1
|
Chavez-Yenter A, Sardi J, Sasson JP, Wood M. Pituitary enlargement in a carotid-cavernous fistula: An atypical imaging manifestation. Radiol Case Rep 2024; 19:785-790. [PMID: 38111563 PMCID: PMC10726331 DOI: 10.1016/j.radcr.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/03/2023] [Accepted: 11/05/2023] [Indexed: 12/20/2023] Open
Abstract
A carotid-cavernous fistula is a rare abnormal communication between carotid vasculature and the cavernous sinus. Development of a carotid-cavernous fistula often results from trauma, but may be spontaneous in the setting of predisposing risk factors. Suspicion for a spontaneous fistula is understandably low on routine non-contrast imaging. In this article, we present a case of a carotid-cavernous fistula initially presenting with the potentially underrecognized imaging manifestation of diffuse pituitary enlargement identified on a non-contrast CT, later revealed to be due to the presence of the fistula.
Collapse
Affiliation(s)
| | - Justin Sardi
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - J. Pierre Sasson
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| | - Monica Wood
- Department of Radiology, Mount Auburn Hospital, Cambridge, MA, USA
| |
Collapse
|
2
|
Grzywotz A, Li Y, Unger N, Kiewert C, Chmielewski WX, Sure U, Uerschels A, Wrede K, Kreitschmann-Andermahr I. Pituitary enlargement in patients with cerebrospinal fluid drainage due to ventricular shunt insertion: know the condition and do not mistake for adenoma. Pituitary 2023; 26:164-170. [PMID: 36652088 PMCID: PMC9908659 DOI: 10.1007/s11102-022-01296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Childhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage. PATIENTS AND METHODS Retrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed. RESULTS Pituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p < 0.001; pituitary volume, t = 3.03; p = 0.006). In patients available for pre- and postoperative comparison, there was also a significant increase in pituitary size and volume postoperatively (mean preoperative midsagittal height 2.54 ± 1.0 mm vs. 6.6 ± 0.7 mm post-surgery; mean pre-operative pituitary volume 120.5 ± 69.2 mm3 vs. 368.9 ± 57.9 mm3 post-surgery). CONCLUSION Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro-Kellie doctrine, stating that intracranial depletion of CSF-as caused by v.p. shunting-leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.
Collapse
Affiliation(s)
- Agnieszka Grzywotz
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Yan Li
- Institute of Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Nicole Unger
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Cordula Kiewert
- Department of Pediatric Endocrinology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Witold X Chmielewski
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Anne Uerschels
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| |
Collapse
|
3
|
Quiroga-Padilla PJ, González-Devia D, Andrade R, Escalante P, Jiménez-Hakim E. Sellar Gangliocytoma: Case Report and Review of an Extremely Rare Tumour. Case Rep Neurol 2021; 13:475-482. [PMID: 34413750 PMCID: PMC8339522 DOI: 10.1159/000517368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Sellar gangliocytomas (SGs) are rare, well-differentiated, low-grade neoplasias that commonly present along with a pituitary adenoma (PA). We describe a case of a 52-year-old woman with a 2-year history of headache, body weight increase, and recent onset of arterial hypertension and type 2 diabetes mellitus. Work-up tests revealed a normal hypophyseal profile, except for mild ACTH elevation, and a sellar mass on magnetic resonance imaging (MRI). A diagnosis of an enlarging pituitary macroadenoma was established, and to prevent symptom progression, the tumour was resected. Pathology showed 2 cell populations: ganglion and corticotrope cells. Three years after surgery, the patient no longer had a headache but persisted with arterial hypertension and type 2 diabetes mellitus. A literature review produced 207 cases of SGs. They typically present in women at 40 years of age and the most common clinical presentation are symptoms of acromegaly. Of the documented cases, 74 and 93% were treated with surgery alone or combined treatments (radiotherapy, radiosurgery, or pharmacotherapy), respectively. The majority of deaths associated with a SG came from the first half of the 20th century. In conclusion, this patient presented with a silent SG with likely pituitary hyperplasia. SGs are a challenging diagnosis, have a benign course, and may provide insights into PA tumourigenesis.
