Pituitary Metastasis of Pancreatic Origin in a Dog Presenting with Acute-Onset Blindness

2013 ◽  
Vol 49 (6) ◽  
pp. 403-406 ◽  
Author(s):  
Rodrigo Gutierrez-Quintana ◽  
Inés Carrera ◽  
Melanie Dobromylskyj ◽  
Janet Patterson-Kane ◽  
Maria Ortega ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Optic Chiasm ◽  
Acute Onset ◽  
Mri Findings ◽  
Pituitary Mass ◽  
Pituitary Metastases ◽  
History Of ◽  
Pancreatic Origin ◽  
Single Lesion ◽  
Pituitary Metastasis

Pituitary metastases have rarely been recorded in dogs, and to date, none of those reported have been of pancreatic origin. MRI findings are available for only one of those cases. Herein the authors present an 11 yr old English springer spaniel diagnosed with pituitary metastasis of pancreatic origin with a 24 hr history of blindness and only a single lesion on MRI. Neurologic and ophthalmologic examinations localized the lesion to the optic nerves, optic tracts, or optic chiasm. MRI showed a single lesion characterized by a well-circumscribed pituitary mass with extrasellar extension, causing compression of the optic chiasm. Signal intensity was unusual as enhancement could not be appreciated after contrast administration. The dog was euthanized without further diagnostic tests. Histopathologic examination revealed a poorly differentiated exocrine pancreatic carcinoma with widespread metastasis involving the pituitary gland. To the authors’ knowledge, this is the first such case reported in a dog. Pituitary metastases should be included as a differential diagnosis for dogs presenting with acute-onset blindness and for single brain masses affecting the pituitary gland.

scholarly journals SAT-243 Lymphocytic Hypophysitis Mimicking Pituitary Apoplexy in a 27-Year-Old Woman

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Danielle C Brooks ◽  
Richard S Haber
Keyword(s):  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Lymphocytic Hypophysitis ◽  
Surgical Pathology ◽  
Bright Spot ◽  
Inflammatory Disorder ◽  
Pituitary Mass ◽  
Ct Angiogram ◽  
Wide Range

Abstract Introduction: Lymphocytic hypophysitis is an uncommon inflammatory disorder of the pituitary gland. Peripartum women are most often affected, but it can be seen in a wide range of patients. Patients can present with pituitary dysfunction or mass effect symptoms, making it difficult to differentiate from a pituitary adenoma. Pituitary apoplexy is an acute syndrome due to hemorrhage into the pituitary gland causing headache, visual deficits, and hypoadrenalism. We present a case of a woman with a pituitary mass presenting with symptoms mimicking pituitary apoplexy, in whom surgical pathology later revealed lymphocytic hypophysitis without evidence of hemorrhage. Clinical Case: A 27-year-old non-pregnant female presented with severe headaches, nausea, vomiting, and diplopia for four days. A presumed pituitary macroadenoma was diagnosed two years previously during a workup for irregular menses. An emergency evaluation with a CT angiogram of the head showed enhancement at the superior aspect of and surrounding the pituitary gland. MRI of the pituitary revealed an enhancing 17 x 17 mm sellar and suprasellar mass compressing the optic chiasm, without evidence of the normal pituitary posterior bright spot. Visual field testing was normal. She was referred for transsphenoidal resection of the pituitary mass due to persistent headaches, optic chiasm impingement, and suspicion of pituitary apoplexy. Intraoperatively, there was no evidence of hemorrhage. Central diabetes insipidus and hypothyroidism developed in the post-operative period. She was discharged on hydrocortisone replacement therapy (20 mg in the morning, 10 mg in the afternoon). An outpatient random cortisol level of 1.2 mcg/dL (reference: 6.7 - 22.6 mcg/dL) while off hydrocortisone for twenty-four hours confirmed hypocortisolism. Surgical pathology showed moderate lymphocytic infiltrate and focal germinal centers in the adenohypophysis consistent with lymphocytic hypophysitis. Conclusion: Although lymphocytic hypophysitis is well-described in the literature, its association with symptoms suggesting pituitary apoplexy has been reported only rarely. This atypical case shows that lymphocytic hypophysitis can present with acute symptoms mimicking pituitary apoplexy. The case highlights the difficulties in recognizing lymphocytic hypophysitis prior to surgery and emphasizes the need to consider the diagnosis in patients presenting with pituitary masses and/or symptoms of pituitary apoplexy.

