Acute brain swelling in the course of fulminant pituitary apoplexy probably induced by cytokine storm: A case report

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  • サイトカインストームによる急性脳腫脹が推察された劇症型下垂体卒中の１例
  • サイトカインストーム ニ ヨル キュウセイ ノウ シュチョウ ガ スイサツ サレタ ゲキショウガタ カスイタイ ソッチュウ ノ 1レイ

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Abstract

<p>  There are limited reports of pituitary apoplexy showing a fulminant clinical course. A 38‒year‒old Japanese woman was admitted to the emergency room 4 hr after suddenly developing a headache. She had recently noticed changes in her facial appearance and that her ring and shoe sizes had increased. She presented no neurological symptoms and was diagnosed with pituitary apoplexy based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Based on her basal levels of pituitary hormones and the results of the pituitary stimulation test, we suspected a growth hormone (GH)‒producing pituitary adenoma. She exhibited left abducens nerve palsy 20 hr after disease onset, followed by mild disturbance of consciousness and a high fever of 39.9° at 27 hr and 30 hr post‒disease onset, respectively. After neurological worsening was confirmed, transsphenoidal surgery was performed at 37 hr after onset. Poor arousal and dilated pupils were noted immediately after surgery. CT showed no intracranial hemorrhage, but the entire brain was markedly swollen. Contrast‒enhanced CT scans were performed to examine cerebral circulation: poor intracranial filling was observed. We considered cytokine storms induced by the release of cytokines from tumor necrotic tissues as a possible cause and thus measured serum interleukin (IL)‒4, ‒6, ‒8, ‒10, and tumor necrosis factor‒α levels. The serum IL‒6 level was abnormally high (257 pg/mL), but the IL‒6 level in the resected tissue was nearly 30 times higher (7660 pg/g tissue). We speculated that the abnormally high IL‒6 level was caused by tumor necrosis. We further postulate that a large number of cytokines released from tumor necrotic tissues into the basal cistern may have induced a severe vasospasm and subsequent acute brain swelling.</p>

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