Cerebrospinal fluid rhinorrhea as a complication of ACTH-secreting pituitary macroadenoma in a patient with morbid obesity
https://doi.org/10.14341/omet2014457-61
Abstract
Cushing's disease (CD) is a progressive neuroendocrine disease caused by a pituitary tumor producing excessive amounts of ACTH. In most cases (80-85%) the cause of the disease is a pituitary corticotroph microadenomas (located within the sella, measuring 3–10 mm, rarely multiple microadenomas) and only 15% of cases are presented as corticotroph hyperplasia or pituitary macroadenoma extending beyond the sella. The macroadenomas in CD usually extend suprasellar (10%), infrasellar tumor growth is relatively rare (5%). If the clinical picture is subtle, the symptoms are caused by the development "mass effect" of the tumor as it propagates to the surrounding pituitary structures. Suprasellar growth leads to compression of the optic chiasm with narrowing of visual fields, infrasellar growth destructs the bottom of the sella turcica and may cause nasal cerebrospinal fluid leak, which is dangerous due depressurization of the cranial cavity and its communication with environmental pathogens, development of life-threatening conditions such as meningitis, meningoencephalitis, ventriculitis. Leading life-threatening complications of the CD are infectious and cardiovascular. But in the case of nasal liquorrhea with expansion of the tumor in sphenoid sinus with destruction of the bottom of the sella, there is an immediate threat to the life of the patient. This article presents an example of a patient with morbid obesity and lack of specific clinical manifestations of CD, in whom the diagnosis of disease CD was made on the results of laboratory and instrumental examination, which experienced a spontaneous nasal cerebrospinal fluid leak.
About the Authors
Dar'ya Viktorovna Petrova
Endocrinology Research Centre, Moscow
Russian Federation
residence
Russian Federation
residence
Laris Konstantinovna Dzeranova
Endocrinology Research Centre, Moscow
Russian Federation
MD, PhD, chief researcher at the Neuroendocrinology and osteopathies Department
Russian Federation
MD, PhD, chief researcher at the Neuroendocrinology and osteopathies Department
Andrey Yurievich Grigoriev
Endocrinology Research Centre, Moscow
Russian Federation
MD, PhD, Head of the Neurosurgery Department
Russian Federation
MD, PhD, Head of the Neurosurgery Department
Oksana Vladimirovna Ivashchenko
Endocrinology Research Centre, Moscow
Russian Federation
neurosurgeon, researcher at the Neurosurgery Department
Russian Federation
neurosurgeon, researcher at the Neurosurgery Department
Anastasia Mikhailovna Lapshina
Endocrinology Research Centre, Moscow
Russian Federation
PhD, researcher at the Pathomorphology Department
Russian Federation
PhD, researcher at the Pathomorphology Department
Aleksandr Valerievich Vorontsov
Endocrinology Research Centre, Moscow
Russian Federation
MD, PhD, professor
Russian Federation
MD, PhD, professor
References
1. Pivonello R, De Martino MC, De Leo M, Tauchmanovà L, Faggiano A, Lombardi G, et al. Cushing's syndrome: aftermath of the cure. Arq Bras Endocrinol Metab 2007;51(8):1381–1391. PMID: 18209877. doi: 10.1590/S0004-27302007000800025.
2. Марова Е.И., Арапова С.Д., Манченко О.В. Достижения в лечении болезни Иценко-Кушинга. / Лекции по эндокринологии под редакцией Аметова А.С. – М.: 2009. – С. 196–216 [Marova EI, Arapova SD, Manchenko OV. Dostizheniya v lechenii bolezni Itsenko-Kushinga. In: Lektsii po endokrinologii. Ametov AS, editor. 2009. p. 196–216.]
3. Schlosser RJ, Wilensky EM, Grady MS, Bolger WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol 2003;17(4):191–195. PMID: 12962187.
4. Ricchetti A, Burkhard PR, Rodrigo N, Gamulin Z, Côte M, Reverdin A, et al. Skull base cerebrospinal fluid fistula: a novel detection method based on two-dimensional electrophoresis. Head Neck 2004;26(5):464–469. PMID: 15122664. doi: 10.1002/hed.10359.
