headache. Neurological examinations were normal without signs of meningeal irritation. The serum and CSF titer of HCG were raised markedly. The laboratory data of the CSF were normal and there were no pathological cells in the CSF. The CT scans revealed a large heterogeneous mass containing multiple areas of negative density in the pineal region. There were negative density droplets in the bilateral frontal horn on the same CT scans indicating a presence of free fats. At surgery, an yellowish oily material was drained from the tumor, but there was no sign of meningitis over the cortical surface of the occipital lobe. An intraventricular free fat on CT scan have been reported in fourteen cases including ours following the first case described by Fawcitt in 1976. Although most of the cases presented headache, only two cases was diagnosed clinically as chemical meningitis. Pathological changes indicating granulomatous meningitis, however, were noted in five cases, all of them presenting seizure attacks.
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PMID:[A case of pineal teratoma with intraventricular free fat seen in CT scan]. 382 57

This paper reviews both minor and major adverse reactions caused by estrogenic substances (natural and synthetic, steroidal and nonsteroidal) of which diethylstilbestrol is the prototype of nonsteroidal synthetic estrogen. Minor side effects include nausea, breast tenderness, and excessive cervical secretions (most common), headache, and water and salt retention (less common and often eradicated by lowering estrogen dosage). Vertigo, yeast infections, depression, and photosensitivity are other minor effects. Major side effects are discussed in some detail. Major effects include those on the endocrine system (e.g., feminization in boys and men and precocious puberty in girls); breast tumors; endometrial carcinoma; ovarian tumors; hypertension; thromboembolism; blood clotting excesses; various metabolic effects (including lipid metabolism and carbohydrate metabolism alterations); liver changes (bile alterations and neoplasms); porphyria; melanoma; and effects on a fetus in situ during maternal estrogen administration. In general, lowering doses of estrogen should help eradicate or alleviate most of these effects.
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PMID:Clinical toxicology of estrogens. 741 28

We used the aromatase inhibitor testolactone (40 mg/kg.day) to treat 12 girls with precocious puberty due to the McCune-Albright syndrome for periods of 0.5-5 yr. In the 7 girls who received testolactone for at least 3 yr, the mean +/- SD serum estradiol level was 618 +/- 268 pmol/L at the start of therapy and fell to 156 +/- 84 pmol/L at 1 yr, 116 +/- 48 pmol/L at 2 yr, and 241 +/- 260 pmol/L at 3 yr (P < 0.05 compared to the start of therapy), with recurrent ovarian cysts at 3 yr in 2 patients. These 7 girls averaged 8 menses/yr before therapy. The average frequency of menses decreased to 2 episodes/yr during the first year of treatment, 3/yr during the second year, and 4/yr during the third year. The mean +/- SD testosterone levels were slightly above the normal prepubertal range (0.51 +/- 0.2 nmol/L) before treatment and did not change significantly during treatment. The mean +/- SD androstenedione levels rose from 1.1 +/- 0.6 nmol/L before treatment to 2.1 +/- 0.1 nmol/L at 2 yr and 2.8 +/- 0.1 nmol/L after 3 yr of treatment (P < 0.05 compared to before treatment) and were consistent with normal adrenarche. The mean predicted adult stature was 143.0 +/- 7.8 cm before treatment and 147.3 +/- 11.5 cm at 3 yr (P = NS). In 3 of 12 girls, all with bone age greater than 12 yr, the gonadotropin responses to LHRH indicated early central precocious puberty after 1-4 yr of treatment. The adverse effects of testolactone were transient abdominal pain, headache, and diarrhea in 3 girls and elevated hepatic enzymes in 1 girl who had abnormal liver function before treatment. Six families acknowledged difficulty in adhering to the daily dosing schedule. We conclude that testolactone can be effective in the treatment of LHRH-independent precocious puberty in girls with McCune-Albright syndrome, but that some patients exhibit an escape from the effects of treatment after 1-3 yr.
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PMID:Long-term testolactone therapy for precocious puberty in girls with the McCune-Albright syndrome. 837 Jun 86

A prospective study of seven consecutive patients with congenital arachnoid cysts treated endoscopically is reported. The ages of the patients at the time of diagnosis ranged from 6 to 47 years with three patients under 15 years. Two cysts were located in the posterior cranial fossa, four in the middle cranial fossa, and one in the suprasellar-prepontine area. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, balance problems, and precocious puberty. The authors performed cystocisternostomies and ventriculocystostomies via burr holes with the aid of a universal neuroendoscopic system. Minor bleeding was easily controlled by rinsing. In one case, the endoscopic procedure had to be abandoned because of significant bleeding, which obscured a clear operative view, and an open microsurgical cyst fenestration was performed. The follow-up review periods in this group of patients ranged from 15 to 30 months. There was no mortality or morbidity. Symptoms were relieved in five patients and improved in one. Precocious puberty in one case continued. In six cases, follow-up magnetic resonance images or computerized tomography scans revealed a decrease in the size of the cysts. Although the follow-up period is too short to make statements on long-term outcome, the authors recommend the minimally invasive endoscopic approach for treatment of arachnoid cysts as the first therapy of choice. Should the endoscopic procedure fail, established treatment options such as microsurgical fenestration or cystoperitoneal shunting can subsequently be performed without causing additional risk to the patient.
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PMID:Neuroendoscopic approach to arachnoid cysts. 875 59

