scholarly journals Macroprolactinoma Presenting With Hyponatremia; A Rare Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A592-A592
Author(s):  
Safa Ibrahim ◽  
David Wenkert
Keyword(s):  
Pituitary Adenoma ◽  
Urine Osmolality ◽  
Optic Chiasm ◽  
Fluid Restriction ◽  
Pituitary Macroadenoma ◽  
Mechanical Pressure ◽  
Tissue Mass ◽  
Patient Reported ◽  
Rare Case Report ◽  
The Right

Abstract Background: Hyponatremia is a common electrolyte abnormality, investigating the etiology can be challenging to the clinician, especially when the cause has rarely been associated with hyponatremia. Macroprolactinoma has rarely been reported as a cause of hyponatremia. We are reporting a case of macroprolactinoma presenting with hyponatremia. Care Report: A 67 year old female previously healthy female, presented with a fall due to syncopal episode. Patient reported lightheadedness for a week prior to presentation. On physical examination, patient had bilateral periorbital ecchymoses, and swelling of the nose. Remaining of physical exam was unremarkable. Lab work showed hyponatremia with high urine osmolality and high urine sodium, consistent with syndrome of inappropriate antidiuretic hormone (SIADH). CT head showed Intrasellar soft tissue mass represents a pituitary macroadenoma. Pituitary hormonal workup showed high prolactin: 2,808 ng/mL, the rest of pituitary profile was normal, including pituitary-adrenal axis evaluation. Pituitary MRI confirmed a large pituitary macroadenoma measuring 1.7 x 2.9 x 2.5 cm, which displaces and compresses the optic chiasm and invades the right cavernous sinus. She was treated with fluid restriction and salt tablets with improvement of sodium level to normal. Cabergoline 0.25 mg twice a week was started with improvement of prolactin level to 156 ng/mL over 9 months period. Discussion: Pituitary macroadenoma rarely associated with hyponatremia, and when reported it is usually secondary to hypopituitarism (low ACTH or low TSH). However, there are few cases reported of SIADH related hyponatremia in the presence of normal pituitary function. Although the exact mechanism of exaggerated production of arginine vasopressin (AVP) is not fully understood, the likely theory thought to be related to the mechanical pressure on the axonal terminal of AVP neurons by the large pituitary tumor. Conclusion: Hyponatremia due to SIADH has been linked in few cases with nonfunctioning pituitary adenoma. Only two cases found in the literature reporting SIADH secondary to prolactin producing pituitary adenoma, with our case being the third reported case.

scholarly journals SAT-236 Unusual Presentation of a Stable Pituitary Macroadenoma with Pituitary Apoplexy Causing SIADH and Pan-hypopituitarism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Louna S El-Zein ◽  
Dania Abushanab ◽  
Bayan Chaker
Keyword(s):  
Pituitary Adenoma ◽  
Urine Osmolality ◽  
Tolerance Test ◽  
Empty Sella ◽  
Urine Specific Gravity ◽  
Oral Glucose ◽  
Fluid Restriction ◽  
Pituitary Macroadenoma ◽  
Free T4 ◽  
Work Up

