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Results for “Hypothalamic Neoplasms”

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PubMedDate not supplied

MR imaging of pituitary dwarfism.

The purpose of this study was to determine whether the MR findings of idiopathic pituitary dwarfism correlated with a clinical history of perinatal abnormalities and abnormal levels of pituitary hormones. MR examinations of 18 patients with pituitary dwarfism were performed; these patients were divided into two groups: those with ectopic posterior lobes (group 1) and those with normal posterior lobes (group 2). Among the seven patients in group 1, MR showed hyperintense signal at the median eminence of the hypothalamus, which was regarded as the ectopic posterior lobe of the pituitary gland. The mean anteroposterior length and height of the pituitary gland in group 1 patients were significantly smaller than those dimensions in the normal control group; the pituitary stalk was not detected in three of seven patients. Six of seven patients were products of breech presentation with perinatal asphyxia. The peak serum growth hormone level was less than 5 ng/ml when assessed by insulin-induced hypoglycemia or the clonidine test. MR findings in the 11 patients with pituitary dwarfism and normal posterior lobes were normal except that the mean size of the pituitary gland was slightly smaller than that of normal controls. The clinical history of these patients was normal except for perinatal asphyxia in one case. Our findings in patients with pituitary dwarfism, with or without an ectopic posterior pituitary lobe suggest that the ectopic lobe, visualized as a bright spot at the median eminence of the hypothalamus, may be common when pituitary dwarfism follows perinatal anoxic/ischemic episodes.

Adolescent↗
PubMedDate not supplied

Hamartomas of the tuber cinereum: CT, MR, and pathologic findings.

The neuroimaging studies, clinical evaluations, and surgical and pathologic findings in five children with biopsy-proved hamartomas of the tuber cinereum were reviewed. Surgical and/or MR findings showed that patients with precocious puberty had pedunculated lesions while those with seizures had tumors that were sessile with respect to the hypothalamus. The radiologic studies included six MR examinations in four patients and CT studies in all five patients. Three children presented with precocious puberty and two with seizures, one of which was a gelastic (spasmodic or hysteric laughter) type of epilepsy. MR studies were obtained both before and after surgery in two patients, only preoperatively in a third patient, and only postoperatively in the fourth child. MR was superior to CT in displaying the exact size and anatomic location of the hamartomas in all cases. The mass was isointense with gray matter on sagittal and coronal T1-weighted images, which best displayed the relationship of the hamartoma to the third ventricle, infundibulum, and mammillary bodies. Intermediate- or T2-weighted images showed signal characteristics of the hamartoma to be isointense (one case) or hyperintense (two cases) relative to gray matter. The difference in T2 signal intensity did not correlate with any obvious differences in histopathology. CT showed attenuation isodense with gray matter, and no calcium. There was no enhancement on CT. There was no enhancement on MR in the one case in which contrast medium was administered. Preservation of the posterior pituitary bright spot was noted on all pre- and postoperative T1-weighted MR scans.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

Magnetic resonance imaging of hypothalamic hamartomas causing gelastic epilepsy.

Hypothalamic hamartomas may cause a peculiar epileptic syndrome characterized by seizures of laughter and precocious puberty. Four mentally handicapped patients suffering from gelastic epilepsy were referred to our institution for investigation; three of them also presented with precocious puberty. In all four cases magnetic resonance imaging (MRI) revealed a space-occupying lesion of the hypothalamus that was considered to be a hamartoma. Biopsies were not performed. Hamartomas appear isodense in plain computed tomography scans, and they do not enhance. Such lesions display an isointense signal in T1-weighted magnetic resonance images and a hyperintense signal in proton density and T2-weighted images. MRI is the procedure of choice for detecting such lesions at the base of the brain.

Adolescent↗
PubMed1991

[Precocious puberty and laugh attacks].

A 7 year old girl presented with precocious puberty and ictal laughter. Brief, repetitive, stereotyped attacks of laughter were the first manifestation of the epileptic syndrome. Stages of puberty were noted as B III-IV and PH II according to Tanner. X-rays showed a bone age of 11 years and the weight increased from the 50th beyond 97th percentile. Plasma concentrations of LH, FSH, testosterone and Ostradiol were elevated. The CT scan was normal and a magnetic resonance imaging showed an hypothalamic hamartoma. The control of the seizures control and social adjustment were poor. MR scanning 3 years later showed no change in the size of the lesion.

