RESUMO
OBJECTIVE: To report 2 interesting cases of pituitary metastasis (PM) with differing presentations, and briefly review the literature regarding the incidence, presentation, and natural history of PMs. METHODS: Case report and literature review. RESULTS: Patient 1 had known widely metastatic papillary thyroid cancer and presented with signs and symptoms of anterior pituitary dysfunction. He was found to have an undetectable AM cortisol. Further lab evaluation showed complete anterior panhypopituitarism. Pituitary magnetic resonance imaging (MRI) revealed an infiltrative pituitary lesion, which was presumed to be a meta-static lesion from his thyroid cancer. Patient 2 presented with an acute increase in urinary frequency and polydipsia. Water deprivation testing confirmed central diabetes insipidus (DI). Brain MRI showed an infiltrative pituitary lesion, which was the first sign of recurrent metastatic colon cancer. Subsequently, he developed the rapid onset of complete anterior panhypopituitarism. Review of the literature shows that when PMs produce symptoms, the most common presentation has traditionally been central DI. However, this is shifting as the incidence of anterior dysfunction and cranial nerve abnormalities is rising in more recent reviews. CONCLUSION: Central DI has traditionally been the most common presenting symptom of PM, however symptoms reflective of anterior pituitary dysfunction and cranial nerve abnormalities are being reported with increasing frequency. PM should remain in the differential in any form of pituitary dysfunction.
RESUMO
OBJECTIVE: To investigate the effects of intravenous chromium on serum glucose and insulin infusion rates in hospitalized patients with severe insulin resistance. METHODS: In this retrospective study, we reviewed hospital records from January 1, 2008, to December 1, 2008, to identify patients for whom intravenous chromium was ordered at our academic medical center. To be included, patients were required to demonstrate profound insulin resistance and uncontrolled hyperglycemia (defined as the inability to achieve a blood glucose value less than 200 mg/dL during the 12 hours before chromium was given despite administration of continuous insulin infusion at a rate of 20 or more units/h) and to have received a continuous infusion of chromium chloride at 20 mcg/h for 10 to 15 hours for a total dose of 200 to 240 mcg. RESULTS: Fourteen patients met our inclusion criteria. Over the hour preceding intravenous chromium infusion, the mean ± standard deviation rate of insulin infusion was 31 ± 15 units/h, and blood glucose was 326 ± 86 mg/dL. Twelve hours after the initiation of chromium, these values were 16 ± 16 units/h and 162 ± 76 mg/dL, respectively (P = .011 for difference in mean insulin rate from baseline, P<.001 for difference in mean blood glucose from baseline) and 24 hours after, these values were 12 ± 15 units/h and 144 ± 48 mg/dL, respectively (P<.001 for both). CONCLUSIONS: Intravenous chromium decreases insulin needs and improves glucose control at 12 and 24 hours compared with baseline values. Chromium appears to improve hyperglycemia and insulin resistance in acutely ill patients and represents a potential new therapy. Future prospective randomized controlled trials are needed to confirm these results.
