Beatriz Olson | PubMed Health

PubMed2005

Lymphocytic hypophysitis.

Lymphocytic hypophysitis (LH) is a rare but increasingly recognized inflammatory disorder of the pituitary, usually associated with pregnancy. Knowledge of this condition is largely anecdotal; the cause, incidence, and natural history are unknown. Cases are usually discovered at biopsy and surgical intervention for a presumptive pituitary neoplasm. Here we describe two cases of lymphocytic hypophysitis. In the first case the patient underwent surgery for presumptive adenoma, and pathology at resection established the diagnosis of lymphocytic hypophysitis. The second case was strongly suspicious for LH by history, endocrine profile, and imaging, and was managed nonoperatively. Though magnetic resonance imaging (MRI) features are not diagnostic, knowledge of imaging features together with clinical history may permit avoidance of surgery.

Adult↗

PubMedDate not supplied

Fatal factitious Cushing's syndrome and invasive aspergillosis: case report and review of literature.

OBJECTIVE: To present the first reported fatality from invasive aspergillosis related to factitious Cushing's syndrome. METHODS: We summarize the history, clinical findings, and outcome in a patient ultimately found to have factitious Cushing's syndrome. In addition, the dangers of fulminant infections in untreated Cushing's syndrome are analyzed relative to molecular and immunologic aspects, and the pertinent literature is reviewed. RESULTS: A 33-year-old female medical transcriptionist was admitted with rapidly fatal septic shock and diffuse pulmonary infiltrates. Autopsy revealed invasive pulmonary aspergillosis and atrophied adrenal cortices. On subsequent investigation, hidden bottles of prednisone were found throughout the patient's home. Factitious Cushing's syndrome has rarely been described and can be a difficult diagnosis to establish, but it is important to recognize this condition because of its potentially drastic consequences. Our understanding of the mechanism of immunosuppression from glucocorticoids related to the increased risk of invasive fungal infections is evolving. Factitious illness can manifest in numerous ways; therefore, health-care providers in all specialties should be familiar with epidemiologic, diagnostic, and treatment considerations for this illness. CONCLUSION: Endocrinologists should be aware of the possibility of factitious Cushing's syndrome because it can be an elusive and ultimately fatal condition.

Adult↗