Xanthomatous Hypophysitis: A Case Report and Comprehensive Literature Review

PurposeXanthomatous hypophysitis (XHP) is an extremely rare form of primary hypophysitis for which there is a lack of clinical experience. A comprehensive understanding of its clinical characteristics, diagnosis and treatment is needed.MethodsHere, we report a case study and conduct a systematic review of XHP. Thirty-six cases were included, and their clinical manifestations, endocrine assessment, imaging features, treatment and follow-up data were collected and analyzed.ResultsThe mean age at diagnosis was 39.1 years, and females were predominant (75.0%). The most common symptom was headache (68.6%), and 66.7% of female patients presented menstrual disorders. The most common pituitary dysfunction was growth hormone (GH) deficiency. More than half of patients exhibited central diabetes insipidus (CDI). The majority of patients had an imaging presentation of a cystic lesion with peripheral enhancement. Pituitary stalk thickening was observed in half of the patients. Total lesion resection was achieved in 57.1% of cases. The recurrence rate after partial resection and biopsy was significantly higher than that after total lesion resection (57.1% vs. 0.0%, P = 0.0147). The most common pituitary hormone abnormalities to resolve after surgery were hyperprolactinemia (100.0%) and GH deficiency (91.7%). The typical pathological feature was inflammatory infiltration of foamy histiocytes, which showed positivity for CD68.ConclusionDiagnosis of XHP is difficult when relying on clinical symptoms and imaging features. Therefore, surgical histopathology is necessary. Based on the available evidence, total lesion resection is recommended for treatment. However, the long-term prognosis for this rare disease remains unclear.

Download Full-text

Clinical Characteristics and CT Manifestations of 143 Patients With 2019 Novel Coronavirus Disease (COVID-19) in Taizhou City, Zhejiang, China

10.21203/rs.3.rs-32895/v1 ◽

2020 ◽

Author(s):

Yani Kuang ◽

Susu He ◽

Shuangxiang Lin ◽

Rui Zhu ◽

Rongzhen Zhou ◽

...

Keyword(s):

Clinical Symptoms ◽

Protein A ◽

Clinical Manifestations ◽

Imaging Features ◽

First Case ◽

Severe Group ◽

Laboratory Examinations ◽

The Difference ◽

Severity Of The Disease ◽

Novel Coronavirus

Abstract Background: In December 2019, the first case of pneumonia associated with the SARS-CoV-2 was found in Wuhan and rapidly spread throughout China, so data are needed on the affected patients. The purpose of our study was to find the clinical manifestations and CT features of COVID-19.Methods: All patients with COVID-19 in Taizhou city were retrospectively included and divided into non-severe group and severe group according to the severity of the disease. The clinical manifestations, laboratory examinations and imaging features of COVID-19 patients were analyzed, and the differences between the two groups were compared.Results: A total of 143 laboratory-confirmed cases were included in the study, including 110 non-severe patients and 33 severe patients. The median age of patients was 47 (range 4–86 years). Fever (73.4%) and cough (63.6%) were the most common initial clinical symptoms. Between two groups of cases, the results of aspartate transaminase, creatine kinase and lactate dehydrogenase, serum albumin, CR, glomerular filtration rate, amyloid protein A, fibrinogen, calcitonin level and oxygen partial pressure, IL – 10, absolute value of CD3, CD4, CD8 were different, and the difference was statistically significant (P < 0.05). Therefore, these quantitative indicators can be used to help assess the severity. On admission, the CT showed that the lesions were mostly distributed in the periphery of the lung or subpleural (135 cases (98%)), and most of lesions presented as patchy (81%), mixed density (63%) shadow. Consolidation (68% vs 41%), bronchial inflation signs (59% vs 41%), and bronchiectasis (71% vs 39%) were more common in the severe group.Conclusions: Most of the cases of COVID-19 in Taizhou have mild symptoms and no death. In addition to clinical symptoms, some laboratory tests (such as absolute values of CD4 and CD8) and CT findings can be used to assess the severity of the disease.

