1/29. Rapid enlargement and recurrence of a preexisting intrasellar craniopharyngioma during the course of two pregnancies. Case report.Enlargement of preexisting pituitary adenomas during pregnancy is well documented, but this phenomenon is unusual for nonendocrine pituitary tumors such as craniopharyngiomas. Only six cases of craniopharyngioma have been reported as presenting during pregnancy. The authors describe a 19-year-old woman who presented with amenorrhea and galactorrhea caused by an intrasellar mass. Seven months later, when she was 20 weeks pregnant, the patient developed sudden visual dysfunction. Emergency transsphenoidal surgery was performed to restore visual function, and the tumor was found to be a craniopharyngioma. The patient had spontaneous labor and delivered a healthy infant at term. The tumor recurred 4 years later, during her second pregnancy, and was again entirely removed via a second transsphenoidal approach. She again had a normal term delivery. During the 5-year follow-up period she has demonstrated no endocrinological or visual dysfunction. Control magnetic resonance images have revealed no recurrence of the tumor. The transsphenoidal approach seems to be the safest procedure to use during pregnancy to achieve an immediate optic nerve decompression and to preserve pituitary function.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
2/29. prolactinoma causing secondary amenorrhea in a woman with Ullrich-turner syndrome.This is the case report of a girl who was diagnosed as having Ullrich-Turner mosaic at the age of 12 years. She had normal pubertal development and menarche at the age of 15 years. The patient had regular menstrual cycles for 12 months before developing secondary amenorrhea. She was started on estrogen/gestagen replacement therapy by her gynecologist. Several months later a prolactinoma was diagnosed by laboratory and imaging techiques. A second-generation dopamine agonist led to almost regular cycles. Therefore, even in patients with susceptibility to ovarian failure secondary amenorrhea necessitates thorough diagnostic investigation. Copyrightz1999S.KargerAG,Basel- - - - - - - - - - ranking = 6keywords = amenorrhea (Clic here for more details about this article) |
3/29. Composite pituitary adenoma and intrasellar tuberculoma: report of a rare case.Tuberculous involvement of the pituitary gland is rare. We report a unique case of a composite lesion consisting of pituitary adenoma and intrasellar tuberculoma. A 24-year-old lady presented with features of acromegaly and amenorrhea. serum growth hormone levels were found to be raised. Radiological investigations were consistent with a pituitary adenoma. decompression of the lesion was done through trans-sphenoidal approach. Histological examination revealed a growth hormone secreting pituitary adenoma in association with a granulomatous lesion suggesting of pituitary tuberculoma. No other evidence of tuberculosis was found in the brain or spinal cord. This type of dual pathology has been reported only once in the earlier literature.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
4/29. Concomitant occurrence of macroprolactin, exercise-induced amenorrhea, and a pituitary lesion: a diagnostic pitfall. Case report.The authors report the case of a 37-year-old woman who presented with amenorrhea and an increased level of serum prolactin. Magnetic resonance images of the pituitary revealed a lesion with characteristics consistent with those of a microadenoma. Transsphenoidal exploration was performed, but a prolactinoma was not found. After endocrinological review, the patient's hyperprolactinemia was found to be caused by the presence of macroprolactin and her amenorrhea was due to intense exercise and low body weight. Macroprolactin is an isoform of prolactin that is variably reactive in assays for prolactin, but displays minimum bioactivity in vivo. patients with macroprolactin are mostly asymptomatic. This phenomenon may cause elevated prolactin values, which the authors view as apparent hyperprolactinemia. The presence of macroprolactin is an underrecognized problem, occurring in as many as 15 to 20% of patients with elevated prolactin values and often leading to unnecessary, expensive diagnostic procedures and inappropriate treatment. The presence of macroprolactin should always be suspected when the patient's clinical history or clinical or radiological data are incompatible with the prolactin value. physicians dealing with diagnosis and treatment of hyperprolactinemia (general practitioners, gynecologists, neurosurgeons, endocrinologists, and biochemists) should be aware of the potentially misleading nature of macroprolactin.- - - - - - - - - - ranking = 6keywords = amenorrhea (Clic here for more details about this article) |
5/29. Prolactin-producing pituitary adenoma associated with prolactin cell hyperplasia.A 24-yr-old woman with amenorrhea, galactorrhea, hyperprolactinemia, and sellar mass underwent transsphenoidal surgery. Histologic, immunohistochemical, and electron microscopic investigation revealed a well-differentiated, sparsely granulated prolactin (PRL) cell adenoma of the pituitary showing conclusive PRL immunoreactivity. In the nontumorous adenohypophysis PRL cell hyperplasia was noted. Marked differences were evident between the neoplastic and hyperplastic areas. The tumor consisted of sparsely granulated PRL cells immunoreactive only for PRL. As demonstrated by immunoelectron microscopy, the hyperplastic area comprised monohormonal sparsely granulated PRL cells as well as bihormonal mammosomatotrophs immunoreactive for both PRL and growth hormone. The MIB-1 index was higher whereas microvessel density was lower in the adenoma as compared with the hyperplastic area. In addition, the nontumorous area showed lymphocytic infiltration whereas inflammatory reaction was not seen in the adenoma. This case represents a rare association of a PRL cell adenoma and PRL cell hyperplasia. The fact that these two lesions were contiguous in the surgically removed material raises the possibility that hyperplasia can precede and transform into adenoma.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
