Abscesso hipofisário simulando apoplexia

Colli, Máikel Luís; Migowski, Walter; Czepielewski, Mauro Antônio; Ferreira, Nelson Pires; Gross, Jorge Luiz

doi:10.1590/s0004-27302006000600021

Cited by 5 publications

(3 citation statements)

References 32 publications

(40 reference statements)

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“…In particular, the frequency of isolated pachymeningeal metastasis in metastatic breast cancer was reportedly 1.5%. Pituitary abscesses may also present with clinical and imaging findings similar to PA [ 15 16 ]. Furthermore, it is difficult to exclude infectious conditions in PA patients because the cerebrospinal fluid (CSF) study may not be helpful due to the accompanying chemical meningitis [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

Lee

Hwang

Park

2023

Brain Tumor Res Treat

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Pituitary apoplexy (PA) is a clinical syndrome resulting from sudden hemorrhage and/or infarction of the pituitary gland. Recent reports documented the development of PA secondary to treatment with gonadotropin-releasing hormone (GnRH) agonists for prostate cancer. A 52-year-old woman visited our emergency room with a severe headache, occurred 1 day prior. She underwent breast-conserving surgery for breast cancer 1 month prior. She was currently undergoing radiation and hormone therapy, consisting of leuprorelin. Brain contrast-enhanced MRI revealed a pituitary adenoma with internal hemorrhage in the sellar and suprasellar areas. Pachymeningeal enhancement was observed along the retroclival and bilateral frontal areas. The patient was diagnosed with PA and aseptic meningitis. The patient underwent total excision via transsphenoidal surgery 8 days after admission. The patient was pathologically diagnosed with a pituitary adenoma with necrosis. On immunochemical staining, the tumor was positive for follicle-stimulating hormone. The follow-up MRI revealed no evidence of residual tumor or an improved pachymeningeal enhancement. She is currently undergoing follow-up at the neurosurgery and endocrinology outpatient departments with no noted complications. In breast cancer patients receiving GnRH agonist therapy, PA may be rare complication.

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Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

Lee

Hwang

Park

2023

Brain Tumor Res Treat

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“…PA can develop secondary to preexisting conditions such as a pituitary adenoma, Rathke’s cleft cyst, craniopharyngioma, granulomatous disease, or autoimmune lymphocytic hypophysitis (in children) [9, 10, 11]. Secondary PA is also a well-known but rare complication of pituitary surgical procedures or radiation interventions [8, 12, 13]. PA is considered an infectious disease with a broad spectrum of causative microorganisms [2, 6, 8].…”

Section: Discussionmentioning

confidence: 99%

Pituitary abscess: two case reports

et al. 2019

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BackgroundPituitary abscess is a rare condition with nonspecific symptoms that can be delayed. Proper diagnosis needs to occur preoperatively so that the management can be set up accordingly. Accurate diagnosis is challenging because many differential diagnoses can exhibit the same magnetic resonance imaging features.Case presentationWe report two cases of pituitary abscess. The first patient was a 66-year-old Arab woman who underwent a surgical procedure for a pituitary macroadenoma and presented 3 months later with chronic headaches and panhypopituitarism. A pituitary abscess was found on the follow-up magnetic resonance imaging. The second patient was a 64-year-old Arab man with no medical history who presented with a chiasmal syndrome with headaches and panhypopituitarism. Brain magnetic resonance imaging showed a heterogeneous pituitary mass that turned out to be a pituitary abscess intraoperatively. These two patients were treated with hormone substitution, endoscopic transsphenoidal drainage, and antibiotherapy, with excellent outcomes.ConclusionsPituitary abscess is a rare and serious condition. Preoperative diagnosis can be challenging because of the many existing differential diagnoses upon imaging. Magnetic resonance imaging is the mainstay technique of imaging due to its multimodal nature. These cases demonstrate the variable patterns of a pituitary abscess seen on magnetic resonance imaging and the potential difficulties in achieving an accurate diagnosis preoperatively due to many other conditions potentially exhibiting the same magnetic resonance imaging features.

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“…The presence of a round cystic mass with a thin peripheral rim enhancement following gadolinium injection at MRI, occasionally associated with a thickened pituitary stalk and symptoms of diabetes insipidus may be suggestive of pituitary abscess. Based on the MRI image, differential diagnosis of the sellar mass with other diseases such as a pituitary adenoma [2,7,32], pituitary apoplexy [33], pituitary germinal tumor [34] or hypophysitis [3] is to be considered. Diabetes insipidus has been reported only in some cases, but pituitary insufficiency and symptoms of intracranial mass are common; in few cases, pituitary insufficiency may not develop as shown by Takahashi in a 13-years-old girl with pituitary abscess associated to mild sphenoid sinusitis [7].…”

Section: Discussionmentioning

confidence: 99%

Primary pituitary abscess followed by empty sella syndrome in an adolescent girl

Pepene¹,

Ilie²,

Mihu³

et al. 2008

Pituitary

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Primary pituitary abscess is a rare pituitary pathology, particularly at a young age and is characterized by atypical clinical features making the diagnosis difficult. Correct diagnosis and therapy are mandatory due to the potentially lethal outcome of pituitary infection. We report the case of an adolescent girl presenting with headache, diabetes insipidus and central thyro-gonadic insufficiency with no history of infection, in whom the intra-operative diagnosis of primary pituitary abscess was made. Bacterial cultures indicated infection with Streptococcus spp. One year after neurosurgery and antibiotic therapy, recovery of diabetes insipidus and pituitary insufficiency was documented except for persistence of subnormal growth hormone secretion. Post-surgery, pituitary magnetic resonance imaging revealed an empty sella syndrome.

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Abscesso hipofisário simulando apoplexia

Cited by 5 publications

References 32 publications

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

Pituitary Apoplexy After Leuprolide Therapy in a Breast Cancer Patient: A Case Report

Pituitary abscess: two case reports

Primary pituitary abscess followed by empty sella syndrome in an adolescent girl

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