Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Diabetes Insípida/etiología , Apoplejia Hipofisaria/complicaciones , Apoplejia Hipofisaria/terapia , Adenoma/complicaciones , Adenoma/diagnóstico , Diabetes Insípida/terapia , Cefalea/etiología , Hidrocortisona/sangre , Hipertensión/complicaciones , Hipófisis/fisiología , Neoplasias Hipofisarias/complicacionesRESUMEN
We report a case of pituitary apoplexy resulting in right internal carotid artery occlusion accompanied by hemiplegia and lethargy. A 43-yr-old man presented with a sudden onset of severe headache, visual disturbance and left hemiplegia. Investigations revealed a nodular mass, located in the sella and suprasellar portion and accompanied by compression of the optic chiasm. The mass compressed the bilateral cavernous sinuses, resulting in the obliteration of the cavernous portion of the right internal carotid artery. A border zone infarct in the right fronto-parietal region was found. Transsphenoidal tumor decompression following conservative therapy with fluid replacement and steroids was performed. Pathological examination revealed an almost completely infarcted pituitary adenoma. The patient's vision improved immediately after the decompression, and the motor weakness improved to grade IV+ within six months after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. However, clinicians should be aware of the possibility and the appropriate management of such an occurrence.
Asunto(s)
Adulto , Humanos , Masculino , Enfermedades de las Arterias Carótidas/diagnóstico , Arteria Carótida Interna/patología , Diagnóstico Diferencial , Embolización Terapéutica , Angiografía por Resonancia Magnética , Apoplejia Hipofisaria/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
A 41-yr-old man was admitted with acute headache, neck stiffness, and febrile sensation. Cerebrospinal fluid examination showed pleocytosis, an increased protein level and, a decreased glucose concentration. No organisms were observed on a culture study. An imaging study revealed pituitary macroadenoma with hemorrhage. On the 7th day of the attack, confusion, dysarthria, and right-sided facial paralysis and hemiparesis were noted. Cerebral infarction on the left basal ganglia was confirmed. Neurologic deficits gradually improved after removal of the tumor by endoscopic transnasal transsphenoidal approach. It is likely that the pituitary apoplexy, aseptic chemical meningitis, and cerebral infarction are associated with each other. This rare case can serve as a prime example to clarify the chemical characteristics of pituitary apoplexy.
Asunto(s)
Adulto , Humanos , Masculino , Adenoma/complicaciones , Infarto Cerebral/etiología , Imagen por Resonancia Magnética , Meningitis/etiología , Apoplejia Hipofisaria/complicaciones , Neoplasias Hipofisarias/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Pituitary tumours are the most common sellar masses, frequently presenting with visual impairment and endocrine abnormalities. Two cases of pituitary tumour presenting with ptosis are reported
Los tumores pituitarios son las masas selares más comunes, que frecuentemente se presentan con problemas de visión y anormalidades endocrinas. Se presentan dos casos de tumor de la pituitaria, acompañados de ptosis izquierda
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Adenoma/complicaciones , Apoplejia Hipofisaria/complicaciones , Blefaroptosis/etiología , Neoplasias Hipofisarias/complicaciones , Adenoma/diagnóstico , Imagen por Resonancia Magnética , Neoplasias Hipofisarias/diagnósticoRESUMEN
A patient with pituitary apoplexy is reported who, in addition to the clinical features of apoplexy, developed a cerebral infarct secondary to compression of the internal carotid artery. The mechanisms of a cerebral infarct associated with pituitary apoplexy are discussed.
Asunto(s)
Adenoma/complicaciones , Adulto , Arteria Carótida Interna/fisiopatología , Infarto Cerebral/etiología , Constricción Patológica , Resultado Fatal , Humanos , Masculino , Necrosis , Apoplejia Hipofisaria/complicaciones , Neoplasias Hipofisarias/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing disease. In the few cases reported in the literature, they have been found in long term hypercortisolism. We communicate a 43 yr old woman with a 4 year evolution Cushing syndrome, who developed sudden cephalea and oftalmoplejia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma with intracapsular hemorrhage and suprasellar expansion. In the functional tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and 8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol levels were lower than those observed in Cushing syndrome of similar magnitude. The tumor was resected by transphenoidal surgery and immunohistochemistry to ACTH was positive. In this case, the laboratory results suggest a partial remission of the hypercortisolism after pituitary apoplexy
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias Hipofisarias/complicaciones , Apoplejia Hipofisaria/complicaciones , Síndrome de Cushing/etiología , Dexametasona , Nifedipino/uso terapéutico , Desamino Arginina Vasopresina , Hiperfunción de las Glándulas Suprarrenales , Oftalmoplejía/etiología , Síndrome de Cushing/diagnóstico , Pruebas de Función HipofisariaRESUMEN
Nove pacientes operados portadores de macroadenomas hipofisários que apresentaram hemorragia intratumoral foram revisados. O diagnóstico baseou-se nos sinais e sintomas clínicos, tomografia computadorizada (TC), ressonância nuclear magnética (RNM) e estudo histológico. Todos os tumores apresentavam expansäo supra-selar. Cinco pacientes tiveram sintomas agudos como cefaléia, vômitos, meningismo, diplopia e déficit da acuidade e do campo visual, enquanto 4 tiveram hemorragia "assintomática". Os pacientes foram operados pela via transesfenoidal e, à cirurgia, 6 apresentavam coleçäo sangüínea e 3, enfarte hemorrágico. O tempo médio entre a admissäo e a cirurgia foi de 18 días. Näo houve mortalidade operatória. A cirurgia proporcionou a melhora dos sintomas visuais e oculomotores na grande maioria dos pacientes, porém näo trouxe melhora da funçäo endócrina.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adenoma/complicaciones , Apoplejia Hipofisaria/complicaciones , Neoplasias Encefálicas/complicaciones , Hemorragia Cerebral/complicaciones , Hipófisis , Neoplasias Hipofisarias/complicaciones , Adenoma/diagnóstico , Adenoma/cirugía , Apoplejia Hipofisaria/cirugía , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Hemorragia Cerebral/cirugía , Neoplasias Hipofisarias/diagnóstico , Neoplasias Hipofisarias/cirugía , Espectroscopía de Resonancia Magnética , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Two cases of acidophil adenoma of the pituitary causing sudden blindness from pituitary apoplexy are presented. The tumours had been clinically silent, without producing any symptoms of endocrine dysfunction. Radiological evidence was very conclusive. Transfrontal craniotomy with decompression resulted in quick and dramatic visual improvement. The interesting syndrome of clinical manifestations is discussed.