scholarly journals Pituitary hyperplasia causing complete bitemporal hemianopia with resolution following surgical decompression: case report

2020 ◽  
pp. 1-5
Author(s):  
Nataly Raviv ◽  
Ami Amin ◽  
Tyler J. Kenning ◽  
Carlos D. Pinheiro-Neto ◽  
David Jones ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Surgical Decompression ◽  
Pituitary Hormone ◽  
Visual Field Examination ◽  
Endoscopic Endonasal ◽  
Normal Limits ◽  
Pituitary Hyperplasia ◽  
Bitemporal Hemianopia

In this report, the authors demonstrated that idiopathic pituitary hyperplasia (PH) can cause complete bitemporal hemianopia and amenorrhea, even in the setting of mild anatomical compression of the optic chiasm and normal pituitary function. Furthermore, complete resolution of symptoms can be achieved with surgical decompression.PH can occur in the setting of pregnancy or end-organ insufficiency, as well as with medications such as oral contraceptives and antipsychotics, or it can be idiopathic. It is often found incidentally, and surgical intervention is usually unnecessary, as the disorder rarely progresses and can be managed by treating the underlying etiology. Here, the authors present the case of a 24-year-old woman with no significant prior medical history, who presented with bitemporal hemianopia and amenorrhea. Imaging revealed an enlarged pituitary gland that was contacting, but not compressing, the optic chiasm, and pituitary hormone tests were all within normal limits. The patient underwent surgical decompression of the sella turcica and exploration of the gland through an endoscopic endonasal transsphenoidal approach. Pathology results demonstrated PH. A postoperative visual field examination revealed complete resolution of the bitemporal hemianopia, and menstruation resumed 3 days later. The patient remains asymptomatic with no hormonal deficits.

scholarly journals Pituitary Hyperplasia Secondary to Primary Hypothyroidism Mimicking a Macroadenoma With Optical Chiasm Compression

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A599-A600
Author(s):  
Mariana Tazima Fujiwara ◽  
Karla Borges Daniel ◽  
Marília Bortolotto Felippe Trentin ◽  
Murilo Oliveira Cerci ◽  
Heraldo Mendes Garmes
Keyword(s):  
Case Report ◽  
Thyroid Function ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Primary Hypothyroidism ◽  
Psychomotor Development ◽  
Normal Range ◽  
Pituitary Hyperplasia ◽  
Pituitary Lesion

Abstract Background: A long term untreated primary hypothyroidism can stimulate thyrotropes proliferation, leading to pituitary hyperplasia. This condition is known as pituitary hyperplasia secondary to primary hypothyroidism (PHPH). It is a rare condition that mimics pituitary adenoma and can achieve large proportions with optic chiasm compression. A misdiagnosis may be catastrophic, and a pituitary resection wrongly performed. Clinical Case: A 25-year-old woman with a medical history of delayed neuro psychomotor development and epilepsy due to congenital CNS malformation had a Brain MRI performed for epilepsy follow-up three years earlier. At that time, neuroimaging had shown a pituitary enlargement, and laboratory data were diagnostic of severe primary hypothyroidism with TSH of 290.6 uUI/mL (normal range 0.4 to 4.5 uUI/mL) and T4L <0.23 ng/dL (normal range: 0.9 to 1.8 ng/dL). She then had received a 75 mcg levothyroxine prescription. However, the patient missed medical follow-up and returned three years later, when sella turcica MRI showed a 0.9x1.0x1,4 cm pituitary lesion, consistent with a macroadenoma with suprasellar extent near the optic chiasm. Because of the cognitive impairment, the patient was not able to complete the visual field test. Neurology service referred the patient to endocrinology evaluation for surgical treatment. Hypothyroidism was still uncontrolled with TSH 157.1 uUI/mL and T4L 0.28 ng/dL. We had adjusted the levothyroxine dose to 125 mcg and advised adherence. Subsequent thyroid function tests had shown TSH 6.91 uUI/mL and T4L 1.15 ng/dL. After thyroid function stabilization, the patient performed a new sella turcica MRI, which had not evidenced pituitary lesion. Pituitary hyperplasia secondary to primary hypothyroidism was her final diagnosis. Conclusion: This case report illustrates the importance of the correct diagnosis and treatment of PHPH. Levothyroxine replacement, with TSH normalization, reverses the gland hyperplasia within 2 to 4 months. References: 1. Cao J, Lei T, Chen F, Zhang C, Ma C, Huang H. Primary hypothyroidism in a child leads to pituitary hyperplasia: A case report and literature review. Medicine (Baltimore). 2018 Oct;97(42):e12703.2. Shivaprasad KS, Siddardha K. Pituitary Hyperplasia from Primary Hypothyroidism. N Engl J Med. 2019 Feb 21;380(8):e9.

