ABSTRACT
INTRODUCTION: Pituitary disorders during pregnancy are uncommon. The approach should include a close follow-up in order to reduce maternal and fetal risks associated with physiological changes during pregnancy or treatment side effects. MATERIALS AND METHODS: We report a 21-year-old woman with a thyroid-stimulating hormone-secreting pituitary macroadenoma and positive antithyroid antibodies. She was initially treated using transsphenoidal pituitary surgery. The patient relapsed 17-month post-surgery. Somatostatin analog therapy was started which rapidly controlled the hyperthyroidism. Eleven months later, while receiving octreotide, the patient reported to be pregnant and the medication was stopped. Gestation and delivery went well with a healthy full-term newborn. The patient developed a postpartum thyroiditis 15 weeks after giving birth. Twenty-eight months postpartum the patient remains euthyroid without medication. CONCLUSIONS: The overall positive outcomes of the four cases reported in literature, including this new case, suggest that pregnancy should not be absolutely contraindicated in women with thyrotropinomas. We emphasize the effectiveness of octreotide to control hyperthyroidism, as well as stopping medication when a patient is found to be pregnant. In our case, close observation following octreotide cessation had a positive outcome.
Subject(s)
Adenoma/drug therapy , Pituitary Gland/drug effects , Pituitary Neoplasms/drug therapy , Pregnancy Complications, Neoplastic/drug therapy , Adenoma/metabolism , Adenoma/physiopathology , Adenoma/surgery , Adult , Antineoplastic Agents, Hormonal/administration & dosage , Antineoplastic Agents, Hormonal/adverse effects , Antineoplastic Agents, Hormonal/therapeutic use , Combined Modality Therapy/adverse effects , Drug Monitoring , Female , Humans , Hyperthyroidism/etiology , Hyperthyroidism/prevention & control , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/physiopathology , Neoplasm, Residual , Octreotide/administration & dosage , Octreotide/adverse effects , Octreotide/therapeutic use , Organ Sparing Treatments/adverse effects , Pituitary Gland/metabolism , Pituitary Gland/surgery , Pituitary Neoplasms/metabolism , Pituitary Neoplasms/physiopathology , Pituitary Neoplasms/surgery , Pregnancy , Pregnancy Complications, Neoplastic/physiopathology , Term Birth , Thyrotropin/metabolism , Treatment Outcome , Young AdultABSTRACT
La miositis proliferativa es una lesión muy infrecuente y benigna, la presencia de metaplasia ósea es aún más rara. Su rápido crecimiento y el patrón de infiltración difusa propicia la confusión con un tumor maligno. Se trata de un paciente varón de 68 años con antecedente de sarcoma fibromixoide de bajo grado que presentó aumento de volumen en hombro izquierdo. Se observa en el músculo deltoides una lesión blanquecina, mal delimitada que mide 2 × 1 cm. Se identifica una proliferación de células fusiformes, células pseudoganglionares y osteoide calcificado. La inmunohistoquímica muestra positividad para vimentina, β-catenina (citoplasmático), Ki 67 (6%) y positividad focal para miosina músculo liso y actina muscular en las células fusiformes, negatividad para MYO-D1, miogenina, CD-34, desmina, caldesmón. El diagnóstico es miositis proliferativa con focos de metaplasia ósea (AU)
Proliferative myositis is a rare, benign lesion and the presence of osseous metaplasia is even more infrequent. Its rapid growth and diffuse infiltration pattern may cause it to be confused with a malignant tumour. We present a case of proliferative myositis in a 68 year old male with a history of low grade fibromyxiod sarcoma who presented with swelling in the anterior left shoulder. An ill-defined, 2 × 1 cm whitish lesion was found in the deltoid muscle. A proliferation of spindle cells, pseudoganglion cells and calcified osteoid was observed. Immunohistochemistry showed positivity for vimentin, β-catenin (cytoplasmic), Ki 67 (6%) and focal positivity for actin and myosin smooth muscle in spindle cells, negativity for MYO-D1, myogenin, CD34, desmin, caldesmon. A diagnosis of proliferative myositis with foci of osseous metaplasia was made (AU)
