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Almajali F, Almajali M, Schwetye K, Alexopoulos G, Khan M, Coppens J, Mercier P. IgG4-negative pituitary inflammatory pseudotumor with sphenoidal involvement resembling a macroadenoma. Br J Neurosurg 2023; 37:1886-1892. [PMID: 33063545 DOI: 10.1080/02688697.2020.1834509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Inflammatory pseudotumors (IPTs) are rare benign conditions of unknown etiology that can affect any part of the body. IPTs are most commonly associated with Immunoglobulin G4 (IgG4)-related disease. Central nervous system IPTs, especially with pituitary involvement, are even rarer entities. The presence of an IgG4-negative pituitary IPT with simultaneous extracranial involvement has not been reported. CASE REPORT We present the case of a 41-year-old female with past medical history of rheumatoid arthritis and a diagnosis of pituitary IPT with coexisting sphenoidal (extracranial) involvement mimicking a pituitary macroadenoma at presentation. The patient underwent multiple consecutive biopsies, and an extensive workup prior to establishing the diagnosis. Laboratory work-up showed normal serum IgG4 and unremarkable liver function tests. CONCLUSION Pituitary lesions with simultaneous sphenoidal involvement in patients with IgG4-negative systemic inflammatory disease should raise the clinical suspicion for intracranial IPTs, as these tumors can mimic aggressive counterparts causing adjacent bony erosion, and local invasion.
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Affiliation(s)
- Fawwaz Almajali
- Department of Neurology, Saint Louis University, St. Louis, MO, USA
| | | | - Kate Schwetye
- Department of Pathology, Saint Louis University, St. Louis, MO, USA
| | | | - Maheen Khan
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
| | - Jeroen Coppens
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
| | - Philippe Mercier
- Department of Neurosurgery, Saint Louis University, St. Louis, MO, USA
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2
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Lojou M, Bonneville JF, Ebbo M, Schleinitz N, Castinetti F. IgG4 hypophysitis: Diagnosis and management. Presse Med 2020; 49:104016. [PMID: 32234384 DOI: 10.1016/j.lpm.2020.104016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/13/2019] [Indexed: 02/06/2023] Open
Abstract
IgG4-related hypophysitis is a rare disease, due to a lymphoplasmocytic IgG4 positive infiltration of the pituitary. Literature data are scarce, even though the description of cases has drastically increased over the last years. The aim of this review is to better characterize the natural history, the diagnosis and the management of IgG4-related hypophysitis, based on a clinical case, an exhaustive Pubmed research, and a reappraisal of the criteria for diagnosis. We will specifically focus on the differences with other etiologies of hypophysitis, in the aim of improving the diagnostic procedures for all the physicians who could have to take care of such patients.
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Affiliation(s)
- M Lojou
- Inserm, U1251, CRMR HYPO, department of endocrinology, Aix-Marseille université, La Conception hospital, AP-HM, 147, boulevard Baille, Marseille, France
| | - J F Bonneville
- Departments of endocrinology and medical imaging, centre hospitalier universitaire de Liège, Liège, Belgium
| | - M Ebbo
- Département de médecine interne, Timone, Aix-Marseille université, AP-HM, 13005 Marseille, France
| | - N Schleinitz
- Département de médecine interne, Timone, Aix-Marseille université, AP-HM, 13005 Marseille, France
| | - F Castinetti
- Inserm, U1251, CRMR HYPO, department of endocrinology, Aix-Marseille université, La Conception hospital, AP-HM, 147, boulevard Baille, Marseille, France.
