scholarly journals A case of pituitary abscess presenting without a source of infection or prior pituitary pathology

2016 ◽  
Vol 2016 ◽  
Author(s):  
Derick Adams ◽  
Philip A Kern
Keyword(s):  
Risk Factors ◽  
Pituitary Hormone ◽  
List Type ◽  
Pituitary Abscess ◽  
Surgical Specimen ◽  
Source Of Infection ◽  
Staphylococcus Capitis ◽  
Suprasellar Region ◽  
Visual Changes ◽  
Transsphenoidal Resection

Summary Pituitary abscess is a relatively uncommon cause of pituitary hormone deficiencies and/or a suprasellar mass. Risk factors for pituitary abscess include prior surgery, irradiation and/or pathology of the suprasellar region as well as underlying infections. We present the case of a 22-year-old female presenting with a spontaneous pituitary abscess in the absence of risk factors described previously. Her initial presentation included headache, bitemporal hemianopia, polyuria, polydipsia and amenorrhoea. Magnetic resonance imaging (MRI) of her pituitary showed a suprasellar mass. As the patient did not have any risk factors for pituitary abscess or symptoms of infection, the diagnosis was not suspected preoperatively. She underwent transsphenoidal resection and purulent material was seen intraoperatively. Culture of the surgical specimen showed two species of alpha hemolytic Streptococcus, Staphylococcus capitis and Prevotella melaninogenica. Urine and blood cultures, dental radiographs and transthoracic echocardiogram failed to show any source of infection that could have caused the pituitary abscess. The patient was treated with 6weeks of oral metronidazole and intravenous vancomycin. After 6weeks of transsphenoidal resection and just after completion of antibiotic therapy, her headache and bitemporal hemianopsia resolved. However, nocturia and polydipsia from central diabetes insipidus and amenorrhoea from hypogonadotrophic hypogonadism persisted. Learning points Pituitary abscesses typically develop in patients who have other sources of infection or disruption of the normal suprasellar anatomy by either surgery, irradiation or pre-existing pathology; however, they can develop in the absence of known risk factors. Patients with pituitary abscesses typically complain of headache, visual changes and symptoms of pituitary hormone deficiencies. As other pituitary neoplasms present with similar clinical findings, the diagnosis of pituitary abscess is often not suspected until transsphenoidal resection is performed. Prompt surgical and medical treatment of pituitary abscess is necessary, which typically results in improvement in headache and visual changes; however, pituitary hormone deficiencies are typically often permanent.

scholarly journals 1351 Primary Pituitary Abscess Presenting as An Isolated Bitemporal Hemianopia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Tan ◽  
A Zammit
Keyword(s):  
Primary Source ◽  
Pituitary Surgery ◽  
Resonance Imaging ◽  
Pituitary Abscess ◽  
Cystic Fluid ◽  
Source Of Infection ◽  
Life Threatening ◽  
Pituitary Lesion ◽  
Bitemporal Hemianopia ◽  
Transsphenoidal Resection

Abstract Pituitary abscesses are rare yet life-threatening entities. Most common presenting features are headache, hypopituitarism, and visual changes. Majority of patients are found to have a predisposing risk factor, such as a pre-existing pituitary lesion, recent pituitary surgery or irradiation, or a primary source of infection. We present the case of a 53-year-old male with a spontaneous pituitary abscess, who presented with an isolated bitemporal hemianopia, but was otherwise asymptomatic with no known risk factors. Magnetic resonance imaging showed a sellar and suprasellar mass, thought to be a pituitary macroadenoma. He underwent endoscopic transsphenoidal adenectomy and cystic fluid was seen intraoperatively. Microbiology analysis showed Staphylococcus Aureus, and a course of intravenous ceftriaxone was commenced. Histopathology reported no evidence of adenoma and impression was of a pituitary abscess. Following transsphenoidal resection and commencement of antibiotic therapy, the bitemporal hemianopia resolved. We therefore report a rare case of primary pituitary abscess and emphasise the importance of including this condition as a differential diagnosis in any patient with a visual deficit or new pituitary lesion.

scholarly journals An intrasellar germinoma with normal tumor marker concentrations mimicking primary lymphocytic hypophysitis

