Inflammatory and granulomatous expansive lesions of the pituitary

Carpinteri, R.; Patelli, Ilaria; Casanueva, Felipe F.; Giustina, Andrea

doi:10.1016/j.beem.2009.05.009

Cited by 111 publications

(91 citation statements)

References 98 publications

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“…The unexpected observation of ADH as the sole additional deficiency in nine patients may relate to the association of ADH deficiency and histiocytosis (21), and MRI may potentially identify the structural lesion in such cases (22). Patients with additional pituitary deficiencies diagnosed during follow-up had a higher incidence of breech presentation, perinatal asphyxia, and neonatal complications, and a trend toward greater delivery complications.…”

Section: European Journal Of Endocrinologymentioning

confidence: 94%

Development of additional pituitary hormone deficiencies in pediatric patients originally diagnosed with idiopathic isolated GH deficiency

Blum

Deal

Zimmermann

et al. 2014

European Journal of Endocrinology

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Objective: We assessed the characteristics of children initially diagnosed with idiopathic isolated GH deficiency (IGHD) who later developed additional (multiple) pituitary hormone deficiencies (MPHD). Design: Data were analyzed for 5805 pediatric patients with idiopathic IGHD, who were GH-naïve at baseline and GH-treated in the multinational, observational Genetics and Neuroendocrinology of Short Stature International Study. Methods: Development of MPHD was assessed from investigator diagnoses, adverse events, and concomitant medications. Analyses were performed for all patients and for those who developed MPHD within 4.5 years or had R3.5 years, follow-up and continued to have IGHD (4-year cohort). Results: MPHD developed in 118/5805 (2.0%) children overall, and in 96/1757 (5.5%) in the 4-year cohort. Patients who developed MPHD had more profound GHD, with decreased height SDS, IGF1 SDS and peak stimulated GH, and greater height decrement vs target, compared with children who continued to have IGHD (P!0.001 for each variable). Delivery complications, congenital anomalies, and perinatal/neonatal adverse events occurred more frequently in patients who developed MPHD. The most frequent additional deficiency was TSH (82 patients overall); four patients developed two pituitary hormone deficiencies and one developed three deficiencies. Multivariable logistic regression indicated that years of follow-up (odds ratio 1.55), baseline age (1.17), baseline height SDS (0.69), and peak stimulated GH (0.64) were associated with the development of MPHD. Conclusions: MPHD is more likely to develop in patients with more severe idiopathic IGHD. Older baseline age, lower baseline height SDS, and longer follow-up duration are associated with increased risk of development of MPHD.

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Section: European Journal Of Endocrinologymentioning

confidence: 94%

Development of additional pituitary hormone deficiencies in pediatric patients originally diagnosed with idiopathic isolated GH deficiency

Blum

Deal

Zimmermann

et al. 2014

European Journal of Endocrinology

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“…ECD was considered but excluded due to lack of typical findings and lack of systemic involvement. 19 LYH or autoimmune hypophystis is characterised by focal or diffuse inflammatory infiltration and variable degree of pituitary involvement. 19 It can be divided into three subtypes: lymphocytic adenohypophysitis, lymphocytic infundibuloneurohypophysitis and lymphocytic panhypophysitis.…”

Section: Discussionmentioning

confidence: 99%

“…19 LYH or autoimmune hypophystis is characterised by focal or diffuse inflammatory infiltration and variable degree of pituitary involvement. 19 It can be divided into three subtypes: lymphocytic adenohypophysitis, lymphocytic infundibuloneurohypophysitis and lymphocytic panhypophysitis. It can be frequently associated with other autoimmune conditions, most commonly autoimmune thyroid disease (reported in 15-25% of LYH cases, 75% of these being chronic autoimmune thyroiditis).…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Intracranial Inflammatory Process of Unknown Origin

Badran¹,

Abdelsadq²,

Abbas³

et al. 2017

Neuro – Open Journal

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We present an unusual case of steroid responsive inflammatory condition, involving sellar suprasellar region with further ependymal lesions. This is complicated by previous surgery due to pituitary adenoma, not thought to related to inflammatory process. The patient responded well to steroids, but deteriorated due to development of hydrocephalus caused by obstruction due to adhesions. Despite extensive literature review and consideration of all known pathological conditions, it was concluded that the condition represented another inflammatory entity not yet fully characterised. The case also highlights that despite the steroid responsive nature of the condition, the ependymal involvement can result in progressive acute obstructive hydrocephalus with clinical deterioration. This case also suggests close follow-up and early imaging for early detection and treatment of this complication. CASE REPORTThis case report pertains to a 46-year-old male Caucasian who had endoscopic treatment for a pituitary adenona three years previously. He required replacement hydrocortisone and testosterone. Prior to the surgery, he was not known to have any other neurological issues.A year after surgery following minor trauma, he underwent a computed tomography (CT) scan of the head. This confirmed no residual pituitary tumour (Figure 1). He was somewhat non-compliant with endocrine follow-up. Surveillance magnetic resonance imaging (MRI) imaging 2 years following initial surgery demonstrated post-up change with some enhancing tissue scaling the pituitary stalk and hypothalamic region; this was not clearly seen on the previous CT scan, possibly due to different modalities and absence of contrast imaging. Two months later, he developed polydipsia, fatigue and a partial left-sided homonymous visual field deficit. There was progressive confusion with fluent dysphasia and inattention. He was pyrexial. Gaze evoked nystagmus was present to the right. The rest of his examination was unremarkable. MRI brain demonstrated significant progression of the abnormalities seen on the earlier scan with increased enhancing tissue involving the pituitary stalk, hypothalamic area and floor of the 3 rd ventricle, also including the optic chiasm (Figure 2). Associated signal

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“…This modality help identify multiple osseous and tissue lesions and is of use for narrowing the differential diagnosis. Pituitary MRI (figure 7) will show enhancing thickened pituitary stalk (31)(32). …”

Section: Langerhans Cells Histiocytosismentioning

confidence: 99%