Extrapontine Myelinolysis and Reversible Parkinsonism After Hyponatremia Correction in a Case of Pituitary Adenoma: Hypopituitarism as a Predisposition for Osmotic Demyelination
| Autor: | Krishna C Joshi, Kiran Khanapure, Aniruddha Tekkatte Jagannatha, Parichay J. Perikal, Sunil V. Furtado, Alangar S Hegde |
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| Rok vydání: | 2018 |
| Předmět: |
Adenoma
medicine.medical_specialty Hydrocortisone Hypopituitarism Pituitary neoplasm Gastroenterology Levodopa 03 medical and health sciences 0302 clinical medicine Parkinsonian Disorders Pituitary adenoma Internal medicine medicine Humans Pituitary Neoplasms 030212 general & internal medicine Saline Solution Hypertonic business.industry Parkinsonism Middle Aged medicine.disease Hypertonic saline Myelinolysis Central Pontine Central pontine myelinolysis Surgery Female Neurology (clinical) Hyponatremia business 030217 neurology & neurosurgery Demyelinating Diseases |
| Zdroj: | World neurosurgery. 118 |
| ISSN: | 1878-8769 |
| Popis: | Background Osmotic demyelination syndrome commonly follows rapid correction of hyponatremia. Although pons is a common location, extrapontine locations, such as striatum and thalamus, have been reported. Case Description A 48-year-old woman presented with masked facies, shuffling gait, and pill-rolling tremors suggestive of acute-onset parkinsonism. Hyponatremia was diagnosed following a bout of diarrhea, which was corrected with hypertonic saline. Magnetic resonance imaging of the brain showed a giant pituitary adenoma. Hyperintensities on T2-weighted imaging were also seen at the level of pons and bilateral striatum. Central pontine myelinolysis and extrapontine myelinolysis were diagnosed. Hormonal assay showed hypocortisolism, secondary hypothyroidism, and hypogonadism. The patient was started on levodopa-carbidopa, steroids, and thyroxine. She underwent transnasal pituitary adenoma excision. At 6 months postoperatively, she had recovered completely with normal gait. Repeat imaging showed complete resolution of myelinolysis. At 36 months, she continued to have hypocortisolism and hypothyroidism requiring replacement. Conclusions Extrapontine myelinolysis with parkinsonism and asymptomatic central pontine myelinolysis is rare with few cases described in the literature. Our patient had a pituitary adenoma with hyponatremia requiring sodium correction, and we believe that hypopituitarism might have predisposed her to osmotic demyelination. We reviewed relevant literature on extrapontine myelinolysis in suprasellar tumors and the pathophysiology. Hypopituitarism is an underrecognized cause of hyponatremia. When treating a patient with hyponatremia, knowing the pituitary function status is a prerequisite for the physician to prevent osmotic demyelination syndrome. |
| Databáze: | OpenAIRE |
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