We report a case of "functional aqueductal stenosis" which reveals dilatation of the lateral and 3rd ventricles without stenosis at the aqueduct in MRI. This case shows a pineal teratoma which presents one year later with symptoms of hydrocephalus caused by "functional aqueductal stenosis". A seven-year-old boy was admitted to our department owing to headache and vomiting. CT and MRI showed hydrocephalus. The lateral and 3rd ventricles were dilated while the 4th ventricle was normal. Furthermore, tumoral obstruction of the aqueduct was not found. After a ventriculoperitoneal shunt, he recovered well without neurological deficits. One year later, symptoms of precocious puberty, that is the appearance of public hair and deepening of his voice, were found. A follow-up MRI demonstrated a pineal region tumor. Although human chorionic gonadotropin level in the serum and urine was transiently elevated, it normalized before surgery. The operation was performed by the occipital transtentorial approach and the tumor was totally removed. Histological examination proved this tumor to be a mature teratoma, showing three germ cell layers. About two weeks later, he was discharged without any neurological deficit. In this case, although hydrocephalus occurred, MRI didn't demonstrate aqueductal obstruction caused by the tumor. However, one year later, a pineal region tumor was confirmed by MRI. This suggests that hydrocephalus might have some association with the appearance of the pineal region tumor. Therefore, it is necessary to be aware of the possibility of the occurrence of tumors whenever we encounter "functional aqueductal obstruction", when MRI doesn't demonstrate aqueductal obstruction caused by a tumor.
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PMID:[A case of pineal teratoma arising from hydrocephalus of unknown cause]. 918 93

The gonadotropin-releasing hormone (GnRH) agonists are a relatively new class of drugs that are potentially effective in treating disorders that are aggravated either by estrogen or testosterone. GnRH agonists are effective in the treatment of endometriosis, as well as other disorders, such as advanced prostrate cancer, precocious puberty and uterine leiomyomata. While the GnRH agonists reduce the extent of the endometrial lesions and the occurrence of pelvic pain associated with endometriosis, these agents are associated with physical and psychiatric side effects. The adverse effects of these agents are consistent with the physiological effects of ovarian suppression, such as vasomotor instability, vaginal dryness, and headaches. Preliminary results of a prospective, double-blind placebo-controlled study and an open label trial indicates that depressive mood symptoms increase in women treated with GnRH agonist therapy for endometriosis. Additional evidence suggest that sertraline effectively manages depressive mood symptoms associated with GnRH agonist therapy. The reason for the decline in mood on GnRH agonists is postulated to be associated with the decline in estrogen levels. Effective treatment strategies for depressive mood symptoms in women on GnRH agonists therapy may offer insight into the mechanisms of action of estrogen on mood.
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PMID:Depressive symptoms associated with gonadotropin-releasing hormone agonists. 970 54

Prolactin-secreting adenoma, which usually presents with amenorrhea and galactorrhea syndrome, is quite rarely diagnosed in the prepubertal age group. We reported a rare case of a prepubertal prolactin-secreting adenoma and discuss its clinical, radiological and histological features. An 8-year-old girl presented with headache, progressive visual deterioration and precocious puberty. The serum prolactin level was 57.8 ng/ml. Computerized tomography and magnetic resonance imaging revealed an invasive suprasellar tumor. The tumor was partially resected through an interhemispheric approach in a first operation, and residual tumor was resected through the right pterional approach in a second operation. The histological diagnosis was a prolactin-secreting adenoma with high cellular pleomorphism. The Ki-67 labeling index was 5.7%, indicating aggressive biological behavior. Postoperatively, the patient was prescribed bromocriptine as maintenance therapy, and the serum prolactin level became normalized. There is a tendency for diagnosis of a prepubertal prolactin-secreting adenoma to be delayed because there are no endocrinological manifestations. Therefore, the tumor tends to become larger and invasive. Although it is rarely experienced, a prolactin-secreting adenoma should be considered in the differential diagnosis of a large, invasive parasellar lesion in the prepubertal age group.
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PMID:Prolactin-secreting macroadenoma in a prepubertal girl. 984 Mar 87


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