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3
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Liu Y, Wang L, Zhang W, Pan H, Yang H, Deng K, Lu L, Yao Y, Chen S, Chai X, Feng F, You H, Jin Z, Zhu H. Hypophyseal Involvement in Immunoglobulin G4-Related Disease: A Retrospective Study from a Single Tertiary Center. Int J Endocrinol 2018; 2018:7637435. [PMID: 29755523 PMCID: PMC5883929 DOI: 10.1155/2018/7637435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/08/2017] [Accepted: 10/18/2017] [Indexed: 12/20/2022] Open
Abstract
This study aims to outline the clinical features and outcomes of IgG4-related hypophysitis (IgG4-RH) patients in a tertiary medical center. We reviewed clinical manifestations and imaging and pituitary function tests at baseline, as well as during follow-up. Ten patients were included. The mean age at diagnosis of IgG4-RH was 48.4 (16.0-64.0) years. An average of 3 (0-9) extrapituitary organs were involved. Five patients had panhypopituitarism, three had only posterior hypopituitarism, one had only anterior hypopituitarism, and one had a normal pituitary function. One patient in our study had pituitary mass biopsy, lacking IgG4-positive cells despite lymphocyte infiltration forming an inflammatory pseudotumor. Five patients with a clinical course of IgG4-RH less than nine months and a whole course of IgG4-RD less than two years were managed with glucocorticoids, while three patients with a longer history were administered glucocorticoids plus immunosuppressive agents. One patient went through surgical excision, and one patient was lost to follow-up. All patients showed a prompt response clinically, but only three patients had normalized serum IgG4 levels. Two patients who took medications for less than six months relapsed. Conclusions. IgG4-RD is a broad disease, and all physicians involved have to be aware of the possibility of pituitary dysfunction. Younger patients should be expected. The histopathological feature of pituitary gland biopsy could be atypical. For patients with a longer history, the combination of GC and immunosuppressive agents is favorable. Early and adequate courses of treatment are crucial for the management of IgG4-RH. With GC and/or immunosuppressant treatment, however, pituitary function or diabetes insipidus did not improve considerably.
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Affiliation(s)
- Yang Liu
- Department of Neurosurgery, Peking Union Medical College, Beijing 100730, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College, Beijing 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College, Beijing 100730, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College, Beijing 100730, China
| | - Shi Chen
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Xiaofeng Chai
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Zimeng Jin
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health and Family Planning Commission, Department of Endocrinology, Peking Union Medical College, Beijing 100730, China
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Sarı E, Ataş E, Bulut EB, Sarı S, Akın O, Saldır M, Karslıoğlu Y, Yeşilkaya E. Inflammatory Myofibroblastic Tumor Presenting with Diabetes Insipidus in an Eight-Year-Old Boy: A Case Report. J Clin Res Pediatr Endocrinol 2015; 7:340-3. [PMID: 26777048 PMCID: PMC4805229 DOI: 10.4274/jcrpe.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMT) develop as a non-neoplastic proliferation of myofibroblasts in a myxoid to collagenous stroma admixed with inflammatory cells. The symptoms depend on the specific location of the tumor, which can be anywhere, but is particularly in the respiratory system. Thus, patients with IMT can present with a variety of findings. A pediatric patient with IMT who presented with cough, breathlessness, polyuria-polydipsia, and convulsions is described in this report.
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Affiliation(s)
- Erkan Sarı
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey Phone: +90 312 304 43 65 E-mail:
| | - Erman Ataş
- Gülhane Military Medicine Academy, Department of Pediatric Oncology, Ankara, Turkey
| | - Engin Burak Bulut
- Gülhane Military Medicine Academy, Department of Pediatric Surgery, Ankara, Turkey
| | - Sebahattin Sarı
- Gülhane Military Medicine Academy, Department of Radiology, Ankara, Turkey
| | - Onur Akın
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Mehmet Saldır
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | | | - Ediz Yeşilkaya
- Gülhane Military Medicine Academy, Department of Pediatric Endocrinology, Ankara, Turkey
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5
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Leporati P, Landek-Salgado MA, Lupi I, Chiovato L, Caturegli P. IgG4-related hypophysitis: a new addition to the hypophysitis spectrum. J Clin Endocrinol Metab 2011; 96:1971-80. [PMID: 21593109 PMCID: PMC3135201 DOI: 10.1210/jc.2010-2970] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT Hypophysitis is a chronic inflammation of the pituitary gland that comprises an increasingly complex clinicopathological spectrum. Within this spectrum, lymphocytic and granulomatous hypophysitis are the most common forms, but newer variants have recently been reported. OBJECTIVE The aims of the study were to describe a new patient with IgG4-related hypophysitis, review the published literature, and provide diagnostic criteria. SETTING A 75-yr-old man presented with a 1-yr history of frontal headache. Initial studies revealed panhypopituitarism and a mass in both the sella turcica and the sphenoidal sinus. The patient underwent transphenoidal surgery, initiated high-dose prednisone followed by hormone replacement therapy, and was closely monitored for 3 yr. RESULTS Symptoms improved after prednisone, along with shrinkage of the pituitary and sphenoidal masses, but recurred when prednisone dose was lowered. Histopathology showed a marked mononuclear infiltrate in both the pituitary and sphenoidal specimens, mainly characterized by increased numbers of plasma cells. Many of the infiltrating plasma cells (>10 per high-power field) were IgG4-positive. Review of the literature identified 11 cases of IgG4-related hypophysitis (two diagnosed based on pituitary histopathology). CONCLUSIONS We describe the first Caucasian patient with biopsy-proven IgG4-related hypophysitis and provide classification criteria for this disease.
