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Case Reports
. 2024 Nov 1;63(21):2953-2959.
doi: 10.2169/internalmedicine.3390-23. Epub 2024 Mar 11.

Hypopituitarism due to CNS Aspergillus Infection

Shogo Funakoshi  1 , Mitsuru Nishiyama  1   2 , Masahiro Komori  3 , Masamitsu Hyodo  3 , Yu Kawanishi  4 , Tetsuya Ueba  4 , Shimpei Fujimoto  1 , Yoshio Terada  1
Affiliations
Case Reports

Hypopituitarism due to CNS Aspergillus Infection

Shogo Funakoshi et al. Intern Med. .

Abstract

A 59-year-old man was admitted to our hospital with hyponatremia. An endocrine examination indicated panhypopituitarism, and magnetic resonance imaging revealed a mass-like lesion in the pituitary gland. Sinus endoscopy revealed a fungal mass in the sphenoid sinus, and the patient was diagnosed with hypopituitarism due to aspergillosis of the central nervous system (CNS). The patient's hyponatremia resolved with hydrocortisone replacement. Although the right internal carotid artery was eventually occluded, antifungal medications were administered for the aspergillosis, and the patient's general condition improved. The patient's CNS lesions have remained under control since discharge. This is the first case to suggest that ACTH secretion may be relatively preserved in Aspergillus-induced hypopituitarism.

Keywords: Aspergillus; carotid occlusion; hyponatremia; hypopituitarism; invasive sinus fungal infection.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
[A, D] T1-weighted magnetic resonance images (coronal section). [B, E] Gadolinium-enhanced T1-weighted magnetic resonance images (coronal section). A gadolinium-enhanced T1-weighted magnetic resonance image [C] (sagittal section). Magnetic resonance angiography image [F]. An irregular mass-like lesion around the right cavernous sinus to pituitary gland (B, C, arrows), and irregular wall thickness in the right sphenoid sinus (C, E, arrows). Right carotid stenosis observed on magnetic resonance angiography (F, arrows).
Figure 2.
Figure 2.
Sinus endoscopy revealed a fungal mass in the right sphenoid sinus (arrows).
Figure 3.
Figure 3.
Magnetic resonance images and magnetic resonance angiography images at admission [A-1, B-1, C-1] and after medication [A-2, B-2, C-2]. Gadolinium-enhanced T1-weighted images (coronal section) [A-1, B-1, A-2, B-2] and magnetic resonance angiography images [C-1, C-2]. The thickening of the sphenoid sinus disappeared [A-1, A-2] and the mass-like lesion of pituitary gland showed slightly improvement [B-1, B-2] after antifungal treatment. Magnetic resonance angiography initially showed right carotid stenosis (C-1, arrows) and eventually occlusion (C-2).
Figure 4.
Figure 4.
The clinical course of the present case. IVIG: Intravenous immunoglobulin, MCFG: micafungin, VRCZ: voriconazole
See this image and copyright information in PMC

References

    1. Joshi MN, Whitelaw BC, Carroll PV. Hypophysitis: diagnosis and treatment. Eur J Endocrinol 179: R151-R163, 2018. - PubMed
    1. Gubbi S, Hannah-Shmouni F, Verbalis JG, Koch CA. Hypophysitis: an update of the novel forms, diagnosis and management of disorders of pituitary inflammation. Best Pract Res Clin Endocrinol Metab 33: 101371, 2019. - PMC - PubMed
    1. Langlois F, Varlamov EV, Fleseriu M. Hypophysitis, the growing spectrum of a rare pituitary disease. J Clin Endocrinol Metab 107: 10-28, 2022. - PMC - PubMed
    1. Schwartz S, Kontoyiannis DP, Harrison T, Ruhnke M. Advances in the diagnosis and treatment of fungal infection of the CNS. Lancet Neurol 17: 362-372, 2018. - PubMed
    1. Nathan CL, Emmert BE, Nelson E, Berger JR. CNS fungal infections: a review. J Neurol Sci 422: 117325, 2021. - PubMed

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