Cerebral Cortex↗
PubMed1990

Navy helicopter pilot with a juxtasellar mass: case report with aeromedical considerations.

A Navy helicopter pilot was found to have a suprasellar mass during evaluation for primary infertility and mildly elevated prolactin level. Extensive evaluation revealed no other abnormalities. After 1 year of followup without radiographic tumor enlargement, he was returned to flying duties with continuing medical monitoring. Aeromedical considerations for tumors in the juxtasellar region are reviewed, including neuroendocrine disorders, neuro-ophthalmologic defects, and neurological impairment. The impact of improved diagnostic capabilities on aeromedical disposition is discussed.

Adult↗
PubMedDate not supplied

Precocious puberty in a monozygous twin: report of case.

This report describes some effects of premature production of sex hormones observed in a boy with precocious puberty. The data presented are compared with corresponding skeletal and oral factors in an unaffected monozygous twin brother.

Astrocytoma↗
PubMedDate not supplied

MR imaging of the ectopic bright signal of posterior pituitary regeneration.

High-field-strength MR studies of 13 patients with sellar and/or parasellar tumors revealed an aberrant location of the posterior pituitary bright signal in the hypothalamus in seven cases and in relation to the pituitary infundibulum in six cases. Five of the MR studies were obtained in patients who had not had surgery and had pituitary adenomas producing compression and/or destruction of the posterior lobe. In the other eight cases, the aberrant bright signal occurred after hypophysectomy in seven patients and after removal of a craniopharyngioma in the eighth. Accumulation of neurosecretory material and regeneration of pituitary tissue in these ectopic locations have been documented previously in animal experiments and in a few reports in humans after hypophysectomy. MR imaging now provides further corroborative evidence in vivo of this process in which a "miniature posterior lobe" is formed.

Adenoma↗
PubMedDate not supplied

Hamartoma of the tuber cinereum: a comparison of MR and CT findings in four cases.

Hamartoma of the tuber cinereum is a well-recognized cause of central precocious puberty. We report three patients with an isodense, nonenhancing mass within the interpeduncular cistern identified by CT. In a fourth patient, the CT scan was normal. MR imaging was obtained in all cases and demonstrated a sessile or pedunculated mass of the posterior hypothalamus arising from the region of the tuber cinereum. The smallest mass was 2 mm in diameter and was found in the patient in whom the CT scan was normal. The signal intensity of the masses was generally homogeneous and isointense relative to gray matter on T1- and intermediate-weighted images, and hyper-intense on T2-weighted images. MR imaging accurately diagnoses hypothalamic hamartomas, identifies small hamartomas of the tuber cinereum more sensitively than CT does, and provides optimal imaging for serial evaluation while the patient is being treated medically.

Child↗
PubMed1989

[Hypothalamic glioma with diencephalic syndrome and following precocious puberty--a case report].

A 1-year 11-month-old girl was admitted for losing her weight and gait disturbance. At 4 months of age, she began to become emaciated inspite of normal food intake. Physical and neurological examinations were normal except for a marked lack of subcutaneous fat, irritability and nystagmus. CT scans demonstrated a large tumor occupied in the third ventricle and marked dilatation of the lateral ventricles. Endocrinological studies revealed high levels of plasma growth hormone (GH) in contrast with normal levels of somatomedin-C. The basal value of GH returned to normal with a subnormal response to insulin subsequently after VP-shunt. Then, a pilocytic astrocytoma was partially resected with transcallosal approach. Postoperative course was uneventful and her growth rate returned to normal range. CT scans after radiation therapy of 49 Gy showed marked decrease in size of the tumor. At 3 years and 6 months of age, enlargement of her breast was pointed out although MRI indicated no enlargement of the tumor. Basal value of LH, FSH, E 1 and E 2 elevated and LHRH test showed over-response of LH and FSH. Other hypothalamic-pituitary functions were partially preserved. Case of precocious puberty following diencephalic syndrome associated to the hypothalamic and/or optochiasmatic glioma is quite rare in the previous literature. Mechanisms of diencephalic syndrome and following puberty are unclear. However, endocrinological and radiological findings observed in the present case suggest that hormonal disfunction might be due to the failure of inhibition on GH and LHRH secretion mechanism in the anterior hypothalamus.

