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Granulomatous Giant-Cell Hypophysitis

Granulomatous Giant Cell Hypophysitis


Presentation

  • Four cases are presented here with radiological, endocrinological, and surgical findings.[ncbi.nlm.nih.gov]
  • The present case shows that glucocorticoid has an effect on amendment of idiopathic giant cell granulomatous hypophysitis.[ncbi.nlm.nih.gov]
  • […] and proteomic analysis, all the way to clinical analysis (histopathology and imaging) and new therapeutic approaches Clear presentation by endocrine researchers of the cellular and molecular mechanisms underlying pituitary hormones and growth factors[books.google.com]
  • Abstract A 32-year-old woman presented with severe headache, photophobia, fever, nausea, vomiting, and worsening vision. She had also noted several months of amenorrhea. She was febrile to 38.9 degrees C.[ncbi.nlm.nih.gov]
  • We report a case presented with hypopituitarism symptoms due to tuberculosis etiology and pathology revealed non-caseating giant cell granulomatous hypophysitis.[endocrine-abstracts.org]
Pathologist
  • Edited by four leading surgical pathologists - Noel Weidner, MD, Richard J. Cote, MD, Saul Suster, MD and Lawrence M.[books.google.com]
  • Kradin is also an Associate Pathologist at Massachusetts General Hospital in the Immunopathology Unit. His techniques include tissue culture and immunocytochemistry, flow cytometry, Northern blotting and immunocytochemistry. Dr.[books.google.com]
  • Subhashis Mitra Consultant Pathologist, Department of Pathology, Advanced Medicare and Research Institute (Vision Care Hospital, 223, 230 Barkohala Lane, Mukundapur, Kalikapur, Kolkata - 700 099, West Bengal India Source of Support: None, Conflict of[ijpmonline.org]
  • They come to the pathologist more frequently when they are at an advanced stage, producing a mass effect and/or hypothalamic. However, the most enigmatic form of granulomatous hypophysitis is idiopathic.[omicsonline.org]
Swelling
  • Magnetic resonance imaging (MRI) revealed swelling of the hypophysis and a mass lesion expanding into the right cavernous sinus. The supplement dose of dexamethasone for hypothalamic hypocortisolism manifested diabetes insipidus.[ncbi.nlm.nih.gov]
  • It is characterized by five signs, An acronym that may be used to remember the key symptoms is PRISH, for pain, redness, immobility, swelling.[wikivisually.com]
Intravenous Administration
  • The pituitary stalk was thickened and enhanced after intravenous administration of gadolinium.[ncbi.nlm.nih.gov]
Chronic Fatigue Syndrome
  • Kradin has a number of clinical interests including Chronic Fatigue Syndrome, Interstitial Lung Disease, Multiple Chemical Sensitivity and Pulmonary Immunology. He also holds an Associate Professor position of Pathology at Harvard Medical School.[books.google.com]
Diplopia
  • A 53-year-old man was seen in outpatient clinics of this hospital because of a 1-year history of diplopia, polydipsia, and polyuria. Imaging studies showed mucosal thickening of the sphenoid sinus and enlargement of the pituitary gland.[nejm.org]
  • There were no cushingoid or acromegaloid features, no diplopia or ptosis, and no polyuria.[jpgo.org]
  • Bitemporal hemianopsia accounts for the majority of visual symptoms, with impaired acuity and diplopia being relatively uncommon. Endocrine dysfunction has been reported in up to 80% of cases.[surgicalneurologyint.com]
Photophobia
  • Abstract A 32-year-old woman presented with severe headache, photophobia, fever, nausea, vomiting, and worsening vision. She had also noted several months of amenorrhea. She was febrile to 38.9 degrees C.[ncbi.nlm.nih.gov]
  • The patient reported a 2 weeks history of headache, nausea, and vomiting was accompanied by photophobia. He had been to an emergency room, and anti-nausea and pain medications had been prescribed.[surgicalneurologyint.com]
Suggestibility
  • CONCLUSION: The coincidence of a contrast-enhancing pituitary mass with a thickened pituitary stalk and the awareness of the rare occurrence of endocrine inactive tumors in women of childbearing age should suggest an inflammatory pituitary condition.[ncbi.nlm.nih.gov]
  • The laboratory findings were suggest the central hypothyroidism. Gonadotropin levels were consistent with menopause. Basal cortisol level was found 2 μg/dl. Serum sodium and potassium levels were in normal range.[endocrine-abstracts.org]
  • On repeat MRI four days later at our institute, the findings were the same; additionally there was thickening of the pituitary stalk suggestive of probable hypophysitis.[jpgo.org]
  • Several authors have suggesting using steroid therapy to decrease the pituitary size and possibly alter the autoimmune response.[pituitaryadenomas.com]
  • Endocrine investigations suggested panhypopituitarism in all three patients and imaging revealed a suprasellar mass compressing the optic chiasm suggestive of CP or Rathke's cleft cyst in one patient and non-functioning pituitary macroadenoma in two patients[edmcasereports.com]
Lethargy
  • Case Report: A 51-year-old female admitted to our clinic with symptoms of mild headache and lethargy. Laboratory findings revealed TSH: 2.28 μIU/ml (normal, 0.34–5.6) fT 3 : 2.08 pg/ml (normal, 2.5–3.9) fT 4 : 0.56 ng/dl (normal, 0.61–1.12).[endocrine-abstracts.org]
  • Case Report A 48-year-old woman with a known diagnosis of Wegener's granulomatosis presented with a 2-week history of progressive visual loss and gradually worsening polyuria, polydipsia, lethargy, and headaches.[ajnr.org]
  • In addition, she gave a history of lethargy and frontal headaches.[edmcasereports.com]
Paresis
  • Abstract A 38-year-old man presented with headache, fever, and double vision associated with right abducens nerve paresis. He had neither nuchal rigidity nor visual field defect.[ncbi.nlm.nih.gov]
  • […] hypophysitis. ( 12434181 ) Endo T....Yoshimoto T. 2002 34 Granulomatous hypophysitis and bilateral optic neuropathy. ( 11315980 ) Arsava E.M....Selekler K. 2001 35 Idiopathic giant cell granulomatous hypophysitis with hypopituitarism, right abducens nerve paresis[malacards.org]