scholarly journals 55-year-old Woman with Headache, Vomiting, and Visual Disturbance

2020 ◽  
Vol 4 (2) ◽  
pp. 116-120
Author(s):  
Lana Shaker ◽  
Jill Ripper ◽  
Tiffany Murano
Keyword(s):  
Sella Turcica ◽  
Vital Signs ◽  
Stable Condition ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Deficiency Anemia ◽  
Case Presentation ◽  
Normal Limits ◽  
History Of ◽  
Tomography Scan

Case Presentation: A 55-year-old woman with a past medical history of hypertension, hyperlipidemia, and iron deficiency anemia presented to the emergency department with three days of headache, nausea, vomiting, and visual changes. Her vital signs were within normal limits. She was noted to have a left cranial nerve six palsy on exam. Results: Her laboratory testing revealed leukocytosis, hyponatremia, and hypokalemia. A non-contrast computed tomography scan of the head revealed an enlarged sella turcica and pituitary gland with hemorrhage and deviation of the optic chiasm. Conclusion: Her symptoms improved and she was discharged from the hospital in stable condition.

scholarly journals Primary empty sella syndrome associated with visual deterioration salvaged by chiasmapexy: Report of a case and discussion of the literature

2020 ◽  
Vol 11 ◽  
pp. 48
Author(s):  
John Ouma
Keyword(s):  
Visual Fields ◽  
Sella Turcica ◽  
Optic Chiasm ◽  
Empty Sella ◽  
Endoscopic Endonasal ◽  
Gradual Improvement ◽  
Empty Sella Syndrome ◽  
Visual Deterioration ◽  
Neurosurgical Technique

Background: Empty sella syndrome (ESS) is a condition in which there is loss of volume of the pituitary gland, which is the normal constituent of the sella turcica. There may be visual and endocrine deficits associated with this condition, and radiologically, there may be downward prolapse of the optic chiasm. It occurs in a primary ESS, poorly understood form, as well as a secondary ESS form that follows medical or surgical treatment of a pituitary macroadenoma, or else spontaneous hemorrhage into such a tumor. Case Description: A 56-year-old man presenting with deficits of both visual acuity and visual fields in the setting of radiological ESS without associated optic chiasm prolapse is discussed. He underwent endoscopic endonasal chiasmapexy with gradual improvement of his visual function over the following 6 months. Conclusion: ESS is a potentially potent cause of visual deterioration that lends itself to reversal through a relatively simple neurosurgical technique. This case illustrates that actual prolapse of the chiasm is neither a prerequisite for visual deterioration nor its reversal the mechanism of visual improvement after chiasmapexy, raising the question of the mechanisms at play in cases such as this. It confirms the role of chiasmapexy in the management of selected cases of ESS.

scholarly journals Endoscopic Endonasal Orbital Apex Decompression for Carotid Cavernous Fistula