Astrocytoma↗
PubMed1989

Magnetic resonance imaging of pituitary and parasellar abnormalities.

The ease, safety, accuracy, reliability, specificity, and sensitivity of the diagnosis of disorders of the sellar region all have been enhanced by MRI. This article demonstrates the normal anatomy and the wide array of pathology that can be visualized by MRI. Magnetic resonance has become the imaging modality of choice for most of the disorders within and about the sella.

Adenoma↗
PubMed1989

[A case of primary hypothalamic malignant lymphoma with diabetes insipidus].

A case of primary malignant lymphoma involving the hypothalamus is reported. A 31-year-old man was admitted with progressive disorientation. A computed tomography (CT) scan demonstrated a normodense, homogenously enhanced, and nodular shaped mass lesion involving the suprasellar region and extending to the third ventricle. In view of marked cerebral edema, dexamethasone was intravenously administered, at a dose of 4 mg/4 hr, and gradually tapered off. CT scans obtained 10 days after the admission revealed dramatic regression of the lesion, which corresponded with the clinical remission. However, on the 4th day after the discontinuance of corticosteroid, a CT scan demonstrated the recurrence of the mass lesion. Because of the rapid deterioration of consciousness and the progressive enlargement of the mass and dilatation of the ventricles, partial removal of tumor and ventricular drainage were carried out on the 24th day after admission. Dexamethasone was intravenously administered again at a dose of 4 mg/4 hr. A CT scan obtained five days after the operation showed complete disappearance of the lesion, and the patient had became almost alert. CT scans obtained on the 18th day and the 35th day after the operation showed complete disappearance of the mass. However, Magnetic Resonance Imaging revealed a localized area of abnormal signal intensity in the hypothalamus. Diabetes insipidus was continuously observed from the time of admission. A concomitant change of beta-2-microglobulin (beta-2-MG) and immunoglobulin (IgA, IgG, IgM) concentrations in serum and cerebrospinal fluid (CSF) with clinical profiles and CT findings were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Hypernatremia due to hypothalamic tumor: ADH response to changes in plasma osmolality].

A case of a patient with the syndrome of chronic hypernatremia and hypodispia due to hypothalamic tumor was studied to evaluate the change of ADH response to plasma osmolality during the clinical course. A 23-year-old man was admitted for investigation of anorexia, hypodipsia and gait disturbance. Examination showed memory disturbance and generalized muscle weakness. Investigation showed marked hypernatremia (177 mEq/l) and hypopituitarism. Water loading test showed that ADH was not stimulated by hyperosmolality but continued to be secreted at a more or less constant level approximating normal basal state. CT scan revealed hypothalamic tumor. The tumor was suspected to be germinoma due to its radiosensitivity and high serum hCG level. After irradiation, the tumor lesion disappeared. ADH secretion came to be responsive to changes in osmolality but the response of the system was markedly reduced compared with the normal response, and hypodipsia and hypernatremia still remained. We conclude that the adipsia and complete destruction of the osmoreceptor in the patient caused marked hypernatremia and the destruction of ADH osmostat improved partially after irradiation. We believe it very useful for analyzing the disturbance of osmoregulatory system to evaluate the relationship of plasma ADH to plasma osmolality.

Adult↗
PubMed1987

Ectopic pituitary and hypothalamic hormone syndromes.

The pathophysiology and diagnosis of ectopic hormone syndromes are discussed, and a classification of hypothalamic and pituitary ectopic syndromes is provided. Ectopic hypothalamic syndromes resulting from tumor elaboration of GRH, GnRH, CRF, and SRIF and ectopic pituitary hormone hypersecretion of GH, PRL, and TSH are reviewed comprehensively. A practical approach to the clinical work-up and management of these newly described disorders is provided.

Hamartoma↗