■垂体促肾上腺皮质激素大腺瘤,占7%至23%的促肾上腺皮质激素腺瘤,很少出现中风。该报告旨在描述患有稀疏颗粒的促肾上腺皮质激素肿瘤(SGCT)的患者,出现中风和皮质醇增多症缓解。
■一名33岁的男性患者出现在救护车上,突然出现严重头痛和恶心/呕吐。体格检查显示双颞侧偏盲,右侧第三颅神经麻痹复视,腹部纹,面部过多,背侧和锁骨上脂肪垫。磁共振成像显示,蝶鞍引起3.2厘米的肿块,出血压迫视交叉,伸入蝶窦和海绵窦.初步调查显示血浆皮质醇水平为64.08(参考范围[RR],2.36-17.05)mcg/dL。他接受了紧急经蝶窦手术。病理诊断为SGCT。术后,发现以下实验室发现:(1)皮质醇水平,<1.8ug/dL(RR,2.4-17);(2)促肾上腺皮质激素水平,36pg/mL(RR,0-81);(3)促甲状腺激素水平,0.07uIU/mL(RR,0.36-3.74);(4)游离甲状腺素水平,1ng/dL(RR,0.8-1.5);(5)黄体生成素水平,<1mIU/mL(RR,1-12);(6)促卵泡激素水平,1mIU/mL(RR,1-12);和(7)睾酮水平,28.8ng/dL(RR,219.2-905.6),随着对氢化可的松的持续需求,左甲状腺素,睾酮替代,并继续跟进。
■促肾上腺皮质激素腺瘤分为密集颗粒状,稀疏的颗粒,还有Crooke细胞肿瘤.颗粒稀疏模式与较大的肿瘤大小和术后缓解率降低有关。
■本报告说明了一例罕见的皮质醇增多症缓解病例,原因是SGCT中风并随后出现中枢肾上腺功能不全,甲状腺功能减退,和性腺功能减退.
UNASSIGNED: Pituitary corticotroph macroadenomas, which account for 7% to 23% of corticotroph adenomas, rarely present with apoplexy. This report aimed to describe a patient with a sparsely granulated corticotroph tumor (SGCT) presenting with apoplexy and remission of hypercortisolism.
UNASSIGNED: A 33-year-old male patient presented via ambulance with sudden onset of severe headache and nausea/vomiting. Physical examination revealed bitemporal hemianopsia, diplopia from right-sided third cranial nerve palsy, abdominal striae, facial plethora, and dorsal and supraclavicular fat pads. Magnetic resonance imaging demonstrated a 3.2-cm mass arising from the sella turcica with hemorrhage compressing the optic chiasm, extension into the sphenoid sinus and cavernous sinus. Initial investigations revealed a plasma cortisol level of 64.08 (reference range [RR], 2.36-17.05) mcg/dL. He underwent emergent transsphenoidal surgery. Pathology was diagnostic of SGCT. Postoperatively, the following laboratory findings were found: (1) cortisol level, <1.8 ug/dL (RR, 2.4-17); (2) adrenocorticotropic hormone level, 36 pg/mL (RR, 0-81); (3) thyroid-stimulating hormone level, 0.07 uIU/mL (RR, 0.36-3.74); (4) free thyroxine level, 1 ng/dL (RR, 0.8-1.5); (5) luteinizing hormone level, <1 mIU/mL (RR, 1-12); (6) follicle-stimulating hormone level, 1 mIU/mL (RR, 1-12); and (7) testosterone level, 28.8 ng/dL (RR, 219.2-905.6), with ongoing requirement for hydrocortisone, levothyroxine, testosterone replacement, and continued follow-up.
UNASSIGNED: Corticotroph adenomas are divided into densely granulated, sparsely granulated, and Crooke cell tumors. Sparsely granulated pattern is associated with a larger tumor size and decreased remission rate after surgery.
UNASSIGNED: This report illustrates a rare case of hypercortisolism remission due to apoplexy of an SGCT with subsequent central adrenal insufficiency, hypothyroidism, and hypogonadism.