共查询到20条相似文献,搜索用时 15 毫秒
1.
Kishore Kumar Behera Ranjan Kumar Jena Subhendu Kumar Sahoo Uttam Kumar Soren 《Ethiopian journal of health sciences》2021,31(5):1069
BackgroundAutoimmune hypophysitis is the consequence of an immune-mediated inflammation of the pituitary gland, which is rare, and most frequently occurs in females during postpartum periods. It usually responds well to corticosteroid treatment with reported resolution of the pituitary mass lesion.Case ReportA 51 years male presented with a one-month history of lethargy, headache, nausea, proximal muscle weakness with intermittent flushing. He was a diabetic with metformin 500mg twice daily. No other remarkable medical history or family history of autoimmune disease. On examination, he had no neurological deficit with a normal visual field. His initial biochemical evaluation showed features of secondary hypothyroidism as evidenced by low free FT4 and suppressed TSH with normal electrolytes. The subsequent evaluation of his hormonal profile revealed panhypopituitarism. Contrast MRI of pituitary showed an enhanced homogenous mass and minimal stalk thickening with a dural tail and preserved posterior bright spot. He was managed with glucocorticoid 20 mg once daily for two weeks along with levothyroxine and testosterone replacement. After two weeks of treatment, he improved clinically. Repeat MRI imaging of the pituitary showed complete resolution of the homogenous mass.ConclusionAlthough autoimmune hypophysitis is rare in males, a careful clinical history with necessary hormonal investigations is required for the suspicion about the inflammatory pituitary disorders This current case highlights glucocorticoid as the primary modality of treatment and the need for long-term follow-up with periodic clinical assessment. 相似文献
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Vervenne WL Bakker PJ Stalpers LJ Bosch DA 《Nederlands tijdschrift voor geneeskunde》2000,144(11):527-531
In two men aged 19 and 24 years, a rare malignant intracranial germ cell tumour was diagnosed in the pineal gland region and in the second patient in a suprasellar position as well. Although histological confirmation is required in general to diagnose a malignancy, obtaining it can be difficult and potentially dangerous in case of intracranial neoplasms. The clinical picture of a young patient with an intracerebral tumour localised in the midline of the brain and increased levels of the tumour markers alpha-foetoprotein and/or human chorion gonadotrophin (beta-HCG) in blood and/or CSF makes any other diagnosis highly unlikely. There is no place for radical surgery in the first-line treatment of malignant intracerebral germ cell tumours because of the sensitivity to radio- and chemotherapy. Also, the sensitivity to chemotherapy makes it possible to reduce radiation volume and dose in an effort to avoid the serious complications of craniospinal irradiation. Both patients responded well to chemotherapy based on cisplatin followed by radiotherapy. 相似文献
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Ben Abdallah N Cherif L Khiari K Hadj Ali I Turki S Mezni F Ben Jilani S Ben Maïz H 《La Tunisie médicale》2002,80(3):158-161
Suprasellar germinomas are frequent in childhood and adolescence, particularly in male sex. The clinical and neuroendocrine abnormalities depend of tumor localization: Increased intracranial pressure, visual disturbances, hypopituitarism, Parinaud syndrome. We report two cases of suprasellar germinoma in young male patients (16 and 18 years old). The first patient hrad corticotorpin insufficiency and clinical signs of hypothyro?dism and hypogonadism. The second had central hypocorticism, hypothyro?dism and hypogonadism associated with central diabetes insipidus and hyperprolactinemia. The diagnosis of germinoma was confirmed after surgery by anatomopathologic examination in the first case and by stereotaxic biopsy in the second case. Treatment by radiotherapy improves prognosis of this disease. 相似文献
4.
