Baldomero González-Virla

Cardiovascular Risk and Metabolic Syndrome Characteristics in Patients with Nonfunctional Pituitary Macroadenoma

Context An elevated incidence of type 2 diabetes and cardiovascular disease (CVD) has been reported in patients with nonfunctional pituitary macroadenoma (NFPMA). There is no information about metabolic syndrome and cardiovascular risk in patients with NFPMA in our population. Objective Analyze the metabolic syndrome (MetS) components and estimate cardiovascular risk in patients with NFPMA. Design and Setting Retrospective study, at the tertiary care center. Patients and Methods 71 patients with NFPMA treated according to a preestablished multimodal protocol. Main Outcome Measures Prevalence of diabetes, hypertension, high cholesterol, obesity, and cardiovascular risk and its relationship with the clinical and biochemical characteristics. Results The prevalence of diabetes, hypertension, high cholesterol, and obesity at diagnosis was 30%, 27%, 48%, and 85% and did not change upon the last visit. The prevalence of MetS changes from 54 to 48% (p = 0.001). NFPMA patients showed a significant increase risk for high total cholesterol (SMR 1.68, 95% CI 1.28–2.17, p = 0.001) and diabetes (SMR 3.19, 95% CI 2.19–4.49, p = 0.01). According to Globorisk, the male gender was an evidence of high CVD before (81% versus 18%, p = 0.01) and after (72% versus 28%, p = 0.01) multimodal treatment. Conclusion A high prevalence of cardiovascular and metabolic disease and a high cardiovascular risk were evidenced in patients with NFPMA, especially in men. Risk factors such as the personal history of hypertension and dyslipidemia could explain the foregoing, so the control and treatment of metabolic parameters and cardiovascular risk should be an integral part of the follow-up of these patients.

AN UNUSUAL INITIAL MANIFESTATION OF PROLACTINOMA WITH POSTTRAUMATIC PITUITARY APOPLEXY

ABSTRACT Objective: Posttraumatic pituitary apoplexy (PPA) is a rare entity, especially in hormonally active pituitary adenomas. There are no case reports of PPA-like initial manifestations of prolactinoma. Methods: We present a case report of PPA in a 46-year-old patient with unknown macroprolactinoma. Likewise, we present a literature review of PPA. Results: Patient was admitted to the emergency room due to traumatic brain injury, with altered state of consciousness. Physical examination revealed hypotension, tachycardia, bilateral periorbital ecchymosis, left ptosis, mydriasis, and abnormal reflexes by cranial nerves II, III, IV, VI, and VIII. Non-contrasted computed tomography was performed on the patients head, revealing only an incidental sellar lesion with hemorrhagic infarct. Supportive measures to ensure hemodynamic stability and hydrocortisone replacement were initiated. There was evidence of hypocortisolism, central hypothyroidism, hypogonadotropic hypogonadism, and hyperprolactinemia evidence...

Anorexia–cachexia syndrome-like hypothalamic neuroendocrine dysfunction in a patient with a papillary craniopharyngioma

The craniopharyngiomas are solid cystic suprasellar tumors that can present extension to adjacent structures, conditioning pituitary and hypothalamic dysfunction. Within hypothalamic neuroendocrine dysfunction, we can find obesity, behavioral changes, disturbed circadian rhythm and sleep irregularities, imbalances in the regulation of body temperature, thirst, heart rate and/or blood pressure and alterations in dietary intake (like anorexia). We present a rare case of anorexia–cachexia syndrome like a manifestation of neuroendocrine dysfunction in a patient with a papillary craniopharyngioma. Anorexia–cachexia syndrome is a complex metabolic process associated with underlying illness and characterized by loss of muscle with or without loss of fat mass and can occur in a number of diseases like cancer neoplasm, non-cancer neoplasm, chronic disease or immunodeficiency states like HIV/AIDS. The role of cytokines and anorexigenic and orexigenic peptides are important in the etiology. The anorexia–cachexia syndrome is a clinical entity rarely described in the literature and it leads to important function limitation, comorbidities and worsening prognosis. Learning points: Suprasellar lesions can result in pituitary and hypothalamic dysfunction. The hypothalamic neuroendocrine dysfunction is commonly related with obesity, behavioral changes, disturbed circadian rhythm and sleep irregularities, but rarely with anorexia–cachexia. Anorexia–cachexia syndrome is a metabolic process associated with loss of muscle, with or without loss of fat mass, in a patient with neoplasm, chronic disease or immunodeficiency states. Anorexia–cachexia syndrome results in important function limitation, comorbidities that influence negatively on treatment, progressive clinical deterioration and bad prognosis that can lead the patient to death. Anorexia–cachexia syndrome should be suspected in patients with emaciation and hypothalamic lesions.

MANDIBULAR BROWN TUMOUR AS ATYPICAL PRESENTATION OF PRIMARY HYPERPARATHYROIDISM, CLINICAL CONSIDERATIONS AND DIFFERENTIAL DIAGNOSIS. TWO CASES REPORT AND REVIEW OF THE LITERATURE.

Objective. We report two cases of patients who developed solitary expansive mandibular tumor of aggressive behavior who were surgically removed in suspicion of malignancy with histopathological diagnosis of Central Giant Cell Granuloma and Giant Cell Bone Tumor in patients undiagnosed of primary hyperparathyroidism (PHTP). Methods: Two cases report and review of the literature. Results: We present two cases of single mandibular tumor with aggressive, expansive, rapidly evolving behavior. In both cases, a malignant tumor process was suspected and the lesion was surgically resected. The histopathological diagnosis was Giant Cell Bone Tumor (GCTB) in one and Central Giant Cell Granuloma (CGCG) in the other. We are unaware of their biochemical studies of both patients at the time of the intervention. Several months later, they were sent to the Endocrinology Service for hypercalcemia. One of them presented hypercalcemic crisis and pancreatitis and the other a pathological fracture of humerus. The diagnosis of ...