2021 ◽  
pp. 014556132110303
Author(s):  
Noah Shaikh ◽  
Anthony Leonard ◽  
Caitlyn Patton ◽  
SoHyun Boo ◽  
John Nguyen ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Standard Of Care ◽  
Endoscopic Endonasal Approach ◽  
Orbital Apex ◽  
Abducens Palsy ◽  
Carotid Cavernous Fistula ◽  
Endoscopic Endonasal ◽  
Cavernous Fistula ◽  
Novel Approach ◽  
Gaze Palsy

Significance Statement This case report demonstrates a novel approach to treating a rare indirect carotid cavernous fistula (CCF) and associated abducens palsy. Although endovascular treatment is the standard of care in the management of CCFs, it was contraindicated in this patient. Instead, she underwent an endoscopic endonasal approach (EEA) with decompression of the medial orbital apex, including the cavernous sinus and optic nerve, with complete resolution of headache, lateral gaze palsy, and diplopia within 2 months.

Upper cervical myelopathy due to arachnoiditis and spinal cord tethering from adjacent C-2 osteomyelitis

2007 ◽  
Vol 6 (1) ◽  
pp. 64-67 ◽  
Author(s):  
Sharad Rajpal ◽  
Krisada Chanbusarakum ◽  
Praveen R. Deshmukh
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Complete Resolution ◽  
Magnetic Resonance Image ◽  
Epidural Abscess ◽  
Odontoid Process ◽  
Surgical Decompression ◽  
Upper Cervical ◽  
High Cervical ◽  
Spinal Cord Tethering

✓Myelopathy caused by a spinal cord infection is typically related to an adjacent compressive lesion such as an epidural abscess. The authors report a case of progressive high cervical myelopathy from spinal cord tethering caused by arachnoiditis related to an adjacent C-2 osteomyelitis. This 70-year-old woman initially presented with a methicillin-sensitive Staphylococcus aureus osteomyelitis involving the C-2 odontoid process. She was treated with appropriate antibiotic therapy but, over the course of 4 weeks, she developed progressive quadriparesis. A magnetic resonance image revealed near-complete resolution of the C-2 osteomyelitis, but new ventral tethering of the cord was observed at the level of the odontoid tip. She subsequently underwent open surgical decompression and cord detethering. Postoperatively she experienced improvement in her symptoms and deficits, which continued to improve 1 year after her surgery. To the authors’ knowledge, this is the first reported case of progressive upper cervical myelopathy due to arachnoiditis and cord tethering from an adjacent methicillin-sensitive S. aureus C-2 osteomyelitis.

scholarly journals Evaluation of pituitary imaging in patients with PROP-1 gene mutation

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 693 ◽  
Author(s):  
Natalija Tkačenko ◽  
Danutė Lašienė ◽  
Silvija Jakštienė ◽  
Algidas Basevičius ◽  
Rasa Verkauskienė
Keyword(s):  
Transcription Factor ◽  
Pituitary Gland ◽  
Gene Mutation ◽  
Anterior Pituitary ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Imaging Studies ◽  
Pituitary Hyperplasia ◽  
Pituitary Hypoplasia ◽  
Genetically Determined

The most common genetically determined cause of multiple pituitary hormone deficiency is PROP-1 gene mutation. PROP-1 is a transcription factor involved in the development of pituitary gland and affects hormonal synthesis of anterior pituitary. The aim of our study was to evaluate radiological aspects of the pituitary region in patients with PROP-1 gene mutation. Pituitary imaging studies were performed in 12 patients with a confirmed PROP-1 gene mutation. Pituitary hyperplasia was found in 5 (42%) and pituitary hypoplasia in 4 (33%) patients. Changes in pituitary size were not associated with the type of PROP-1 gene mutation.

scholarly journals Pituitary Stem Cell Update and Potential Implications for Treating Hypopituitarism

2011 ◽  
Vol 32 (4) ◽  
pp. 453-471 ◽  
Author(s):  
Frederic Castinetti ◽  
Shannon W. Davis ◽  
Thierry Brue ◽  
Sally A. Camper
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Cell Loss ◽  
Notch Signaling Pathway ◽  
Term Treatment ◽  
Marker Genes ◽  
Pituitary Hormone ◽  
Turnover Rates ◽  
Pituitary Hyperplasia ◽  
Long Term Treatment