Download Full-text

Clinical manifestations and treatment outcomes of scrub typhus in a rural health care facility on the Thailand-Myanmar border

The Journal of Infection in Developing Countries ◽

10.3855/jidc.8912 ◽

2017 ◽

Vol 11 (05) ◽

pp. 407-413 ◽

Cited By ~ 2

Author(s):

Tobias Brummaier ◽

Chatporn Kittitrakul ◽

Vorada Choovichian ◽

Saranath Lawpoolsri ◽

Chayadol Namaik-larp ◽

...

Keyword(s):

Scrub Typhus ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Care Facility ◽

Health Care Facility ◽

Kidney Injury ◽

Rapid Test ◽

Common Symptom ◽

Positive Serology ◽

Adults And Children

Introduction: Scrub typhus is endemic in rural Southeast Asia. The district of Umphang in northwestern Thailand is a prototype environment for this disease. We report the clinical manifestations and outcomes of patients diagnosed with scrub typhus in this area. Methodology: Patients diagnosed with scrub typhus between 2011 and 2014 were analyzed. Diagnosis was based on clinical symptoms in conjunction with a positive rapid test or a pathognomonic eschar lesion. Results: A total of 857 patients were included, of which 488 were adults and 369 were children. Most patients (728; 84.9%) were included via a positive serology on rapid test, 86 patients (10.0%) had eschar only, and 43 patients (5.0%) had both sero-confirmation and presence of eschar. The most common symptom was fever (93.8%), followed by headache (48.1%) and cough (33.1%). Eschars were reported in 129 patients, with a significantly higher percentage in children (p < 0.001), and a different anatomical distribution was found when adults and children were compared. Common complications were elevated transaminases, acute kidney injury, and pneumonia. Most patients recovered from the disease. Conclusions: Scrub typhus in Umphang district is common. Patients can present with a variety of clinical symptoms, regardless of the presence of fever. Standard treatment led to a favorable outcome in most patients.

Download Full-text

Relationship Between Rhinitis, Asthma, and Eczema and the Presence of Sensitization in Young Swiss Adults

Allergy & Rhinology ◽

10.1177/2152656718773606 ◽

2018 ◽

Vol 9 ◽

pp. 215265671877360 ◽

Cited By ~ 1

Author(s):

Urs C. Steiner ◽

Lucas M. Bachmann ◽

Micheal B. Soyka ◽

Stephan Regenass ◽

Lukas Steinegger ◽

...

Keyword(s):

Clinical Symptoms ◽

Allergic Sensitization ◽

Clinical Signs ◽

Clinical Manifestations ◽

Rapid Test ◽

Signs And Symptoms ◽

Causative Factor ◽

Common Disease ◽

Common Symptom ◽

Perennial Rhinitis

Background Rhinitis is a very common disease with allergies being the most frequent causative factor. It can co-occur together with asthma and eczema in atopic as well as in nonatopic patients. Objectives To assess the prevalence of allergic sensitization within patient groups with rhinitis in consideration of the co-occurring disorders of asthma and eczema. Methods Students of the third year of medical school completed an anonymous questionnaire on age, gender, and clinical symptoms, such as seasonal rhinitis, perennial rhinitis, asthma, and eczema, and underwent an ImmunoCAP Rapid test. We calculated the prevalence of sensitization within subgroups of patients reporting allergic disorders, such as rhinitis, asthma, and eczema. Results Questionnaires and ImmunoCAP Rapid tests of 1513 medical students were analyzed. The participants’ self-reported presence of seasonal/perennial rhinitis, asthma, and eczema was compared to the presence of sensitization. Data of 1467 subjects could be analyzed. Seasonal rhinitis was the most common symptom, followed by eczema, asthma, and perennial rhinitis. The participants were differentiated into 16 subgroups according to the combined clinical manifestations of the different symptoms and association to sensitization within subgroups. The prevalence of sensitization ranged from 18% in subjects reporting only eczema without any other symptom to 100% in those reporting to have asthma, seasonal/perennial rhinitis, and eczema together. In subjects reporting no sign or symptom at all, the prevalence of sensitization was 19%. Seasonal rhinitis was the strongest single predictor for sensitization with the highest proportion of sensitized participants in all symptom combinations (67%–100%), followed by perennial rhinitis (31%–100%), asthma (30%–100%), and eczema (18%–100%). Conclusion Rhinitis most often is associated with allergen sensitization, and the probability of sensitization is substantially enhanced by co-occurrence of asthma. A careful assessment of clinical signs and symptoms is important and enables the selection of patients in whom targeted diagnostic analysis and therapy is appropriate. Trial registration: retrospectively registered by the Cantonal Ethics Committee Zurich on 22.01.2016; Nr: 08-2016.

