scholarly journals Macroprolactinoma appearing after resolution of hydrocephalus

2017 ◽  
Vol 2017 ◽  
Author(s):  
Oscar D Bruno ◽  
Ricardo Fernández Pisani ◽  
Gabriel Isaac ◽  
Armando Basso
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Tumour ◽  
Empty Sella ◽  
List Type ◽  
Liquid Pressure ◽  
Final Size ◽  
Mechanical Factors ◽  
Pressure Resistance ◽  
Learning Points

Summary The role of mechanical forces influencing the growth of a pituitary adenoma is poorly understood. In this paper we report the case of a young man with hyperprolactinaemia and an empty sella secondary to hydrocephalia, who developed a macroprolactinoma following the relief of high intraventricular pressure. Learning points: The volume of a pituitary tumour may be influenced not only by molecular but also by local mechanical factors. Intratumoural pressure, resistance of the sellar diaphragm and intracranial liquid pressure may play a role in the final size of a pituitary adenoma. The presence of hydrocephalus may hide a pituitary macroadenoma.

scholarly journals A case of a co-secreting TSH and growth hormone pituitary adenoma presenting with a thyroid nodule

2018 ◽  
Vol 2018 ◽  
Author(s):  
Laura Hamilton Adams ◽  
Derick Adams
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Complete Remission ◽  
Pituitary Adenomas ◽  
Thyroid Nodules ◽  
Pituitary Hormones ◽  
Pituitary Hormone ◽  
List Type ◽  
Learning Points ◽  
Pituitary Macroadenomas

Summary Co-secreting TSH and growth hormone pituitary adenomas are rare. We present a case of a 55-year-old woman who presented with symptoms of neck fullness. Ultrasound revealed multiple thyroid nodules and examination revealed several clinical features of acromegaly. She was found to have a co-secreting TSH and growth hormone pituitary macroadenoma. She underwent surgical resection followed by gamma knife radiation, which resulted in complete remission of her TSH and GH-secreting adenoma. Learning points: TSH-secreting pituitary adenomas are rare and about one-third co-secrete other hormones. Thyroid nodules are common in acromegaly and can be the presenting sign of a growth hormone-secreting pituitary adenoma. In the workup of acromegaly, assessment of other pituitary hormones is essential, even in the absence of symptoms of other pituitary hormone dysfunction. Complete remission of co-secreting GH and TSH pituitary macroadenomas is possible with surgery and radiation alone.

scholarly journals Thyrotoxicosis with absence of clinical features of acromegaly in a TSH- and GH-secreting, invasive pituitary macroadenoma

2015 ◽  
Vol 2015 ◽  
Author(s):  
Philip C Johnston ◽  
Amir H Hamrahian ◽  
Richard A Prayson ◽  
Laurence Kennedy ◽  
Robert J Weil
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Features ◽  
Surgical Removal ◽  
List Type ◽  
Pituitary Macroadenoma ◽  
Pituitary Mass ◽  
Biochemical Evidence ◽  
Learning Points ◽  
Gh Excess

Summary A 54-year-old woman presented with bi-temporal hemianopia, palpitations, and diaphoresis. An invasive pituitary macroadenoma was discovered. The patient had biochemical evidence of secondary hyperthyroidism and GH excess; however, she did not appear to be acromegalic. Surgical removal of the pituitary mass revealed a plurihormonal TSH/GH co-secreting pituitary adenoma. TSH-secreting adenomas can co-secrete other hormones including GH, prolactin, and gonadotropins; conversely, co-secretion of TSH from a pituitary adenoma in acromegaly is infrequent. Learning points This case highlights an unusual patient with a rare TSH/GH co-secreting pituitary adenoma with absence of the clinical features of acromegaly. Plurihormonality does not always translate into the clinical features of hormonal excess. There appears to be a clinical and immunohistochemical spectrum present in plurihormonal tumors.

scholarly journals An intrasellar pituitary adenoma–gangliocytoma presenting as acromegaly

2017 ◽  
Vol 2017 ◽  
Author(s):  
Melissa H Lee ◽  
Penelope McKelvie ◽  
Balasubramanian Krishnamurthy ◽  
Yi Yuen Wang ◽  
Carmela Caputo
Keyword(s):  
Pituitary Adenoma ◽  
Surgical Resection ◽  
Pituitary Adenomas ◽  
Histological Analysis ◽  
Good Prognosis ◽  
List Type ◽  
Ongoing Research ◽  
Learning Points ◽  
Mixed Tumours ◽  
Gh Excess

