11 research outputs found
Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation
Apoplexia subclĂnica em tumores pituitĂĄrios
Apoplexia pituitĂĄria aguda Ă© fenĂŽmeno relativamente raro, mesmo em macroadenomas. No entanto, a presença de ĂĄreas necro-hemorrĂĄgicas intratumorais nestes tumores que nĂŁo se relacionam a qualquer sintomatologia aguda parece ser bem mais frequente do que se imaginava na era da tomografia. Com o advento da ressonĂąncia magnĂ©tica estas ĂĄreas podem ser facilmente diagnosticadas prĂ©-operatoriamente. Dentre os 40 Ășltimos macroadenomas operados e examinados com RMN, 10 possuĂam ĂĄreas apoplĂ©ticas subclĂnicas em seu interior. Sete destes tumores eram nĂŁo secretores, 2 secretores de GH e um de prolactina. O quadro clĂnico incluiu, alĂ©m daqueles correspondentes Ă eventual secreção endĂłcrina, perda visual progressiva (sem histĂłria de piora abrupta ou rĂĄpida) (n=8) e cefalĂ©ia (n=3). ApĂłs a remoção cirĂșrgica destes tumores e descompressĂŁo do aparato Ăłptico, obtivemos melhora visual em 6 pacientes e em 2 a visĂŁo permaneceu inalterada. A cefalĂ©ia desapareceu em 2 casos. A presença de ĂĄreas apoplĂ©ticas nestes macrotumores bem como sua ausĂȘncia em sĂ©ries de microtumores relatadas na literatura sugere que se relacionam mais ao tamanho do tumor do que ao seu carĂĄter secretor ou nĂŁo, o que Ă© compatĂvel com a provĂĄvel natureza (insuficiĂȘncia vascular) da apoplexia subclĂnica nesses casos
Cavernous sinus invasion by pituitary macroadenomas: neuroradiological, clinical and surgical correlation
The classical imaging gold-standard for this diagnosis is the presence of tumor lateral to the carotid artery. Seventeen patients with pituitary macroadenomas with intraoperative confirmation of cavernous sinus invasion were studied with MRI. Only 8 patients had tumor lateral to the carotid artery; 13 had tumor within the carotid syphon and all lacked the ring enhancement of the medial wall of the cavernous sinus. In 10 patients, widening of the posterior double leaflets of the cavernous sinus could be. All patients were operated by the transesphenoidal route. Only one patient was cured by surgery alone. Only 3 patients disclosing the above mentioned MRI features were identified in a series of 250 patients and did not have cavernous sinus invasion. The present criteria proved to be useful in the pre-operative diagnosis of cavenous sinus invasion and patients' counselling. Pre-operative diagnosis of cavernous sinus invasion of pituitary tumors has a great impact in the management of such patients
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EVALUATION OF THE GONADOTROPHIC RESPONSIVENESS OF THE PITUITARY TO ACUTE AND PROLONGED ADMINISTRATION OF LH/FSH-RELEASING HORMONE (LH-RH) IN NORMAL FEMALES AND MALES
ABSTRACT In normal females, the injection of 25 ÎŒg of LH-RH (acute test) induced a greater LH and FSH release from the pituitary in the mid-luteal than in the mid-follicular phase of the menstrual cycle. In normal males, the responsiveness to 25 ÎŒg LH-RH was greater than that in females at mid-follicular but not at the luteal stage. The pituitary response to the prolonged LH-RH infusion (0.21 ÎŒg/min/8 h) was similar in both phases of the cycle of the females with a decline in serum gonadotrophins after the 4th hour and was paralleled by a significant increase of plasma oestradiol levels. In males the LH, but not the FSH secretion was lower as compared to female subjects, and gonadotrophin levels did not show a fall during the infusion. The acute injection of 25 ÎŒg LH-RH at the end of a prolonged infusion induced the same response in the female subjects in both phases of the cycle. In males, the acute test following prolonged infusion produced a similar LH secretion, but a lower FSH response than in females. The comparison of the acute test alone and that preceded by a prolonged LH-RH infusion, demonstrated that, in females, the only significant differences consisted of a greater LH secretion in the former test in the mid-luteal phase. In males there was greater FSH secretion in the acute isolated test than when this test was given after the prolonged infusion
GĂȘmeas idĂȘnticas discordantes para a doença de Cushing: relato de caso Identical twins discordant for Cushing's disease: case report