2013 ◽  
Vol 57 (7) ◽  
pp. 566-570 ◽  
Author(s):  
Mariana F. Guzzo ◽  
Cristina B. Formiga Bueno ◽  
Thiago T. Amancio ◽  
Sergio Rosemberg ◽  
Cleonice Bueno ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Correct Diagnosis ◽  
Careful Analysis ◽  
Malignant Neoplasms ◽  
Pituitary Hormone ◽  
Appropriate Treatment ◽  
Suprasellar Region ◽  
Neoplastic Lesions ◽  
Posterior Pituitary Hormone ◽  
Pituitary Stalk Thickening

Intracranial germinomas (GE) are malignant neoplasms most commonly found in the suprasellar region, which may cause anterior and particularly posterior pituitary hormone deficits with central diabetes insipidus (DI). Differential diagnosis of pituitary stalk thickening includes granulomatous, inflammatory, infectious, and neoplastic lesions. Although careful analysis of clinical, laboratory, and imaging findings may facilitate the diagnosis, transsphenoidal biopsy is indicated to confirm the disease, as the correct diagnosis directs the appropriate treatment.

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

scholarly journals Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 50-60 ◽  
Author(s):  
Alison McMillan ◽  
Mary J. Morrell
Keyword(s):  
Risk Factors ◽  
Older People ◽  
Sleep Disordered Breathing ◽  
Treatment Options ◽  
Current Evidence ◽  
List Type ◽  
Pressure Therapy ◽  
Age Related ◽  
The Impact ◽  
Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

scholarly journals Mapping, cluster detection and evaluation of risk factors of ovine toxoplasmosis in Southern Italy

2016 ◽  
Vol 11 (2) ◽  
Author(s):  
Roberto Condoleo ◽  
Vincenzo Musella ◽  
Maria Paola Maurelli ◽  
Antonio Bosco ◽  
Giuseppe Cringoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Geographical Information Systems ◽  
Southern Italy ◽  
Geographical Information ◽  
Economic Losses ◽  
Common Source ◽  
High Exposure ◽  
Campania Region ◽  
Source Of Infection ◽  
Serological Data

Toxoplasmosis, an important cause of reproductive failure in sheep, is responsible for significant economic losses to the ovine industry worldwide. Moreover, ovine meat contaminated by the parasite <em>Toxoplasma gondii</em> is considered as a common source of infection for humans. The aim of this study was to develop point and risk profiling maps of <em>T. gondii</em> seroprevalence in sheep bred in Campania Region (Southern Italy) and analyse risk factors associated at the flock-level. We used serological data from a previous survey of 117 sheep flocks, while environmental and farm management information were obtained from an analysis based on geographical information systems and a questionnaire purveyance, respectively. An univariate Poisson regression model revealed that the type of farm production (milk and meat vs only meat) was the only independent variable associated with <em>T. gondii</em> positivity (P&lt;0.02); the higher within-flock seroprevalence in milking herds suggests that milking practices might influence the spread of the infection on the farm. Neither environmental nor other management variables were significant. Since a majority of flocks were seasonally or permanently on pasture, the animals have a high exposure to infectious <em>T. gondii</em> oocysts, so the high within-flock seroprevalence might derive from this management factor. However, further studies are needed to better assess the actual epidemiological situation of toxoplasmosis in sheep and to clarify the factors that influence its presence and distribution.

scholarly journals Oral health inequality in people with severe mental illness: a cross-sectional study using National Health and Nutrition Examination Survey 1999-2016

2021 ◽  
Author(s):  
Jing Kang ◽  
Jianhua Wu ◽  
Vishal Aggarwal ◽  
David Shiers ◽  
Tim Doran ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Oral Health ◽  
General Population ◽  
Health Outcomes ◽  
Severe Mental Illness ◽  
Tooth Loss ◽  
List Type ◽  
Cross Sectional ◽  
Oral Health Outcomes