Sloetjes KG van den Bergh JP Wesseling P Otten BJ Pieters GF Hermus AR 《Nederlands tijdschrift voor geneeskunde》2000,144(47):2264-2268
OBJECTIVE: Evaluation of clinical presentation, treatment and follow-up of patients with intracranial germinoma in the Netherlands. DESIGN: Retrospective. METHOD: The case histories of 32 patients with histologically verified intracranial germinoma, registered in the period 1983-1999 in the Pathological Anatomical Nationwide Automated Archive (PALGA), were studied. Fifty of the 59 registered patients were found of whom 6 had no germinoma. Informed consent was obtained from 32 of the 44 patients with respect to studying their medical records for age, symptoms at presentation, diagnostic investigations, presence of tumour markers, treatment and follow up. RESULTS: The patient group consisted of 23 men and 9 women aged 6 to 35.6 years (mean: 17.3) and was subdivided with respect to their tumour localization. In patients with pineal localization symptoms of increased intracranial pressure and eye movement disorders were most prominent, whereas in patients with suprasellar localization endocrine disorders prevailed. Thirty-one patients were treated with radiotherapy, one with combined radiotherapy and chemotherapy and one surgically. Twenty-six patients had remained disease free after a median follow-up of 39 months (range: 0-144 months). One patient developed an intracranial embryonal carcinoma and another a testis seminoma. Two patients died because of recurrences. Two other patients died of causes not directly related to the germinoma. CONCLUSION: At the time of this study 84% of all patients treated with radiotherapy were disease-free. Although the percentage patients who had recovered after treatment (surgical and radiotherapy) was high, many patients either already had or subsequently developed neurological and endocrinological deficiencies. 相似文献
5.
A Crapé F Depuydt C Goethals H Tytgat H Vandeperre 《Nederlands tijdschrift voor geneeskunde》1989,133(9):452-455
A patient is reported with hypothalamic-pituitary dysfunction due to multiple cerebral midline tumours of germinoma type. The symptomatology and differential diagnosis are reviewed. The necessity of stereotactic biopsy is discussed. The treatment of these tumours as proposed in recent literature is mentioned, with special reference to radiotherapy (cranial and spinal) and chemotherapy. 相似文献
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Roentgenological examination of the skull in 11 male-to-female transsexuals revealed considerable asymmetry (2.5–3 mm) of the sellar floor in three cases. There was no asymmetry exceeding 1.5 mm in 103 male controls. Asymmetry of the sella turcica suggests the presence of an intrasellar pituitary tumor. This finding in three patients with transsexualism is of interest in view of reports of endocrine disorders or hormonal secretion abnormalities in patients with atypical sexuality or gender identity problems. 相似文献
8.
目的:分析垂体柄阻断综合征的相关病因,以期减少该病的发生和早期诊治。方法:将53例诊断为垂体柄阻断综合征患者作为病变组,37例相同年龄组正常人作为对照组,搜集相关孕产史及既往史。采用多变量Logistic回归分析垂体柄阻断综合征的相关病因。结果:多因素回归模型分析与垂体柄阻断综合征相关的7种病因,分别为胎位异常(OR=12.107)、新生儿窒息(OR=11.224)、孕期异常(OR=9.204)、生产环境(OR=9.161)、产次(OR=7.195)、胎龄(OR=4.439)、既往史(OR=3.763)。结论:胎位异常、新生儿窒息、孕期异常是垂体柄阻断综合征的主要危险因素。多次生产、生产环境及胎龄因素与垂体柄阻断综合征次相关。既往史与垂体柄阻断综合征无相关。 相似文献
9.
目的 探讨垂体脓肿的临床表现及治疗方法.方法 回顾性分析6例垂体脓肿的诊治资料,并复习相关文献.结果 6例患者中,头痛5例、垂体功能低下4例、视力下降和/或颞侧偏盲4例、发热1例.MRI或cT检查5例有病灶周边环形强化.术前诊断为垂体腺瘤3例,颅咽管瘤1例,垂体脓肿2例.1例经颅手术,5例经蝶手术.术后均静脉滴注抗生素治疗3周.所有病例术后症状缓解,随访8个月至10年,1例经颅手术者2年后复发改行经蝶手术而治愈,5例经蝶手术者无复发.结论 垂体脓肿易误诊,对鞍区囊性病变应怀疑有垂体脓肿的可能.及早经蝶手术及围手术期合理使用抗生素是垂体脓肿治疗的关键. 相似文献
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K. Usharani R. K Roy Vijayalakshmi Jamuna Prakash 《International journal of food sciences and nutrition》2013,64(5):363-369
The nutritional status of 91 cancer patients was assessed at the time of diagnosis and follow-up assessments were carried out at the third and sixth week after initiating different treatment modalities to study the effect of type and duration of treatment on nutritional status. Parameters assessed were anthropometry, biochemical status and clinical signs and symptoms of nutritional deficiencies. Treatment modalities studied were radiotherapy, chemotherapy, chemotherapy+radiotherapy, and combined treatment modality (surgery+radiotherapy+chemotherapy). The nutritional status of male patients was affected most by chemotherapy+radiotherapy while females were affected most with radiotherapy. Biochemical parameters showed a marginal decline in total serum protein and serum albumin concentrations. Haemoglobin concentrations declined substantially with radiotherapy and chemotherapy. The lymphocyte count decreased substantially irrespective of the treatment modality. Clinical examination revealed increased incidences of deficiency signs and symptoms in all patients during follow-up irrespective of treatment modality. 相似文献