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Affiliation(s)
- Paola Leporati
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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6
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Taskapilioglu O, Yurtogullari S, Yilmaz E, Hakyemez B, Yilmazlar S, Tolunay S, Turan F, Bora I. Isolated sixth nerve palsy due to plasma cell granuloma in the sphenoid sinus: case report and review of the literature. Clin Neuroradiol 2011; 21:235-8. [PMID: 21360227 DOI: 10.1007/s00062-011-0054-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
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7
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Sellar inflammatory mass with inflammatory bowel disease. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2010; 24:58-60. [PMID: 20186358 DOI: 10.1155/2010/650692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inflammatory bowel disease may be associated with different intracranial disorders. An inflammatory sellar mass is very rare but includes a variety of noninfectious causes including lymphocytic hypophysitis, granulomatous inflammation and Wegener's granulomatosis. A 32-year-old man was diagnosed with an inflammatory sellar mass associated with an extensive colonic inflammatory process clinically characteristic of Crohn's disease. The concurrent onset of these inflammatory disorders in distinctly separate sites may reflect their common embryological origin or represent an unusual form of metastatic Crohn's disease. Further studies are needed to determine if less overt or focal sellar inflammatory processes occur in inflammatory bowel disease, particularly in Crohn's disease because their occurrence may be critically relevant for long-term management.
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8
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Yamagami K, Yoshioka K, Isaka Y, Inoue T, Hosoi M, Shakudo M, Iwai Y, Sato T. A case of hypopituitarism due to inflammatory myofibroblastic tumor of the sella turnica. Endocr J 2008; 55:339-44. [PMID: 18379128 DOI: 10.1507/endocrj.k07e-047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
An 18-year-old man with 4-year history of central diabetes insipidus and partial pituitary dysfunction was admitted to our hospital because of headache and nasal discharge. Magnetic resonance imaging (MRI) revealed abnormal mass in the sella turnica invading into the cavernous sinus and sinus maxillaries along with thickened tentorium cerebelli. Histopathology of the mass in the sinus maxillaries revealed spindle-shaped cells arranged in a fascicular pattern with varied myxoid and collagenized regions with various inflammatory cells. Immunostaining revealed the spindle-shaped cells were positive for smooth muscle actin. These features were identical to those of inflammatory myofibroblastic tumor (IMT). He was diagnosed with IMT in the sella turnica and other regions. Corticosteroid therapy improved clinical symptoms and follow-up MRI revealed amelioration of the thickened tentorium cerebelli. However, the other lesions were unchanged and pituitary dysfunction did not improve. Although rare, IMT should be considered in the differential diagnosis of a sellar mass. Early treatment with corticosteroid therapy may reduce the risk of disease progression.
