Hypophysitis due to paranasal sinusitis: A neurosurgical perspective from the developing world.

Related Articles

Hypophysitis due to paranasal sinusitis: A neurosurgical perspective from the developing world.

World Neurosurg. 2018 Apr 17;:

Authors: El Malik EFB, Manoranjan B, Ajani O, Zidan A

Abstract
BACKGROUND: and Importance: Sinusitis is a common clinical condition but sphenoid sinusitis is a less common form and even rarer is hypophysitis as a complication of the latter. Clinically, hypophysitis may mimic a pituitary neoplasm in presenting with mass effect and pituitary hormone dysfunction.
CLINICAL PRESENTATION: We present five cases of sinusitis-related hypophysitis treated at the Royal Care International Hospital in Khartoum, Sudan. Clinical symptoms at presentation included: headache, fever, ptosis, ophthalmoplegia and history of sinusitis with running nose (nasal discharge). None of the patients were immunocompromised nor had any of them signs of meningitis. Laboratory tests indicated neutrophilia and elevated inflammatory indices, namely; CRP and ESR. There was also a disturbance of the hypothalamic-pituitary hormone axis, particularly impaired cortisol level. MRI scans on all patients revealed swollen masses in the pituitary fossa and enhancement of the sellar region and paranasal sinuses, especially the sphenoid sinus. All cases were empirically treated with hydrocortisone and amoxicillin-clavulanate resulting in reversal of symptoms.
CONCLUSION: Sinusitis is common in tropical regions where the climate is usually warm, and often hot, and dry. Here, the condition is considered a common incidental finding in MRI examinations done for various indications. Hence, it is not considered as a serious health problem. Though our group of cases are small, we emphasize the importance of keeping a high index of suspicion for the diagnosis of hypophysitis in relevant case settings. This would help make an early diagnosis and assure appropriate medical, perhaps non-surgical, management.

PMID: 29678705 [PubMed - as supplied by publisher]

https://ift.tt/2K3CJJI