Workup

  • Autoimmune workup did not reveal any abnormality with CRP - 1.2 mg/l (normal 7 mg/l); antinuclear antibodies ( 1:40), and antineutrophilic cytoplasmic antibodies ( 1:16), anti-TPO Ab - 4 IU/l ( 9), RA factor 4 IU/l ( 20), and anti-TTG Ab- 3.54 IU/ ml[ijem.in]
Enlarged Sella
  • The MR imaging features included a thickened stalk, a diffusely and uniformly enlarged gland, a normal size or minimally enlarged sella, and enhancement of the optic chiasm. Hypophysitis is of two types: lymphocytic and granulomatous.[ajnr.org]
  • Magnetic resonance imaging (MRI) scan demonstrated an enlarged sella and a large well-marginated patchily enhancing soft tissue mass within sellar and suprasellar regions. There was no parasellar extension, and no necrosis or hemorrhage.[cancerjournal.net]
  • An unusual cause of hyperprolactinemia and enlarged sella turcica. JAMA. 1981. 246: 1811-2 36. Rivera JA. Lymphocytic hypophysitis: Disease spectrum and approach to diagnosis and therapy. Pituitary. 2006. 9: 35-45 37.[surgicalneurologyint.com]
Hyperprolactinemia
  • This entity should be considered when evaluating patients with a pituitary mass and evidence of hypopituitarism and hyperprolactinemia.[ncbi.nlm.nih.gov]
  • This is especially true for patients with hyperprolactinemia, diabetes insipidus or hypopituitarism. Medical therapy is aimed at treating endocrinopathies and replacing deficient hormones.[ccpd.ucsf.edu]
  • Serum levels of LH and follicle-stimulating hormone were normal over time, and mild hyperprolactinemia was present with normal increments over time ( Table 2 ).[kjim.org]
  • In this case, there was hyperprolactinemia secondary to stalk compression and, as demonstrated by MRI, the epicenter of the mass is located inside the sella.[path.upmc.edu]
  • The hormonal abnormalities have varied from panhypopituitarism to single hormone abnormalities such as hyperprolactinemia, hypothyroidism, or hypoadrenalism.[pituitaryadenomas.com]
Granulomatous Tissue
  • Acta Neurochir 2002, 144: 1233-1237 [ PubMed ] 9) Mueller W, Schneider GH, Hoffmann KT, Zschenderlein R, von Deimling A: Granulomatous tissue response in germinoma, a diagnostic pitfall in endoscopic biopsy.[turkjpath.org]

Treatment

  • Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.com]
  • OBJECTIVE: To describe the clinical features of giant-cell granulomatous hypophysitis and to report on the results of corticosteroid treatment.[ncbi.nlm.nih.gov]
  • Right abducens nerve paresis, diabetes insipidus and dysfunction of the anterior lobe were amended by the treatment with prednisolone for 4 months, and findings of the pituitary gland and stalk were normalized.[ncbi.nlm.nih.gov]
  • Corticosteroids are considered as primary treatment along with desmopressin if patients have DI to avoid traumatic effects of surgery. Surgical treatment is useful for relieving the elevated pressure effects on optic and occulomotor nerve.[jpgo.org]
  • Treatment and prognosis Based on case series-level evidence, good response is seen to corticosteroids such as prednisolone or hydrocortisone 1,2.[radiopaedia.org]

