1/38. Lymphocytic hypophysitis presenting with diabetes insipidus: MR findings.It has been thought that neurohypophysial involvement manifesting as central diabetes insipidus in lymphocytic hypophysitis is rare. The radiological and clinicopathological features of two cases represent a variant of lymphocytic adenohypophysitis and/or lymphocytic infundibulo-neurohypophysitis are discussed.- - - - - - - - - - ranking = 1keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
2/38. Painful swelling of the thigh in a diabetic patient: diabetic muscle infarction.A 44-year-old woman with a 5-year history of poorly controlled Type 1 diabetes mellitus presented with a painful, firm and warm swelling in her right thigh. pain was severe but the patient was not febrile, and had no history of trauma or abnormal exercise. Laboratory tests showed ketoacidosis, major inflammation (erythrocyte sedimentation rate (ESR) = 83 mm/h), normal white blood cell count and normal creatine kinase level. Plain radiographs were normal, and there were no signs of thrombophlebitis at Doppler ultrasound. magnetic resonance imaging (MRI) showed diffuse enlargement and an oedematous pattern of the adductors, vastus medialis, vastus intermedius and sartorius of the right thigh. The patient's symptoms improved dramatically, making biopsy unnecessary, and a diagnosis of diabetic muscular infarction was reached. Idiopathic muscular infarction is a rare and specific complication of diabetes mellitus, typically presenting as a severely painful mass in a lower limb, with high ESR. The diabetes involved is generally poorly controlled longstanding Type 1 diabetes with established microangiopathy. Differential diagnoses include deep vein thrombosis, acute exertional compartment syndrome, muscle rupture, soft tissue abscess, haematoma, sarcoma, inflammatory or calcifying myositis and pyomyositis. In fact, physician awareness should allow early diagnosis on the basis of clinical presentation, routine laboratory tests and MRI, thereby avoiding biopsy and its potential complications as well as unnecessary investigations. rest, symptomatic pain relief and adequate control of diabetes usually ensure progressive total recovery within a few weeks. Recurrences may occur in the same or contralateral limb.- - - - - - - - - - ranking = 0.012389977063603keywords = diabetes (Clic here for more details about this article) |
3/38. Idiopathic giant-cell granulomatous hypophysitis mimicking acute meningitis.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. Laboratory evaluation revealed a markedly elevated erythrocyte sedimentation rate. Lumbar puncture revealed a cerebrospinal fluid lymphocytic pleocytosis and an elevated protein level. Endocrine studies revealed evidence of panhypopituitarism without diabetes insipidus. A magnetic resonance imaging study showed a 2-cm pituitary mass with optic chiasmal compression. The patient had a trans-sphenoidal resection of the mass. pathology revealed multinucleated giant cells in necrotic debris, but no evidence of pituitary tumor. Studies looking for evidence of systemic granulomatous disease were negative. The patient was considered to have idiopathic giant-cell granulomatous hypophysitis. After surgery, the patient's vision improved and hormone replacement therapy was initiated. This case illustrates that idiopathic giant-cell granulomatous hypophysitis should be considered in the differential diagnosis of a patient presenting with a pituitary mass, hypopituitarism, and meningitis-like symptoms.- - - - - - - - - - ranking = 0.2keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
4/38. 'Stalkitis' in a pregnant 32-year-old woman: a rare cause of diabetes insipidus.A case of lymphocytic infundibulo-neurohypophysitis (LINH) or 'stalkitis' in a 32-year-old woman who presented with diabetes insipidus (DI) during pregnancy is reported here. The diagnosis was made with MR imaging. The clinical and radiological features of this rare disorder and the differential diagnosis of infundibular mass lesions are discussed. The differentiation from lymphocytic adenohypophysitis (LAH) is made. No improvement of the DI accompanying LINH is achieved with trans-sphenoidal surgery. Hence, recognition of typical cases with MR imaging and appropriate medical management avoids unnecessary neurosurgery. This is the second reported case of LINH associated with pregnancy and may suggest an association.- - - - - - - - - - ranking = 1keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
5/38. A case of lymphocytic infundibuloneurohypophysitis: histophathological studies.A 57-year-old woman presented with 2-year history of polyuria and polydipsia. Hormonal studies revealed almost normal anterior pituitary function and central diabetes insipidus. magnetic resonance imaging showed thickening of the pituitary stalk and enlargement of the neurohypophysis without high intensity of the posterior lobe on T1-weighted images, which were compatible with lymphocytic infundibuloneurohypophysitis. Transsphenoidal biopsy was done and histological examination disclosed moderate fibrosis and lymphocytic infiltration not only in the posterior pituitary, but also in the adjacent anterior pituitary part of the gland. The lymphocytes both in the anterior and posterior pituitary were mainly T cells that were positive for UCHL 1, CD 3, and CD 8. Immunofluorescence of frozen tissue detected immunecomplex deposition in small vessels and the interstitium. These findings suggested that allergic reactions may play an important role in the pathogenesis of lymphocytic infundibuloneurohypophysitis.- - - - - - - - - - ranking = 0.2keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
