Acute chagas' disease presenting with a suprasellar mass and panhypopituitarism.
Although intrinsic pituitary lesions are the most common cause of hypopituitarism, suprasellar masses can produce similar symptoms. The differential diagnosis of a suprasellar mass includes cystic lesions, tumors, granulomatous disease, and infection. The etiology is not always obvious, and despite extensive work-up, may remain elusive. A 28-year-old Mexican man presented with complaints of headache and weakness for two weeks duration. He became increasingly lethargic and an MRI revealed a two centimeter suprasellar mass. Testing of the hypothalamic-pituitary axis suggested panhypopituitarism. He was prescribed treatment with hydrocortisone, DDAVP, and levothyroxine. Open craniotomy and biopsy of the hypothalamus revealed marked inflammation with plasma cells, histiocytes, and small lymphocytes. Light microscopy revealed macrophage-contained leishmania-like organisms although results were not immediately available. Pathological data was consistent with acute infection by Trypanasoma cruzi. Despite supportive efforts, the patient expired two months after presentation. This case illustrates the difficulty of diagnosing and the potential rapid mortality of a suprasellar mass. Because of the wide consideration of etiologies, a tissue diagnosis is needed. However, as this case illustrates, a definitive tissue diagnosis is not always possible, even following biopsy during open craniotomy.
Choi
Hoon-Ji Helen
HJ
Department of Endocrinology, Metabolism, and Molecular Medicine, Charles Drew University of Medicine & Science, 1731 East 120th Street, Los Angeles, CA 90059, USA.
Cornford
Marcia
M
Wang
Lina
L
Sun
Julie
J
Friedman
Theodore C
TC
D000328:Adult; D000818:Animals; D020863:Central Nervous System Cysts / Q000175:diagnosis / Q000209:etiology* / Q000469:parasitology; D014355:Chagas Disease / Q000175:diagnosis* / Q000473:pathology; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007018:Hypopituitarism / Q000175:diagnosis / Q000209:etiology* / Q000469:parasitology; D008297:Male; D013974:Thyroxine / Q000627:therapeutic use; D014349:Trypanosoma cruzi / Q000302:isolation & purification
D003894:Deamino Arginine Vasopressin; D013974:Thyroxine; D006854:Hydrocortisone