Download Full-text

Pituitary dysfunction in patients with ANCA associated vasculitis: prevalence, presentation, and outcomes

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622320930636 ◽

2020 ◽

Vol 11 ◽

pp. 204062232093063

Author(s):

Chunjia Li ◽

Yu Zou ◽

Xin Lu ◽

Guochun Wang ◽

Xiaoming Shu

Keyword(s):

Immunosuppressive Therapy ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Antineutrophil Cytoplasmic Antibody ◽

Magnetic Resonance Images ◽

Initial Symptom ◽

Pituitary Fossa ◽

Pituitary Dysfunction ◽

Anca Associated Vasculitis ◽

Positron Emission

Background: The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are rare multisystem autoimmune diseases characterized by inflammatory cell infiltration causing necrosis of small blood vessels. Pituitary involvement in AAV is poorly described. This study aimed to describe the prevalence, clinical characteristics, and outcomes of pituitary involvement in patients with AAV. Methods: A total of 150 patients diagnosed with AAV and hospitalized in the China–Japan Friendship Hospital between 2009 and 2019 were enrolled in this retrospective study. Patients diagnosed with pituitary involvement in AAV were selected for inclusion. Results: Three patients (2%) were identified with pituitary involvement. Two patients had positive ANCA titers, one with proteinase 3 positive and one with myeloperoxidase positive antibodies. Pituitary dysfunction presented as an initial symptom in one patient and developed over the course of the diseases in the other two patients. All three patients had abnormal hormones. Among them, two patients had an enlarged pituitary, shown by magnetic resonance images (MRIs), and one patient had a normal sized pituitary, shown by MRI, but presented with increased linear radioactivity uptake in the pituitary fossa by positron emission tomography-computed tomography. All patients were treated with corticosteroid and immunosuppressive therapy. Both pituitary dysfunction and vasculitis were in remission. Conclusion: Pituitary involvement is uncommon in AAV and it can occur at any point during AAV. The main clinical manifestations are central diabetes insipidus and panhypopituitarism. Immunosuppressive therapy could significantly alleviate clinical symptoms as well as pituitary imaging.

Download Full-text

Neurosyphilis presenting with myelitis-Case series and literature review

10.21203/rs.2.1849/v1 ◽

2019 ◽

Author(s):

Yali Wu ◽

Wenqing Wu

Keyword(s):