6/38. Lymphocytic hypophysitis masking a suprasellar germinoma in a 12-year-old girl--a case report.Case history, light and electron microscopic findings of a case of a lymphocytic hypophysitis in coincidence with a suprasellar germinoma in a 12-year-old girl are reported. The girl presented with a long time case history of diabetes insipidus and subsequent panhypopituitarism. Two years after the diagnosis of diabetes insipidus magnetic resonance imaging (MRI) showed a tumorous enlargement of the sellar content and pituitary stalk. A transnasal exploration was initially performed and revealed a lymphocytic hypophysitis. light microscopy showed a dense infiltration of mature lymphocytes and plasma cells in the interstitium of the anterior pituitary gland. The stalk area could not be exposed to exclude a germinoma. One year later the lesion relapsed despite dexamethason therapy and a second operation by another neurosurgeon had to be performed. light microscopy showed lymphocytic infiltrates, fibrosis and necrosis. The diagnosis was a lymphocytic hypophysitis again. Though transcranially exposed only pituitary tissue was removed. No infundibular mass became visible at surgery as shown by MRI. The girl developed five months later multiple cerebral lesions, which revealed to be a germinoma. Lymphocytic hypophysitis in children is very rare and a coincidence with a germinoma has not been described from histopathological aspect until now. The origin of the pituitary infiltration is discussed.- - - - - - - - - - ranking = 0.4keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
7/38. Lymphocytic hypophysitis: report of an unusual case of a rare disorder.A 36-year-old non-pregnant woman presented with a four-month history of progressive visual deterioration and amenorrhea. The latest gestation was 6 years earlier. Hormonal study revealed central diabetes insipidus, hypopituitarism, and slightly increased prolactin level. Ophthalmologic examination showed bilateral hemianopsia. In the magnetic resonance imaging an intrasellar mass with supra and retrosellar extension was found. The mass showed a polylobular aspect with heterogeneous signal within the tissue. The normal neurohypophysis could not be identified. Pterional craniotomy was performed. The pathological examinations revealed fibrous tissue with heavy inflammatory infiltrate composed of lymphocytes and plasma cells, islands of eosinophilic epithelial cells stained positively for chromogranin, GH, ACTH, and PRL and negatively for antibodies directed against HLA-II antigens. This case of lymphocytic hypophysitis was not related to pregnancy and involved the neurohypophysis. We discuss the features that can help to make a preoperative differential diagnosis.- - - - - - - - - - ranking = 0.2keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
8/38. Intravenous immunoglobulin therapy for diabetic amyotrophy.A 49-year-old woman with diabetes mellitus developed progressive weakness and atrophy of both thighs rendering her wheelchair-bound within two months. The neurological findings and electrophysiological test results were compatible with diabetic amyotrophy (DA). Immediately after intravenous immunoglobulin (IVIg) therapy (20 g x 3 days), she became able to walk with a cane. After the next course of the therapy, she could walk without assistance. This dramatic effect of IVIg therapy together with the recent observation of vasculitic neuropathy in DA indicates an inflammatory process in this condition, and gives support to this treatment for DA.- - - - - - - - - - ranking = 0.0024779954127206keywords = diabetes (Clic here for more details about this article) |
9/38. Factitial panniculitis and necrotizing fasciitis in juvenile diabetes.A fifteen-year-old diabetic girl developed multiple inflammatory areas on the extremities and abdominal wall at the site of insulin injection. The bizarre clinical manifestations led to great difficulties in determining both its etiology and its treatment. However, three months after her initial hospitalization, we found that the lesions were probably secondary to self-injection with a chemical agent rather than a result of insulin allergy. If idiopathic recurrent dermal infection is observed, then factitial origin should be suspected.- - - - - - - - - - ranking = 0.0099119816508824keywords = diabetes (Clic here for more details about this article) |
10/38. Infundibulohypophysitis in a man presenting with diabetes insipidus and cavernous sinus involvement.Infundibulohypophysitis is an unusual inflammatory condition that affects the infundibulum, the pituitary stalk, and the neurohypophysis and may be part of a range that includes lymphocytic hypophysitis. Lymphocytic hypophysitis occurs mainly in women and most often presents in the later stages of pregnancy. Infundibulohypophysitis usually presents with diabetes insipidus and the cause remains unclear. The case of a 46 year old man with a 12 week history of polyuria and polydipsia is reported. Cranial diabetes insipidus was diagnosed on the basis of a water deprivation test. Initial cranial and pituitary imaging studies were normal. He subsequently developed symptoms of panhypopituitism over a period of 6-9 months and then, more acutely, developed diplopia secondary to a fourth nerve palsy. Further brain imaging studies disclosed an enhancing pituitary stalk and a left cavernous sinus lesion. An initial trial of immunosuppressive treatment did not help symptoms significantly. The diagnosis of infundibulohypophysitis was made on histological evidence. The patient was treated with prednisolone and methotrexate. At 9 months he is well, without symptoms, and the radiological abnormalities have resolved.- - - - - - - - - - ranking = 1.2keywords = diabetes insipidus, insipidus, diabetes (Clic here for more details about this article) |
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