RESUMO
El absceso hipofisario es un proceso infeccioso dentro de la silla turca, infrecuente, grave y de difícil diagnóstico debido a sintomatología variada e inespecífica. Presentamos 3 casos clínicos de abscesos hipofisarios, teniendo en común la presencia de lesiones preexistentes. Todos fueron intervenidos quirúrgicamente, 2 pacientes resultaron ser abscesos asépticos y en un paciente se aisló Aspergillus capsulatum. Presentaron buena evolución con el tratamiento médico pero con secuelas de hipopituitarismo. Es muy importante tener en cuenta el absceso hipofisario entre los diagnósticos diferenciales de las masas que se localicen en esa región debido a que el diagnóstico oportuno y el tratamiento correcto son relevantes para el pronóstico de estos pacientes.
Pituitary abscess is due to a severe and uncommon infection in the sella. It is difficult to diagnose due to varied and non-specific symptoms. A report is presented of 3 cases of pituitary abscess, which had the presence of pre-existing injuries in common. All were subjected to surgery, with aseptic abscesses found in 2 patients, and Aspergillus capsulatum was isolated in 1 patient. They showed good progress with medical treatment, but with sequelae of hypopituitarism. It is very important to consider the pituitary abscess in the differential diagnosis of the masses that are located in that region, as a timely diagnosis and proper treatment can be important for the prognosis of these patients.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hipófise/patologia , Imageamento por Ressonância Magnética , Hipófise/microbiologia , Hipófise/diagnóstico por imagem , Infecções do Sistema Nervoso Central/diagnóstico por imagem , Abscesso/cirurgiaRESUMO
Functional interactions between neuroendocrine and immune systems are mediated by similar ligands and receptors, which establish a bi-directional communication that is relevant for homeostasis. We investigated herein the hypothalamus-pituitary-adrenal (HPA) axis in mice acutely infected by Trypanosoma cruzi, the causative agent of Chagas' disease. Parasites were seen in the adrenal gland, whereas T. cruzi specific PCR gene amplification product was found in both adrenal and pituitary glands of infected mice. Histological and immunohistochemical analyses of pituitary and adrenal glands of infected animals revealed several alterations including vascular stasis, upregulation of the extracellular matrix proteins fibronectin and laminin, as well as T cell and macrophage infiltration. Functionally, we detected a decrease in CRH and an increase in corticosterone contents, in hypothalamus and serum respectively. In contrast, we did not find significant changes in the amounts of ACTH in sera of infected animals, whereas the serum levels of the glucocorticoid-stimulating cytokine, IL-6 (interleukin-6), were increased as compared to controls. When we analyzed the effects of T. cruzi in ACTH-producing AtT-20 cell line, infected cultures presented lower levels of ACTH and pro-opiomelanocortin production when compared to controls. In these cells we observed a strong phosphorylation of STAT-3, together with an increased synthesis of IL-6, suppressor of cytokine signaling 3 (SOCS-3) and inhibitor of activated STAT-3 (PIAS-3), which could explain the partial blockage of ACTH production. In conclusion, our data reveal that the HPA axis is altered during acute T. cruzi infection, suggesting direct and indirect influences of the parasite in the endocrine homeostasis.
Assuntos
Doença de Chagas/fisiopatologia , Sistema Hipotálamo-Hipofisário/microbiologia , Sistema Hipófise-Suprarrenal/microbiologia , Glândulas Suprarrenais/microbiologia , Glândulas Suprarrenais/fisiologia , Hormônio Adrenocorticotrópico/análise , Hormônio Adrenocorticotrópico/metabolismo , Animais , Corticosterona/análise , Corticosterona/metabolismo , Hormônio Liberador da Corticotropina/análise , Hormônio Liberador da Corticotropina/metabolismo , Sistema Hipotálamo-Hipofisário/fisiologia , Hipotálamo/microbiologia , Hipotálamo/fisiologia , Immunoblotting , Imuno-Histoquímica , Interleucina-6/análise , Interleucina-6/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Hipófise/microbiologia , Hipófise/fisiologia , Sistema Hipófise-Suprarrenal/metabolismo , Proteínas Inibidoras de STAT Ativados/análise , Proteínas Inibidoras de STAT Ativados/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fator de Transcrição STAT3/análise , Fator de Transcrição STAT3/metabolismo , Proteína 3 Supressora da Sinalização de Citocinas , Proteínas Supressoras da Sinalização de Citocina/análise , Proteínas Supressoras da Sinalização de Citocina/metabolismo , Trypanosoma cruziRESUMO
Pituitary tuberculomas are exceptionally rare. Even with no evidence of systemic tuberculosis, it is important to recognize these lesions in the differential diagnosis of the intrasuprasellar tumors because they are curable. At present, in developed countries the frequency of intracranial tuberculomas of nervous system tumors is around 0.5-4%, whereas in under developed countries is 15-30%. It mainly affects children and young adults. In some cases, an accurate diagnosis may lead to an efficient medical therapy on the basis of biological, hormonal and imaging scans examinations. The case we studied shows the difficulties encountered in the diagnosis of a thickened stalk having normal pituitary image. It is to be highlighted the usage of the Polymerase Chain Reaction (PCR) technique.