Clinical Symptoms ◽

Treponema Pallidum ◽

Clinical Manifestations ◽

Case Series ◽

Transverse Myelitis ◽

Penicillin G ◽

Imaging Features ◽

Delayed Treatment ◽

Systemic Corticosteroids ◽

Magnetic Resonance Imaging Mri

Abstract Background Neurosyphilis is a great imitator because of its various clinical symptoms. Syphilitic myelitis is extremely rare manifestation of neurosyphilis and often misdiagnosed. However, a small amount of literature in the past described its clinical manifestations and imaging features, and there was no relevant data on the prognosis, especially the long-term prognosis. In this paper, 4 syphilis myelitis patients admitted to our hospital between July 2012 and July 2017 were retrospectively reviewed. In the 4 patients, 2 were females, and 2 were males. We present our experiences with syphilitic myelitis, discuss the characteristics, treatment and prognosis. Case presentation The diagnosis criteria were applied: (1) diagnosis of myelitis established by two experienced neurologist based on symptoms and longitudinally extensive transverse myelitis (LETM) at the cervical and thoracic levels mimicked neuromyelitis optic (NMO) on magnetic resonance imaging (MRI) ; (2) Neurosyphilis (NS) was diagnosed by positive treponema pallidum particle assay (TPPA) and toluidine red untreated serum test (TRUST) in the serum and CSF; (3) negative human immunodeficiency virus (HIV). Likewise, all patients were negative for serum anti-aquaporin 4 (AQP-4), as well as negative bacterial, fungal, virus, or mycobacterium tuberculosis in the CSF. Treatment included intravenous penicillin G, with 24 million units of penicillin G per day administered intravenously for 14 days, and three patients were also treated with systemic corticosteroids. Neurological examination, serologic syphilis diagnostic tests (TPPA, TRUST) and cerebrospinal fluid tests (TPPA, TRUST) were examined approximately every 12~24 weeks after treatment. The follow-up time ranged from 12 to 70 months, with an average of 36.6 months. The prognosis was well in 3 cases who received early anti-syphilis treatment, but 1 case who received delayed treatment due to misdiagnose had no improvement. Conclusions Neurosyphilis should be considered when there are long hyperintensity lesions in the MRI spinal cord. Prompt diagnosis and combined antibiotics-corticosteroid therapy may improve neurological prognosis.

Download Full-text

Altered Biological Rhythm and Alzheimer's Disease: A Bidirectional Relationship

Current Alzheimer Research ◽

10.2174/1567205018666211124104710 ◽

2021 ◽

Vol 18 ◽

Author(s):

Manli Wang ◽

Hang Yu ◽

Song Li ◽

Yang Xiang ◽

Weidong Le

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Biological Rhythms ◽

Biological Rhythm ◽

Common Symptom ◽

Research Focus ◽

Bidirectional Relationship ◽

Research Findings

: Biological rhythms have become the research focus in recent years. Biological rhythm disruption is a common symptom of Alzheimer's disease (AD) patients, which is usually consid- ered as the late consequence of AD. Recent studies have shown that biological rhythm disruption even occurs before the onset of clinical symptoms of AD. The causal relationship between AD and biological rhythm disruption is not clear. Delineating their relationship can help understand the dis- ease mechanisms and make the early diagnosis of AD possible. This review integrates the research on the abnormal changes of the biological rhythm-related parameters in the clinical manifestations of AD patients and the roles of the biological rhythm disorders in AD. We will discuss the links be- tween biological rhythms and AD, with the focus on the bidirectionality between biological rhythms and AD processes. Collectively, these updated research findings may provide the basis for further exploring the significance of rhythm in the diagnosis and treatment of AD.

Download Full-text

Prognosis and role of clinical and imaging features in patients with malignant pericardial effusion: a single-center study in China

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02331-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shucai Wang ◽

Jiazheng Zhao ◽

Chanchan Wang ◽

Ning Zhang

Keyword(s):