Summary Most cases of acromegaly are due to growth hormone (GH)-secreting pituitary adenomas arising from somatotroph cells. Mixed pituitary adenoma and gangliocytoma tumours are rare and typically associated with hormonal hypersecretion, most commonly GH excess. Differentiating these mixed tumours from conventional pituitary adenomas can be difficult pre-operatively, and careful histological analysis after surgical resection is key to differentiating the two entities. There is little literature addressing the possible mechanisms for the development of mixed pituitary adenoma–gangliocytomas; however, several hypotheses have been proposed. It still remains unclear if these mixed tumours differ from a clinical perspective to pituitary adenomas; however, the additional neural component of the gangliocytoma does not appear to modify the aggressiveness or risk of recurrence after surgical resection. We report a unique case of acromegaly secondary to a mixed GH-secreting pituitary adenoma, co-existing with an intrasellar gangliocytoma. Learning points: Acromegaly due to a mixed GH-secreting pituitary adenoma and intrasellar gangliocytoma is rare. These mixed tumours cannot be distinguished easily from ordinary pituitary adenomas on the basis of clinical, endocrine or neuroradiologic findings, and histological analysis is required for a definitive diagnosis. Surgical resection is usually sufficient to provide cure, without the need for adjuvant therapy. These mixed tumours appear to have a good prognosis although the natural history is not well defined. The pathogenesis of these mixed tumours remains debatable, and ongoing research is required.

scholarly journals Plasma exchange in the treatment of thyroid storm secondary to type II amiodarone-induced thyrotoxicosis

2016 ◽  
Vol 2016 ◽  
Author(s):  
Ling Zhu ◽  
Sueziani Binte Zainudin ◽  
Manish Kaushik ◽  
Li Yan Khor ◽  
Chiaw Ling Chng
Keyword(s):  
Plasma Exchange ◽  
Thyroid Storm ◽  
List Type ◽  
Type Ii ◽  
Free Triiodothyronine ◽  
Bridging Therapy ◽  
Session Type ◽  
Learning Points ◽  
Prompt Diagnosis

Summary Type II amiodarone-induced thyrotoxicosis (AIT) is an uncommon cause of thyroid storm. Due to the rarity of the condition, little is known about the role of plasma exchange in the treatment of severe AIT. A 56-year-old male presented with thyroid storm 2months following cessation of amiodarone. Despite conventional treatment, his condition deteriorated. He underwent two cycles of plasma exchange, which successfully controlled the severe hyperthyroidism. The thyroid hormone levels continued to fall up to 10h following plasma exchange. He subsequently underwent emergency total thyroidectomy and the histology of thyroid gland confirmed type II AIT. Management of thyroid storm secondary to type II AIT can be challenging as patients may not respond to conventional treatments, and thyroid storm may be more harmful in AIT patients owing to the underlying cardiac disease. If used appropriately, plasma exchange can effectively reduce circulating hormones, to allow stabilisation of patients in preparation for emergency thyroidectomy. Learning points Type II AIT is an uncommon cause of thyroid storm and may not respond well to conventional thyroid storm treatment. Prompt diagnosis and therapy are important, as patients may deteriorate rapidly. Plasma exchange can be used as an effective bridging therapy to emergency thyroidectomy. This case shows that in type II AIT, each cycle of plasma exchange can potentially lower free triiodothyronine levels for 10h. Important factors to consider when planning plasma exchange as a treatment for thyroid storm include timing of each session, type of exchange fluid to be used and timing of surgery.

scholarly journals Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature

2014 ◽  
Vol 2 (1) ◽  
pp. K1-K5 ◽  
Author(s):  
Ashraf Roshdy ◽  
Georgios T Karapanagiotidis ◽  
Mazin A I Sarsam ◽  
Simon N Fletcher
Keyword(s):  
Differential Diagnosis ◽  
Aortic Valve ◽  
List Type ◽  
Pannus Formation ◽  
Acute Obstruction ◽  
Review Of The Literature ◽  
Management Options ◽  
Diagnostic Modalities ◽  
Learning Points

SummaryAcute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management.Learning pointsAcute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

scholarly journals Vanishing hypercalciuric kidney stones after treating underlying acromegaly

2013 ◽  
Vol 2013 ◽  
Author(s):  
Eline van der Valk ◽  
Tom Tobe ◽  
Aline Stades ◽  
Alex Muller
Keyword(s):  
Calcium Oxalate ◽  
Kidney Stones ◽  
Common Finding ◽  
List Type ◽  
Primary Role ◽  
Short Overview ◽  
Learning Points

Summary A 53-year-old male presented with recurrent calcium oxalate kidney stones as a first sign of underlying acromegaly, which vanished when his acromegaly was controlled. The exact mechanism behind hypercalciuria and urolithiasis in acromegaly is not yet clear. By discussing this case, a short overview of the pathophysiology of hypercalciuria in acromegaly and practical insights are given. Learning points Hypercalciuria is a common finding in acromegaly. There are only few reports describing hypercalciuric kidney stones in acromegaly. We assume that in acromegaly there is a primary role of IGF1-mediated, PTH-independent increase in calcitriol synthesis resulting in hypercalciuric kidney stones.