Abstract We are reporting a case of SIADH hyponatremia and pan-hypopituitarism in an otherwise stable appearing non-functional pituitary macroadenoma on MRI that suddenly developed apoplexy. Patient is a 52-year-old hispanic male with a history of a pituitary adenoma diagnosed initially on 06/2017 during MRI head for chronic headaches. MRI Pituitary on 07/2018 showed “well-circumscribed lesion” measuring approximately 12.7 x 14.8 x 13.4 mm in AP. Hormonal work up was normal in 06/2017, 01/2018, and 07/2018. In 07/2018 labs showed: IGF-1 247 ng/mL (65–222), ACTH 28 pg/mL (7–69), random cortisol 8.58 microg/dL (3.09–22.4), TSH 2.3 mIU/mL (0.4–5.5), fT4 1.06 ng/dL (0.8–1.8), LH 4.6 mIU/mL (0.98–79.7), FSH 6.2 MIU/mL (1–18), prolactin 2.92 ng/mL (2.1–24), and testosterone 310 ng/dL (87–814). Oral glucose tolerance test was done and showed: GH was 0.34 ng/mL at baseline and 1.01 ng/mL after 75 g oral glucose (equivocal result). Repeat IgF1 was normal after that. Subsequently, patient was admitted on 09/24/2018 with severe headaches, nausea, vomiting, polyuria, and polydipsia. He was hypotensive and tachycardic and was found to be hyponatremic with a Na of 124, lowest at 119 where hypertonic saline was given at that point. Urine output was 1.5 L in 24 hours while he was on an 0.8 L fluid restriction, and then 6 L the following day while he was on 1.5 L fluid restriction, serum osmolality was 251, urine osmolality was 1003, urine specific gravity was >1.030. Nephrology agreed to the diagnosis of SIADH. Blood work on 09/24 showed: random cortisol 0.67 microg/dL, TSH 0.19 mIU/mL, free T4: 0.63 ng/dL, ACTH 11 pg/mL, LH 2.4 mIU/mL, FSH 4.7 MIU/mL, testosterone 13 ng/dl. Patient was started on Levothyroxine 125 mcg and hydrocortisone stress dose. MRI brain was done and showed a pituitary macro-adenoma, measuring approximately 14 x 11 x 11 mm with no significant change in size since 6/30/2017, without optic nerve compression, no hemorrhage was mentioned. Work up for other causes of panhypopituitarism, i.e. hemochromatosis was done and was negative: Ferritin: 258 ng/mL (22–322). CT abdomen and pelvis was also done and showed normal adrenal glands. We thought about granulomatous infiltrative diseases like sarcoidosis since 1–25 (OH) vitamin D was high at 120 pg/mL (19.9–79.3). CT neck and chest was done but was negative for sarcoidosis or lymphadenopathy. Patient was seen outpatient by neurosurgery in 1/2019 and a repeat MRI was done which reported resolution of cystic and blood material from a pituitary adenoma, and per neurosurgery there is resolution of a pituitary cystic adenoma with apoplexy that now looks like a partial empty sella. Patient currently continues to be pan-hypopituitary requiring hydrocortisone, levothyroxine and testosterone replacement. SIADH has resolved. An otherwise non-functioning stable pituitary macroadenoma on MRI, can suddenly present as symptomatic apoplexy with SIADH and pan-hypopituitarism.

scholarly journals A Case of Silent Corticotroph Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A563-A563
Author(s):  
Usonwanne U Ibekwe ◽  
Nathan Zwagerman ◽  
Srividya Kidambi ◽  
Jerald Peter Marifke
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Endoscopic Resection ◽  
Staining Pattern ◽  
Positive Staining ◽  
Sellar Mass ◽  
Post Surgery ◽  
Morning Cortisol ◽  
Patient Reported ◽  
The Right

Abstract Background: Silent Corticotroph Adenomas (SCAs) are tumors with no biochemical or clinical features consistent with hypercortisolism but have positive immunostaining for ACTH. They account for approximately 1.1-6% of all pituitary adenomas and 5.5% of nonfunctioning adenomas. Clinical Case: A 49-year-old woman presented to clinic with a 6-month history of headache, vision changes, fatigue, hair thinning, brittle nails, lightheadedness, polydipsia, easy bruising, increased appetite, and weight gain of 178 pounds in 2 years. Labs obtained: morning cortisol 10 mcg/dl(7-25 mcg/dl), ACTH 59 pg/ml(7.2-63 pg/ml), IGF-1 96 ng/ml(52-328 ng/ml), LH 0.2 mIU/ml(1.9-12.5 mIU/ml), FSH 0.8 mIU/ml(2.5-10.2mIU/ml), alpha subunit <0.1 ng/ml(52-328 ng/ml), TSH 0.991 uIU/ml(0.358-3.74 uIU/ml), free T4 1.12 ng/dl(0.76-1.46 ng/dl), salivary cortisol 66 ng/dl(<100 ng/dl), 24-hour urine cortisol 10 mcg/24hr(3.5-45 mcg/24hr) and prolactin 64.3 ng/ml(2.8-29.2 ng/ml). No hook effect noted with serial dilution. MRI brain showed a 22 x 29 x 26 mm sellar mass extending into the suprasellar cistern displacing and compressing the optic nerves and chiasm superiorly with partial invasion into the right cavernous sinus. She had an endoscopic resection of the sellar mass. She developed diabetes insipidus post-operatively and required desmopressin transiently. In the immediate post-operative period, morning cortisol and ACTH were 16.9 ug/dl(6.2-19.4 ug/dL) 24.8 pg/ml(7.2-63.3 pg/ml) respectively. She was sent home without steroids. Pathology showed a staining pattern consistent with pituitary adenoma with positive staining for ACTH. One month after her surgery she was admitted with symptoms of orthostatic hypotension. Cortisol at 5pm was 3 ug/dl(2.3-11.9 ug/dl), ACTH 31.7 pg/ml(7.2-63.3pg/ml). She had a cosyntropin stimulation test done with peak cortisol of 19.3 ug/dl at 60 minutes. Due to her symptoms, she was started on oral hydrocortisone (HC) for secondary adrenal insufficiency (AI), but was eventually tapered off the steroids. Six months after her surgery, she developed worsening headaches. Repeat MRI obtained showed significant growth of the residual adenoma on the right side of the sella, invading the cavernous sinus. Morning cortisol level of 5.3 mcg/dl(4.3-22.4 mcg/dl) and ACTH level was 11 pg/ml(6-50 pg/ml). She had a repeat endoscopic resection of the pituitary tumor. Her post-surgery cortisol at 2 PM was 3 mcg/dl at which time patient reported symptoms of AI. She was discharged on HC. Pathology again showed a staining pattern consistent with pituitary adenoma with positive staining for ACTH. MIB-1 proliferative index was 5.6%. P53 immunostaining showed a moderate density of moderately intense nuclei in the adenoma. Conclusion: This case illustrates aggressive nature of SCAs with higher risk of recurrence compared to other non-functioning adenomas and therefore requires close follow up.