AbstractOBJECTIVETo explore whether people with severe mental illness (SMI) experience worse oral health compared to the general population, and the risk factors for poor oral health in people with SMI.METHODThis study used cross-sectional data from the National Health and Nutrition Examination Survey (1999-2016) including on self-rated oral health, ache in mouth, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. The authors used ordinal logistic regression and zero-inflated negative binomial models to explore predictors of oral health outcomes.RESULTS53,348 cases were included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.40, 95% CI: 1.12-1.75). In people with SMI, the risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.CONCLUSIONSPeople with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Having a healthy lifestyle such as performing regular physical exercise and flossing may lower the risk of poor oral health. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes.Significant outcomes (x3)People with severe mental illness were at 40% higher risk of tooth loss when compared to the general population.Older adults, smokers and people with diabetes were at particularly high risk of poor oral health.Physical exercise and daily use of dental floss were associated with better oral health outcomes.Limitations (x3)The number of cases with data on periodontal disease was limited.The study was cross-sectional so causation could not be inferred.The analysis used prescriptions of antipsychotic and mood stabilising medication as a proxy measure of severe mental illness, as clinical diagnoses were not available in the dataset.Data availability statementThe NHANES 1999-2016 data is available at CDC website: https://www.cdc.gov/nchs/nhanes/index.htm, and is accessible and free to download for everyone.

scholarly journals Sinusitis Independently Predicts the Presence of Headache Following Endoscopic Transsphenoidal Resection for Pituitary Adenomas

2021 ◽  
Author(s):  
Jiayu Gu ◽  
Xiaoqun Chen ◽  
Yunzhi Zou ◽  
Shuo Yang ◽  
Siyu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Meta Analysis ◽  
Confidential Interval ◽  
Endoscopic Endonasal ◽  
Postoperative Headache ◽  
The One ◽  
Headache Impact ◽  
Transsphenoidal Resection

Abstract Purpose Headache is common among patients with pituitary adenomas undergone endoscopic endonasal surgery (EES), but was seldomly concerned before. The present study aims to investigate the incidence and profile of risk factors of headache after EES.Methods A meta-analysis was performed to evaluate the occurrence proportions of postoperative headache in patients with pituitary adenomas. Then, a cohort of 101 patients undergone EES were enrolled for analyzing risk factors of headache. The Headache Impact Test (HIT-6) was used to score the headache preoperatively, 1 month and 3 months postoperatively. Results A total of 18 studies and 4442 participants were included for meta-analysis. The pooled occurrence proportion of postoperative headache was 29% (95% confidential interval: 20-38%). For the 101 patients enrolled in the present study, 26 (25.74%) of them had a HIT-6 scores of > 55 preoperatively, but decreased to 22 (21.78%) at 1 month, and 6 (5.94%) at 3 months, postoperatively. Multivariate analysis showed that pituitary apoplexy (OR=3.591, 95%CI 1.219-10.575, p=0.020) and Hardy's grade C-D (OR=21.06, 95%CI 2.25-197.02, p=0.008) were independently risk factors for preoperative headache. In contrast, postoperative sinusitis (OR=3.88, 95%CI 1.16-13.03, P=0.028) and Hardy's grade C-D (OR=10.53, 95%CI 1.02-109.19, P=0.049) independently predicted the presence of postoperative headache at 1 month. At 3 months postoperatively, the proportion of sinusitis tended to be higher in the headache group than the one in non-headache group (100% vs. 30.0%, p=0.070). Conclusion Headache is very common following EES for pituitary adenomas. Prophylactic management of postoperative sinusitis may help to alleviate postoperative headache.

scholarly journals Cantu syndrome and hypopituitarism: implications for endocrine monitoring

2019 ◽  
Vol 2019 ◽  
Author(s):  
Nicholas J Theis ◽  
Toby Calvert ◽  
Peter McIntyre ◽  
Stephen P Robertson ◽  
Benjamin J Wheeler
Keyword(s):  
Anterior Pituitary ◽  
Autosomal Dominant ◽  
Genetic Disorder ◽  
Facial Features ◽  
Pituitary Hormone ◽  
List Type ◽  
Pituitary Dysfunction ◽  
Pathogenic Variants ◽  
Clinical Surveillance ◽  
Learning Points

Summary Cantu syndrome, or hypertrichotic osteochondrodysplasia, is a rare, autosomal dominant genetically heterogeneous disorder. It is characterized by hypertrichosis, cardiac and skeletal anomalies and distinctive coarse facial features. We report a case where slowed growth velocity at 13 years led to identification of multiple pituitary hormone deficiencies. This adds to other reports of pituitary abnormalities in this condition and supports inclusion of endocrine monitoring in the clinical surveillance of patients with Cantu syndrome. Learning points: Cantu syndrome is a rare genetic disorder caused by pathogenic variants in the ABCC9 and KCNJ8 genes, which result in gain of function of the SUR2 or Kir6.1 subunits of widely expressed KATP channels. The main manifestations of the syndrome are varied, but most commonly include hypertrichosis, macrosomia, macrocephaly, coarse ‘acromegaloid’ facies, and a range of cardiac defects. Anterior pituitary dysfunction may be implicated in this disorder, and we propose that routine screening should be included in the clinical and biochemical surveillance of patients with Cantu syndrome.

