1/67. recurrence of adrenal aldosterone-producing adenoma.Conn's syndrome (adrenal aldosterone-producing adenoma) and bilateral adrenal hyperplasia are the most common causes of primary aldosteronism. The treatment of choice for patients with aldosterone-producing adenoma is unilateral total adrenalectomy. recurrence after adequate surgery is exceptional. We present a patient with recurrence of an aldosterone-producing adenoma in the right adrenal gland 9 years after adenomectomy of a aldosterone-producing adenoma in the same adrenal gland. We conclude that adenomectomy is not an adequate therapy for patients with adrenal aldosterone-producing adenoma.- - - - - - - - - - ranking = 1keywords = adenoma, gland (Clic here for more details about this article) |
2/67. adenocarcinoma of the prostate with ectopic antidiuretic hormone production: a case report.An 88-year-old patient with a poorly differentiated adenocarcinoma of the prostate gland was found to have all cardinal findings of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Elevated levels of antidiuretic hormone were found in the patient's serum and in the prostatic tumor and the cytoplasms of the tumor was positive for prostate specific antigen and was faintly positive for antidiuretic hormone (ADH). He responded well to combination therapy of androgen blockade with leuprorelin acetate and flutamide, and laboratory findings of SIADH and serum ADH level returned to normal. However, he died of sudden profuse bleeding caused by gastric ulcers 6 months after the therapy. Ten cases of SIADH caused by prostatic cancer have been reported including the present case.- - - - - - - - - - ranking = 0.0048073052727855keywords = gland (Clic here for more details about this article) |
3/67. Prostatic carcinoma producing syndrome of inappropriate secretion of antidiuretic hormone.The syndrome of inappropriate secretion of antidiuretic hormone was recognized in a sixty-year-old man with a poorly differentiated metastatic adenocarcinoma of the prostate gland. Elevated levels of antidiuretic hormone were found in the patient's serum and in the prostatic tumor but not in the cerebrospinal fluid. The patient's clinical course is detailed, and the pathophysiology of this syndrome is discussed.- - - - - - - - - - ranking = 0.0048073052727855keywords = gland (Clic here for more details about this article) |
4/67. acromegaly caused by a growth hormone-releasing hormone-secreting carcinoid tumor: case report.OBJECTIVE AND IMPORTANCE: We describe a patient with acromegaly and pituitary hyperplasia secondary to a growth hormone-releasing hormone-secreting gastrointestinal carcinoid tumor. This case report illustrates the importance of including this rare clinical syndrome in the differential diagnosis of acromegaly for patients with suspected or known neuroendocrine tumors. CLINICAL PRESENTATION: A 19-year-old, Asian-American, male patient with a 2-year history of a nonresectable, metastatic, intestinal carcinoid tumor presented with complaints of headaches, arthralgias, sweats, and changing features. The examination revealed a young subject with acromegalic features, without visual field deficits. magnetic resonance imaging revealed a diffuse sellar mass that extended suprasellarly to compress the optic chiasm. Endocrinological studies demonstrated a growth hormone level of more than 100 ng/ml and an inappropriately elevated growth hormone-releasing hormone level. INTERVENTION: The patient underwent transsphenoidal resection of the pituitary mass for diagnostic and decompressive purposes. The pathological examination revealed pituitary hyperplasia, without evidence of an adenoma. Therapy with long-acting repeatable octreotide (Sandostatin LAR; Novartis AG, Basel, switzerland) was initiated postoperatively, to further control the acromegaly and carcinoid tumor. The soft-tissue swelling resolved, and the patient remained free of headaches, arthralgias, and sweats at the 6-month follow-up examination. CONCLUSION: Ectopic acromegaly is a rare syndrome that must be recognized by neurosurgeons because its treatment differs from that of classic pituitary acromegaly. We describe a patient for whom this syndrome was documented with magnetic resonance imaging, endocrinological testing, and pathological examinations.- - - - - - - - - - ranking = 0.11004282105049keywords = adenoma (Clic here for more details about this article) |
