11/47. Neonatal identification of pituitary aplasia: a life-saving diagnosis. review of five cases.BACKGROUND: Neonatal onset hypopituitarism is a life-threatening, potentially treatable endocrine disease. A possible cause is congenital absence of the anterior pituitary gland, a condition very rarely reported in the literature. methods: A series of 5 cases of children with pituitary aplasia referred to the Centre of Paediatric endocrinology 'Rina Balducci', Tor Vergata University, Rome, is presented. RESULTS: Major clinical features in our patients were respiratory distress on the first day of life, in spite of uneventful pregnancy, labour and delivery, metabolic acidosis, non-cholestatic jaundice, hypotonia, severe hypoglycaemia, hypogenitalism, and midline defects. diagnosis was established by endocrine tests during hypoglycaemia and hypothalamic-pituitary MRI scan. Symptoms disappeared soon after replacement therapy was started. CONCLUSION: We stress the importance of performing baseline endocrine tests as soon as possible during hypoglycaemia and MRI of the brain aimed at visualizing the hypothalamic-pituitary area in neonates with hypogenitalism and severe unexplained hypoglycaemia, so that the irreversible neurological and developmental consequences of panhypopituitarism can be prevented by adequate replacement therapy.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
12/47. A case of cystic lymphocytic hypophysitis with cacosmia and hypopituitarism.Lymphocytic hypophysitis is a rare inflammatory disease of the pituitary gland that is being increasingly recognized as a cause of hypopituitarism. This condition may be due to an autoimmune pituitary destruction which usually occurs in young women during pregnancy or in the immediate postpartum period. We describe a case of cystic pituitary mass in a thirty-eight year-old woman presenting with nausea, vomiting, cold intolerance, blurring of vision and the presence of disagreeable odors for a one-month period. She had secondary amenorrhea and galactorrhea for three months. Combined anterior pituitary stimulation test confirmed the diagnosis of hypopituitarism. magnetic resonance imaging scan with enhancement showed a huge cystic sellar mass with suprasellar extension and thickening of the pituitary stalk. Transsphenoidal exploration was performed with preoperative diagnosis of pituitary macroadenoma with cystic necrosis. Histological examination revealed lymphocytic hypophysitis characteristic of diffuse, dense lymphocytes and plasma cells infiltration with surrounding interstitial reactive fibrosis. Postoperatively, the patient's olfactory function returned to normal but combined anterior pituitary stimulation test showed persistence of hypopituitarism with mild hyperprolactinemia. Prednisolone, thyroxine and estrogen replacements were started and clinical symptoms were much improved. In summary, we report an extremely rare case of a woman with cystic lymphocytic hypophysitis with cacosmia and hypopituitarism, confirmed by histological examination.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
13/47. A patient with low free T4 and low thyroid-stimulating hormone without hypopituitarism.A 39-year-old entertainer was referred in November 2000 for suspected secondary hypothroidism found during a routine insurance check. Thyroid stimulating hormone (TSH) was 0.30 mIU/L (NR 0.47-4.68 mIU/L) and total T4 was 21.6 nmol/l (NR 57.9-154.4 nmol/l). She had enjoyed good past health and gave birth to a baby girl at 32 weeks gestation in July 2000. She was clinically euthyroid and there was no goiter. Menses was regular with oral contraception. Thyroid function was rechecked with free T4 7.9 pmol/1 (NR 10.2-19.6 pmol/1) and TSH 5.44 mIU/l (NR 0.3-4 mIU/l). Further inquiry revealed that she had been taking a weight reducing drug since December 1999 for fear of potential weight gain during pregnancy. This was identified to be Tri-iodothyroacetic acid (Triac). Serial thyroid function tests showed gradual recovery of thyroid function after Triac was stopped.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
14/47. seizures and the pituitary gland during pregnancy.We present the anaesthetic management of a woman who, at 10 days post partum, suffered a series of convulsions in the context of two episodes of post partum haemorrhage. The probable aetiology of the convulsions is discussed.- - - - - - - - - - ranking = 4keywords = pregnancy (Clic here for more details about this article) |
15/47. Spontaneous pregnancy and partial recovery of pituitary function in a patient with Sheehan's syndrome.Sheehan's syndrome is caused by pregnancy-related hemorrhage leading to ischemic necrosis of the anterior pituitary gland and hypopituitarism. Spontaneous pregnancy in Sheehan's syndrome is very rare. We report the case of a patient with Sheehan's syndrome who suffered from anterior pituitary insufficiency, but with sparing of gonadotropic function. The patient became pregnant spontaneously and, after her second delivery, thyrotropic function recovered. However, the patient's growth hormone and cortisol levels remained unresponsive to an insulin-tolerance test. This case demonstrates that pituitary function may recover from less extensive pituitary ischemia. We emphasize the importance of early identification of pregnancy in such cases. It is crucial to institute adequate hormone-replacement therapy during pregnancy, since hypopituitarism is associated with high fetal and maternal morbidity and mortality.- - - - - - - - - - ranking = 8keywords = pregnancy (Clic here for more details about this article) |