scholarly journals Pituitary metastasis unveiling a lung adenocarcinoma

2021 ◽  
Vol 2021 ◽  
Author(s):  
Ana M Lopes ◽  
Josué Pereira ◽  
Isabel Ribeiro ◽  
Ana Martins da Silva ◽  
Henrique Queiroga ◽  
...  
Keyword(s):  
Lung Adenocarcinoma ◽  
Pituitary Gland ◽  
Metastatic Disease ◽  
Initial Presentation ◽  
Rapid Progression ◽  
List Type ◽  
History Of ◽  
Metastatic Involvement ◽  
Pituitary Lesion ◽  
Pituitary Metastasis

Summary Pituitary metastasis (PM) can be the initial presentation of an otherwise unknown malignancy. As PM has no clinical or radiological pathognomonic features, diagnosis is challenging. The authors describe the case of a symptomatic PM that revealed a primary lung adenocarcinoma. A 62-year-old woman with multiple sclerosis and no history of malignancy, incidentally presented with a diffusely enlarged and homogeneously enhancing pituitary gland associated with stalk enlargement. Clinical and biochemical evaluation revealed anterior hypopituitarism and diabetes insipidus. Hypophysitis was considered the most likely diagnosis. However, rapid visual deterioration and pituitary growth raised the suspicion of metastatic involvement. A search for systemic malignancy was performed, and CT revealed a lung mass, which proved to be a lung adenocarcinoma. Accordingly, the patient was started on immunotherapy. Resection of the pituitary lesion was performed, and histopathology analysis revealed metastatic lung adenocarcinoma. Following surgery, the patient underwent radiotherapy. More than 2 years after PM detection, the patient shows a clinically relevant response to antineoplastic therapy and no evidence of PM recurrence. Learning points Although rare, metastatic involvement of the pituitary gland has been reported with increasing frequency during the last decades. Pituitary metastasis can be the initial presentation of an otherwise unknown malignancy and should be considered in the differential diagnosis of pituitary lesions, irrespective of a history of malignancy. The sudden onset and rapid progression of visual or endocrine dysfunction from a pituitary lesion should strongly raise the suspicion of metastatic disease. MRI features of pituitary metastasis can overlap with those of other pituitary lesions, including hypophysitis; however, rapid pituitary growth is highly suggestive of metastatic disease. Survival after pituitary metastasis detection has improved over time, encouraging individualized interventions directed to metastasis to improve quality of life and increase survival.

Pituitary metastases of Hürthle cell carcinoma of the thyroid

2021 ◽  
Vol 14 (1) ◽  
pp. e239456
Author(s):  
Nosakhare Paul Ilerhunmwuwa ◽  
Robert Goldspring ◽  
Simon Page ◽  
Ravikanth Gouni
Keyword(s):  
Cell Carcinoma ◽  
Radioiodine Therapy ◽  
Follicular Thyroid Carcinoma ◽  
External Beam Radiotherapy ◽  
Optic Chiasm ◽  
Pituitary Mass ◽  
Hürthle Cell ◽  
Hürthle Cell Carcinoma ◽  
Hurthle Cell Carcinoma ◽  
History Of

An 85-year-old man was referred to endocrinology following the discovery of an incidental pituitary mass on cranial imaging which was thought to be a non-functioning adenoma during an admission with headaches, lethargy, confusion and hyponatraemia. He had a history of Hürthle cell carcinoma of the thyroid treated with total thyroidectomy, ablative radioiodine therapy and thyroxine replacement. Subsequently, he developed metastatic spread to the neck, lungs and skeleton. About 9 months later, the patient had deterioration of vision. MRI showed a rapidly expanding pituitary mass with compression of the optic chiasm. Biochemical investigations confirmed hypocortisolism and hypogonadism. The patient underwent trans-sphenoidal resection of the pituitary mass followed by external beam radiotherapy to the pituitary bed. Histopathology confirmed a metastatic deposit of Hürthle cell carcinoma, which is a rare and aggressive variant of follicular thyroid carcinoma.

scholarly journals Posterior circulation stroke presenting as a new continuous cough: not always COVID-19

2021 ◽  
Vol 14 (1) ◽  
pp. e240270
Author(s):  
Mazhar Warraich ◽  
Paul Bolaji ◽  
Saugata Das
Keyword(s):  
Lower Lobe ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Posterior Circulation ◽  
Mri Findings ◽  
Silent Aspiration ◽  
Lateral Medullary Infarction ◽  
Posterior Circulation Stroke ◽  
History Of ◽  
Medullary Infarction

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.

