ABSTRACT
El tirotropinoma es el adenoma hipofisario menos frecuente (< 2 %). Debido a su infrecuencia, describimos 5 casos. Caso 1: Varón de 23 años, presentó fibrilación auricular aguda. El perfil tiroideo mostró: TSH: 4,2 uUI/ml (0,3-4), T4: 14,8 ug/dl (4,5-12,5), T4L: 2,2 ng/dl (0,8-1,9),T3: 170 ng/dl (80-180), T3L: 7,8 pg/ml (1,8-4,6) y test de TRH-TSH plano. La resonancia nuclear magnética (RNM) de cerebro reveló un macroadenoma. Se inició tratamiento con metimazol sin lograr respuesta apropiada. Luego comenzó tratamiento con octreótido-Lar logrando el eutiroidismo. Fue intervenido por vía transesfenoidal (TE), confirmándose por inmunohistoquímica (IHQ) adenoma (+) para TSH. A los 7 días luego de la cirugía la TSH se constató suprimida. Cinco años después se encuentra en remisión. Caso 2: Mujer de 41 años, consultó por hipertiroidismo bioquímico e hipertensión arterial (HTA). La evaluación hormonal mostró: TSH: 3,21 uUI/ml (0,4-4), T4: 16,9 ug/dl (4,5-10,9), T4L: 2,2 ng/dl (0,8-1,5), T3: 245 ng/dl (60-180) y test de TRH-TSH plano. La RNM evidenció un microadenoma de 2 mm. La terapia con cabergolina no modificó las hormonas tiroideas. El tumor mostró crecimiento progresivo (10,8 mm a los 2 años). Se operó por vía TE y el tumor fue (+) en la IHQ para TSH y GH. Luego de la cirugía presentó TSH suprimida por 15 días. Actualmente lleva un año y medio libre de enfermedad. Caso 3: Hombre de 53 años consultó por disminución de la libido, impotencia sexual y aumento de peso. El laboratorio reveló: TSH: 9,1 uUI/ml, T4L: 1,79 ng/dl (0,9-1,8), T3: 164 ng/dl (40-181). En la RNM se halló un macroadenoma. Se realizó cirugía TE, el adenoma fue (+) para TSH y GH en la IHQ. Evolucionó con hipotiroidismo primario. Caso 4: Mujer de 36 años consultó por hipertiroidismo. El perfil tiroideo reveló: TSH: 3,76 uUI/ml (0,4-4), T4: 13,2 ug/dl (4-12), T4L: 2,3 ng/dl (0,9-1,7), T3: 247 ng/dl (70-200) y test TRH-TSH plano. La RNM evidenció un adenoma de 10 mm. Se intervino ...
Thyrotropinomas are the less frequent adenomas (< 2 %). Because of their infrequency, we report 5 cases. Case 1: 23-year-old man, with sudden atrial fibrillation. The hormonal profile showed: TSH: 4.2 uIU/ml (0.3-4), T4: 14.8 ug/dl (4.5-12.5), FT4: 2.2 ng/dl (0.8-1.9), T3: 170 ng/dl (80-180), FT3: 7.8 pg/ml (1.8-4.6) and flat TRH test. MRI revealed a macroadenoma. Therapy with metimazol was initiated, without response. Subsequently, treatment with octreotide-Lar was started and euthyroidism was reached. He underwent transsphenoidal surgery. Immunohistochemistry was positive for TSH. One week after surgery, TSH was suppressed. He has been free of disease for the last 5 years. Case 2: 41-year-old woman with biochemical hyperthyroidism and hypertension. Labs showed: TSH: 3.21 uIU/ml (0.4-4), T4: 16.9 ug/dl (4.5-10.9), FT4: 2.2 ng/dl (0.8-1.5), T3: 245 ng/dl (60-180) and flat TRH test. On MRI a microadenoma of 2 mm was diagnosed. Therapy with cabergoline did not normalize thyroid hormones. The tumor grew to 10.8 mm after 2 years. Transsphenoidal surgery was performed. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 18 months. Case 3: 53-year-old man, with loss of libido, sexual impotence and weight gain. Laboratory tests revealed: TSH: 9.1 uIU/ml, FT4: 1.79 ng/dl (0.9-1.8), T3: 164 ng/dl (40-181). MRI showed a macroadenoma. Transsphenoidal surgery was performed, the adenoma was positive for TSH and GH. The patient evolved with primary hypothyroidism. Case 4: 36-year-old woman who presented with hyperthyroidism. The thyroid profile revealed: TSH: 3.76 uIU/ml (0.4-4), T4: 13.2 ug/dl (4-12), FT4: 2.3 ng/dl (0.9-1.7), T3: 247 ng/dl (70-200) and TRH test was flat. MRI showed an adenoma of 10 mm. She underwent transsphenoidal surgery. Immunohistochemical staining was positive for TSH and GH. She evolved with suppressed TSH for 15 days. She has been free of disease for the last 8 years. Case 5: 