RESUMO
Lymphocytic Hypophysitis is a rare autoimmune disease of the pituitary presenting mainly with features of a mass lesion and loss of pituitary function. Its course is quite unpredictable and its treatment is still controversial as experience in the field remains scarce. We describe a 45 year-old woman with a history of recurrent fever and meningeal symptoms who was referred 3 years later to our department for pituitary insufficiency. Hormonal studies revealed an anterior pituitary deficiency and autoimmune thyroiditis. Pituitary hypertrophy as evidenced by magnetic resonance imaging showed complete regression upon hydrocortisone substitution therapy. Two years later, fever and meningeal symptoms recurred as well as pituitary hypertrophy. Cerebrospinal fluid analysis revealed an aseptic lymphocytic meningitis. Pituitary biopsy confirmed the diagnosis of LH. The patient was started on prednisone 70 mg per day. She improved clinically and radiologically and remained free of symptoms thereafter. At a recent follow up the MRI showed an empty sella turcica. Hereby we illustrate a yet unreported pattern of LH presenting as a recurrent aseptic meningitis. We also describe one of the long-term course of the disease which is still unpredictable.
Assuntos
Doenças Autoimunes/patologia , Linfocitose/patologia , Doenças da Hipófise/patologia , Hipófise/patologia , Anti-Inflamatórios/administração & dosagem , Doenças Autoimunes/tratamento farmacológico , Feminino , Humanos , Hidrocortisona/administração & dosagem , Linfocitose/tratamento farmacológico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Doenças da Hipófise/tratamento farmacológico , RecidivaRESUMO
Authors report two cases of spontaneous hematoma of the thyroid gland. Emergency surgery was performed on note of them. After reminding the role of different investigations, they discuss the interest of computed tomography to exclude extracranial carotid artery aneurysm. They explain a therapeutic approach according to the repercussions of hematoma: a compressive syndrome requires a difficult emergency surgery.
Assuntos
Hematoma/etiologia , Doenças da Glândula Tireoide/complicações , Idoso , Constrição Patológica , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Feminino , Hematoma/diagnóstico , Hematoma/cirurgia , Humanos , Pessoa de Meia-Idade , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia , Distúrbios da Voz/etiologiaRESUMO
The authors report a case of suppurative thyroiditis revealing cancer of the piriform sinus. The course ran two distinct phases. Initially, symptoms resolved under methylprednisolone and ampicillin given with a diagnosis of acute thyroiditis. After corticosteroids were discontinued, a tumefaction in the thyroid area recurred, with clinical features indicating centesis that removed 30 cc of pus ORL examination connected this suppurative thyroiditis to an epithelioma of a piriform sinus.