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Affiliation(s)
- Keiko Yamagami
- Department of Endocrinology and Metabolism, Osaka City General Hospital, Miyakojima-ku, Osaka, Japan
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9
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Rathke’s cleft cyst rupture as potential initial event of a secondary perifocal lymphocytic hypophysitis: proposal of an unusual pathogenetic event and review of the literature. Neurosurg Rev 2008; 31:157-63. [DOI: 10.1007/s10143-008-0120-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 09/19/2007] [Accepted: 11/11/2007] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Lymphocytic hypophysitis is a disorder of the pituitary gland that presents as a sellar mass lesion and/or hypopituitarism. It causes pituicyte destruction and hypopituitarism and is speculated to have an autoimmune basis. DIAGNOSIS Lymphocytic hypophysitis should be considered in the differential diagnosis of pituitary masses and/or hypopituitarism in females who are pregnant or in the early postpartum period, especially in cases associated with other autoimmune diseases or unusual patterns of hormone deficiencies. A definitive diagnosis requires tissue biopsy. A presumptive clinical diagnosis can be made based on a history of gestational or postpartum hypopituitarism, a contrast-enhancing sellar mass with imaging features characteristic of lymphocytic hypophysitis, a pattern of pituitary hormone deficiency with early loss of adrenocorticotrophic hormone and thyroid-stimulating hormone unlike that typically found with macroadenomas, relatively rapid development of hypopituitarism and a degree of pituitary failure disproportionate to the size of the mass. Symptoms resulting from partial or panhypopituitarism occur in approximately 80% of cases and multiple deficiencies are found in approximately 75% of cases. MANAGEMENT Appropriate management remains controversial. Corticosteroid therapy has been advocated as a means of attenuating inflammation, but given the uncertainty of its efficacy and the known adverse effects, such therapy does not seem justified for most patients. The optimal surgical strategy involves partial resection of the mass to decompress the surrounding structures. All patients with lymphocytic hypophysitis require appropriate replacement therapy for deficient hormones. Long-term follow-up is mandatory to monitor for the development of other hormonal deficits.
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Affiliation(s)
- Mark E Molitch
- Division of Endocrinology, Metabolism, and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill. 60611, USA.
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11
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Skierczynski PA, Goodman JM, Signal P, Payner TD, Bonnin JM. Idiopathic hypertrophic pachymeningitis resulting in delayed panhypopituitarism. Endocr Pract 2007; 13:481-6. [PMID: 17872350 DOI: 10.4158/ep.13.5.481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe an adult man with idiopathic hypertrophic pachymeningitis (IHPM) that progressed to involve the pituitary gland and caused hypopituitarism 6 years after the onset of the first symptom. METHODS We describe the slow 6-year progression of IHPM in a man being treated with steroids, radiation, and antineoplastic medications and present clinical, pathologic, and imaging data. The pertinent literature is also reviewed. RESULTS A 35-year-old man who presented with headaches, pain, and sensory loss on the right side of his face had thickened, inflamed dura without granulomas. Initially, the right middle fossa, the lateral wall of the right cavernous sinus, and the tentorium were involved. Results from a dural biopsy specimen were consistent with IHPM. His symptoms were only partially controlled with continuous high-dose steroids, cyclophosphamide, azathioprine, and radiation therapy. IHPM was diagnosed based on findings from an open brain biopsy. Other pathologic causes of inflammatory dural thickening were excluded. Six years after the onset of the first clinical manifestation of IHPM, the patient developed panhypopituitarism. Magnetic resonance imaging showed that the inflammatory process had invaded the pituitary gland. IHPM was confirmed by findings from transsphenoidal biopsy. CONCLUSION IHPM is a rare disorder characterized by an unexplained inflammatory thickening of the dura at the skull base. The usual clinical symptoms are intractable headache and cranial nerve palsies. Physicians must be aware that IHPM can be slowly progressive despite attempted treatment, and that the disease process can invade the sella with dysfunction of both the anterior and the posterior pituitary gland.
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Affiliation(s)
- Paul A Skierczynski
- The Division of Endocrinology, Diabetes, and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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Favier I, Haan J, van Duinen SG, Ferrari MD. Typical cluster headache caused by granulomatous pituitary involvement. Cephalalgia 2007; 27:173-6. [PMID: 17257239 DOI: 10.1111/j.1468-2982.2007.01268.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A young woman had typical cluster headache attacks and a pituitary mass lesion. The headache attacks resolved after transsphenoidal resection of the tumour, which was diagnosed as a granulomatous inflammation. The association between cluster headache and granulomatous enlargement of the pituitary gland has never been described before. This case reinforces the growing evidence that even in typical cases of cluster headache, neuroimaging is mandatory to exclude structural lesions.
