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Frontiers in Oncology 2022Pituitary metastases are very rare in cancer patients and often originate from lung or breast tumors. They usually occur in patients with known metastatic disease, but...
INTRODUCTION
Pituitary metastases are very rare in cancer patients and often originate from lung or breast tumors. They usually occur in patients with known metastatic disease, but rarely may be the first presentation of the primary tumor.
METHODS
We present the case of a 58 years-old-man who reported a three-month history of polyuria-polydipsia syndrome, generalized asthenia, panhypopituitarism and bitemporal hemianopsia. Brain-MRI showed a voluminous pituitary mass causing posterior sellar enlargement and compression of the surrounding structures including pituitary stalk, optic chiasm, and optic nerves.
RESULTS
The patient underwent neurosurgical removal of the mass. Histological examination revealed a poorly differentiated adenocarcinoma of uncertain origin. A total body CT scan showed a mass in the left kidney that was subsequently removed. Histological features were consistent with a clear cell carcinoma. However, endoscopic examination of the digestive tract revealed an ulcerating and infiltrating adenocarcinoma of the gastric cardia. Total body PET/CT scan with 18F-FDG confirmed an isolated area of accumulation in the gastric cardia, with no hyperaccumulation at other sites.
CONCLUSION
To the best of our knowledge, there are no reports of pituitary metastases from gastric cardia adenocarcinoma. Our patient presented with symptoms of sellar involvement and without evidence of other body metastases. Therefore, sudden onset of diabetes insipidus and visual deterioration should lead to the suspicion of a rapidly growing pituitary mass, which may be the presenting manifestation of a primary extracranial adenocarcinoma. Histological investigation of the pituitary mass can guide the diagnostic workup, which must however be complete.
PubMed: 36686817
DOI: 10.3389/fonc.2022.1059361 -
Cancers Jan 2023Pituitary hormone deficiency (PHD) is one of the most common symptoms and postoperative complications of craniopharyngiomas (CPs). However, the risk factors for PHD in...
BACKGROUND
Pituitary hormone deficiency (PHD) is one of the most common symptoms and postoperative complications of craniopharyngiomas (CPs). However, the risk factors for PHD in CPs are little known. The purpose of this study was to analyze the risk factors of pre- and postoperative PHD and to investigate replacement therapy for CP patients.
METHODS
A retrospective study of 126 patients diagnosed with CP was performed. Univariate analysis was performed using Pearson's chi-squared test or Fisher's exact test, and a multiple logistic binary regression model was used to identify the influencing factors of pre- and postoperative PHD in craniopharyngioma.
RESULTS
Children and patients with hypothalamic involvement were more likely to have preoperative PHD. Patients with suprasellar lesions had a high risk of postoperative PHD, and preoperative PHD was a risk factor for postoperative PHD.
CONCLUSION
Children have a high incidence of preoperative PHD. Preoperative PHD can serve as an independent risk factor for postoperative PHD. Preoperative panhypopituitarism can serve as an indication of pituitary stalk sacrifice during surgery. The management of replacement therapy for long-term postoperative endocrine hormone deficiency in patients with craniopharyngioma should be enhanced.
PubMed: 36672290
DOI: 10.3390/cancers15020340 -
Cureus Jan 2023Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as...
Slipped capital femoral epiphyses (SCFE) is considered to be a very common disorder among adolescent age group. Multiple risk factors have been reported such as obesity, endocrine disorders, vitamin D deficiency, and panhypopituitarism. The diagnosis of SCFE is important especially in its early stages as this would prevent complications and delay in surgical intervention. The diagnosis is mainly done by radiological imaging and clinical evaluation. However, clinical evaluation is often overlooked. Herein, we present a case of a seven-year-old with SCFE that was diagnosed late due to negative radiological imaging and received late surgical intervention. Therefore, it is recommended that orthopedic surgeons use their clinical sense and examination skills to diagnose SCFE promptly, in order to maintain a short follow-up window to prevent any delay in surgical management and to observe for any progression, even if the radiological findings are normal.
PubMed: 36618493
DOI: 10.7759/cureus.33396 -
Journal of the ASEAN Federation of... 2022A collision tumor involving metastasis to a pituitary adenoma is rare. We describe a case of a 68-year-old Bidayuh woman with underlying treatment-responsive lung...
A collision tumor involving metastasis to a pituitary adenoma is rare. We describe a case of a 68-year-old Bidayuh woman with underlying treatment-responsive lung adenocarcinoma, who presented with mass effect, panhypopituitarism and polyuria. Her initial imaging study reported pituitary macroadenoma, and she was treated with hormone replacement therapy. She then underwent transsphenoidal tumor debulking surgery with subsequent histopathological findings of a collision tumor of an adenocarcinoma with metastasis to a non-functioning pituitary adenoma.