scholarly journals Sporadic ovarian sex cord-stromal tumor with annular tubules: a rare case report

2019 ◽  
Vol 7 (9) ◽  
pp. 3591
Author(s):  
Krutika Patel ◽  
Devang Painter ◽  
Vashudha M. Bhagat ◽  
Pinkal Shah
Keyword(s):  
Granulosa Cell ◽  
Stromal Tumor ◽  
Tissue Mass ◽  
Predominant Component ◽  
Rare Case Report ◽  
Chief Complaints ◽  
Sporadic Cases ◽  
Post Menopausal ◽  
The Right ◽  
Sex Cord Stromal Tumor

Ovarian sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of SCTAT in a 40 year old lady with no association of Peutz-Jegher (P-J) syndrome. The patient’s chief complaints were post-menopausal bleeding for 1 year on and off along with menorrhagia. MRI abdomen was suggestive of intensely enhancing solid tissue mass lesion in the right  adnexa, features suggestive of ovarian mass. Panhysterectomy was done. Grossly uterus and left adnexa appeared to be normal. Right ovary showed mass measuring 17x11x9cm3 in size, on cut section, solid, homogenous lobulated, yellowish areas identified. Microscopic and Immunohistochemistry findings confirmed the diagnosis of sex cord stromal tumor with annular tubules of granulosa cell type. PAS stain supported the diagnosis.

scholarly journals SAT-273 Case of Mistaken Identity?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carlos Pla
Keyword(s):  
Muscle Weakness ◽  
Pituitary Adenomas ◽  
Complete Resolution ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Pituitary Macroadenoma ◽  
Patient Reported ◽  
Work Up

Abstract Introduction Pituitary adenomas occur in 10-15% of patients and the majority are benign. Prolactinomas are the most common form of secretory pituitary adenoma. Pituitary apoplexy, a medical emergency with resulting visual loss and hormonal hyposecretion, requires rapid surgical intervention. We present a case of pituitary macroadenoma that underwent pituitary resection for acute visual disturbance which was later discovered to be caused by undiagnosed demyelinating disease. Clinical Case Patient is a 32-year-old male who presented initially with complain of fatigue and decreased libido. Work up revealed elevated prolactin level and low testosterone. MRI showed a 2x3cm pituitary macroadenoma. At moment of diagnosis, patient was otherwise asymptomatic. He was started on bromocriptine. During follow up visits, patient reported visual disturbance. First MRI in our clinic showed no suprasellar extension, no impingement of optic chiasm and nonspecific white matter disease. At that time, visual field testing showed left temporal defect in superior quadrant. Follow up MRI 1 year later continued to show a stable macroadenoma without impingement of the optic chiasm, but patient reported progressive left vision disturbance and new right vision loss. He was evaluated in the emergency room where he was treated for pituitary apoplexy with steroids and surgery. Vision improved the next day. Despite uncomplicated post-operative course, patient developed proximal muscle weakness and exam notable for diffuse motor deficit in bilateral lower extremities with hyperreflexia. Endocrinology workup was negative for hypercortisolism and ophthalmology diagnosed him with optic neuropathy. Neurology evaluation led to a diagnosis of multiple sclerosis (MS). Patient was started on natalizumab with complete resolution of all visual and muscle symptoms. Clinical lesson Our patient presented with complaints of fatigue, decreased libido and work up that showed a macroprolactinoma without MRI evidence of optic chiasm impingement. During treatment, he developed acute visual deficits that were attributed to pituitary apoplexy. This visual disturbance improved after surgery and use of high dose IV steroids, with the latter likely treating what had been an MS flare. In hindsight, ophthalmologic evaluation before surgery had shown new color blindness, a sign of optic neuropathy. Despite temporary relief, patient progressed to develop new muscle weakness and recurrent visual disturbance which led to the diagnosis of MS. Since being diagnosed and treated for MS, he has had complete resolution of his symptoms. This case stresses the importance of considering other etiologies for visual defects in patients with pituitary adenomas.

