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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This review touches on differential diagnosis of pituitary tumors, their histologic types, prognosis, X-ray appearance, the technique of transsphenoid ablation of pituitary tumors, indications of the transsphenoid vs. the upper approach and the results of 164 cases operated on since 1966. Diagnosis relies clinically on evidence of panhypopituitarism or hypersecretion of growth hormone of ACTH and ophthalmologic or neurologic signs. In their histologic cell types, somatotrophs correspond to eosinophils, nonfunctional adenomas to chromophobes, and hypercorticism to basophils. Various types of tumors can be distinguished by tomography, gas pneumoencephalography and carotid angiography. The technical details of transsphenoid surgery under a microscope of 350 mm focal length and televised gas encephalography are described. Macroscopically, the tumors may be invasive adenomas, soft friable, or cystic. Possible immediate complications, besides bleeding, may be collapse of the roof of the sella, or rupture of the sellar diaphragm causing leakage of cephalorachidian fluid. the transsphenoid route is indicated in 60% of cases with rounded tumors, in tumors evolving downward into the floor of the sella, in patients over 65 or blind because of optic nerve compression. The upper route is advised in tumors growing upward, restrained by the optic nerve or in patients with anatomic defects preventing the lower approach. In 164 operations the authors had 5 deaths, 6 fistulas of cephalorachidian fluid, 2 patients temporarily blinded, 2 with loss of visual acuity, and only 4 relapses.
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PMID:[Surgery of hypophyseal tumors by the trans=sphenoid approach. apropos of 164 cases]. 124 35

We describe a rare association of Cushing's disease causing avascular osteonecrosis of the femoral head in a patient with operated pituitary macroadenoma. Avascular necrosis of the femoral head (AVN) is not a common cause of musculoskeletal disability. Though AVN of the hip is a well-recognized complication of steroid treatment, it is rare in cases of endogenous hypercortisolism. To our knowledge, only 16 patients with AVN, associated with endogenous Cushing's syndrome (CS), have been documented in the medical literature. AVN associated with glucocorticoid use is more likely to manifest as bilateral disease than either idiopathic AVN or ethanol-associated AVN. We describe a 26-year-old woman who was diagnosed with Cushing's disease in 2007 and operated in the same year for an ACTH secreting pituitary adenoma, who was consequently given replacement dose steroid therapy for post operative panhypopituitarism. During follow up, she complained of bilateral hip pain and difficulty in ambulation. Magnetic resonance imaging showed multiple bony infarcts in the proximal femur and distal femur with femoral head collapse fractures bilaterally, consistent with AVN. She further underwent decompression surgery on bilateral hip joints. This case illustrates that AVN, an orthopaedic emergency, can be an alarming manifestation of Cushing's disease.
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PMID:Avascular osteonecrosis of femoral head in a postoperative patient of pituitary Cushing's disease. 2464 Feb 10

Osteonecrosis, commonly known as avascular necrosis (AVN) of bone, is one of the universally recognized side effects of high-dose steroids and commonly involves femur head leading to significant morbidity. However, the development of AVN in the femoral head due to low-dose oral corticosteroid therapy in a short time is a rare occurrence. Management by stopping corticosteroid treatment can be challenging in many cases due to the adrenal crisis. Glucocorticoids may have to be continued in the lowest possible dose using a physiological preparation, such as hydrocortisone, when the stoppage is not possible. In this article, we report a 34-year-old male patient with hypopituitarism who developed bilateral AVN while receiving a mild physiological replacement oral prednisolone dose for only three years for secondary adrenal insufficiency of hypopituitarism after transsphenoidal surgery. The patient was switched to hydrocortisone and underwent core decompressive surgery resulting in a reduction of hip pain and improvement. The case report intends to highlight the occurrence of AVN of the femur even with a very low dose of corticosteroid used for the treatment of panhypopituitarism. Avascular necrosis should be considered in the differential diagnosis in patients with hip pain, even in low-dose steroid use because early diagnosis is essential to prevent progression, collapse, and eventually the need for hip replacement in AVN.
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PMID:Avascular necrosis of the femoral head due to low-dose corticosteroid used in a patient with panhypopituitarism: A case report and literature review. 3258 43