Topics: Humans; Female; Aged; Pituitary Neoplasms; Adenoma; Adenocarcinoma of Lung; Hypopituitarism; Lung Neoplasms
PubMed: 36578883
DOI: 10.15605/jafes.037.02.09 -
Internal Medicine (Tokyo, Japan) Aug 2023Cryptococcal meningitis is a critical disease that occasionally involves immunosuppressed patients. We herein report a 79-year-old Japanese man who received low-dose...
Cryptococcal meningitis is a critical disease that occasionally involves immunosuppressed patients. We herein report a 79-year-old Japanese man who received low-dose prednisolone therapy for neurosarcoidosis and panhypopituitarism. He presented a 10-day history of a fever and altered mental status. The FilmArray Meningitis/Encephalitis Panel and serum cryptococcal antigen tests were both negative, but the cerebrospinal fluid sample became positive for Cryptococcus neoformans after seven-day incubation. After the diagnosis of cryptococcal meningitis, we successfully treated the patient with a recommended treatment regimen. When an immunocompromised patient presents with a subacute fever accompanying any central nervous symptoms, cryptococcal meningitis should be screened for.
Topics: Male; Humans; Aged; Meningitis, Cryptococcal; Cryptococcus neoformans; Sarcoidosis; Prednisolone; Meningitis
PubMed: 36575015
DOI: 10.2169/internalmedicine.0879-22 -
Journal of Clinical Medicine Dec 2022Background: Non-syndromic combined pituitary hormone deficiency (CPHD) occurs due to defects in transcription factors that govern early pituitary development and the...
Background: Non-syndromic combined pituitary hormone deficiency (CPHD) occurs due to defects in transcription factors that govern early pituitary development and the specification of hormone-producing cells. The most common mutations are in the Prophet of Pit-1 (ProP1) gene. This work aims to (1) report findings of genetic analyses of Tunisian patients with non-syndromic CPHD and (2) describe their phenotype patterns and their evolution through life. Methods: Fifteen patients from twelve unrelated families with variable clinical phenotypes were included after excluding autoimmune and acquired forms of non-syndromic CPHD. Detailed pedigree charts and auxological, hormonal, radiological, and therapeutic details were recorded. Sanger sequencing was performed, and sequences were analyzed with a specific focus on coding and splice site regions of the ProP1 gene. Retained variants were classified using several in silico pathogenicity prediction tools and the VarSome platform. Results: We identified the common p.Arg73Cys mutation in seven patients from four unrelated pedigrees. We found a novel homozygous mutation (c.340C>T) in one sporadic case. This mutation generates a truncated ProP1 protein, predicted to be non-functional, lacking the last 112 codons (p.(Gln114Ter)). We confirmed by polymerase chain reaction (PCR) the absence of large exon deletions or insertions in the remaining sporadic patients (7/8). Conclusions: We report two mutations {one newly identified [p.(Gln114Ter)] and one previously reported (p.Arg73Cys)} in five unrelated Tunisian families with non-syndromic CPHD. This work is of clinical importance as it reports the high frequency of the p.Arg73Cys mutation in Tunisian CPHD families. Our study also illuminated the involvement of novel gene(s) in the emergence of non-syndromic CPHD.
PubMed: 36556141
DOI: 10.3390/jcm11247525 -
Frontiers in Oncology 2022The transcranial approach (TCA) has historically been used to remove craniopharyngiomas. Although the extended endoscopic endonasal approach (EEA) to these tumors has...
INTRODUCTION
The transcranial approach (TCA) has historically been used to remove craniopharyngiomas. Although the extended endoscopic endonasal approach (EEA) to these tumors has been more commonly accepted in the recent two decades, there is debate over whether this approach leads to better outcomes. The goal of this systematic review and meta-analysis was to more comprehensively understand the benefits and limitations of these two approaches in craniopharyngioma resection based on comparative studies.
METHODS
We conducted a systematic literature search in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations using MEDLINE, EMBASE, and the Cochrane Library. A total of 448 articles were screened. Data were extracted and analyzed using proportional meta-analysis. Eight comparative studies satisfied the inclusion criteria. The extent of resection, visual outcomes, and postoperative complications such as endocrine dysfunction and cerebrospinal fluid (CSF) leakage were compared.