Prognosis

  • Treatment and prognosis Based on case series-level evidence, good response is seen to corticosteroids such as prednisolone or hydrocortisone 1,2.[radiopaedia.org]
  • The effectiveness of radiotherapy is unknown in germinomas with granulomatous reaction but it has been reported to lead to a favorable prognosis 5.[turkjpath.org]
  • Radical surgery is the treatment of choice and carries an excellent prognosis with no recurrence.[edmcasereports.com]
  • Until a specific pituitary antibody for this disease or a characteristic radiographic feature, as by MR spectroscopy, has been identified, the clinical diagnosis of this entity must rely on the histologic study of the pituitary Therapy and Prognosis The[pituitaryadenomas.com]
  • We believe that the significance of this association should be verified, in order to clarify its impact on prognosis and eventually on the treatment strategies. Conflict of Interests The authors declare that they have no conflict of interest.[omicsonline.org]

Etiology

  • Stain for acid fast bacilli and fungal etiologies were negative. The evaluation of etiology and differential diagnosis of granulomatous hypophysitis was done. Tuberculosis was diagnosed.[endocrine-abstracts.org]
  • This classic histological finding differentiates it from the histological appearances of other etiologies of hypophysitis, those being: lymphocytic hypophysitis : lacks plasma cells and presents in a young female demographic 1,2 granulomatous hypophysitis[radiopaedia.org]
  • It was reasonably assumed, therefore, that this disease has an auto immune etiology.[pituitaryadenomas.com]
  • In the absence of any evidence of any local or systemic causes of granulomatous inflammation, an immune etiology has to be considered.[cancerjournal.net]
  • Perhaps this suggests an underlying and unifying autoimmune etiology for both GH and PCNSV with a common target found in both hypophyseal and vascular tissue.[surgicalneurologyint.com]

Epidemiology

  • The next and largest section of the book concerns autoimmune thyroid disease, and authors of these chapters take the reader through the basic epidemiology, genetic and environmental risk factors, immunopathogenesis, and the diagnostic and management aspect[books.google.com]
  • .), Epidemiology (C.N.), Neurosurgery (A.O.), Neuroradiology (M.G.P.), and Molecular Microbiology and Immunology (P.C., N.R.R.), The Johns Hopkins University, Baltimore, Maryland 21205 Diabetes and Endocrine Department, Kameda medical center Masuzawa[slideplayer.com]
  • […] the two diseases represent an autoimmune spectrum from a purely lymphocytic form constituting the predominant early lesion to a granulomatous form appearing later. 1 Granulomatous hypophysitis , however differs from lymphocytic hypophysitis in certain epidemiological[japi.org]
  • Granulomatous hypophysitis, however, differs from lymphocytic hypophysitis in certain epidemiological features, which are mostly associated with pregnancy and autoimmune diseases [ 6 ].[kjim.org]
  • The early observation suggested the possibility of a spectrum of progression starting with LYH and progressing to GH.[ 25 ] In contrast, other authors cited key epidemiological factors of LYH that were not found in GH including female bias, association[surgicalneurologyint.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiologic process apparently begins as an acute inflammatory response with enlargement of the gland, as noted in 95% tissue-documented cases.[pituitaryadenomas.com]

Prevention

  • Is chronic lung disease in low birth weight infants preventable? A survey of eight centers. ‎ Página 84 - Tanner JM, Whitehouse RH, Marubini E, Resele LF. The adolescent growth spurt of boys and girls of the Harpenden growth study. ‎[books.google.es]
  • […] surgery is recommended for all cases to aid unequivocal diagnosis, disease specific therapy, rapid decompression and resolution of symptoms, and to obviate unnecessary steroid therapy. [1], [2] Frozen section examination can be done intra-operatively to prevent[ijpmonline.org]
  • There are valves in most veins to prevent backflow, veins are present throughout the body as tubes that carry blood back to the heart.[wikivisually.com]
  • The significance of this inflammatory reaction could be that to prevent the extent of the tumor, as reported in several types of malignant neoplasms as part of a spontaneous regression process [ 17 ]; the exclusivity in our case was that pituitary adenomas[omicsonline.org]
  • We describe a case of Wegener's granulomatosis with granulomatous hypophysitis and suggest possible indications revealed by MR imaging to allow medical management and prevent surgery.[ajnr.org]

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