11/86. hypopituitarism following closed head injury.We describe four young patients (age 19-34 years) with hypopituitarism following closed head injury. The diagnosis was made by demonstration of low basal pituitary hormone levels and dynamic tests showing low pituitary reserve. The time interval between the injury and diagnosis of hypopituitarism was between three weeks and two months demonstrating the difficulty and complexity of making this diagnosis. Three of our patients (all patients suffering from anterior pituitary hormone deficiency) had ACTH deficiency, a condition which may be life threatening if left undiagnosed; these patients also demonstrated central hypothyroidism. Hypogonadotrophic hypogonadism occurred in three of the patients and was treated with hormonal replacement. diabetes insipidus was the only insult in one of our patients, accompanied other hormonal deficits in two, and did not appear at all in another patient. Information about skull damage was available for three of the patients, and included skull base and facial bone fractures, probably reflecting the extent of injury necessary to cause hypopituitarism. All patients regained normal lives with adequate hormonal replacement therapy.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
12/86. hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.OBJECTIVE: The causes of hypopituitarism in adult life are most frequently cerebral tumors, pituitary infarction, head trauma, pituitary surgery, or irradiation. We report a case of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm. Two previous cases after the rupture of a cerebral aneurysm have been reported. DESIGN: Case report. patients: One 42-yr-old man. MEASUREMENTS AND MAIN RESULTS: A 42-yr-old man was admitted as an emergency for unconsciousness. The computed tomography showed a massive subarachnoid hemorrhage, and specific angiography showed an aneurysm in the internal carotid. The aneurysm was successfully clipped through craniotomy. The patient's hospital course was marked by a few episodes of pulmonary infection, and a tracheotomy was performed. The patient was transferred to the rehabilitation unit; he received a rating of 9 on the glasgow coma scale. Seven months after rupture of the aneurysm, the patient was readmitted to the intensive care unit for septic shock, with pulmonary infection associated with vomiting and diarrhea. Despite standard therapy and inotropic support, there was no improvement of his clinical condition. Adrenal failure was then suspected. Treatment was started immediately with hydrocortisone (50 mg) four times a day. Within hours, his clinical condition improved. The following month, the patient was weaned off his tracheotomy and had nearly recovered. Endocrine tests confirmed the cortisol insufficiency but also hypothyroidism and hypogonadotropic hypogonadism secondary to hypopituitarism. CONCLUSION: Our case is the first one reported of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.- - - - - - - - - - ranking = 0.003814673999672keywords = trauma (Clic here for more details about this article) |
13/86. A case of hypopituitarism with diabetes insipidus and loss of thirst. role of antidiuretic hormone and angiotensin ii in the control of urine flow and osmolality.A 20-yr-old male was found to have diabetes insipidus is association with panhypopituitarism but without any focal neurological lesion being identified. He was initially treated with steroid supplements, the features of diabetes insipidus being controlled with a thiazide diuretic. Eighteen months later the patient lost thirst sensation and stopped treatment, subsequently being re-admitted with severe dehydration, oliguria and focal neurological signs. Further investigation, including brain biopsy, confirmed the presence of an atypical pinealoma which was considered inoperable. Measurements of plasma antidiuretic hormone (ADH) and angiotensin ii (AII) concentrations during the severe dehydration showed very high levels of AII, but inappropriately low plasma ADH levels for the severity of dehydration. We consider that the evidence obtained from this case supports the view that the oliguria with hypertonic urine present during severe dehydration was due to a direct renal action of the very high AII levels, possibly supplemented by the residual ADH secretion.- - - - - - - - - - ranking = 0.53377401225969keywords = brain (Clic here for more details about this article) |
14/86. Infundibulohypophysitis in a man presenting with diabetes insipidus and cavernous sinus involvement.Infundibulohypophysitis is an unusual inflammatory condition that affects the infundibulum, the pituitary stalk, and the neurohypophysis and may be part of a range that includes lymphocytic hypophysitis. Lymphocytic hypophysitis occurs mainly in women and most often presents in the later stages of pregnancy. Infundibulohypophysitis usually presents with diabetes insipidus and the cause remains unclear. The case of a 46 year old man with a 12 week history of polyuria and polydipsia is reported. Cranial diabetes insipidus was diagnosed on the basis of a water deprivation test. Initial cranial and pituitary imaging studies were normal. He subsequently developed symptoms of panhypopituitism over a period of 6-9 months and then, more acutely, developed diplopia secondary to a fourth nerve palsy. Further brain imaging studies disclosed an enhancing pituitary stalk and a left cavernous sinus lesion. An initial trial of immunosuppressive treatment did not help symptoms significantly. The diagnosis of infundibulohypophysitis was made on histological evidence. The patient was treated with prednisolone and methotrexate. At 9 months he is well, without symptoms, and the radiological abnormalities have resolved.- - - - - - - - - - ranking = 0.53377401225969keywords = brain (Clic here for more details about this article) |