scholarly journals Molecular Profile of a Pituitary Rhabdomyosarcoma Arising From a Pituitary Macroadenoma: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinci Lu ◽  
Liam Chen
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Radiation Treatment ◽  
Clinical Symptoms ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Molecular Profile ◽  
Pituitary Macroadenoma ◽  
Incidental Discovery ◽  
Magnetic Resonance Imaging Mri

Pituitary sarcoma arising in association with pituitary adenoma is an uncommon finding. Most cases of secondary sarcoma have been noted to arise with a median interval of 10.5 years post radiation. In this case report, we describe a 77-year-old man with an incidental discovery of a pituitary macroadenoma on magnetic resonance imaging (MRI) and underwent radiotherapy. Three years after radiation treatment, there was an acute change in clinical symptoms and increase in tumor size and mass effect on the optic chiasm which prompted surgical resection. A pituitary adenoma along with a separate spindle-cell sarcomatous component was identified in histology. Immunohistochemical stain for muscle markers confirmed a development of pituitary rhabdomyosarcoma (RMS). Molecular profiling of the tumor identified mutations in TP53, ATRX, LZTR1, and NF1. Despite its rarity, characterization of pituitary RMS with immunohistochemistry and molecular studies may provide an insight to its pathophysiological relationship with pituitary adenoma.

scholarly journals Aggressive Adenoid Cystic Carcinoma of Maxillary Sinus in a 43-Year-Old Male: Rare Case Report and Review of Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Koorosh Rahmani ◽  
Shokouh Taghipour Zahir ◽  
Mohammad Baghi Yazdi ◽  
Alireza Navabazam
Keyword(s):  
Adenoid Cystic Carcinoma ◽  
Maxillary Sinus ◽  
Histopathological Examination ◽  
Tissue Mass ◽  
Adenoid Cystic ◽  
Sinus Wall ◽  
End Of Treatment ◽  
Rare Case Report ◽  
The Right ◽  
Immunohistochemical Studies

Adenoid cystic carcinoma (ACC) is a rare malignant tumor, mostly involving the minor salivary glands. Herein, we present a case of ACC in a 43-year-old man with symptoms of dental abscess as the initial presentation of the tumor. In spiral computed tomography (CT) scan, soft tissue mass with the erosion of maxillary sinus wall on the right side of the alveolar ridge was evident. Histopathological examination of the excised tumor with immunohistochemical studies (C-kit, Vimentin, pan-cytokeratin, p53, p63, and ki67 positive reaction) confirmed grade 2 ACC in the maxillary sinus. The patient underwent hemimaxillectomy and right-neck dissection. Due to the extension of tumor cells excessively into the surrounding tissues and involvement of orbital bone, complete and total resection of the tumor with safe margins could not be done. After surgery, adjuvant radiotherapy was considered for the patient. At the end of treatment, the patient lost his eye vision. Seventeen months from initial diagnosis, he was still alive without lung or distant metastasis.

scholarly journals LONG-TERM FOLLOW-UP AFTER TRANSCRANIAL HYPOPHYSECTOMY IN MACROPROLACTINOMAS

2016 ◽  
Vol 3 (1) ◽  
pp. 44-50
Author(s):  
Adina Ghemigian ◽  
Mara Carsote ◽  
Cristina Ghervan ◽  
Anda Dumitrașcu ◽  
Simona Elena Albu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Obstructive Hydrocephalus ◽  
Optic Chiasm ◽  
Pituitary Insufficiency ◽  
Pituitary Mass ◽  
First Case ◽  
Long Term Follow Up ◽  
The Right ◽  
Pathological Report