RESULTS AND DISCUSSION
Eight studies, involving 376 patients, were included. Resection by EEA led to a greater rate of gross total resection (GTR) (odds ratio [OR], 2.42; p = 0.02; seven studies) with an incidence of 61.3% vs. 50.5% and a higher likelihood of visual improvement (OR, 3.22; p < 0.0001; six studies). However, TCA resulted in a higher likelihood of visual deterioration (OR, 3.68; p = 0.002; seven studies), and was related, though not significantly, to panhypopituitarism (OR, 1.39; p = 0.34; eight studies) and diabetes insipidus (OR, 1.14; p = 0.58; seven studies). Although TCA showed significantly lower likelihoods of CSF leakage (OR, 0.26; 95% confidence interval [CI], 0.10-0.71; p = 0.008; eight studies) compared to EEA, there was no significant difference in meningitis (OR, 0.92; 95% CI, 0.20-4.25; p = 0.91; six studies) between the two approaches. When both approaches can completely resect the tumor, EEA outperforms TCA in terms of GTR rate and visual outcomes, with favorable results in complications other than CSF leakage, such as panhypopituitarism and diabetes insipidus. Although knowledge of and competence in traditional microsurgery and endoscopic surgery are essential in surgical decision-making for craniopharyngioma treatment, when both approaches are feasible, EEA is associated with favorable surgical outcomes.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021234801.
PubMed: 36530998
DOI: 10.3389/fonc.2022.1058329 -
Clinical Case Reports Dec 2022Pituitary metastases are rare. Clinical presentation could range from asymptomatic to panhypopituitarism or local symptoms. We present a case report of a 43-year-old...
Pituitary metastases are rare. Clinical presentation could range from asymptomatic to panhypopituitarism or local symptoms. We present a case report of a 43-year-old male patient with a new onset headache, visual disturbances, and panhypopituitarism. The investigation led to the diagnosis of pituitary metastasis as the first manifestation of underlying lung cancer.
PubMed: 36518913
DOI: 10.1002/ccr3.6601 -
Case Reports in Endocrinology 2022. We present a case of Langerhans cell histiocytosis (LCH) with gastrointestinal involvement masquerading as inflammatory bowel disease (IBD) in a patient who initially...
. We present a case of Langerhans cell histiocytosis (LCH) with gastrointestinal involvement masquerading as inflammatory bowel disease (IBD) in a patient who initially had features of central diabetes insipidus (CDI). A 19-year-old male presented at 14 years of age with central diabetes insipidus. He subsequently developed panhypopituitarism and sellar-suprasellar mass, the biopsy of which was inconclusive. Secondary causes for hypophysitis were ruled out. Five years later, he developed perianal pus discharging sinuses, positive ASCA, and sacroiliitis. Rectal ulcer biopsy showed nonspecific inflammation and necrosis. Hence, he was managed as inflammatory bowel disease (IBD). Due to nonresponsiveness of symptoms, doubt about diagnosis was invoked and rectal ulcer biopsy was repeated, which then showed infiltration by Langerhans cells. Hence, he was diagnosed with LCH and showed resolution of symptoms on initiating steroids and vinblastine. . Gastrointestinal involvement by LCH is unusual and only rarely has represented a prominent clinical manifestation. In most cases, such involvement suggests widespread multisystem disease. Its distinctive morphologic and immunohistochemical features allow LCH to be distinguished from other inflammatory infiltrations found in mucosal biopsy specimens. . Preceding CDI and hypopituitarism may predict LCH in patients with IBD-like diseases.
PubMed: 36518157
DOI: 10.1155/2022/4672473 -
AACE Clinical Case Reports 2022Pituitary abscess is an uncommon infectious process, comprising <1% of pituitary pathology; however, it can be challenging to diagnose and treat.
BACKGROUND/OBJECTIVE
Pituitary abscess is an uncommon infectious process, comprising <1% of pituitary pathology; however, it can be challenging to diagnose and treat.
CASE REPORT
A 46-year-old woman with acquired immunodeficiency syndrome (AIDS) presented with headaches, nausea, and visual disturbances. Imaging revealed a sellar mass with peripheral wall enhancement. She was found to have panhypopituitarism. A diagnosis of pituitary abscess was made based on the patient's presentation and imaging results. She was started on broad-spectrum antibiotics, corticosteroids, and thyroid hormone, with improvement of her symptoms and imaging results. Surgery was not performed given the patient's immunocompromised state and improvement with medical therapy.
DISCUSSION
Infection spread from neighboring structures is a common cause of pituitary abscess, and such infections can occur after surgery or head trauma. Pituitary abscesses can be difficult to distinguish from other lesions; however, rim enhancement is one of the classic findings. Pituitary dysfunction is common, with secondary adrenal insufficiency and diabetes insipidus being the most common hormonal deficiencies found. In addition to antibiotic therapy, the transsphenoidal debridement approach has been the most common route of treatment.
CONCLUSION
We present a case of pituitary abscess in a patient with AIDS, which likely developed after the patient sustained head trauma. Our patient presented with evidence of panhypopituitarism, requiring emergency treatment. Antibiotic therapy alone was used for treatment. She had to complete a 6-week course of a broad-spectrum antibiotic regimen because the culprit organism could not be identified. Given her posttreatment imaging studies, pituitary function recovery was unlikely because the pituitary gland was completely compromised.
PubMed: 36447827
DOI: 10.1016/j.aace.2022.08.002