Hypothalamus-Pituitary Dysfunction as an Independent Risk Factor for Postoperative Central Nervous System Infections in Patients With Sellar Region Tumors

Infections and gender: clues for diagnosis of adrenal insufficiency-a case report and a review of the literature

The clinical presentation of adrenal insufficiency, a condition causing adrenal hormone deficiency, is characterised by non-specific symptoms and signs: consequently, an important diagnostic delay is often evident which correlates with an increased mortality. This case report shows how the clustering of some symptoms and signs may hamper the diagnostic suspicion for this condition: serum electrolyte alterations and weight loss, when associated to recurrent infections and, in female patients, an empty sella may further guide the clinician towards a diagnosis of adrenal insufficiency. Accordingly, a clinical approach taking into account gender medicine could improve the diagnostic workup.

Early Identification of Correlated Risk Factors can Improve the Prognosis of Patients with Postoperative Intracranial Infection

BACKGROUND

 In this retrospective study, we explore the clinical risk factors correlated to the prognosis of patients who suffered from central nervous system infection after a neurosurgical procedure.

METHODS

 The study included 113 patients diagnosed with a postoperative intracranial infection. Several factors with clinical relevance were identified and analyzed by univariate analyses. The risk factors that showed any significant difference between the cases were analyzed by multivariate logistic regression analyses.

RESULTS

 Here we show that the duration of the drainage before infection (measured in days; Beta [B]: -0.113; odds ratio [OR]: 0.893; 95% confidence interval [CI]: 0.805-0.991; p = 0.033), the number of antibiotics used for the treatment (B: -1.470; OR: 0.230; 95% CI: 0.072-0.738; p = 0.013), and the number of leucocytes in the cerebrospinal fluid (CSF; B: -0.016; OR: 0.984; 95% CI: 0.970-0.998; p = 0.027) are risk factors for the prognosis of patients with an intracranial infection. In contrast, the duration of antibiotic treatment (measured in days; B: 0.176; OR: 1.193; 95% CI: 1.063-1.339; p = 0.003) turned out to be a positive factor for recovery from infection.

CONCLUSIONS

 Our results suggest that early identification of the correlated risk factors can improve the prognosis of patients with intracranial infection after neurosurgery.

Case report: A rare case of thyrotropin-secreting pituitary macroadenoma with diffuse calcification presenting with hyperthyroidism and literature review

Background

Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas (TSHomas) are rare and usually present with hyperthyroidism. Calcification in pituitary tumors is an infrequent finding. Herein, we report an extremely rare case of TSHoma with diffuse calcification.

Case description

A 43-year-old man was admitted to our department with a complaint of palpitations. An endocrinological examination revealed elevated serum levels of TSH, free triiodothyronine (FT3), and free thyroxin, whereas the physical examination revealed no obvious abnormality. Computerized tomography (CT) showed a sellar mass with diffuse calcification. Contrast-enhanced T1-weighted images revealed a less-enhancing tumor without obvious suprasellar or parasellar expansion. The tumor was completely removed via endoscopic transnasal-sphenoidal surgery. Microscopically, nests of cells were inconspicuous among the diffuse psammoma bodies. Expression of TSH was patchy, and only several TSH-positive cells were observed. Postoperatively, the serum levels of TSH, FT3, and FT4 decreased to their normal range. Follow-up MR images showed no evidence of residual tumor or regrowth after the resection.

Conclusions

Herein, we report a rare case of TSHoma with diffuse calcification that presented with hyperthyroidism. A correct and early diagnosis was made according to the European Thyroid Association guidelines. This tumor was completely removed via endoscopic transnasal-transsphenoidal surgery (eTSS), and thyroid function was normalized after the operation.