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Affiliation(s)
- I Favier
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.
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13
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Kartal I, Yarman S, Tanakol R, Bilgic B. Lymphocytic panhypophysitis in a young man with involvement of the cavernous sinus and clivus. Pituitary 2007; 10:75-80. [PMID: 17273922 DOI: 10.1007/s11102-007-0003-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lymphocytic hypophysitis is an unusual inflammatory lesion that is caused by autoimmune destruction of the pituitary gland. We report a case of 42-year-old man who presented with a 6-month history of severe headache, blurred vision in the right eye, hearing loss, polyuria, polydipsia, and impotence. Medical history showed that he and his mother had osteopetrosis. The results of the physical examination and laboratory tests showed that secondary hypothyroidism, hypogonadism, and hypocortisolism had developed. Central diabetes insipidus was diagnosed by water deprivation test. MRI of the sella showed pituitary enlargement with symmetrical suprasellar expansion, compression of the chiasma, thickened infundibulum, and involvement of both bilateral cavernous sinuses and clivus. Hormonal substitution with hydrocortisone, levothyroxine, and DDAVP resulted in rapid improvement of all symptoms and signs. Transsphenoidal biopsy was diagnostic of lymphocytic hypophysitis. In spite of extensive literature reviewing, we have not been aware of any case of lymphocytic hypophysitis with clivus involvement. The present case represents a variant of lymphocytic hypophysitis which has progressed to involve bilateral cavernous sinuses and the clivus.
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Affiliation(s)
- Ilkay Kartal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Istanbul, Turkey.
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14
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Lachenal F, Cotton F, Desmurs-Clavel H, Haroche J, Taillia H, Magy N, Hamidou M, Salvatierra J, Piette JC, Vital-Durand D, Rousset H. Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature. J Neurol 2006; 253:1267-77. [PMID: 17063320 DOI: 10.1007/s00415-006-0160-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Accepted: 10/31/2005] [Indexed: 12/29/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown etiology that affects multiple organs. We report 6 cases of ECD with neurological involvement and neuroradiological abnormalities on brain MRI. A literature review revealed 60 other cases of ECD with neurological involvement. We therefore analyzed 66 ECD patients with neurological involvement. Cerebellar and pyramidal syndromes were the most frequent clinical manifestations (41% and 45% of cases), but seizures, headaches, neuropsychiatric or cognitive troubles, sensory disturbances, cranial nerve paralysis or asymptomatic lesions were also reported. Neurological manifestations were always associated with other organ involvement, especially of bones (at least 86%) and diabetes insipidus (47%). Neurological involvement was responsible for severe functional handicaps in almost all patients and was responsible for the death of 6 of the 66 patients (9%). Neuroradiological findings could be separated into three patterns: the infiltrative pattern (44%), with widespread lesions, nodules or intracerebral masses, the meningeal pattern (37%), with either thickening of the dura mater or meningioma-like tumors, and the composite pattern (19%), with both infiltrative and meningeal lesions.
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Affiliation(s)
- Florence Lachenal
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, 69495, Pierre-Bénite, Cedex, France.
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15
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Schlienger JL, Delemer B, Vinzio S. [Impact of systemic disease on the pituitary gland]. ANNALES D'ENDOCRINOLOGIE 2006; 67:316-24. [PMID: 17072236 DOI: 10.1016/s0003-4266(06)72605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Systemic diseases located in hypothalamo-pituitary region can slowly induce pituitary deficiency, diabetes insipidus and morphological abnormalities. The aim of this study is to review recent clinical data about diagnosis of these rare diseases, with a focus on granulomatous diseases: histiocytosis and sarcoidosis. Recent clinical studies on histiocytosis have improved our knowledge about endocrine expression of the disease in children and in adults as well. Diabetes insipidus is the most frequent condition, described mainly in children. GH deficiency is the most frequent pituitary deficit in children and adult patients. During neurosarcoidosis, diabetes insipidus is the most frequent condition and gonadotropic deficiency is the most frequent deficit but GH has not been systematically studied. MRI allows visualisation of some lesions and is very useful to follow the disease course. Diagnosis of these diseases is made by clinical evaluation of all the sites and by pathological analysis of biopsies of peripheral lesions. While pituitary hormone replacement therapy does not seem to raise specific problems in these diseases, etiological treatments are not yet available and indications for antimitotic or immunomodulatory treatment are sometimes discussed.