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Usharani K Roy RK Vijayalakshmi Prakash J 《International journal of food sciences and nutrition》2004,55(5):363-369
The nutritional status of 91 cancer patients was assessed at the time of diagnosis and follow-up assessments were carried out at the third and sixth week after initiating different treatment modalities to study the effect of type and duration of treatment on nutritional status. Parameters assessed were anthropometry, biochemical status and clinical signs and symptoms of nutritional deficiencies. Treatment modalities studied were radiotherapy, chemotherapy, chemotherapy+radiotherapy, and combined treatment modality (surgery+radiotherapy+chemotherapy). The nutritional status of male patients was affected most by chemotherapy+radiotherapy while females were affected most with radiotherapy. Biochemical parameters showed a marginal decline in total serum protein and serum albumin concentrations. Haemoglobin concentrations declined substantially with radiotherapy and chemotherapy. The lymphocyte count decreased substantially irrespective of the treatment modality. Clinical examination revealed increased incidences of deficiency signs and symptoms in all patients during follow-up irrespective of treatment modality. 相似文献
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A 39-year-old woman was admitted with complaints of weight gain, a decreased sense of well-being and amenorrhoea. One and a half year prior to admission she had been involved in a serious road accident and had spent several days in coma due to an epidural haematoma. She was found to have hypopituitarism with deficient somatotropic and gonadotropic axes, as well as mild hyperprolactinaemia, probably due to a pituitary stalk lesion. All patients with severe trauma to the skull are at risk of developing posttraumatic hypopituitarism, so that pituitary function testing should be performed routinely, certainly in the presence of symptoms. 相似文献
14.
Wientjes CA Koedam NA van Keulen EM Naber AH 《Nederlands tijdschrift voor geneeskunde》2008,152(31):1737-1742
A 79-year-old woman presented with complaints of upper abdominal pain, nausea and vomiting since a few days. Laboratory tests showed no abnormalities except for some indications of an inflammation. Based on the medical history, physical examination and findings from radiological examination, initially the diagnosis was 'chronic pancreatitis with formation ofa pseudocyst caused by alcohol abuse'. After one week the patient developed cholestatic liver function disorders with elevated serum pancreatic enzymes. A CT scan of the abdomen showed a dilated gallbladder and progression of the cystic lesion in the pancreatic head with compression of the distal common bile duct. An endoscopic retrograde cholangiopancreatography was performed and the findings fitted a diagnosis of an intraductal papillary mucinous neoplasm. Differentiation between an inflammatory or neoplastic origin of cystic lesions in the pancreas can be difficult. There is a risk ofmisdiagnosing a cystic neoplasm for a pseudocyst. This may lead to delays in making the correct diagnosis. 相似文献
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Schinagl DA Kappelle AC van der Maazen RW Bussink J 《Nederlands tijdschrift voor geneeskunde》2003,147(52):2565-2569
In two women, aged 86 and 56 years, respectively, who suffered from back pain and loss of strength, and in a 55-year-old man who lost sensation and strength in his left leg, spinal-cord compression in connection with vertebral destruction was seen on radiological examination. When spinal-cord compression is the result of a local malignant tumour, the therapy often entails emergency radiotherapy. In the first two patients, histological examination revealed a solitary plasmocytoma and curative high-dose radiotherapy was applied. The third patient also had a lung tumour and received low-dose palliative radiotherapy to the vertebrae, as a metastasis was suspected. Later, however, histopathologic examination of the vertebral lesion revealed osteomyelitis due to Listeria monocytogenes and the lung tumour was diagnosed as a pT2N0M0 broncho-alveolar carcinoma which was surgically removed. When a patient is referred with a nontraumatic spinal-cord injury, it is important to complete the radiological and histological examinations before starting emergency radiotherapy in order to prevent an inadequate or even incorrect treatment. 相似文献
16.
Three cases of CSF rhinorrhoea due to pituitary tumours are reported and the literature reviewed. The treatment of choice appears to be trans-sphenoidal exploration of the pituitary fossa with insertion of a free muscle graft followed by radiotherapy. The probability of the tumour being a prolactin-secreting adenoma is discussed. 相似文献
17.