Stem cells have been identified in organs with both low and high cell turnover rates. They are characterized by the expression of key marker genes for undifferentiated cells, the ability to self-renew, and the ability to regenerate tissue after cell loss. Several recent reports present evidence for the presence of pituitary stem cells. Here we offer a critical review of the field and suggest additional studies that could resolve points of debate. Recent reports have relied on different markers, including SOX2, nestin, GFRa2, and SCA1, to identify pituitary stem cells and progenitors. Future studies will be needed to resolve the relationships between cells expressing these markers. Members of the Sox family of transcription factors are likely involved in the earliest steps of pituitary stem cell proliferation and the earliest transitions to differentiation. The transcription factor PROP1 and the NOTCH signaling pathway may regulate the transition to differentiation. Identification of the stem cell niche is an important step in understanding organ development. The niche may be the marginal zone around the lumen of Rathke's pouch, between the anterior and intermediate lobes of mouse pituitary, because cells in this region apparently give birth to all six pituitary hormone cell lineages. Stem cells have been shown to play a role in recurrent malignancies in some tissues, and their role in pituitary hyperplasia, pituitary adenomas, and tumors is an important area for future investigation. From a therapeutic viewpoint, the ability to cultivate and grow stem cells in a pituitary predifferentiation state might also be helpful for the long-term treatment of pituitary deficiencies.

Symptomatic Arnold-Chiari malformation: review of experience with 22 cases

1987 ◽  
Vol 66 (6) ◽  
pp. 812-816 ◽  
Author(s):  
William O. Bell ◽  
Edward B. Charney ◽  
Derek A. Bruce ◽  
Leslie N. Sutton ◽  
Luis Schut
Keyword(s):  
Chiari Malformation ◽  
Complete Resolution ◽  
Older Patients ◽  
Surgical Decompression ◽  
Complete Relief ◽  
Content Type ◽  
Arnold Chiari Malformation ◽  
Feeding Difficulty ◽  
Symptoms And Signs ◽  
Chiari Malformations

✓ Twenty-two patients with closed myelomeningoceles, shunted hydrocephalus, and symptomatic Arnold-Chiari malformations were studied retrospectively. Seventeen of the 22 patients were aged 6 months or younger; five patients were aged 3 to 23 years. Patients in the younger group presented with stridor, apnea, and/or feeding difficulty; those in the older group presented with hemiparesis, quadriparesis, oscillopsia, nystagmus, or opisthotonos. Fourteen of the 17 younger patients underwent surgical decompression of the Arnold-Chiari malformation: 10 within 18 days following the onset of symptoms and four on Day 19 or later. Of the 10 infants with early treatment, five eventually died secondary to continued symptoms and five survived. Of those surviving, three were asymptomatic and two had continuing symptoms but were improved over their preoperative state. Among the four patients undergoing surgery later, two died, one had lessening of stridor, and one had complete relief of symptoms. Of the three infants not undergoing decompression, two died and one eventually became asymptomatic. All five of the older patients underwent decompression and all had complete resolution of their preoperative symptoms and signs. The authors conclude that while decompression of a symptomatic Arnold-Chiari malformation may be effective in children and adults, this treatment does not always improve the clinical condition of infants. This may be the result of ischemic/hypoxic effects on the infant's brain stem, which may not be organized normally at birth.

scholarly journals Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma

2018 ◽  
Vol 79 (S 02) ◽  
pp. S194-S195
Author(s):  
Justin Davanzo ◽  
Neerav Goyal ◽  
Brad Zacharia
Keyword(s):  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach ◽  
Close Proximity ◽  
Dural Opening ◽  
Neurologically Intact ◽  
Video Abstract

AbstractThis video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm.The link to the video can be found at: https://youtu.be/tahjHmrXhc4.

Sign in / Sign up

Export Citation Format

Share Document