Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Arachnoid cysts, most characteristically situated in the middle cranial fossa, have been described at other situations, in the posterior fossa and in the interpeduncular region. A case of primary amenorrhoea, obesity, with short stature, proved to be associated with a huge arachnoid cyst involving the L. middle and anterior cranial fossae; and pituitary fossa, producing panhypopituitarism with right faciobrachial paresis, normal visual fields and visual acuity. No evidence of progress of the lesion has been found after 3 years of observation, and further conservative management with regular CT scanning and oestrogen replacements is proposed.
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PMID:Hypopituitarism with arachnoid cyst. 656 32

30 patients with pituitary tumors were treated in our unit and followed for 26-45 months. 14 patients had nonsecreting adenomas, 7 had acromegaly, 5 had prolactinomas, 3 had Cushing's disease. One patient had a choristoma of the pituitary stalk. The patient with a choristoma, 7 patients with nonsecreting adenomas, 4 with acromegaly, 1 prolactinoma and 3 with Cushing's disease had been operated by transsphenoidal microsurgery prior to Gamma Knife (GK) treatment. From this group, one patient with a nonsecreting adenoma and two with acromegaly had undergone fractional external radiotherapy after surgery. Stereotactic MRI localization had been used in all cases. All the tumors showed either a reduction in volume or cessation of growth; 85% of the patients with acromegaly showed normalization of growth hormone (GH) levels. Normalization of ACTH levels occurred in the 3 patients with Cushing's disease. All the patients with prolactinomas showed reduction of prolactin levels but normalization did not occur. However, in 3 cases the bromocriptine could be withdrawn. Deterioration of vision was not observed. One patient suffered transient paresis of the third cranial nerve that improved with steroids. Panhypopituitarism appeared in one case of Cushing's disease two years after the treatment. In the remaining cases there were no changes in their previous physiological pituitary function. We conclude that GK radiosurgery in pituitary tumors is an effective alternative to transsphenoidal microsurgery when compression of surrounding structures does not exist, and it can efficiently replace conventional irradiation.
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PMID:Pituitary tumors and gamma knife surgery. Clinical experience with more than two years of follow-up. 978 42

Pituitary apoplexy is a rare and underdiagnosed clinical syndrome. It results from hemorrhagic infarction of the pituitary gland. In its classical form it is characterized by acute headache, ophthalmoplegia, visual loss and pituitary insufficiency. Meningeal irritation signs, clinically indistinguishable from infectious meningitis, are considered rare and have not been reported as presenting signs. We report a 53-yr-old man who was admitted to hospital following acute headache, fever, neck stiffness and paresis of the left oculomotor and abducent nerves. A lumbar puncture revealed an increased number of polymorphs but with a sterile cerebral spinal fluid. Magnetic resonance imaging (MRI) showed an intrasellar mass with central necrosis in an enlarged sella. Endocrinological evaluation demonstrated insufficient thyroid, adrenocortical, and gonadal function. Necrosis within a chromophobe adenoma was found upon surgical decompression of the sella. After surgery anterior panhypopituitarism did not recover, while ophthalmoplegia subsided. The patient is now in good health under appropriate hormonal replacement therapy.
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PMID:Acute sterile meningitis as a primary manifestation of pituitary apoplexy. 1466 31

We retrospectively analysed the incidence, clinical presentation, endocrinological and radiological findings, medical and surgical management of pituitary apoplexy in our department (single-centre study), having a large experience in pituitary surgery. Among 1540 pituitary lesions, 24 patients presented with pituitary apoplexy. Their charts were retrospectively reviewed. The symptoms included headache (92%), nausea and vomiting (54%), visual deficit (50%), oculomotor paresis (54%) and/or an altered mental state (42%). Skull X-rays (n = 14) demonstrated an enlarged sella turcica in all cases; CT-scan and/or MRI always revealed a sellar and suprasellar expanding lesion. Panhypopituitarism was present on admission in 70% of the patients. Urgent therapeutic management included high-dose cortisone treatment in all but one patients and CSF drainage in three. Three patients were treated conservatively. Nine patients were operated on rapidly, within hours or a few days because of severe visual deficit and/or altered level of consciousness. Nineteen patients were operated by the trans-sphenoidal approach; one of them required a second operation by craniotomy. There were two deaths related to the illness and one to an ill-defined reason at 4 months. Among the other patients 95% made a good recovery. All but two patients required a substitutive treatment with adrenal (83%), thyroid (68%), gonadal (42%) and/or growth (16%) hormones. The preoperative visual deficits recovered in all but one patients (92%) whereas the oculomotor pareses improved in all but two patients (85%). In conclusion, pituitary tumour apoplexy is a rare event, complicating in our series 1.6% of 1540 pituitary adenomas. Even in severe cases, complete recovery is possible if the diagnosis is rapidly obtained and adequate management is initiated in time. Surgical results after trans-sphenoidal approach are in the majority of cases very satisfactory.
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PMID:Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. 1648 32

Pituitary apoplexy (PA), which is one of the most serious life-threatening complications of pituitary adenoma, is characterized by abrupt onset of headache, nausea, vomiting, visual disturbances and oculomotor paresis. Combination of oculomotor cranial nerve paralysis with normal visual fields is very rare in PA. We report a 60-year-old acromegalic man presented with panhypopituitarism and bilateral total opthalmoplegia without a visual field defect. At initial evaluation his clinical findings were compatible with adrenal crisis and eye examination revealed total opthalmoplegia, bilateral ptosis and normal vision. MRI showed a large heterogeneous mass in the pituitary fossa. Although clinical findings due to adrenal crisis improved after glucocorticoid therapy there was no improvement in opthalmoplegia and ptosis. The patient underwent transsphenoidal excision of the pituitary mass. Histological examination revealed an adenoma with large areas of hemorrhagic infarction and most of the cells were positive for GH in immunohistochemical analysis. Although opthalmoplegia was severe at presentation, total recovery was achieved 3 months after transsphenoidal surgery. Therefore the presented case clearly demonstrates that opthalmoplegia without a visual field defect due to PA has a good prognosis and early diagnosis and treatment including surgical decompression are crucially important.
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PMID:Complete surgical resolution of bilateral total opthalmoplegia without visual field defect in an acromegalic patient presented with pituitary apoplexy. 1778 21

Metastatic tumours to the pituitary gland are rare. The most frequent are metastases from breast and lung. We describe three patients with metastatic tumours: (I) a 54-year-old patient with metastatic renal clear-cell carcinoma and consequent disturbances in visual acuity, cranial nerve paresis and panhypopituitarism, (II) a 60-year-old patient with a diffuse large B-cell lymphoma with panhypopituitarism and diabetes insipidus and (III) a 57-year-old patient with metastasis of breast cancer and panhypopituitarism, visual impairment and cranial nerve paresis. A transnasal endoscopic biopsy and resection of the tumour was performed in all patients, followed by the oncological treatment. Despite the rarity of the disease, it is important to suspect a metastatic pituitary tumour especially in the case of diabetes insipidus, ophthalmoplegia, rapid course of the disease and headaches. In 20-30% of patients, a metastasis to the pituitary is the first manifestation of a tumour of unknown origin. Surgical and adjuvant therapy may improve the quality of life. The survival is not affected, however, and the prognosis of the disease is usually poor.
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PMID:Hypophyseal metastases: A report of three cases and literature review. 2763 23