5/67. January 2002: 59-year-old woman with an intrasellar lesion.An intrasellar lesion resembling a hormone-inactive pituitary adenoma was resected in a 59-year-old woman. The well-differentiated benign tumor was composed of ganglion-like cells, clusters of adenohypophyseal tissue as well as a GH-expressing adenoma. In addition, small cells exhibited an intermediate neuronal and epithelial immunoreactivity. Surrounding the tumor was a spindle cell component that histologically resembled Antoni A areas of a schwannoma, but showed a mixed immunohistochemical profile. Final diagnosis was intrasellar glioneuronal hamartoma with GH-cell pituitary adenoma.- - - - - - - - - - ranking = 0.33012846315148keywords = adenoma (Clic here for more details about this article) |
6/67. Ectopic TSH-secreting pituitary adenoma of the vomerosphenoidal junction.OBJECTIVE: We describe an unusual case of ectopic TSH-secreting pituitary adenoma arising from the vomerosphenoidal junction. CLINICAL PRESENTATION: A 52-Year-old man with a long-standing history of hyperthyroidism was referred to the University Hospital in September 2001 because of increasingly disabling symptoms of nasal obstruction. For the past 18 Years the patient had complained of palpitations, hypertension, weight loss, and nervousness. A presumptive diagnosis of Graves' disease was made. Treatment with methimazole was begun, but the patient was lost to follow-up. On admission, physical examination revealed signs of hyperthyroidism and a large diffuse goiter. Tests of thyroid function showed inappropriate secretion of TSH with hyperthyroidism. Both a TSH-secreting pituitary adenoma and resistance to thyroid hormone could be taken into account. There was no evidence of pituitary tumour by magnetic resonance imaging (MRI), but a large space-occupying lesion involving the nasal cavity and the nasopharynx was incidentally discovered. INTERVENTATION AND TECHNIQUE: Using an endoscopic endonasal approach, the tumour was removed en bloc together with the sphenoid floor, sphenoid rostrum, bony septum, and part of the soft palate mucosa. Histological features and immunophenotype were those of a TSH-secreting tumour. CONCLUSION: Although exceedingly rare, ectopic TSH-secreting pituitary tumour should be borne in mind in cases of inappropriate secretion of TSH with hyperthyroidism and no evidence of pituitary tumour by computed tomography and/or MRI when a mass located along the migration path of the Rathke's pouch is demonstrated by radiological examination. To our knowledge, this is only the second reported case in the literature.- - - - - - - - - - ranking = 0.66025692630295keywords = adenoma (Clic here for more details about this article) |
7/67. hypercalcemia and breast cancer related to parathormone-like secretion by liver metastases.A premenopausal woman developed hypercalcemia 30 months after treatment for infiltrating breast cancer. After bone metastases had been excluded, primary hyperparathyroidism was suspected. A parathyroid adenoma was removed and histologically confirmed. hypercalcemia, associated with low plasma phosphate and severely depressed plasma parathormone (PTH) levels, persisted. Further investigations showed liver metastases from the primary breast cancer and also secretion of a PTH-like substance. Antitumoral treatment was effective on the liver metastases and also normalized calcemia and the PTH-like substance, demonstrating the existence of a paraneoplastic syndrome related to the secretion of a PTH-like substance by disseminated liver metastases of primary breast cancer.- - - - - - - - - - ranking = 0.11004282105049keywords = adenoma (Clic here for more details about this article) |
8/67. Recurrent hypercalcemia due to ectopic production of parathyroid hormone-related protein and intact parathyroid hormone in a single patient with multiple malignancies.OBJECTIVE: To report a case of recurrent hypercalcemia due to ectopic production of parathyroid hormone (PTH) and parathyroid hormone-related protein (PTH-rP) from transitional cell carcinoma of the urinary bladder. methods: We present clinical, laboratory, and pathologic findings in a 73-year-old man with recurrent hypercalcemia. Results of serum calcium, PTH, PTH-rP and immunostaining of tumors for PTH and PTH-rP over 9 years are presented. RESULTS: In 1990 this patient was diagnosed with primary hyperparathyroidism, which was cured by resection of a parathyroid adenoma in the neck. hypercalcemia recurred in 1992, and he was found to have squamous cell carcinoma of the right lung. PTH-rP levels were not measured, but the resected tumor immunostained positive for the presence of PTH-rP. The patient subsequently remained normocalcemic until 1996, when the plasma calcium and PTH levels increased again. Surgical exploration of the neck revealed no parathyroid adenoma. Elevated