Filter

Refine by subject

Refine by date

—
  • Print
  • Save
  • Print

Diagnosis and Treatment > Signs and Symptoms

You are looking at 1 - 1 of 1 items for :

  • Cerebrospinal fluid rhinorrhoea x
  • Neck pain/discomfort x
Clear All
Yoko Olmedilla Endocrinology and Nutrition Service, Gregorio Marañón General Universitary Hospital, Madrid, Spain

Search for other papers by Yoko Olmedilla in
Google Scholar
PubMed Close
,
Shoaib Khan Oxford Centre for Endocrinology, Diabetes and Metabolism, Churchill Hospital, Oxford, UK

Search for other papers by Shoaib Khan in
Google Scholar
PubMed Close
,
Victoria Young Departments of Neuroradiology, John Radcliffe Hospital, Oxford, UK

Search for other papers by Victoria Young in
Google Scholar
PubMed Close
,
Robin Joseph Departments of Neuroradiology, John Radcliffe Hospital, Oxford, UK

Search for other papers by Robin Joseph in
Google Scholar
PubMed Close
,
Simon Cudlip Departments of Neurosurgery, John Radcliffe Hospital, Oxford, UK

Search for other papers by Simon Cudlip in
Google Scholar
PubMed Close
,
Olaf Ansgorge Departments of Neuropathology, John Radcliffe Hospital, Oxford, UK

Search for other papers by Olaf Ansgorge in
Google Scholar
PubMed Close
,
Ashley Grossman Oxford Centre for Endocrinology, Diabetes and Metabolism, Churchill Hospital, Oxford, UK

Search for other papers by Ashley Grossman in
Google Scholar
PubMed Close
, and
Aparna Pal Oxford Centre for Endocrinology, Diabetes and Metabolism, Churchill Hospital, Oxford, UK

Search for other papers by Aparna Pal in
Google Scholar
PubMed Close

Summary

A 21 year-old woman was found to have a pituitary macroadenoma following an episode of haemophilus meningitis. Biochemical TSH and GH excess was noted, although with no clear clinical correlates. She was treated with a somatostatin analogue (SSA), which restored the euthyroid state and controlled GH hypersecretion, but she re-presented with a further episode of cerebrospinal fluid (CSF) leak and recurrent meningitis. Histology following transsphenoidal adenomectomy revealed a Pit-1 lineage plurihormonal adenoma expressing GH, TSH and PRL. Such plurihormonal pituitary tumours are uncommon and even more unusual to present with spontaneous bacterial meningitis. The second episode of CSF leak and meningitis appears to have been due to SSA therapy-induced tumour shrinkage, which is not a well-described phenomenon in the literature for this type of tumour.

Learning points:

  • Pit-1 lineage GH/TSH/PRL-expressing plurihormonal pituitary adenomas are uncommon. Moreover, this case is unique as the patient first presented with bacterial meningitis.

  • Inmunohistochemical plurihormonality of pituitary adenomas does not necessarily correlate with biochemical and clinical features of hormonal hypersecretion.

  • Given that plurihormonal Pit-1 lineage adenomas may behave more aggressively than classical pituitary adenomas, accurate pathological characterization of these tumours has an increasing prognostic relevance.

  • Although unusual, a CSF leak and meningitis may be precipitated by SSA therapy of a pituitary macroadenoma via tumour shrinkage.

Taxonomy:
Clinical Overview, Gland/Organ, Pituitary, Topic, Pituitary, Hormone, Cortisol, GH, IGF1, Prolactin, Somatostatin, Thyroxine (T4), Triiodothyronine (T3), TSH, Condition/ Syndrome, Cerebrospinal fluid leakage, Hyperthyroidism, Meningitis, Pituitary adenoma, Plurihormonal pituitary adenoma, Patient Demographics, Age, Adult, Gender, Female, Ethnicity, White, Country of Treatment, United Kingdom, Diagnosis and Treatment, Signs and Symptoms, Back pain, Cerebrospinal fluid rhinorrhoea, Headache, Hyperthyroidism, Neck pain/discomfort, Investigation, ACTH stimulation, Cortisol, CT scan, FT3, FT4, GH, GH day curve, Haematoxylin and eosin staining, Histopathology, IGF1, Immunohistochemistry, MRI, Prolactin, TSH, Intervention, Resection of tumour, Transsphenoidal surgery, Medication, Antibiotics, Lanreotide, Somatostatin analogues, Related Disciplines, Oncology, Publication Details, Case Report Type, Unique/unexpected symptoms or presentations of a disease
DOI:
https://doi.org/10.1530/EDM-18-0130
Volume/Issue:
Volume 2019: Issue 1
Open access