[目的]探讨孕早中期孕妇产前筛查唐氏综合征和其他严重先天缺陷的方法及临床应用。[方法]应用全自动时间分辨荧光分析法对720例孕早中期孕妇进行血清标志物(PAPP-A/freeβ-HCG或者AFP/freeβ-HCG/μE3)联合筛查,使用Multical软件筛查高风险孕妇,通过羊水或脐带血细胞培养获得染色体核型以明确诊断。[结果]筛查随访的396例孕妇中,筛查出唐氏综合征及18-三体高风险者2例,NTD高风险者1例,单项指标异常者5例,明确诊断唐氏综合征1例、18-三体1例、臂间倒位1例、缺失1例、重型地中海贫血1例,无脑畸形1例。[结论联合筛查血清标志物的效率高于单项筛查,血清标志物单项筛查阳性者也应建议行产前诊断。唐氏综合征筛查是预测不良妊娠结局的有效指标,联合产前诊断对防止先天缺陷儿出生有重要的临床意义。 相似文献
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Beersma MF Grimbergen YA Kroon FP Veldkamp PJ 《Nederlands tijdschrift voor geneeskunde》2004,148(6):286-288
A 44-year-old woman suffered fever, headache and meningism during a summer stay in a region of central Italy where sand-fly fever is endemic. A few days after returning to the Netherlands, she appeared mentally and physically slow but had no fever. Because of the possibility of viral meningitis an examination of the cerebrospinal fluid (CSF) was carried out. This revealed a cell count of 1074/3 cells. Toscana virus antibodies of the IgG and IgM subclass were detected in two respective serum samples and in the CSF. This led to the diagnosis 'Toscana virus meningo-encephalitis'. Toscana virus is classified amongst the sandfly fever virus group. These viruses are transmitted by sand flies (Phlebotomus species) which reside in humid areas around the Mediterranean. Toscana virus is the main cause of viral meningoencephalitis in some areas of central Italy and possibly in southern Spain. The patient recovered within a few days without antiviral therapy. Toscana virus meningo-encephalitis should be included in the differential diagnosis of holidaymakers with neurological symptoms returning from the Mediterranean. 相似文献
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病毒性脑炎患儿神经元特异性烯醇化酶的水平变化及临床意义 总被引:2,自引:0,他引:2
目的:探讨病毒性脑炎患儿脑脊液(CSF)及血清中神经元特异性烯醇化酶(NSE)水平的变化及临床意义。方法:以28例病毒性脑炎患儿作为观察组,选择同期住院怀疑中枢神经系统疾病但脑脊液正常、最后确诊为上呼吸道感染的患儿作为对照组,两组患儿均于入院后24~48 h行腰椎穿刺取脑脊液,同时抽取静脉血,用酶连免疫吸附法(ELISA)检测脑脊液和血清中的NSE浓度。结果:病毒性脑炎患儿脑脊液和血清中NSE水平分别为(23.16±5.93)μg/L和(17.80±4.27)μg/L,对照组分别为(8.96±1.03)μg/L和(7.78±0.94)μg/L,两组有显著性差异(P均<0.01),且血清中NSE浓度与脑脊液中NSE浓度呈正相关(r=0.84,P<0.01)。结论:病毒性脑炎患儿脑脊液和血清中NSE浓度明显升高,脑脊液和血清中NSE可作为判断病毒性脑炎患儿脑组织损伤的客观指标之一。 相似文献
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Maclean L Odiit M Sternberg JM 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2006,100(3):270-275
Intrathecal cytokine levels and blood-cerebrospinal fluid (CSF) barrier function were studied in 91 Trypanosoma brucei rhodesiense-infected patients. The CSF concentration of the cellular immune activation marker neopterin and the cytokines IL-6 and IL-10 were increased over control and post-treatment levels in all patients, with maximal levels observed in late-stage (meningoencephalitic) individuals. Analysis of CSF/serum concentration quotients indicated that IL-10 and neopterin were derived from central nervous system synthesis in at least 25% of the patients. Blood-CSF barrier dysfunction occurred in 64% of late-stage patients but not in early-stage patients. While the high level of neopterin observed in the late-stage patient CSF is indicative of widespread cellular activation, the increased levels of IL-6 and IL-10 suggest that counter-inflammatory cellular responses may be important in the regulation of neuropathogenesis in late-stage human African trypanosomiasis. 相似文献