scholarly journals SUN-290 Pituitary Hyperplasia Due to Uncontrolled Primary Hypothyroidism: Case Series and Literature Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Pablo Godoy Alonso ◽  
Germán González de la Cruz ◽  
Marlon Vladimir Vázquez-Aguirre ◽  
Andrea Rocha Haro ◽  
Karla Krystel Ordaz Candelario ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Feedback Inhibition ◽  
Case Series ◽  
Optic Chiasm ◽  
Primary Hypothyroidism ◽  
Autoimmune Hypothyroidism ◽  
Hormonal Replacement ◽  
Pituitary Hyperplasia ◽  
History Of

Abstract Background: Pituitary hyperplasia secondary to primary hypothyroidism results from the loss of thyroxine feedback inhibition and the subsequent overproduction of TSH. Case 1: A 18-year-old female presented with a chronic history of spontaneous galactorrhea, headache and malaise. Autoimmune primary hypothyroidism was diagnosed, with elevated TSH of 490 mIU/L (0.3-5) and low fT4 of 0.33 ng/dL (0.63-1.34). Pituitary MRI showed an enlarged pituitary with compression of the optic chiasm. Hormonal replacement with levothyroxine 75 mcg qd was started. Five months later she was asymptomatic, and normal TSH (1.64 mIU/L) and fT4 (0.9 ng/dL) levels. A new MRI revealed normal size of pituitary gland, with no compression of the optic chiasm and an intact infundibulum. Case 2: A 24-year-old female with type 1 diabetes and autoimmune primary hypothyroidism, presented with a five-year history of galactorrhea and oligomenorrhea. She was treated with insulin glargine 20U qd, and levothyroxine 200 mcg/day. However, patient’s adherence was bad. She consulted a primary health physician who suspected a prolactinoma after high prolactin levels (77.65, normal 2.64-13.13 ng/mL). Cabergoline was started without any clinical improvement. She then was referred to our service for follow-up. TSH results showed 500 mIU/L, with low fT4 (0.08 ng/dL). Prolactin levels was normal. Pituitary MRI revealed diffuse enlargement of the gland, with compression of infundibulum and optic chiasm. Treatment was modified to levothyroxine/liothyronine 100/20mcg 1 ½ tablet qd. After 7 months, we confirmed normal TSH (0.76 mIU/L) and fT4 (1.23 ng/dL), and the patient was asymptomatic. After 17 months, new MRI showed normal pituitary gland without any compression. Case 3: A 23-year-old female with a history of Addison′s disease and hypothyroidism diagnosed at age 17 presented with a 6-month history of somnolence, fatigue, headache and amenorrhea. She was previously treated with hydrocortisone 25mg/day, fludrocortisone 0.1mg/day, and levothyroxine 200mcg/day. Patient’s adherence was bad, and multiple hospitalizations because of adrenal crises were reported. Her initial hormonal evaluation revealed high TSH of 460 mIU/L and low fT4 of 0.25 ng/dL, mild hyperprolactinemia (32.16 ng/mL), and very high ACTH levels (2,700 pg/mL, normal 10-100). Pituitary MRI revealed an enlarged pituitary with mild compression of the optic chiasm. Hormonal replacement was modified to fasting levothyroxine alternating 200mcg and 300mcg qd. Her last follow-up showed normal TSH (0.53 mIU/L) and fT4 (1.18 ng/dL) levels. New MRI showed normal pituitary size Conclusion: We presented three young women, with autoimmune hypothyroidism, who developed pituitary hyperplasia and responded to proper hormonal replacement normalizing pituitary size. Reference: Endocrinol Diabetes Metab Case Rep. 2015; 2015: 150056.

scholarly journals Endometrial adenocarcinoma metastatic to the pituitary gland: a case report and literature review

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092451
Author(s):  
Hongquan Du ◽  
Aihua Jia ◽  
Yuan Ren ◽  
Mingyong Gu ◽  
Haomin Li ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Diabetes Insipidus ◽  
Oral Fluid ◽  
Fluid Intake ◽  
Endometrial Adenocarcinoma ◽  
Posterior Lobe ◽  
Laboratory Findings ◽  
Pituitary Metastases ◽  
Pituitary Metastasis

Pituitary metastases are rare, and metastatic pituitary lesions originating from endometrial adenocarcinoma are extremely rare. These lesions can be mistaken for pituitary adenomas and their diagnosis can be very difficult. Pituitary metastases mostly affect the posterior lobe and patients may develop diabetes insipidus. Patients with endometrial cancer complicated with diabetes, including poor glycemic control, may also suffer from thirst, making it more difficult to diagnose diabetes insipidus. A 68-year-old woman who was being followed-up for primary endometrial adenocarcinoma was admitted for gradually worsened polyuria and polydipsia. Her laboratory findings were compatible with diabetes insipidus. Magnetic resonance imaging revealed thickening of the pituitary stalk, involvement of the superior pituitary gland, and disappearance of hyperintensity in the posterior lobe, indicating pituitary metastasis. Increased urine output and oral fluid intake in a patient with a diagnosis of carcinoma may indicate possible pituitary metastasis, and the hormonal insufficiency should be corrected to improve the patient’s quality of life.