15/86. Traumatic hypopituitarism due to maternal uterine leiomyomas.hypopituitarism has been associated with different types of head trauma including traumatic delivery. We report a case of hypopituitarism in a boy with a history of induced traumatic labor associated with maternal uterine leiomyomas. He also had head and face deformations that were apparently caused by spatial restriction due to the enlarging leiomyomas while the patient was growing in utero. Trauma to the pituitary stalk could have occurred by cerebral entrapment and the pressures of labor. Although hypopituitarism has been associated with traumatic delivery and breech delivery, there are no reported cases related to uterine leiomyomas.- - - - - - - - - - ranking = 0.015258695998688keywords = trauma (Clic here for more details about this article) |
16/86. Hypophyseal hemorrhage and panhypopituitarism during puumala virus infection: magnetic resonance imaging and detection of viral antigen in the hypophysis.We describe 3 cases of nephropathia epidemica (NE) that confirm that puumala virus infection may cause hypophyseal injury. autopsy revealed a hemorrhagic hypophysis positive for puumala virus antigen in both neuroendocrine stromal and vascular endothelial cells in 1 patient, and 2 patients developed hypophyseal hemorrhage (diagnosed with magnetic resonance imaging) during or shortly after acute NE, both of whom developed panhypopituitarism.- - - - - - - - - - ranking = 0.14285714285714keywords = injury (Clic here for more details about this article) |
17/86. Anterior hypopituitarism with unusual delayed onset of diabetes insipidus after penetrating head injury.Neuroendocrine dysfunctions are among the various complications that occur after traumatic brain injury. We report a case of onset of diabetes insipidus during acute rehabilitation of a 20-yr-old patient with a traumatic brain injury caused by a gunshot wound. Our case is the latest onset of diabetes insipidus after traumatic brain injury that has been reported in the literature.- - - - - - - - - - ranking = 65.752667644419keywords = traumatic brain injury, brain injury, traumatic brain, brain, injury, trauma (Clic here for more details about this article) |
18/86. A 43-year-old male with untreated panhypopituitarism due to absence of the pituitary stalk: from dwarf to giant.A 43-yr-old male was referred because of an x-ray made after a fall, which showed open epiphysis of the arm. The man had always been short for his age; during childhood he once consulted a pediatrician because of short stature, but thereafter he never sought medical attention. At age 18 yr he was not allowed to join the army because of his height of 147 cm. He continued to grow steadily and finally reached 193 cm. He had no complaints and considered himself reasonably fit. physical examination showed a disproportional man with a body mass index of 29.3 kg/m(2) and Tanner stage P1G1. Laboratory investigations showed hormone levels consistent with multiple pituitary deficiency, with dynamic tests consistent with hypothalamic or pituitary stalk disease. Magnetic resonance scanning of the brain showed a small anterior pituitary remnant, no pituitary stalk, and an ectopic neurohypophysis. This case of untreated panhypopituitarism shows a particular growth curve with an average growth velocity of 2 cm/yr, resembling patients with estrogen receptor mutation or aromatase deficiency. A literature study of other adult patients with untreated panhypopituitarism shows a variable growth pattern. Some speculations about possible reasons for this variability in clinical characteristics are presented.- - - - - - - - - - ranking = 0.53377401225969keywords = brain (Clic here for more details about this article) |
19/86. Osmotic demyelination syndrome: reversible MRI findings in bilateral cortical lesions.A 70-year-old man who suffered from osmotic demyelination syndrome (ODS) is presented. dyspnea, pseudobulbar palsy and motor weakness were seen. MRI in the acute stage revealed focal abnormal high-signal lesions in the pons, thalamus and bilateral cortical areas on T1-weighted and FLAIR images. With corticosteroid therapy he recovered from his dyspnea and severe pseudobulbar palsy, and the spastic quadriplegia gradually improved. One year later the brain lesions had disappeared on T1-, T2-weighted and FLAIR images. To detect the cortical or subcortical lesions in ODS, FLAIR imaging should be performed routinely.- - - - - - - - - - ranking = 0.53377401225969keywords = brain (Clic here for more details about this article) |
20/86. A homozygous mutation in HESX1 is associated with evolving hypopituitarism due to impaired repressor-corepressor interaction.The paired-like homeobox gene expressed in embryonic stem cells Hesx1/HESX1 encodes a developmental repressor and is expressed in early development in a region fated to form the forebrain, with subsequent localization to Rathke's pouch, the primordium of the anterior pituitary gland. Mutations within the gene have been associated with septo-optic dysplasia, a constellation of phenotypes including eye, forebrain, and pituitary abnormalities, or milder degrees of hypopituitarism. We identified a novel homozygous nonconservative missense mutation (I26T) in the critical Engrailed homology repressor domain (eh1) of HESX1, the first, to our knowledge, to be described in humans, in a girl with evolving combined pituitary hormone deficiency born to consanguineous parents. neuroimaging revealed a thin pituitary stalk with anterior pituitary hypoplasia and an ectopic posterior pituitary, but no midline or optic nerve abnormalities. This I26T mutation did not affect the dna-binding ability of HESX1 but led to an impaired ability to recruit the mammalian Groucho homolog/transducin-like enhancer of split-1 (Gro/TLE1), a crucial corepressor for HESX1, thereby leading to partial loss of repression. Thus, the novel pituitary phenotype highlighted here appears to be a specific consequence of the inability of HESX1 to recruit Groucho-related corepressors, suggesting that other molecular mechanisms govern HESX1 function in the forebrain.- - - - - - - - - - ranking = 1.6013220367791keywords = brain (Clic here for more details about this article) |
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