plasma levels of calcium and PTH persisted after surgery. In 1998 the patient was diagnosed with stage IV invasive transitional cell carcinoma (TCC) of the urinary bladder and underwent radical cystectomy. The tumor tissue was not immunoreactive to PTH-rP. A year later, plasma levels of PTH and PTH-rP increased, but surgical re-exploration of the neck again revealed no parathyroid adenoma. CT scanning identified a large retroperitoneal mass, and a CT-guided biopsy of the mass showed metastatic, poorly differentiated TCC immunopositive for PTH and PTH-rP. CONCLUSION: This is the first report of ectopic production of PTH from metastatic TCC of the urinary bladder coexisting with PTH-rP mediated hypercalcemia.- - - - - - - - - - ranking = 0.33012846315148keywords = adenoma (Clic here for more details about this article) |
9/67. Ectopic adrenocorticotropic hormone-syndrome in medullary carcinoma of the thyroid: a retrospective analysis and review of the literature.Cushing's syndrome (CS) in medullary thyroid carcinoma (MTC) is rare. Only 50 cases have been reported. We report 10 cases of MTC with ectopic adrenocorticotropic hormone (ACTH)-dependent syndrome (EAS), analyzed retrospectively. Among 1640 patients with MTC, 13 developed EAS (0.7%). In 10 patients CS could unequivoqually be related to MTC (0.6%). CS was always clinically obvious. It revealed MTC in 3 cases and followed diagnosis by an average of 34.5 months in the others. Metastases were often present at diagnosis. immunohistochemistry with ACTH antibodies was positive in one case. diagnosis of ectopic CS was established according to clinical and biologic features, and absence of corticotropic adenoma as well as parallel evolution between tumor and CS. Therapy was medical and surgical: anticortisolic drugs alone or in association with somatostatin analogue, somatostatin analogue alone, and bilateral adrenalectomy. Eight patients died within 2 to 30 months, 4 of hypercortisolism complications (3 peritonitis and 1 hypokalaemia), 4 of MTC progression. EAS is a rare complication of MTC. The prognosis is poor because of frequency of metastasis at diagnosis. Persistent hypercortisolism can, by itself, lead to death, and has to be treated specifically.- - - - - - - - - - ranking = 0.11004282105049keywords = adenoma (Clic here for more details about this article) |
10/67. acromegaly and somatotroph hyperplasia with adenomatous transformation due to pituitary metastasis of a growth hormone-releasing hormone-secreting pulmonary endocrine carcinoma.CONTEXT: GHRH excess from extracranial endocrine tumors is known to cause somatotroph hyperplasia and acromegaly. Hypothalamic gangliocytomas producing GHRH are also known to be associated with pituitary adenomas causing acromegaly. OBJECTIVES: The objective of this study was to describe a case of acromegaly due to a pulmonary GHRH-secreting endocrine carcinoma with metastasis to the pituitary gland and to look at the peculiar histological features of this case. SUBJECT: The patient was a 44-yr-old woman who was diagnosed with a biopsy-proven metastatic pulmonary endocrine tumor during pregnancy. After delivery, she underwent radiation and chemotherapy for pulmonary and skeletal metastases. Her disease was clinically stable for 7 yr until she developed bitemporal hemianopia. She had symptoms and signs of acromegaly. methods: Imaging, biochemical, and histological studies were performed. RESULTS: magnetic resonance imaging (MRI) of the brain confirmed the presence of a 2.6-cm lesion within the sella turcica extending above the sella and compressing the optic chiasm. Endocrine studies showed elevated serum levels of GH, prolactin, alpha-subunit of glycoprotein hormones, IGF-I, chromogranin a, and GHRH. The patient underwent uneventful transsphenoidal resection of the sellar tumor. Postoperatively, she noted an improvement in symptoms of acromegaly. Histological examination confirmed metastatic endocrine carcinoma to the pituitary, and immunohistochemistry localized GHRH to the tumor cells. The adjacent pituitary exhibited somatotroph hyperplasia with abundant reactivity for GH and alpha-subunit. In addition, there was focal neoplastic transformation to a sparsely granulated somatotroph phenotype with fibrous bodies. CONCLUSION: This is the first report of a GHRH-producing endocrine tumor metastasizing to the pituitary and causing local hyperstimulation with somatotroph hyperplasia and adenomatous transformation.- - - - - - - - - - ranking = 0.66506423157574keywords = adenoma, gland (Clic here for more details about this article) |
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