5. Wax M, Ramadan H, Ortiz O, Wetmore S. Contemporary management of cerebrospinal fluid rhinorrhea. Otolaryngology – Head and Neck Surgery 1997;116(4):442–449. doi: 10.1016/S0194-5998(97)70292-4.
6. Ramsden JD, Corbridge R, Bates G. Bilateral cerebrospinal fluid rhinorrhoea. J. Laryngol. Otol 2000;114(02):10–1258. doi: 10.1258/0022215001904897.
7. Findling JW, Raff H. Screening and Diagnosis of Cushing's Syndrome. Endocrinology and Metabolism Clinics of North America 2005;34(2):385–402. doi: 10.1016/j.ecl.2005.02.001.
8. Tiryakioglu O, Ugurlu S, Yalin S, Yirmibescik S, Caglar E, Yetkin DO, et al. Screening for Cushing's syndrome in obese patients. Clinics 2010;65(1):9–13. doi: 10.1590/S1807-59322010000100003.
9. Алгоритм обследования и лечения пациентов в эндокринологии / Под редакцией Дедова И.И., Мельниченко Г.А. М.:2008. – С. 1–10 [Algoritm obsledovaniya i lecheniya patsientov v endokrinologii ed, by Dedov II, Mel'nichenko GA. Moscow: 2008.]
10. Nieman LK, Biller BMK, Findling JW, Newell-Price J, Savage MO, Stewart PM, et al. The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism 2008;93(5):1526–1540. doi: 10.1210/jc.2008-0125.
11. Schievink WI, Gordon OK, Tourje J. Connective Tissue Disorders with Spontaneous Spinal Cerebrospinal Fluid Leaks and Intracranial Hypotension: A Prospective Study. Neurosurgery 2004;54(1):65–71. PMID: 14683542. doi: 10.1227/01.NEU.0000097200.18478.7B.
12. Asano N, Taki K, Kondo T, et al. A case of spontaneous intracranial hypotension effectively treated with cervical epidural blood patch. Masui 2004;53(10):1185–8. PMID: 15552956.
13. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous Cerebrospinal Fluid Leaks: A Variant of Benign Intracranial Hypertension. Annals of Otology, Rhinology & Laryngology 2006;115(7):495–500. doi: 10.1177/000348940611500703.
14. Suryadevara AC, Fattal M, Woods CI. Nontraumatic cerebrospinal fluid rhinorrhea as a result of pseudotumor cerebri. American Journal of Otolaryngology 2007;28(4):242–246. PMID: 17606039. doi: 10.1016/j.amjoto.2006.08.013.
15. Badia L, Loughran S, Lund V. Primary Spontaneous Cerebrospinal Fluid Rhinorrhea and Obesity. American Journal of Rhinology 2001;15(2):117–119. doi: 10.2500/105065801781543736.
16. Clark D, Bullock P, Hui T, Firth J. Benign intracranial hypertension: a cause of CSF rhinorrhoea. Journal of Neurology, Neurosurgery & Psychiatry 1994;57(7):847–849. doi: 10.1136/jnnp.57.7.847.
Supplementary files
|
1. Фото 1а | |
| Subject | ||
| Type | Исследовательские инструменты | |
Download
(203KB)
|
Indexing metadata ▾ | |
|
|
2. Фото 1б | |
| Subject | ||
| Type | Исследовательские инструменты | |
Download
(219KB)
|
Indexing metadata ▾ | |
|
|
3. МРТ снимки | |
| Subject | ||
| Type | Исследовательские инструменты | |
Download
(847KB)
|
Indexing metadata ▾ | |
Review
For citations:
Petrova D.V., Dzeranova L.K., Grigoriev A.Yu., Ivashchenko O.V., Lapshina A.M., Vorontsov A.V. Cerebrospinal fluid rhinorrhea as a complication of ACTH-secreting pituitary macroadenoma in a patient with morbid obesity. Obesity and metabolism. 2014;11(4):57-61. (In Russ.) https://doi.org/10.14341/omet2014457-61
Views:
781
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).
Email this article 
