Be careful... She has a pituitary gland in her nose.

In this case report we describe a 38 year-old-female with galactorrhea several months after the birth of an anencephalic child. She had hyperpolactemia and imaging of the pituitary gland revealed a midline defect and a nasopharyngeal mass compatible with a meningo-(hypophyso-) encephalocele and possibly an ectopic teratoma or desmoid. She was treated with dopamine agonists for 10 years and after cessation of therapy her prolactin levels remain normal. The nasopharyngeal mass remained unchanged over time and there were no signs of hypopituitarism. The hyperprolactinemia at presentation was probably caused by earlier pregnancy and stalk dysfunction due to traction by the mass. With decline of pituitary size, after starting dopamine agonists, the traction probably reduced resulting in a normal prolactin level. Our patient was warned against manipulation in de nose, because this could damage the meningo-encephalocele. An MRI will be preformed every 2 years to monitor changes in de mass.

Self-reported loss of consciousness after head trauma does not predispose to hypopituitarism in an older population.

OBJECTIVE: This population study examines the prevalence of hypopituitarism and low bone mineral density (BMD) in older persons reporting loss of consciousness after head trauma (HT). METHODS: Data from the Longitudinal Aging Study Amsterdam were used pertaining to 630 women (53 HT) and 533 men (63 HT). Subjects were asked whether they had ever had an HT with loss of consciousness. Linear regression analysis (adjusted for age, body mass index, chronic diseases, smoking, alcohol use, and gender) was performed to examine the association between HT and serum anteriory pituitary hormone levels, BMD, and quantative ultrasound measurements. RESULTS: Serum follicle stimulating hormone was significantly higher in males in the HT group (P = .05) than in the non-HT group. This difference was not found in women (P = .25). No other differences were observed in serum hormone levels between subjects with and without HT (P > .30). Also, no significant differences between the HT and non-HT group were found in BMD and quantitative ultrasound measurements. CONCLUSION: A self-reported history of HT with loss of consciousness does not seem to increase the risk of hypopituitarism and lower BMD in an aging population.

[A patient with long-term, unrecognized leishmaniasis]. / Een patiënt met jarenlang niet onderkende mucocutane leishmaniasis.

A man from Surinam presented at the Department of Internal Medicine with a perforated septum and progressive collapse of the nose. This condition had existed for 22 years, though earlier analysis had not revealed the cause. Microscopic analysis showed a granulomatous inflammatory reaction, with cultures revealing of Leishmania. The diagnosis was mucocutaneous leishmaniasis and PCR indicated Leishmania braziliensis complex. The patient was treated for mucocutaneous leishmaniasis by a 28-day course of intravenous sodium-stibogluconate therapy. Initially, treatment was stopped briefly due to neurotoxicity, but was recommenced and successfully completed. After treatment the infection parameters returned to normal and the patient was referred for reconstructive nasal surgery. Due to a low parasitic load mucocutaneous leishmaniasis can be difficult to detect, especially in chronic cases. However, the use of molecular techniques has improved both the sensitivity and specificity of detection. The ability to distinguish between different species and sub-species is of prognostic and therapeutic relevance.

[Erythema multiforme vs. Stevens-Johnson syndrome and toxic epidermal necrolysis: an important diagnostic distinction]. / Erythema multiforme versus Stevens-Johnson-syndroom en toxische epidermale necrolyse; belangrijk diagnostisch onderscheid.

Three patients, a girl aged 10 and two women aged 59 and 64 years, had erythema multiforme, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), respectively. SJS and TEN are rare illnesses with a high morbidity and mortality. The aetiology is mainly iatrogenic: a hypersensitivity reaction to certain pharmaceutical prescriptions. SJS and TEN should be differentiated from the more frequent erythema multiforme, a self-limiting disease without important residual symptoms, which is usually initiated by infection with herpes simplex virus. SJS and TEN are variants in a spectrum of exfoliative dermatoses with epidermal necrosis. SJS and TEN on the one hand and erythema multiforme on the other can be distinguished on the basis of aetiology, clinical symptoms and histopathology. The distinction can, however, be difficult, notably in the early stages. The girl recovered completely. The first woman was treated with corticosteroids and also recovered; she was thought to have developed the syndrome as a reaction to malarial prophylactics. The third patient died, despite extensive treatment, of multiorgan failure and sloughing of 70% of the skin, probably as a reaction to amoxicillin given for pneumococcal pneumonia.