Collapse
Affiliation(s)
| | - Deyanira González-Devia
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Department of Internal Medicine, Endocrinology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Rafael Andrade
- Faculty of Medicine, Universidad de Los Andes, Bogotá, Colombia.,Department of Pathology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Paola Escalante
- Department of Pathology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Enrique Jiménez-Hakim
- Department of Neurosurgery, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| |
Collapse
|
4
|
Sapkota S, Karn M, Sapkota S. Pituitary hyperplasia in childhood primary hypothyroidism: a review. Childs Nerv Syst 2021; 37:749-762. [PMID: 33404718 DOI: 10.1007/s00381-020-05014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Pituitary hyperplasia following primary hypothyroidism in pediatric age group population is considered rare with reports of unnecessary neurosurgical intervention for this medically treatable condition. Given the paucity of information on this topic, it is timely to provide clinicians with a comprehensive summary of available research. METHODS A search of published studies in Pubmed, PsychInfo and Cochrane Database with the terms "pituitary hyperplasia" or "pituitary hypertrophy" and "hypothyroidism" was performed and the results filtered for English language, pediatric (0-18 years) population and CT or MRI confirmed findings. 55 studies met the inclusion criteria. Data for a total of 110 patients with pituitary hyperplasia following primary hypothyroidism were extracted. The study population included 29 males and 81 females (M: F= 0.35:1). Patient age varied from 3 weeks to 18 years with a mean age of 10.22 years. RESULTS The most common clinical presentations included growth retardation, constipation and features of myxedema which were present in 78, 36 and 18 percent of children included in our review. Neuroimaging showed the mean (SD) pituitary height being 13.48 mm (4.72 mm). All of the patients achieved resolution of their pituitary mass and clinical as well as biochemical abnormalities 1 to 26 months after initiation of thyroid hormone replacement therapy, with an average time interval of 7.22 months. Our review has tried to delve in the pathophysiology as well as clinical, biochemical and radiological aspects of pediatric pituitary hyperplasia secondary to primary hypothyroidism and provide recommendations for treatment and follow-up. This may help anyone concerned gain a substantial knowledge on this topic.
Collapse
Affiliation(s)
- Shabal Sapkota
- Department of Neurosurgery, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal.
| | - Mitesh Karn
- School of Medicine, Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Sulav Sapkota
- Department of Medical Oncology, Birat Medical College, Biratnagar, Nepal
| |
Collapse
|
5
|
Kim SJ, Yoon JH, Kim HK, Kang HC. Spontaneous ovarian hyperstimulation syndrome in a young female subject with a lingual thyroid and primary hypothyroidism. Korean J Intern Med 2017; 32:559-562. [PMID: 27510824 PMCID: PMC5432798 DOI: 10.3904/kjim.2015.372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/29/2016] [Accepted: 05/15/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Soo Jeong Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Jee Hee Yoon
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
- Correspondence to Ho-Cheol Kang M.D. Department of Internal Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun 58128, Korea Tel: +82-61-379-7620 Fax: +82-61-379-7628 E-mail:
| |
Collapse
|
6
|
Gaspari L, Paris F, Leboucq N, Bonafé A, Sultan C. Reversible growth failure and complete GH deficiency in a 4-year-old girl with very early Hashimoto's thyroiditis and subsequent hyperplasia of pituitary thyrotroph cells. Eur J Pediatr 2016; 175:1119-22. [PMID: 26838584 DOI: 10.1007/s00431-016-2698-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Hashimoto's thyroiditis is a well-known cause of growth retardation in adolescence. It is less frequently seen in children and rarely seen in infants. A 4-year-old girl was referred to our clinic for a second opinion before starting growth hormone (GH) treatment. Linear growth had markedly declined in the past 2 years, with height -3.4 standard deviations. GH deficiency was complete. She had dry, gray-sallow skin and bloated abdomen, but no goiter. The parents reported fatigue and constipation. Hormonal evaluation revealed TSH 629.5 mIU/ml, free T4 0.08 ng/dl, and prolactin 17.2 ng/ml. Bone age was 2 years. Antibodies to thyroglobulin and thyroid peroxidase were positive, suggesting Hashimoto's thyroiditis. Brain magnetic resonance imaging showed anterior pituitary hyperplasia. After 3 years of L-thyroxine therapy, she was symptomless, her height was -0.6 standard deviations, and the TSH level was normal. Brain magnetic resonance imaging showed regression of the pituitary hyperplasia. CONCLUSIONS This report describes a patient with Hashimoto's thyroiditis and pituitary hyperplasia, both quite rare in very young children. Acquired hypothyroidism may appear after neonatal screening and therefore should not be overlooked in investigations of short stature, even when clinical signs of hypothyroidism are absent. WHAT IS KNOWN • Hashimoto's thyroiditis and pituitary hyperplasia are rare in very young children. • Acquired hypothyroidism can appear after negative neonatal screening and should not be overlooked. What is New: • Short children should be evaluated for growth hormone deficiency but only after excluding other causes, particularly hypothyroidism, as we report a child with this disease but no clinical signs of it.
