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World Neurosurgery May 2017Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%-1.1% of operative pituitary lesions. Diagnosis can be challenging,... (Review)
Review
BACKGROUND
Pituitary abscess is a rare but potentially life-threatening condition with an incidence of 0.2%-1.1% of operative pituitary lesions. Diagnosis can be challenging, because this disorder shares many similarities with other pituitary lesions in terms of signs and symptoms and radiographic findings. Most pituitary abscesses are categorized as secondary, arising from preexisting pituitary lesions or in conjunction with transsphenoidal surgery, sepsis, meningitis, or sinusitis. There have been only a few reports of primary pituitary abscess, which occurs without any of the aforementioned risk factors.
CASE DESCRIPTION
We present a case of primary pituitary abscess in a 38-year-old woman with headaches, blurry vision, polyuria, and polydipsia who was found to have hypopituitarism. Brain magnetic resonance imaging showed a sellar/suprasellar mass, which was endoscopically resected via a transsphenoidal approach. Egress of yellow-greenish creamy fluid was noted on dural incision. The patient was treated with a 6-week course of antibiotic therapy postoperatively and had resolution of symptoms.
CONCLUSIONS
A PubMed search was performed; all cases of pituitary abscess reported in the literature were screened, and 200 cases including our case were analyzed with a focus on outcomes. The most common presentations were headache, visual disturbance, and endocrine abnormalities. Approximately 66.1% of patients achieved partial or complete recovery of pituitary function; 75.7% with vision deficits recovered visual function. Treatment via a craniotomy had a recurrence rate of 17.2% compared with 9.7% via a transsphenoidal approach. To our knowledge, this is the first systematic review on the topic and the largest series reported.
Topics: Abscess; Adult; Craniotomy; Databases, Bibliographic; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Perceptual Disorders; Pituitary Gland; Visual Fields
PubMed: 28153622
DOI: 10.1016/j.wneu.2017.01.077 -
Case Reports in Medicine 2019Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal...
Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
PubMed: 30867665
DOI: 10.1155/2019/4204907 -
Neurourology and Urodynamics Nov 2018To explore whether the bladder hypertrophy consistently seen in rats upon streptozotocin injection also occurs in other animal models of type 1 or 2 diabetes and how... (Comparative Study)
Comparative Study
AIMS
To explore whether the bladder hypertrophy consistently seen in rats upon streptozotocin injection also occurs in other animal models of type 1 or 2 diabetes and how hypertrophy is linked to functional alterations of the urinary bladder.
METHODS
A systematic search for the key word combination "diabetes," "bladder," and "hypertrophy" was performed in PubMed; additional references were identified from reference lists of those publications. All papers were systematically extracted for relevant information.
RESULTS
Models other than streptozotocin-injected rats and female animals have been poorly studied. Most animal models of diabetes exhibit less bladder hypertrophy as compared to streptozotocin-injected rats. However, this is not linked to type 1 versus 2 diabetes models, and type 2 models with comparable elevation of blood glucose may exhibit strong or only minor hypertrophy. Bladder dysfunction is frequently observed in experimental diabetes and mostly manifests as increased compliance but does not segregate with hypertrophy. It may at least partly reflect the need to handle large amounts of urine in models associated with major elevation of blood glucose.
CONCLUSIONS
To better understand the relevance of bladder hypertrophy in many models of experimental diabetes, more studies in models of type 2 diabetes are urgently needed. Moreover, the role of factors other than hypertrophy in the genesis of bladder dysfunction requires further exploration.
Topics: Animals; Diabetes Mellitus, Experimental; Hypertrophy; Models, Animal; Rats; Urinary Bladder Diseases
PubMed: 30152546
DOI: 10.1002/nau.23786