| Identifier |
walsh_2019_s1_c4 |
| Title |
A-deno What's Going On! |
| Creator |
Christine Greer; Salina Teja; Jennifer Danesch; Anna Mathew; Vivek Patel; Kimberly Gokoffski |
| Affiliation |
(CG) (ST) (JD) (AM) (VP) (KG) University of Southern California, Los Angeles, California |
| Subject |
Headaches |
| History |
A 68 year-old Hispanic female with hypertension, type II diabetes mellitus, panhypopituitarism after pituitary adenoma resection 30 years prior and subsequent radiation therapy presented with decreased vision in the left eye and severe headache. The patient's vision in the left eye declined in the preceding four months until she could no longer see light. She described a constant pressure within her left eye and 10/10 headache for nine months. The headaches were similar to the headaches she experienced prior to her initial tumor resection. She had presented to an outside emergency department several times given these symptoms and was suspected to have a recurrent pituitary adenoma. Recently, she had become somnolent without focal deficits. Her medications included levothyroxine, hydrocortisone and oral hypoglycemics and there had been no recent change. Her labs were notable for profound hyponatremia. Ophthalmic exam was notable for 20/60 and NLP vision, amaurotic pupil, and RAPD OS. Intraocular pressures and cranial nerves III-VII were normal. There was no proptosis or ocular adnexal abnormality or findings on slit lamp exam. The cup-to-disc ratio was 0.4 bilaterally with mild-moderate pallor of the left optic nerve. Visual field of the right eye showed diffuse depression. MRI brain with and without contrast demonstrated a 16x19x24 mm heterogenous sellar, suprasellar lesion contiguous with the left optic nerve. Within the mass, there was a non-enhancing T1 and T2 hypointense components thought to be consistent with cystic changes and calcification. The peripheral margins exhibited heterogenous nodular enhancement, which extended through the sellar floor to the sphenoid sinus, involving the left optic chiasm and optic nerve. CT head showed sella and clival erosion, no evidence of sinus disease. These findings were believed to be consistent with an invasive pituitary adenoma. The patient was referred for surgical resection at which point a diagnostic procedure was performed. |
| Disease/Diagnosis |
Pituitary aspergillosis is rare and presenting symptoms are often indistinguishable from pituitary adenoma1. In both circumstances, the most common symptoms are headache, vision disturbances and endocrinological abnormalities1,2 . Severe to excruciating headache has been reported in up to 87% of patients with pituitary adenoma 3. As such, the preoperative diagnosis of pituitary aspergillosis is difficult, especially in an immune-competent patient without extensive sinus disease. The clinician must have a high degree of suspicion in recurrent cases of pituitary adenoma which were previously treated with radiation, for atypical possibilities. These include infectious processes such as fungal infiltration, in particular in diabetic patients. |
| Date |
2019-03 |
| References |
1. Liu J, You C, Tang J, Chen L. Fungal pituitary abscess: Case report and review of the literature. Neurology India. 2013;61(2):210. https://www.ncbi.nlm.nih.gov/pubmed/23644345. doi: 10.4103/0028-3886.111168. 2. Lee JH, Park YS, Kim KM, et al. Pituitary aspergillosis mimicking pituitary tumor. AJR. American journal of roentgenology. 2000;175(6):1570-1572. https://www.ncbi.nlm.nih.gov/pubmed/11090377. doi: 10.2214/ajr.175.6.1751570. 3. Levy MJ, Matharu MS, Meeran K, Powell M, Goadsby PJ. The clinical characteristics of headache in patients with pituitary tumours. Brain : a journal of neurology. 2005;128(Pt 8):1921-1930. https://www.ncbi.nlm.nih.gov/pubmed/15888539. doi: 10.1093/brain/awh525. |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Source |
2019 North American Neuro-Ophthalmology Society Annual Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2019 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s62k0w0r |
| Setname |
ehsl_novel_fbw |
| ID |
1431952 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s62k0w0r |