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Affiliation(s)
- J L Schlienger
- Service de Médecine Interne--Nutrition, CHU de Strasbourg, Hôpital de Hautepiere, 1 avenue Molière BP 426, 67098 Strasbourg Cedex, France
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16
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Melgar MA, Mariwalla N, Gloss DS, Walsh JW. Recurrent lymphocytic hypophysitis and bilateral intracavernous carotid artery occlusion. an observation and review of the literature. Neurol Res 2006; 28:177-83. [PMID: 16551436 DOI: 10.1179/016164105x39996] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Bilateral carotid artery occlusion associated with lymphocytic hypophysitis is exceedingly rare. We describe this association and review the literature. METHODS The authors describe a 38-year-old woman with a history of severe headaches. Magnetic resonance (MR) imaging showed an intrasellar mass with invasion of both cavernous sinuses. Lymphocytic hypophysitis was diagnosed by transphenoidal biopsy. In the course of the disease, she developed symptoms of cerebral ischemia attributable to bilateral occlusion of her internal carotid arteries in both cavernous sinuses. She underwent bilateral superficial temporal artery-middle cerebral artery bypass surgery. RESULTS The patient experienced progressive neurological recovery after surgery. A literature search revealed no other cases describing this unique association. CONCLUSIONS Bilateral carotid artery occlusion may develop in the course of lymphocytic hypophysitis with cavernous sinus involvement. If indicated, cerebral revascularization should be performed to reverse cerebral ischemia.
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Affiliation(s)
- Miguel A Melgar
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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17
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Abstract
Lymphocytic hypophysitis (LYH) is a neuroendocrine disorder characterized by autoimmune inflammation of the pituitary gland with various degrees of pituitary dysfunction. The histopathology consists of an initial monoclonal lymphocytic infiltrate, which can heal with minimal sequela or progress to fibrosis and result in permanent hypopituitarism. Coexistence of other autoimmune conditions is reported in 25-50% of cases and pituitary autoantibodies have been detected in up to 70% of biopsy-proven cases. The clinical presentation varies depending on the pituitary segment that is more severely affected. In lymphocytic adenohypophysitis (LAH) an early destruction of the ACTH-producing cells is characteristic. Other anterior pituitary hormones can also be affected but posterior pituitary involvement is absent or minimum. Lymphocytic Infundibuloneurohypophysitis (LINH) typically presents as acute onset diabetes insipidus (DI) with intracranial mass-effect symptoms. A combination of extensive anterior pituitary involvement and DI characterizes lymphocytic Infudibulopanhypophysitis (LIPH). The diagnosis can be challenging in many cases, because distinction from pituitary adenomas and other sellar masses is not obvious. Significant efforts have been made to identify specific serum markers, but it would seem unlikely that this approach will ever have the specificity to replace histopathological examination of a surgical specimen. Diagnostic criteria have been proposed to help in the decision-making process and to avoid, whenever possible, unnecessary invasive procedures. The therapeutic approach is controversial and, although transsphenoidal surgery is often performed, a conservative medical management is justified in many cases, given the self-limited nature of the inflammatory process. This paper reviews the etiology, epidemiology, clinical and radiological findings, diagnosis and management of LYH.
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Affiliation(s)
- Juan-Andres Rivera
- Division of Endocrinology, McGill University and McGill University Health Centre, Montreal, Quebec, H3A 1A1, Canada
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Vittaz L, Ramanoelina J, Mahr A, Cohen R, Cohen P, Reach G, Guillevin L. [Pituitary involvement in Wegener's granulomatosis. Two cases]. Presse Med 2005; 33:1585-90. [PMID: 15687906 DOI: 10.1016/s0755-4982(04)98998-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Wegener's granulomatosis is a necrotizing vasculitis, usually localised in the upper respiratory track, lungs and kidneys. Less than 20 cases of pituitary involvement have been published, and many of them localized to anterior pituitary lesions, revealed by diabetes insipidus. OBSERVATION We report two cases of Wegener's granulomatosis, with anterior pituitary manifestations: the first patient exhibited diabetes insipidus, with secondary revelation of panhypopituitarism. In the second, the anterior pituitary involvement was manifested in the form of amenorrhoea and galactorrhoea. The outcomes followed the course of the systemic disease. DISCUSSION Endocrine manifestations can easily be occulted by the general symptoms of Wegener's granulomatosis, and systematic screening should be applied in cases of pituitary involvement.