16/47. Lymphocytic hypophysitis.Lymphocytic hypophysitis (LH) is a rare but increasingly recognized inflammatory disorder of the pituitary, usually associated with pregnancy. knowledge of this condition is largely anecdotal; the cause, incidence, and natural history are unknown. Cases are usually discovered at biopsy and surgical intervention for a presumptive pituitary neoplasm. Here we describe two cases of lymphocytic hypophysitis. In the first case the patient underwent surgery for presumptive adenoma, and pathology at resection established the diagnosis of lymphocytic hypophysitis. The second case was strongly suspicious for LH by history, endocrine profile, and imaging, and was managed nonoperatively. Though magnetic resonance imaging (MRI) features are not diagnostic, knowledge of imaging features together with clinical history may permit avoidance of surgery.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
17/47. pregnancy in a patient with hypopituitarism following surgery and radiation for a pituitary adenoma.This is a case of partial hypopituitarism resulting from surgery and radiation for a non- functioning pituitary macroadenoma. The patient had amenorrhea which was secondary to hypogonadotrophic hypogonadism and had been on L-thyroxine for central hypothyroidism. For pregnancy, ovulation was induced by gonadotrophins and this was followed by an intrauterine insemination. The antenatal period was uneventful and a Caesarean section was done at 33 weeks when the patient presented with preterm labour. Both infant and mother are well, eight months after delivery.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
18/47. Hypophysitis associated with a ruptured Rathke's cleft cyst in a woman, during pregnancy.We report the case of a 29-yr-old woman who first presented an aseptic meningitis at the beginning of a pregnancy. She was admitted one month later with headaches and vomiting. Panhypopituitarism with diabetes insipidus was diagnosed. Magnetic resonance imaging (MRI) data suggested the existence of lymphocytic infundibulohypophysitis, with inflammation of the suprasellar area. No new symptoms were noticed until 6 months later when this patient pointed out troubles of the visual field, due to a compression of the optic chiasma. Three boluses of 1 g methylprednisolone were prescribed, with no effects. After delivery, the defects of the visual field increased. A neurosurgical intervention was decided. diagnosis of Rathke's cleft cyst (RCC) was made. We concluded that this patient presented a rupture of a RCC, which occurred at the beginning of pregnancy, associated later with panhypopituitarism with diabetes insipidus, due to a probable hypophysitis. The end of the pregnancy was marked by consequences of an increased volume of the RCC. To our knowledge, this case is the first described during pregnancy.- - - - - - - - - - ranking = 8keywords = pregnancy (Clic here for more details about this article) |
19/47. pregnancy-induced changes in insulin-like growth factor i (IGF-I), insulin-like growth factor binding protein 3 (IGFBP-3), and acid-labile subunit (ALS) in patients with growth hormone (GH) deficiency and excess.BACKGROUND: Under most circumstances with altered growth hormone (GH) secretion, the changes of insulin-like growth factor i (IGF-I), insulin-like growth factor binding protein 3 (IGFBP-3), and acid-labile subunit (ALS) are in parallel. The aim of the present study was to compare the effects of pregnancy in a hypopituitary patient with those of pregnancy in an acromegalic patient on IGF-I, IGFBP-3, and ALS. methods AND RESULTS: IGF-I and ALS were low before pregnancy in the hypopituitary patient under glucocorticoid and thyroxine treatment. Gonadotropin treatment allowed her to become pregnant; IGF-I and ALS levels rose in the second half of pregnancy and fell again after delivery. IGF-I concentrations were elevated in the patient with persistent acromegaly before and dropped into the normal range during the first half of pregnancy. In the second half of pregnancy and following delivery, IGF-I levels increased again. IGFBP-3 levels (as assessed by immunoblot analysis as well as by 125I-IGF II ligand blotting) decreased markedly during pregnancy in both patients, suggesting that the placenta rather than pituitary GH regulates IGFBP-3 proteolysis in human pregnancy. The increase of IGF-I (and ALS) during the second half of pregnancy in the individual with pituitary GH deficiency may be attributed to placental GH. The fall of IGF-I (and ALS) into the normal range in the acromegalic patient during the first trimester of pregnancy may be related to decreased production or decreased half-life of these proteins. CONCLUSION: Our data suggest that measures to continuously replace GH or to suppress GH secretion during pregnancy in patients with GH deficiency or excess, respectively, may not be warranted.- - - - - - - - - - ranking = 11keywords = pregnancy (Clic here for more details about this article) |
20/47. Sellar granulomatous mass in a pregnant woman with active Crohn's disease.At the end of her third pregnancy, a woman with a history of chronic active proctocolitis which had been diagnosed as Crohn's disease complained of deterioration of visual acuity. The patient was found to have hypopituitarism and progressive bitemporal hemianopia caused by an intrasellar mass with suprasellar extension. At transsphenoidal surgery an intrasellar granuloma was found without remnants of pituitary tissue. This sellar granuloma could have been an extra-intestinal granuloma of Crohn's disease. However, the possibility that giant cell granulomatous hypophysitis had been present was considered more likely. The occurrence of this disorder in the postpartum period has not been reported before.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
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