Abstract 5813: Vascular Function Measured By Digital Thermal Monitoring Strongly Correlates with the Severity of Coronary Artery Disease Diagnosed by 64 Slice Multidetector Computed Tomography

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Naser Ahmadi ◽  
Vivek Nuguri ◽  
Sumithra Tirunagaram ◽  
Anila Saeed ◽  
Fereshteh Hajsadeghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Multidetector Computed Tomography ◽  
Vascular Function ◽  
List Type ◽  
Thermal Monitoring ◽  
Luminal Stenosis ◽  
Artery Disease

Background: Digital Thermal Monitoring (DTM) of vascular reactivity is a new test of vascular function that correlates well with the Framingham Risk Score and subclinical coronary artery disease measured by the coronary calcium score. This study evaluates whether DTM correlates with the severity of coronary artery disease (CAD) measured by 64 slice multidetector computed tomography (MDCT). Methods: 151 patients, mean age 64±9 years, 69% male, were studied. Each underwent DTM during a 5 minute supra systolic arm-cuff occlusion and MDCT. Post-cuff deflation fingertip temperature rebound (TR) was correlated with CAD severity assessed by MDCT. Results: After adjusting for age, gender and CAD risk factors using logistic regression analysis, the odds ratio for TR in the lowest tertile vs. upper 2 tertiles was 1.3 (95% CI 0.89 –1.6, p=0.4) for mild CAC (luminal stenosis<30%), 2.7 (95% CI 1.2–3.9, p=0.0001) for moderate CAD (30 –70% luminal stenosis) and 6.94 (95% CI 2.2–10.7, p=0.0001) for severe CAD (luminal stenosis>70%) compared to normal coronaries. Additionally, TR was lower in coronary segments with mixed plaque compared to calcified plaque (0.43±0.17 vs. 0.91±0.19, p=0.001). Conclusions: Vascular dysfunction measured by DTM strongly correlates with the severity and characteristics of coronary plaques measured by MDCT, independent of age, gender and cardiac risk factors. DTM may be a useful tool for the identification of high risk patients, additional studies are warranted.

scholarly journals Frequency of antibodies and risk factors associated with Toxoplasma gondii infection in backyard pig production in the city of Mossoró, state of Rio Grande do Norte, Brazil

2019 ◽  
Vol 28 (3) ◽  
pp. 508-513 ◽  
Author(s):  
Isabela Maria Campanelli dos Santos ◽  
Alexandro Iris Leite ◽  
Maria Eduarda Chiaradia Furquim ◽  
Diego Carlos de Souza Zanatto ◽  
Simone de Jesus Fernandes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rio Grande ◽  
Female Gender ◽  
Immunofluorescence Assay ◽  
P Value ◽  
Serum Samples ◽  
Igg Antibody ◽  
Source Of Infection ◽  
Antibody Titers ◽  
Toxoplasma Gondii Infection

Abstract Toxoplasmosis is an important zoonosis for pregnant women and immunosuppressed people. The pig population also becomes infected by this pathogen, and undercooked or raw meat is an important source of infection for humans. The aims of the present study were to evaluate the rate of exposure of pigs to T. gondii in the municipality of Mossoró, Rio Grande do Norte and seek to identify associations with possible risk factors. Blood samples were collected from 412 pigs and were analyzed using the immunofluorescence assay. Among these 412 serum samples, 40.7% were seropositive for T. gondii. The IgG antibody titers were 64 (56 specimens), 128 (32), 256 (37), 512 (23), 1024 (14), 2048 (5) and 4046 (1). Seropositivity for T. gondii was found to be related (p-value < 0.05) to the following factors: female gender, semi-confined rearing system, use of well water, dewormed animals, presence of cats, goats, sheep, mice and vultures on the farm and carcasses left on the ground. In contrast, seropositivity was not related (p-value < 0.05) to the age of the pigs, type of facility or feeding with human food remains. Preventive measures need to be adopted on the farms studied here, with the aim of decreasing the animals’ intake of sporulated oocysts.

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