Pericardial Effusion ◽

Cardiac Tamponade ◽

Sinus Tachycardia ◽

Clinical Manifestations ◽

Common Symptom ◽

Cancer Type ◽

Imaging Features ◽

Factors Affecting ◽

Malignant Pericardial Effusion ◽

Echocardiographic Evidence

Abstract Background The diagnosis of malignant pericardial effusion (MPE) is often associated with a poor prognosis, but due to the complexity and unspecific nature of MPE patients' clinical manifestations, imaging often performs an essential role in diagnosis and prognosis. Methods Patients diagnosed with MPE between 2013 and 2018 at one tumor hospital were included and followed up. The data covered the basic clinical features, imaging findings, treatments and prognosis of patients with MPE, and the factors that may have affected the prognosis were explored. Results A total of 216 patients with MPE were included with the median age of 60 years. The most common primary cancer type was lung cancer (73.6%), the most common symptom was dyspnea (62.9%) and the most common abnormal electrocardiogram finding was sinus tachycardia (42.1%). The median survival time of the 216 patients with MPE was 13.7 months. The factors affecting prognosis were echocardiographic fluid signs (HR = 2.37, P = 0.010), electrocardiographic evidence of sinus tachycardia (HR = 1.76, P = 0.006) and echocardiographic evidence of cardiac tamponade (HR = 3.33, P < 0.001). Conclusions MPE has complex clinical manifestations and an unsatisfactory prognosis. Echocardiographic fluid signs, electrocardiographic evidence of sinus tachycardia, and echocardiographic evidence of cardiac tamponade are independent risk factors affecting prognosis.

Download Full-text

Clinical Character of CASPR2 Autoimmune Encephalitis: A Multiple Center Retrospective Study

Frontiers in Immunology ◽

10.3389/fimmu.2021.652864 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xiaoxiao Qin ◽

Huajun Yang ◽

Fei Zhu ◽

Qun Wang ◽

Wei Shan

Keyword(s):

Limbic Encephalitis ◽

Clinical Manifestations ◽

Autoimmune Encephalitis ◽

Common Symptom ◽

Course Of Disease ◽

Imaging Results ◽

Pet Ct ◽

Magnetic Resonance Imaging Mri ◽

Long Term Prognosis ◽

Cognitive Disturbance

ObjectiveTo examine the clinical characteristics of autoimmune encephalitis associated with the contactin-associated protein-2 (CASPR2) antibody.Materials and MethodsMedical records of all patients diagnosed with CASPR2 antibody-associated encephalitis were retrospectively analysed. Data regarding demographic features, neurological symptoms and signs, laboratory tests, imaging results, treatments, and prognosis were collected.ResultsA total of 25 patients aged from 3 to 79 years old were enrolled in this study, with a median age of 43. Eight of 25 (32%) were female, and 17 of 25 (68%) were male. The median age of symptom onset was 42 years old with the course of disease from onset to hospital admission ranging from 2 days to 6 months (median was 17 days). Six patients (6/25) had fever as an onset symptom. During the course of disease, cognitive disturbance was the most common symptom, which was observed in 17 patients (17/25) in total. Eight patients (8/25) met the criteria for limbic encephalitis. Epileptic seizure occurred in six of these eight patients. Four patients (4/25) were diagnosed as Morvan syndrome. All patients were positive for anti-CASPR2 antibody in the serum (1:10–1:300). In six patients, antibodies were detected both in the blood and CSF (1:32–1:100). White blood cell (WBC) counts in the CSF were elevated in eight patients (8/25). The concentration of proteins in CSF increased in 10 patients (ranging from 480 to 1,337.6 mg/dl), decreased in seven patients (ranging from 23.2 to 130.5 mg/dl) and remained at a normal range in the other eight patients (ranging from 150 to 450 mg/dl). Abnormal electroencephalogram (EEG) activities included slow background activity and epileptic patterns. Abnormal signals in the bilateral hippocampus were detected by magnetic resonance imaging (MRI) in three patients presenting cognitive disturbance. In one patient who had limbic encephalitis, increased metabolism of bilateral basal ganglia and the mesial temporal lobe was revealed by PET-CT. Eleven of 15 patients receiving immunotherapy experienced varying degrees of improvement. Relapse occurred in four of 25 patients (4/25) after 2 months.ConclusionCASPR-antibody-mediated autoimmune encephalitis is characterized by diverse clinical manifestations. The most prominent conclusion revealed by this retrospective analysis is the involvement of both central and peripheral nerve systems, as well as a lower relapse rate, a good response to immunotherapy, and favorable short-term prognosis after treatment was also demonstrated. Besides, additional work is necessary to evaluate the long-term prognosis.

