title: Teaching NeuroImages: Ma2 encephalitis presenting as acute panhypopituitarism in a young man.
abstract: A 21-year-old man presented with headache, hypotonia, hypothermia, and somnolence, deteriorating to a Glasgow Coma Scale score of 3 within days. Hormonal testing revealed panhypopituitarism. His cerebral MRI showed a gadolinium-enhancing lesion in the pituitary gland with adjacent changes to the hypothalamus, midbrain, and basal ganglia (figures 1 and 2). Therapy with prednisolone resulted in rapid improvement. Ma2 antibodies were found in the patient's serum and CSF. FDG-PET demonstrated a tumor mass in the superior mediastinum and histology revealed a mediastinal seminoma. Ma2 antibody-mediated paraneoplastic disease has to be considered as a rare differential diagnosis in patients presenting with acute panhypopituitarism.(1.)
authors.affiliation: From the Departments of Neurology (C.G.B., C.L., A.S, M.B., M.S.) and Neuroradiology (A.M.), University of Göttingen, Germany.
authors.forename: Caroline G
authors.initials: CG
authors.lastname: Bergner
authors.forename: Christine
authors.initials: C
authors.lastname: Lang
authors.forename: Annette
authors.initials: A
authors.lastname: Spreer
authors.forename: Mathias
authors.initials: M
authors.lastname: Bähr
authors.forename: Alexander
authors.initials: A
authors.lastname: Mohr
authors.forename: Mikael
authors.initials: M
authors.lastname: Simons
mesh_terms: D000951:Antigens, Neoplasm / Q000378:metabolism*; D002540:Cerebral Cortex / Q000473:pathology; D004660:Encephalitis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019788:Fluorodeoxyglucose F18; D015600:Glasgow Coma Scale; D006801:Humans; D007018:Hypopituitarism / Q000175:diagnosis / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009419:Nerve Tissue Proteins / Q000378:metabolism*; D010902:Pituitary Gland / Q000473:pathology; D049268:Positron-Emission Tomography; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; C119249:Ma2 antigen; D009419:Nerve Tissue Proteins; D019788:Fluorodeoxyglucose F18