A doença de Cushing Ă© rara em crianças e sua ocorrĂȘncia em gĂȘmeos Ă© ainda mais rara. O presente estudo relata a ocorrĂȘncia de gĂȘmeas idĂȘnticas discordantes quanto Ă doença de Cushing. Uma das gĂȘmeas, desenvolveu sĂndrome de Cushing aos 10 anos de idade. Sua investigação demonstrou cortisol urinĂĄrio elevado, ACTH sĂ©rico elevado e testes de supressĂŁo com dexametasona compatĂveis com doença de Cushing. A RMN mostrou macroadenoma hipofisĂĄrio que foi operado por via transesfenoidal. O estudo imuno-histoquĂmico confirmou a presença de cĂ©lulas produtoras de ACTH. A paciente entrou em remissĂŁo clĂnica e laboratorial desde a cirurgia. ApĂłs o desaparecimento dos estigmas do Cushing, a paciente reiniciou ganho estatural, mas permanece menor que sua irmĂŁ gĂȘmea. Esta Ășltima permanece saudĂĄvel 4 anos apĂłs o inĂcio da doença de sua irmĂŁ. Este Ă© o terceiro caso do gĂȘnero relatado na literatura. Estes achados sugerem que fatores nĂŁo genĂ©ticos estĂŁo envolvidos na gĂȘnese da doença de Cushing.<br>Cushing's disease is rare in children and its ocurrence in identical twins is extremely rare. This paper reports on identical twins discordant for Cushing's disease. One of them first presented with a cushingoid phenotype by the age of 10. Her evaluation showed an increased urinary free-cortisol and serum ACTH. Her pattern in the dexametazone supression tests was compatible with Cushing's disease. MRI disclosed a pituitary macroadenoma which was removed by the transesphenoidal approach. Immunohistochemical studies of the tumor showed the presence of ACTH-producing cells. The patient went into clinical and laboratorial remission after surgery. She re-started to grow after the disappearance of the Cushing's phenotype but she is still shorter than her healthy sister. The latter remains disease-free 4 years after her sister's diagnosis. This represents the third such case reported in the literature. Our findings suggest that acquired factors may be responsible for the genesis of Cushing's disease
Apoplexia pituitĂĄria seguida de remissĂŁo endĂłcrina: relato de dois casos Pituitary apoplexy followed by endocrine remission: report of two cases
A apoplexia pituitĂĄria Ă© evento raro e a ocorrĂȘncia de remissĂŁo endĂłcrina em pacientes portadores de tumores secretores Ă© ainda mais incomum. O presente estudo relata os casos de dois pacientes portadores de macroadenomas (um com doença de Cushing e outro com acromegalia) nos quais houve remissĂŁo endĂłcrina apĂłs apoplexia tumoral. A primeira paciente era portadora de doença de Cushing e teve episĂłdio ictal espontĂąneo de cefalĂ©ia e vĂŽmitos, apĂłs o qual iniciou remissĂŁo endĂłcrina. Como houvesse persistĂȘncia de imagem de macroadenoma Ă ressonĂąncia magnĂ©tica, a paciente foi submetida a cirurgia transesfenoidal, sendo encontrado apenas cisto hemorrĂĄgico hipertensivo, sem sinais de tumor. O segundo paciente apresentava acromegalia e enquanto realizava um teste de LHRH teve evento agudo de cefalĂ©ia e vĂŽmitos, sem perda visual e instalação de diabetes insipidus. A tomografia computadorizada de sela tĂșrcica mostrou sinais de sangue. Como nĂŁo houve quadro visual agudo, o paciente foi seguido com exames de imagens seriadas, que demonstraram o desaparecimento completo da lesĂŁo e o aparecimento de sela vazia. A avaliação endĂłcrina mostrou remissĂŁo da acromegalia. Tendo em vista a tendĂȘncia Ă recidiva jĂĄ documentada na literatura, esses pacientes devem continuar em seguimento a longo prazo.<br>Pituitary apoplexy is rare and endocrine remission in patients with apopletic secreting pituitary adenomas is even rarer. This study reports on two patients with pituitary macroadenomas (one with Cushing's disease and the other with acromegaly) in whom endocrine remission occurred after apoplexy. The first patient had Cushing's disease and had an ictus of headache and vomiting after which she started a progressive remission of hypercortisolism. A post-apoplexy MRI disclosed persistence of a sellar and supra-sellar mass. She was submitted to transesphenoidal surgery. An hypertensive hemorhagic cyst was found with no tumor. The second patient had acromegaly. While performing a LHRH-stimulation test he had an ictus of headache, vomiting, no visual loss and appearance of diabetes insipidus. A CT scan disclosed an intrasellar hematoma. Despite the size of the tumor and since there was no visual impairment, this patient was followed up without surgery. Imaging follow-up showed a progressive shrinkage and disappearance of the mass, which was corroborated by endocrine remission. A high rate of recurrence is reported in such patients in the literature. Both patients are being currently followed-up on a long-term basis