Pilocytic astrocytoma of sellar/suprasellar region determining endocrine manifestations

Abstract

Pilocytic astrocytoma (PA) is a grade I glial neoplasm arising mainly in the cerebellum of children. Herein, the authors report a case of PA in a 21 year-old male patient, who presented headache, vomiting and delayed pubertal development. Serum level of cortisol and testosterone corresponded to 32.8 ug/dl and 0.19 ng/ml, respectively. The computed tomography/magnetic resonance (CT/RM) imaging showed an expansive process compromising suprasellar/hypothalamic region and determining hydrocephalus. The patient underwent resection of the process. Histological evaluation revealed a glial neoplasm constituted by loose glial tissue, small microcysts, areas of dense piloid tissue and Rosenthal fibers. The neoplastic cells were immunoreactive for glial fibrillary acidic protein (GFAP) and negative for chromogranin and synaptophysin. The diagnosis of PA was then established..

Physiopathological Aspects of Sellar Epidermoid Cyst Determining Endocrine Disturbances: A Case Report

“…Symptoms associated to sellar EC can be related to a slow growing mass effect, and include focal neurologic deficits or nonlocalizing signs such as headache, visual alterations, and pituitary dysfunction. 15,[18][19][20][21][22] Epidermoid cysts tend to surround adjacent structures, and its rupture can produces chronic inflammation of the leptomeninges or ependyma. 15,[18][19][20][21] Sellar/suprasellar ECs can determine disturbances in the release and/or production of hormones, because the compressive effect of the process may affect the physiology of the pituitary gland or even determine hypothalamic disorders.…”

“…Since any hypothalamic hormone can be synthesized in more than one hypothalamic nucleus, and a single nucleus may express several hormones, different clinical signs can be identified. 19 Alterations in the suprachiasmatic nucleus of the hypothalamus can be associated with decrease in gonadotropin release. 19 Lesions of the supraoptic nuclei can decrease the synthesis of oxytocin and vasopressin.…”

“…19 Alterations in the suprachiasmatic nucleus of the hypothalamus can be associated with decrease in gonadotropin release. 19 Lesions of the supraoptic nuclei can decrease the synthesis of oxytocin and vasopressin. Damage of the ventromedial nucleus results in obesity; conversely, destruction of the ventrolateral nucleus causes anorexia and cachexia.…”

“…The paired medial and lateral nuclei are associated with autonomic function, in special temperature control and olfaction. 19 The posterior nucleus has been implicated in temperature regulation, and its large neurons are thought to be the source of hypothalamic efferents, which descend to the reticular formation of the brainstem. Increase of prolactin serum levels can be attributed to injury of the arcuate nucleus, which controls the secretion of dopamine (an inhibitor of prolactin secretion).…”

“…Increase of prolactin serum levels can be attributed to injury of the arcuate nucleus, which controls the secretion of dopamine (an inhibitor of prolactin secretion). 19 Hyperprolactinemia exerts an inhibitory activity on the positive feedback effect of estradiol on gonadotropin-releasing hormone (GnRH) secretion. Increase of prolactin seems to depend on decrease of factors that inhibit prolactin secretion, such as dopamine produced by the arcuate nucleus of the hypothalamus (probably compressed by EC).…”