RESUMO
The case history of a 54-year-old male suffering from pituitary macroadenoma with suprasellar extension is reported. A TRH-test with 200 micrograms i.v. was followed by severe headache and vomiting after 60', and by development of ophthalmoplegia on the following day. Hyperdens patches on the CT scan showed haemorrhage into the tumor. A chromophobic adenoma with macroscopic and histological signs of haemorrhage was removed via the transsphenoidal route. In the postoperative period the ophthalmoplegia gradually disappeared but central hypoadrenia and hypothyroidism occurred. This is the second case in the literature showing that TRH alone and in a low dose may cause pituitary tumor apoplexy. It is concluded that TRH-testing is a risk for the patient with pituitary apoplexy. If, due to the size of the tumor the patients have to be operated on in any case, and the test is not of essential diagnostic value, the TRH-test should be done only in selected cases. Its use in the postoperative evaluation however is without risk for the patients.
Assuntos
Adenoma/complicações , Apoplexia Hipofisária/induzido quimicamente , Neoplasias Hipofisárias/complicações , Hormônio Liberador de Tireotropina/efeitos adversos , Adenoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/patologia , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
A case of a widely metastasing malignant ependymoma in a 35-year-old man is reported. The first and most impressive clinical feature was a massive subarachnoid bleed with rapidly developing spinal cord compression due to widespread metastases over the cord and the cauda equina. The cerebral ependymoma was finally shown on a CT scan. Subarachnoid haemorrhage caused by malignant spinal deposits seems to be exceedingly rare. Finally, some problems of classification concerning the malignant forms of ependymoma are discussed.
Assuntos
Neoplasias Encefálicas/patologia , Ependimoma/secundário , Neoplasias da Medula Espinal/secundário , Hemorragia Subaracnóidea/patologia , Adulto , Encéfalo/patologia , Ependimoma/patologia , Humanos , Masculino , Meninges/patologia , Necrose , Medula Espinal/patologia , Neoplasias da Medula Espinal/patologiaRESUMO
A 59 years old woman is presented with acromegaly caused by an adenoma of the hypophysis, mixed cell-type and with a meningioma fibromatosum localized centroparietally. Both tumours were operated successfully, first the meningioma was removed. The hormone levels did not change after the operation of the meningioma, but normalized after the removal of the hypophysis adenoma. The simultaneously occurrence--without previous irradiation--of such tumours is very rare.