Download Full-text

The Interaction of Insulin and Pituitary Hormone Syndromes

Frontiers in Endocrinology ◽

10.3389/fendo.2021.626427 ◽

2021 ◽

Vol 12 ◽

Author(s):

Marie Helene Schernthaner-Reiter ◽

Peter Wolf ◽

Greisa Vila ◽

Anton Luger

Keyword(s):

Diabetes Mellitus ◽

Growth Hormone ◽

Glucose Metabolism ◽

Glucose Homeostasis ◽

Indirect Effects ◽

Gh Deficiency ◽

Fasting Glucose ◽

Pituitary Hormone ◽

Pituitary Dysfunction ◽

And Function

Pituitary hormone axes modulate glucose metabolism and exert direct or indirect effects on insulin secretion and function. Cortisol and growth hormone are potent insulin-antagonistic hormones. Therefore impaired glucose tolerance, elevated fasting glucose concentrations and diabetes mellitus are frequent in Cushing’s disease and acromegaly. Also prolactinomas, growth hormone (GH) deficiency, hypogonadism and hypothyroidism might be associated with impaired glucose homeostasis but usually to a lesser extent. Therefore glucose metabolism needs to be closely monitored and treated in patients with pituitary adenomas. Correction of the pituitary dysfunction is frequently followed by improvement of glucose homeostasis.

Download Full-text

Clinical Characteristics and CT Manifestations of 143 Patients With 2019 Novel Coronavirus Disease (COVID-19) in Taizhou City, Zhejiang, China

10.21203/rs.3.rs-23614/v1 ◽

2020 ◽

Author(s):

Yani Kuang ◽

Susu He ◽

Shuangxiang Lin ◽

Rui Zhu ◽

Rongzhen Zhou ◽

...

Keyword(s):

Clinical Symptoms ◽

Protein A ◽

Clinical Manifestations ◽

Imaging Features ◽

First Case ◽

Severe Group ◽

Laboratory Examinations ◽

The Difference ◽

Severity Of The Disease ◽

Novel Coronavirus

Abstract Background In December 2019, the first case of pneumonia associated with the SARS-CoV-2 was found in Wuhan and rapidly spread throughout China, so data are needed on the affected patients. The purpose of our study was to find the clinical manifestations and CT features of COVID-19.Methods All patients with COVID-19 in Taizhou city were retrospectively included and divided into non-severe group and severe group according to the severity of the disease. The clinical manifestations, laboratory examinations and imaging features of COVID-19 patients were analyzed, and the differences between the two groups were compared.Results A total of 143 laboratory-confirmed cases were included in the study, including 110 non-severe patients and 33 severe patients. The median age of patients was 47 (range 4–86 years). Fever (73.4%) and cough (63.6%) were the most common initial clinical symptoms. Between two groups of cases, the results of aspartate transaminase, creatine kinase and lactate dehydrogenase, serum albumin, CPR, glomerular filtration rate, amyloid protein A, fibrinogen, calcitonin level and oxygen partial pressure, red protein, IL – 10, absolute value of CD3, CD4, CD8 were different, and the difference was statistically significant (P < 0.05). On admission, the CT showed that the lesions were mostly distributed in the external lung or under the pleura (135 cases (98%)), and most of lesions presented as patchy (81%), heterogeneous (73%) and mixed density (63%) shadow. Consolidation (68% vs 41%), bronchial inflation signs (59% vs 41%), and bronchiectasis (71% vs 39%) were more common in the severe group.Conclusions Most of the cases of COVID-19 in Taizhou have mild symptoms and no death. In addition to clinical symptoms, some laboratory tests (such as absolute values of CD4 and CD8) and CT findings can be used to assess the severity of the disease.

Download Full-text