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Affiliation(s)
- Laurence Vittaz
- Service de médecine interne et d'endocrinologie, Hôpital Avicenne, Bobigny
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Jochum W, Hänggi D, Bruder E, Jeck T, Novotny H, Probst A, Tolnay M. Inflammatory myofibroblastic tumour of the sella turcica. Neuropathol Appl Neurobiol 2005; 30:692-5. [PMID: 15541009 DOI: 10.1111/j.1365-2990.2004.00611.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Laurent S, Mouthon L, Longchampt E, Roudaire M, Franc S, Krivitzky A, Cohen R. Medical cure of plasma cell granuloma of the thyroid associated with Hashimoto's thyroiditis: a case report and review. J Clin Endocrinol Metab 2004; 89:1534-7. [PMID: 15070909 DOI: 10.1210/jc.2003-031355] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Plasma cell granuloma (PCG) is a rare, benign inflammatory tumor composed of myofibroblasts, abundant plasma cells, and lymphocytes combined with collagen. A thyroid localization of PCG is extremely rare, and surgical therapy is indicated. We report the case of a 35-yr-old woman with a thyroid PCG, associated with Hashimoto's thyroiditis, that was responsible for tracheal compression. Surgery was performed, but the thyroid could not be removed because of the fibrotic process. The patient was treated with corticosteroids and immunosuppressive therapy. Dyspnea and dysphagia improved within 1 month, whereas thyroid volume returned to normal within 3 yr. We also review other reports of thyroid PCG in the literature and discuss the differential diagnosis and treatment. Although the use of immunosuppressive therapy has never been reported for thyroid PCG until now, this treatment may represent a good alternative to surgery in life-threatening, unresectable PCG.
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Affiliation(s)
- Silvana Laurent
- Internal Medicine and Endocrinology Unit, University Paris XIII and Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, 93009 Bobigny, France
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Bisceglia M, Cammisa M, Suster S, Colby TV. Erdheim-Chester disease: clinical and pathologic spectrum of four cases from the Arkadi M. Rywlin slide seminars. Adv Anat Pathol 2003; 10:160-71. [PMID: 12717118 DOI: 10.1097/00125480-200305000-00004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Michele Bisceglia
- Servizio di Anatomia Patologica and dagger Dipartimento di Scienze Radiologiche, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
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Weidauer S, von Stuckrad-Barre S, Dettmann E, Zanella FE, Lanfermann H. Cerebral Erdheim-Chester disease: case report and review of the literature. Neuroradiology 2003; 45:241-5. [PMID: 12687308 DOI: 10.1007/s00234-003-0950-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2002] [Accepted: 12/24/2002] [Indexed: 11/30/2022]
Abstract
Erdheim-Chester disease is a rare systemic non-Langerhans histiocytosis of unknown etiology that affects multiple organ systems. Cerebral involvement is most often caused by extra-axial masses of foamy histiocytes, whereas intraparenchymal manifestations are less frequent. Review of the literature yielded a total of seven patients with increased signal intensities on T2-weighted images in both dentate nuclei and the peridentate regions. We report on a 44-year-old man with biopsy-proven Erdheim-Chester disease and slowly progressive cerebellar dysfunction. MRI showed additional symmetrical hyperintense signal changes in the superior cerebellar peduncle as well as in the trigonum lemnisci on coronal FLAIR images. The widespread neurological manifestations of cerebral Erdheim-Chester disease and differential diagnosis are discussed.
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Affiliation(s)
- Stefan Weidauer
- Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-1660528, Frankfurt, Germany.
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