title: Pituitary apoplexy due to mucormycosis infection in a patient with an ACTH producing pulmonary tumor.
abstract: Rhinocerebral mucormycosis is an acute, fulminating form of invasive fungal sinusitis occurring principally in individuals who are immunologically or metabolically compromised. The incidence of pituitary apoplexy ranges from 6% to 17%, presenting as a capsule rupture in up to 1.7-2.0%. Isolated cases of mucormycosis are associated with solid tumors and Cushing's syndrome. A 42-year-old, diabetic woman, with Cushing's syndrome of 5 years duration presented with hemiplexy, hemiparesis and altered speech following a syncopal episode and fall. Brain CT scan showed a left temporal lobe infarction. The patient deteriorated rapidly and she died 4 days later. Autopsy findings included: plurihormonal pituitary adenoma with extension to the sphenoid bone and sellar erosion; many thick, septated, mucormycosis hyphae; and recent fronto-temporal brain infarction. Also, a solitary adrenal corticotropic hormone (ACTH)-producing neuroendocrine tumor, 3 cm in diameter, was found in the left lung. This patient illustrates the correlation between ACTH-producing ectopic pulmonary tumor, pituitary apoplexy and mucormycosis.
authors.affiliation: Department of Neuropathology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
authors.forename: Citlaltépetl
authors.initials: C
authors.lastname: Salinas-Lara
authors.forename: Daniel
authors.initials: D
authors.lastname: Rembao-Bojórquez
authors.forename: Erick
authors.initials: E
authors.lastname: de la Cruz
authors.forename: Carlos
authors.initials: C
authors.lastname: Márquez
authors.forename: Lesly
authors.initials: L
authors.lastname: Portocarrero
authors.forename: Martha Lilia
authors.initials: ML
authors.lastname: Tena-Suck
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D009091:Mucormycosis / Q000150:complications / Q000209:etiology*; D010899:Pituitary Apoplexy / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000556:secondary*
chemical_list: D000324:Adrenocorticotropic Hormone