Patterns of pituitary adenoma among adult Sudanese patients

The objective of this study is to determine the clinical presentation and hormonal secretions of patients with pituitary adenomas. This is a descriptive, prospective study on 53 adult Sudanese patients with pituitary adenoma. Only adults [16 years or more] were included. The study was conducted in Al-Shaab Teaching Hospital in the period from January 2001 to February 2007. Twenty eight [52.8%] patients were females and 25 [47.2%] were males. Their ages ranged between 16 -80 years [mean 40.8 +/- 15.6 years]. Twenty seven [50.9%] patients had functioning pituitary adenomas [FPA] and 26 [49.1%] patients had nonfunctioning pituitary adenomas [NFPA]. Hormonal secretion of the adenomas was found to be prolactin in 16 patients [14 females and 2 males], growth hormone in 8 patients [3 females and 5 males], ACTH in 2 patients [one female and one male] and TSH in one female. Macroadenoma was found in 44 patients [83%], while microadenoma was found in 9 patients. All non functioning adenomas were found to be macroadenomas, while functioning adenomas were found in 18 patients with macroadenoma and in 9 patients with microadenoma. In our series all NFPAS were macroadenomas. They were usually discovered late after assuming mass effect or incidentally on imaging for other reasons. Patients with functioning adenomas tend to present earlier with hormonal dysfunction and hence are diagnosed earlier before the tumors assume big sizes. Prolactin secreting tumors are the commonest among functioning pituitary adenomas and tend to predominate in females

Wilson's disease with extensive white and gray matter MRI abnormalities: a case report

Wilson disease is an autosomal recessive disease, characterized by excessive accumulation of copper in the body, particularly in the liver, brain, cornea and kidney, with variable clinical manifestations. The outcome of treatment depends on early diagnosis of the disease before major irreversible tissue destruction occurs. Early diagnosis might be difficult because of its diverse clinical manifestations. We herein report on a patient with severe clinical and imaging manifestations. The patient showed cerebral atrophy and extensive abnormalities in frontal lobes, the putamen, the thalami, cerebral peduncles and posterior aspects of the occipital lobes. Such wide spread changes involving the white matter as well as the gray matter is rarely reported

Intracranial meningioma: findings from Sudan

The objective of this article is to determine the pattern of neurological presentation of meningiomain adult Sudanese patients. In this study we described the clinical presentation and neuroimaging findings in fifty patients with Intracranial meningioma. In all patients the diagnosis was histologically verified. The age distribution of the patients ranged between 19 -70 years, the mean age was 44.5 +/- 13.33 years. Females were 36 [72%] and males 14 [28%]. Male: female ratio was 1:2.6. The presenting symptoms were headache and nausea in 37 [74%] patients, behavioral changes in 34 [68%], visual disturbance in 23 [46%], generalized seizure in 20 [40%], limb weakness in 20 [40%], vomiting in 13 [26%], speech disturbance in 13 [26%], sphincteric disturbances in 11 [22%], focal seizures in 10 [20%], anosmia in 4 [8%], and deafness in 2 [4%]. Meningiomas were located in anterior fossa in 18 patients [40%], parasagittal in 9 [20%], sphenoidal ridge in 8 [18%], posterior fossa in 7 [15.9%], lateral convexity in 5 [11.3%], olfactory groove in 4 [9%], middle fossa in 2 [4.5%] and supraseller area in one [2.2%]. All meningiomas enhanced with gadolinium. Peritumoural oedema was found in 24 [54.5%] patients, hydrocephalus in 11 [25%] and hyperostosis in 9 [20.5%] patients. It has been concluded that the clinical presentation and MRI findings did not differ much from what is reported worldwide

Ataxia telangiectasia: findings from two families in the Sudan

We report herein two families with ataxia telangiectasia. Patients in both families fulfilled the diagnostic criteria and showed unusual presentations that are rarely reported in literature. No patient developed malignancy yet. To the best of our knowledge this is the first report on Ataxia telangiectasia from Sudan

Pott's disease of the spine: findings from Sudan

Spinal tuberculosis is the commonest type of skeletal tuberculosis. It has variable presentations, but commonly presents with backache and weakness of lower limbs. Its prevalence is increasing world wide after the epidemic of HIV. To the best of our knowledge there are no studies addressing the clinical presentation of this disease in Sudan. In this study we included 84 patients with spinal tuberculosis. The study was conducted in two major hospitals in Khartoum in the period from January 2002 to December 2006. Results show males constituted 46 patients [54.8%] and females 38 [45.2%]. Their ages ranged between 16 years and 80 years, the mean age was 44.46 +/- SD 16.99. All patients had pain and or tenderness at the site of the lesion. Paraplegia or paraparesis was reported in 36 patients [42.8%], quadriplegia or quadriparesis in 25 [30%], Sciatica and root weakness in 22 [26.1%] and right brachial monoplegia in one patient. Evidence of active pulmonary tuberculosis was found in 15 patients [17.8%], abdominal tuberculosis in 7 patients [8.3%], lymphatic Tuberculosis in 1 patient [1.2%]. Cervical vertebrae were affected in a total of 26 patients [30.9%], the dorsal in 39 patients [46.4%] and the lumbar in 30 patients [35.7%]. One vertebra was affected in 3 patients [2.57%], 2 adjacent vertebrae in 48 patients [57.14%], 3 vertebrae in 24 patients [28.57%], 4 vertebrae in 4 patients [4.76%], 5 vertebrae in 1 patient [1.19%] and 6 vertebrae in 4 patients [4.76%]. HIV test was negative in all patients. Tuberculin test was positive in 80 patients [95%] and negative in 4 patients [5%]

Osteopetrosis: a rare disease with rare presentations

At least eight types of osteopetrosis have been described in humans. The primary underlying mechanism involved in all forms is the failure of normal osteoclastic bone resorption. Osteopetrosis tarda, the benign adult form, is inherited as an autosomal dominant trait. Patients typically are asymptomatic and have good long-term survival rates because bone marrow failure rarely occurs. A more common and malignant form, osteopetrosis congenita, presents in infancy and results in bone marrow failure caused by complete replacement of the marrow spaces with osteoclasts. Other forms are rare and have variable manifestations. In this communication we report 2 cases on possibly a rare form of osteopetrosis, the intermediate form