Clinical, MRI and histopathological findings in a dog with distemper meningomyelitis

2020 ◽  
Vol 8 (3) ◽  
pp. e001173
Author(s):  
Alessandra Destri ◽  
Lluís Sánchez ◽  
Jennifer Stewart ◽  
Ruth Dennis
Keyword(s):  
Spinal Cord ◽  
Clinical Signs ◽  
Acute Onset ◽  
Mri Findings ◽  
German Shepherd ◽  
German Shepherd Dog ◽  
History Of ◽  
The Right ◽  
Clinical Mri ◽  
Severe Fever

A 14-month-old female entire German Shepherd dog presented with a five-day history of acute onset, progressive, non-ambulatory paraparesis, with lateralisation to the right. The neurolocalisation was to the L4-S1 spinal cord segments. MRI of the thoracic, lumbar and sacral spinal cord revealed multifocal, ill-defined, T2-weighted hyperintense, intramedullary lesions, which were moderately contrast-enhancing, becoming more defined and ovoid to nodular after injection of gadolinium-containing contrast medium. The lesions affected both white and grey matter and were lateralised mainly to the right side. PCR tests on blood and cerebrospinal fluid were positive for canine distemper virus (CDV). Despite intensive treatment, the dog developed myoclonus and severe fever and was humanely euthanased. Postmortem examination confirmed the presence of spinal cord lesions consistent with CDV. Distemper rarely presents with clinical signs of myelopathy exclusively and there is a scarcity of description of MRI findings of distemper meningomyelitis in the literature.

scholarly journals Acquired Monocular Nystagmus as the Initial Presenting Sign of a Chiasmal Glioma

2010 ◽  
Vol 37 (1) ◽  
pp. 96-97 ◽  
Author(s):  
Francois Dominique Jacob ◽  
Vijay Ramaswamy ◽  
Helly R. Goez
Keyword(s):  
Neurofibromatosis Type ◽  
Optic Chiasm ◽  
Acute Onset ◽  
World Health ◽  
Deficiency Anemia ◽  
Low Grade ◽  
Pituitary Fossa ◽  
Who Grade ◽  
History Of ◽  
Funduscopic Examination

A 15-month-old male presented with a one-day history of acute onset, continuous oscillating movement of his right eye. He had received his one-year immunizations four days prior and had a four-day history of a febrile viral respiratory tract infection. Pregnancy was unremarkable. He had severe iron deficiency anemia (MCV 66, Hb 65) and was developmentally delayed, as he was unable to stand independently and was non-verbal. His head circumference was 49 cm (95th percentile) and his weight was at the 25th percentile. On physical examination, continuous horizontal large amplitude pendular nystagmus of the right eye at a frequency of 3-4 Hz was observed. No nystagmus was observed in the left eye, even on funduscopic examination. The child could fixate targets in all four quadrants with both eyes independently, and could fixate and track small objects with both eyes independently suggesting no significant visual field defect or visual loss. Dilated funduscopic examination was normal, extra ocular movements were full, pupils were equal and reactive and there was no relative afferent pupillary defect. The remainder of the neurological examination was normal. There was no head bobbing or anomalous head position and no stigmata of neurofibromatosis type 1. Magnetic resonance imaging of the brain (Figure) demonstrated a 2 cm x 1.6 cm x 1.2 cm suprasellar enhancing mass involving the optic chiasm, hypothalamus, mamillary bodies and superior pituitary stalk. There was no extension into the pituitary fossa or the optic nerves and no ventricular enlargement. A biopsy of the mass was obtained and revealed histology consistent with a low-grade pilocystic astrocytoma (World Health Organization (WHO) grade 1), consistent with a diagnosis of chiasmal glioma.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

2019 ◽  
Vol 15 (9) ◽  
pp. 906-910
Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Stable Condition ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cutis Verticis Gyrata ◽  
Essential Form ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

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