Currently, transcranial hypophysectomy is infrequently used since the trans-sphenoidal approach isvery effective and less invasive. Prolactinomas represent one of the rarest indications for pituitarysurgery due to the spectacular effects of dopamine agonists as cabergoline. A 66-year-old femalepresented at age of 52 with headache, low blood pressure. The investigations revealedpanhypopituitarism, high prolactin and a large pituitary mass with obstructive hydrocephalus at theleft lateral ventricle. Transcranial surgery was performed through a right approach withoutcomplications. The pathological report confirmed a pituitary adenoma with intense cellularpleomorphism. A 29-year-old male was admitted at the age of 28 for severe headache, multipleepisodes of vomiting, and hypotension. Pituitary insufficiency and hyperprolactinemia werecorrelated to the presence of an intrasellar tumor of 2/2 cm with extension to the right cavernoussinus, optic chiasm. The pathological report confirmed a pituitary adenoma. Transcranial pituitarysurgery represents an option only in selected large macroprolactinomas. After procedure, a goodoutcome is expected despite the potential secondary eye field defects or pituitary insufficiencywhich needs medication. Sometime the panhypopituitarism caused first by the tumor itself persistsafter surgery (as in our first case) or it is corrected (as adrenal insufficiency in the second case).The presence of a residual prolactin producing tumor requires long term specific therapy withdopamine agonists.

scholarly journals Bartholin’s gland hyperplasia with dysplastic changes: a rare case report

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
James J Yahaya
Keyword(s):  
Rare Case ◽  
Surgical Excision ◽  
Interesting Case ◽  
Complete Excision ◽  
Surgical Scar ◽  
Bartholin’S Gland ◽  
Patient Reported ◽  
Nodular Hyperplasia ◽  
Rare Case Report ◽  
The Right

Abstract The purpose of this paper is to report unusual, rarest and interesting case of a patient with nodular hyperplasia of Bartholin's gland with dysplastic changes. The case of a 30-year old female with right-sided Bartholin’s gland hyperplasia with dysplastic changes, which was confirmed histopathologically, is presented in this paper. The patient reported increased swelling of the right major labium when she became sexually aroused with intermittent dyspareunia during intercourse. Surgical excision of the swelling was done under general anaesthesia. Healing of the surgical scar was complete and she reported no any discomfort or dyspareunia during sexual intercourse. Bartholin’s gland swellings with firm consistency require complete excision due to possibility of being neoplastic rather than just inflammation, cyst or obstructed gland particularly in postmenopausal women. Diagnosis of nodular hyperplasia of Bartholin’s gland with areas of dysplastic changes in the present case is of great interest and requires further investigation.

scholarly journals ICA Occlusion by an ACTH- secreting pituitary adenoma post-TSS and irradiation

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Diala El-Zammar ◽  
Ryojo Akagami
Keyword(s):  
Pituitary Adenoma ◽  
Cushing’S Disease ◽  
Pituitary Tumour ◽  
Cushing's Disease ◽  
Suppressive Therapy ◽  
Pathological Examination ◽  
Pituitary Macroadenoma ◽  
The Right ◽  
Acth Secreting

Occlusion of intracranial arteries by a pituitary adenoma with ensuing infarction is a rare occurrence. In this case study, we show the instance of a pituitary  macroadenoma and apoplexy causing mechanical obstruction of the internal carot- id artery with consequent infarction following transphenoidal surgery (TSS) and ra- diation therapy in a patient with Cushing’s disease. we report a 44-year-old woman  presented with amenorrhea and headaches. Necessary investigations, resection by  TSS, and microscopic examination revealed an adenocorticotropin (ACTH)-secret- ing pituitary macroadenoma. The pituitary tumour recurred in subsequent years,  resulting in the development of Cushing’s disease and syndrome. despite two more  transphenoidal surgeries, radiotherapy, and medical suppressive therapy, the pi- tuitary adenoma continued to enlarge, and the hypercortisolemia and Cushingoid  symptoms persisted. A craniotomy was arranged as the next step in the treatment strategy. Only hours prior to the scheduled surgery, the patient developed left-sided hemiplegia, was diagnosed with acute occlusion of the right ICA and underwent an emergency bifrontal craniotomy with evacuation of the tumour and decompression.  Pathological examination revealed evidence of apoplexy in the ACTH-secreting pi- tuitary adenoma. This case demonstrates the vast scope of complications that can  arise from pituitary adenomas despite combination therapy and forewarns clinicians to be prepared to manage these infrequent but conceivable occurrences.

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