49-year-old man, with decreased libido and occasional headaches. The hormonal evaluation revealed: TSH: 14.4 uIU/ml (0.3-4.9), T4: 14.8 ug/dl (4.5-12), T4L: 4.1 ng/dl (0.8-1.5). On MRI an invasive macroadenoma was found. Therapy with octreotide-Lar was started and he was lost to follow-up. Conclusions: We report these cases because of their low prevalence. We emphasize that clinical presentation was variable. We can speculate on the secretion of a less biologically active TSH for cases with no symptoms of hyperthyroidism. Five out of five (5/5) showed non-suppressed TSH, 3/5 presented a macrodenoma at initial diagnosis, 3/5 showed TSH suppression one week after surgery, which might be considered as a criteria of cure. Four out of four patients operated on were cured. Rev Argent Endocrinol Metab 51:141-150, 2014 No financial conflicts of interest exist.
ABSTRACT
Three major groups of lesions can cause swelling in the floor of the mouth: infectious, neoplastic, and cystic. We present the case of a patient with inflammatory cyst in the floor of the mouth that reached, in a little while, huge dimensions. Needle aspiration of the lesion caused an infectious process that enlarged the cyst and led to progressive difficulties in breathing. Treatment was by emergency tracheostomy and enucleation of the lesion using an intraoral approach. The enucleation was performed through a mucosal incision along the midline of the floor of the mouth, starting just behind the lingual fold, and extending along the ventral surface of the tongue.
Subject(s)
Airway Obstruction/etiology , Cysts/complications , Mouth Diseases/complications , Mouth Floor/surgery , Aged , Aged, 80 and over , Airway Obstruction/surgery , Biopsy, Needle/adverse effects , Cysts/pathology , Cysts/surgery , Emergencies , Humans , Infections/etiology , Mouth Diseases/pathology , Mouth Diseases/surgery , TracheotomyABSTRACT
Ultrasonography and upper gastrointestinal endoscopy were prospectively used to study 100 consecutive patients with liver cirrhosis. After a period of 20 months to 55 months, 21 patients had died, 23 were lost at follow-up, and 56 patients were reevaluated. In the patients who died during follow-up, the entry liver volume, measured by means of the hepatic volumetric index, was lower as compared to the 56 cirrhotics who survived. During the study period, liver volume significantly decreased to values similar to those observed, at entry, in patients who died. Moreover, esophageal varices increased in size, and the splanchnic veins enlarged. Abdominal ultrasonography provides data regarding the natural history of liver cirrhosis, which might be used, in addition to tests of liver function and endoscopy, as prognostic factors in cirrhotic patients.
Subject(s)
Liver Cirrhosis/diagnosis , Liver/pathology , Spleen/pathology , Ultrasonography , Adult , Aged , Atrophy , Female , Follow-Up Studies , Humans , Hypertrophy , Liver/blood supply , Liver Cirrhosis/mortality , Longitudinal Studies , Male , Mesenteric Veins/pathology , Middle Aged , Portal Vein/pathology , Spleen/blood supply , Splenic Vein/pathology , Time FactorsABSTRACT
The portal blood velocity and flow were measured by means of pulsed echo-Doppler in 60 normal subjects of 4 different age groups (less than or equal to 40, 41-55, 56-70, greater than or equal to 71 years). All subjects had normal routine liver function tests and no history of liver disease. Portal blood velocity decreased from 15.7 +/- 3.2 cm/s in younger subjects to 12.4 +/- 1.7 in subjects over 71 years (ANOVA: p = 0.005). Similarly portal blood flow decreased (p = 0.025). Both portal blood velocity and flow were inversely correlated with age (r = -0.583 and -0.505, respectively). No changes in portal vein diameter were observed. The age-related decline in portal flow may account for the decrease in hepatic blood flow previously documented in the elderly.