6/29. Histochemical and immunohistochemical features of a case showing association of meningioma and prolactinoma containing amyloid.We report the rare case of a 43-year-old woman with a simultaneous meningioma of the sphenoid wing and an amyloid-containing prolactinoma. The patient, who presented with a 17-year history of amenorrhea, and galactorrhea, was found to have a 10-mm mass in the pituitary gland. During excision of this lesion, another mass was noticed, which was located in the sphenoid wing. Both lesions were completely excised. Histopathological examination revealed that the pituitary tumor was a prolactinoma with diffuse amyloid deposition and that the second tumor was a typical meningioma. The coexistence of a prolactinoma containing amyloid and a meningioma is very rare in the literature, so this case is presented here with its histochemical and immunohistochemical features. We discuss the significance of prolactinoma containing amyloid and the simultaneous presentation of these two tumors.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
7/29. Blurred vision during airline flight reveals prolactinoma.BACKGROUND: Pituitary adenomas can manifest with a variety of endocrinologic signs and symptoms, including amenorrhea, galactorrhea, infertility, and acromegaly. Because of the anatomic location of the pituitary gland, and its proximity to the optic chiasm and cavernous sinuses, pituitary adenomas can also result in decreased visual acuity, diplopia, ophthalmoplegia, visual-field loss, and optic atrophy. In general, these tumors are slow-growing. However, there are reports in the medical literature of patients with previously undiagnosed brain tumors in whom neurological signs suddenly developed when in higher altitudes. CASE REPORT: A 47-year-old woman came in for an evaluation of a one-month history of blurry peripheral vision that occurred during-then persisted following--an international flight. Examination and automated visual-field testing revealed a decrease in her best-corrected visual acuity and a bi-temporal hemianopsia. Subsequent examinations by a neurologist and endocrinologist revealed a significant pituitary adenoma-specifically, a prolactinoma. The patient was treated with bromocriptine and has shown a rapid improvement in her visual field and a regression of the tumor, as evidenced by a repeat MRI. CONCLUSION: In this case, the sudden development of the patients symptoms during an airline flight, and the persistence of the symptoms after landing, resulted in the discovery of a prolactinoma.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
8/29. Usefulness of CV 205-502 in a case of allergy to ergot-derived drugs.This study reports a case of allergy to ergot-derived drugs in a patient with a prolactin (PRL)-secreting microadenoma. The anamnesis revealed allergic reactions to the administration of analgesics and antibiotics. The administration of dopamine agonist drugs, such as bromocriptine (BRC; 2.5 mg) or lisuride (0.2 mg), induced after a few minutes the appearance of nausea, vomiting, postural hypotension, headache, edema of the glottis with dispnea and acroedema. The edemas disappeared a few hours after the administration of antihistaminic drugs while nausea, vomiting, postural hypotension and headache persisted for a few days. Therefore, the patient was tested with another dopamine agonist non-ergot-derived drug, quinagolide (CV 205-502), which did not cause side effects or allergic reactions. Furthermore, not only was the responsiveness to the drug optimal but it also normalized the PRL levels, and menses reappeared after more than a 5-year amenorrhea. This report suggests that ergot-derived drugs, such as lisuride and BRC, seldom induce allergic reactions apart from common side effects. Consequently, the feasibility of using a new drug with a different molecular structure (non-ergot derived) effective in the therapy of hyperprolactinemic syndromes represents a good alternative to conventional therapy.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
9/29. Coexisting corticotroph and lactotroph adenomas: case report with reference to the relationship of corticotropin and prolactin excess.A 57-year-old obese woman with hypertension, diabetes mellitus, osteoporosis, and a 40-year history of secondary amenorrhea was diagnosed with corticotropin-dependent Cushing's syndrome. Dynamic endocrine testing and radiological evaluation did not reveal definitively the source of the excess corticotropin. Bilateral adrenalectomy was performed with resolution of the signs and symptoms of hypercortisolism. Four years later, the patient was noted to have rising serum corticotropin levels and an enlarging pituitary mass; hyperprolactinemia also was documented. A diagnosis of Nelson-Salassa syndrome was made, and she underwent a transsphenoidal adenomectomy. A histological examination of the specimen revealed two distinct, albeit contiguous, adenomas: a corticotroph adenoma and a lactotroph adenoma. Postoperatively, the serum prolactin and corticotropin levels decreased significantly. Although the stalk section effect resulting from compression by a pituitary adenoma can raise serum prolactin levels, a concurrent lactotroph adenoma should be considered in patients with nonfunctional or functional pituitary adenomas of other types associated with significantly elevated prolactin levels. The mechanisms underlying simultaneous adrenocorticotropic hormone and prolactin excess are discussed.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
10/29. salmon roe-like amyloid deposition in a prolactinoma: a case report.An unusual case of prolactin-producing adenoma with extensive amyloid deposition is reported to clarify its radiological, intraoperative, and light- and electron-microscopic findings. A 41-year-old female patient complained of amenorrhea persisting for 20 years. magnetic resonance imaging (MRI) revealed a pituitary adenoma, which included low-intensity spots on T1- and T2-weighted images. Intraoperative examination found multiple small, yellowish, spherical masses resembling salmon roe within the adenoma. light and electron microscopy revealed the presence of immunoreactive cells for prolactin intermingled with concentric lamellar bodies of radially arranged amyloid fibrils originating from the endoplasmic reticulum in prolactinoma cells. The extracellular lamellar amyloid deposits were apparently due to degradation of prolactin-producing cells, but the reason for the production and radially arranged accumulation of amyloid remains to be identified.- - - - - - - - - - ranking = 1keywords = amenorrhea (Clic here for more details about this article) |
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