Collapse
|
7
|
Hu YY, Li GM, Hu WW, Wang Y. Characteristics of girls with pituitary hyperplasia and sexual precocity secondary to primary hypothyroidism. Acta Paediatr 2014; 103:e43-8. [PMID: 24118058 DOI: 10.1111/apa.12444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/25/2013] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
AIM To investigate the different characteristics of girls with pituitary hyperplasia secondary to primary hypothyroidism (PPH), with and without sexual precocity. METHODS Pituitary hyperplasia secondary to primary hypothyroidism girls were divided into two groups: group A, with sexual precocity (n = 8), and group B, without sexual precocity (n = 14). The following values were measured before and after 3 months levothyroxine therapy: free triiodothyronine (FT3 ), free thyroxine (FT4 ), thyrotropin (TSH), follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin (PRL), estradiol (E2 ), testosterone (T), pituitary height, uterine volume (UV), ovarian volume (OV) and follicular diameter (FD). RESULTS Thyrotropin, FSH, PRL, E2 , T, pituitary height, UV, OV and FD were higher in group A than group B (all p < 0.05); FT3 , FT4 and LH levels were not different (all p > 0.05). In all of the PPH girls, pituitary height was correlated with FT3 , FT4 and PRL (r = -0.545, p = 0.009, r = -0.567, p = 0.006 and r = 0.666, p = 0.001, respectively). PRL was positively correlated with UV, FD and FSH (r = 0.581, p = 0.005, r = 0.482, p = 0.031 and r = 0.667, p = 0.001, respectively), and FSH was positively correlated with OV (r = 0.522, p = 0.013). These abnormalities regressed after therapy. CONCLUSION Pituitary hyperplasia secondary to primary hypothyroidism girls with sexual precocity have increased plasma TSH, FSH, PRL, E2 and T levels, pituitary height and uterine, ovarian and follicular size.
Collapse
Affiliation(s)
- Yan-Yan Hu
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Gui-Mei Li
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Wen-Wen Hu
- Department of Pediatrics; The People's Hospital of Lanshan District; Linyi China
| | - Yi Wang
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
| |
Collapse
|
8
|
Kanza RE, Gagnon S, Villeneuve H, Laverdiere D, Rousseau I, Bordeleau E, Berube M. Spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma associated with primary hypothyroidism. World J Radiol 2013; 5:20-4. [PMID: 23494012 PMCID: PMC3596565 DOI: 10.4329/wjr.v5.i1.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/21/2012] [Accepted: 08/28/2012] [Indexed: 02/06/2023] Open
Abstract
We report an unusual case of spontaneous ovarian hyperstimulation syndrome and pituitary hyperplasia mimicking macroadenoma in an adult, non-pregnant woman. Her condition was triggered by unrecognized primary hypothyroidism, which regressed after thyroid hormone replacement therapy. This case highlights the need for clinicians and radiologists to familiarize themselves with the clinical and imaging features detected in case of these complications of primary hypothyroidism, which are not well known in the medical and radiological profession. Such improved knowledge will help avoid delays in diagnosis, progression to life-threatening complications, and unnecessary surgery.
Collapse
|