PTTG has a Dual Role of Promotion-Inhibition in the Development of Pituitary Adenomas

2019 ◽  
Vol 26 (11) ◽  
pp. 800-818
Author(s):  
Zujian Xiong ◽  
Xuejun Li ◽  
Qi Yang
Keyword(s):  
Cell Cycle ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Cell Cycle Progression ◽  
Key Factors ◽  
Cycle Progression ◽  
Sister Chromatids ◽  
Regulation Of Cell Cycle ◽  
Late Stages

Pituitary Tumor Transforming Gene (PTTG) of human is known as a checkpoint gene in the middle and late stages of mitosis, and is also a proto-oncogene that promotes cell cycle progression. In the nucleus, PTTG works as securin in controlling the mid-term segregation of sister chromatids. Overexpression of PTTG, entering the nucleus with the help of PBF in pituitary adenomas, participates in the regulation of cell cycle, interferes with DNA repair, induces genetic instability, transactivates FGF-2 and VEGF and promotes angiogenesis and tumor invasion. Simultaneously, overexpression of PTTG induces tumor cell senescence through the DNA damage pathway, making pituitary adenoma possessing the potential self-limiting ability. To elucidate the mechanism of PTTG in the regulation of pituitary adenomas, we focus on both the positive and negative function of PTTG and find out key factors interacted with PTTG in pituitary adenomas. Furthermore, we discuss other possible mechanisms correlate with PTTG in pituitary adenoma initiation and development and the potential value of PTTG in clinical treatment.

scholarly journals Early oxygen levels contribute to brain injury in extremely preterm infants

2021 ◽  
Author(s):  
Krista Rantakari ◽  
Olli-Pekka Rinta-Koski ◽  
Marjo Metsäranta ◽  
Jaakko Hollmén ◽  
Simo Särkkä ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Brain Structures ◽  
High Oxygen ◽  
List Type ◽  
Neurodevelopmental Outcomes ◽  
Oxygen Levels ◽  
Arterial Blood ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

Abstract Background Extremely low gestational age newborns (ELGANs) are at risk of neurodevelopmental impairments that may originate in early NICU care. We hypothesized that early oxygen saturations (SpO2), arterial pO2 levels, and supplemental oxygen (FiO2) would associate with later neuroanatomic changes. Methods SpO2, arterial blood gases, and FiO2 from 73 ELGANs (GA 26.4 ± 1.2; BW 867 ± 179 g) during the first 3 postnatal days were correlated with later white matter injury (WM, MRI, n = 69), secondary cortical somatosensory processing in magnetoencephalography (MEG-SII, n = 39), Hempel neurological examination (n = 66), and developmental quotients of Griffiths Mental Developmental Scales (GMDS, n = 58). Results The ELGANs with later WM abnormalities exhibited lower SpO2 and pO2 levels, and higher FiO2 need during the first 3 days than those with normal WM. They also had higher pCO2 values. The infants with abnormal MEG-SII showed opposite findings, i.e., displayed higher SpO2 and pO2 levels and lower FiO2 need, than those with better outcomes. Severe WM changes and abnormal MEG-SII were correlated with adverse neurodevelopment. Conclusions Low oxygen levels and high FiO2 need during the NICU care associate with WM abnormalities, whereas higher oxygen levels correlate with abnormal MEG-SII. The results may indicate certain brain structures being more vulnerable to hypoxia and others to hyperoxia, thus emphasizing the role of strict saturation targets. Impact This study indicates that both abnormally low and high oxygen levels during early NICU care are harmful for later neurodevelopmental outcomes in preterm neonates. Specific brain structures seem to be vulnerable to low and others to high oxygen levels. The findings may have clinical implications as oxygen is one of the most common therapies given in NICUs. The results emphasize the role of strict saturation targets during the early postnatal period in preterm infants.

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

scholarly journals Role of matrix Metalloproteinases in pituitary adenoma invasion

2018 ◽  
Vol 4 (1) ◽  
Author(s):  
Chengxian Yang ◽  
Xinjie Bao ◽  
Renzhi Wang
Keyword(s):  
Pituitary Adenoma ◽  
Matrix Metalloproteinases
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