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Case Reports 2013; 34(5): 339-342 PubMed PMID: 23922047 Citation  Keywords:  Acromegaly:complications, Adenoma:complications, Adult, Diabetes Mellitus, Humans, Magnetic Resonance Imaging, Male, Pituitary Apoplexy:complications, Pituitary Neoplasms:complications, Remission, Spontaneous, Sella Turcica:pathology,.   

OBJECTIVES: Pituitary apoplexy is a rare clinical syndrome associated with rapid enlargement of a pituitary mass. We report the initial presentation, subsequent course and outcome of an acromegalic patient who developed spontaneous remission following pituitary apoplexy with pathologic findings of tumor infarction.

CLINICAL PRESENTATION: A 38 year-old man with typical acromegalic features was referred to our hospital. He had been diabetic and hypertensive. His basal GH and IGF-1 levels were high (80 µg/L and 747 ng/mL respectively). Sella MRI showed a macroadenoma about 19×20 mm in size. He admitted to emergency department with complains of severe frontal headache accompanied by nausea and vomiting two days after MRI was taken. His neurological examination and visual field test were normal. Emergent MRI of the sella disclosed an enhancing intrasellar mass of 24×23 mm compressing the optic chiasm. The patient underwent transsphenoidal decompression of the lesion. Histological examination revealed an adenomatous tissue showing nonhemorrhagic coagulation necrosis. Before surgery, his GH levels declined to 2.72 µg/L spontaneously and after surgery he was in remission even leading to a state of growth hormone deficiency.

CONCLUSION: When apoplexy occurs in functioning adenomas, it may cause spontaneous remission. However pituitary apoplexy due to tumor infarction is very rare. Various precipitating factors have been reported in 25-30% of pituitary apoplexy patients. Diabetes mellitus and diabetic ketoacidosis are one of these. The presence of contrast media induced endothelial swelling with the result of hypoperfusion and diabetes mellitus associated vasculopathy might be a precipitating factor in this patient....

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Case Reports 2012; 33(6): 574-578 PubMed PMID: 23160230 Citation  Keywords:  Biopsy, Brain Abscess:complications, Diagnosis, Differential, Humans, Hypopituitarism:diagnosis, Magnetic Resonance Imaging, Male, Middle Aged, Pituitary Gland:pathology, Sella Turcica:pathology,.   

: Pituitary abscess is a rare condition. Here, we present the case of a young male patient who was initially found to have a pituitary lesion following the diagnosis of panhypopituitarism. Two years later, he presented with severe headache and was subsequently diagnosed intraoperatively with pituitary abscess. At a follow-up of 6 years after surgery, the patient was continuing to do very well. We discuss the differential diagnosis and demonstrate the evolution of the pituitary lesion on magnetic resonance imaging at four different time points: at the time of the detection of the initial lesion; two years later at the time of the diagnosis of the pituitary abscess; at 7 weeks post operatively; and finally after six years from the pituitary surgery....

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Case Reports 2010; 31(3): 306-309 PubMed PMID: 20588244 Citation  Keywords:  Diagnosis, Differential, Female, Germinoma:complications, Humans, Hypopituitarism:complications, Pituitary Neoplasms:complications, Sella Turcica:pathology, Young Adult,.   

OBJECTIVE: Primary central nervous system germ cell tumors are rare neoplasms usually located in the pineal and/or suprasellar region. Pure germinomas do not usually secrete beta-human chorionic gonadotropin hormone (beta-HCG) or alpha-fetoprotein (AFP) and diagnosis is made a few weeks or months after beginning of symptoms.

CASE: Here we report a case of a pure germinoma in a 20 year-old woman presenting as a sellar mass with suprasellar extension, abnormal serum beta-HCG and a long history of polyuria and polydipsia (4 years), that was initially diagnosed as a pituitary macroadenoma.

CONCLUSION: This presentation highlights the importance of thinking in alternative diagnosis to pituitary adenoma when diabetes insipidus is the initial symptom....

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