PMID- 33708681
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210313
IS  - 1793-5482 (Print)
IS  - 2248-9614 (Electronic)
VI  - 15
IP  - 4
DP  - 2020 Oct-Dec
TI  - A Rare Complication of Pituitary Adenoma Surgery in a Patient with Multiple 
      Endocrine Neoplasia 1 Syndrome with Two Novel Genetic Mutations.
PG  - 1020-1023
LID - 10.4103/ajns.AJNS_100_20 [doi]
AB  - Pituitary adenoma surgeries are common in neurosurgical setup. Majority are 
      tackled by a transsphenoidal route either by endoscopic or microscopic aid. 
      Complications such as cerebrospinal fluid (CSF) leak, meningitis, diabetes 
      insipidus, hematoma, and loss of vision are known, but midbrain infarct is rarely 
      reported. We report and discuss the possible mechanism of this rare and unusual 
      complication in transsphenoidal surgery. A 36-year-old nulliparous female with no 
      comorbidities suffering from primary infertility presented with intermittent 
      headache for 9 months with bitemporal vision disturbances for 3 months, 
      pigmentation around the neck and nape, oligomenorrhea with an established 
      diagnosis of plurihormonal secreting pituitary tumor (predominantly 
      adrenocorticotropic hormone and prolactin), hyperparathyroidism, and diabetes. 
      The whole symptom fitted into the diagnosis of multiple endocrine neoplasia 1 
      (MEN-1) syndrome. Molecular genetic testing was done with full gene sequencing 
      analysis of MEN-1 gene using polymerase chain reaction. Furthermore, Sanger DNA 
      sequencing was done, and two novel variations, namely IVS 9c.1364 + 99C>G and 
      EXON 10 c.1813 C>T (p. L605 L), were detected. Radiology detected a microadenoma 
      in the right lobe of the pituitary with mild deviation of the pituitary stalk on 
      dynamic contrast-enhancing magnetic resonance imaging. Gross total excision of 
      the tumor was done through transsphenoidal approach. The surgery was uneventful 
      other than some blood-mixed CSF leak. Post excision, fat and tissue glue was 
      packed. The patient did not wake up from anesthesia and had bilateral dilated 
      pupil with no oculocephalic reflex. Investigations revealed bilateral thalamic 
      and midbrain infarct. The patient subsequently expired. This case is reported in 
      view of its unusual complication and to create awareness for such a fatal 
      complication following transsphenoidal surgery for pituitary microadenoma and the 
      importance of diligent approach to transsphenoidal surgery and to report novel 
      genetic mutation of MEN-I gene.
CI  - Copyright: (c) 2020 Asian Journal of Neurosurgery.
FAU - Sharma, Neeraj
AU  - Sharma N
AD  - Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, 
      Telangana, India.
FAU - Bhattacharjee, Suchanda
AU  - Bhattacharjee S
AD  - Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, 
      Telangana, India.
FAU - Anne, Beatrice
AU  - Anne B
AD  - Department of Endocrinology, Nizam's Institute of Medical Sciences, Hyderabad, 
      Telangana, India.
LA  - eng
PT  - Case Reports
DEP - 20201221
PL  - India
TA  - Asian J Neurosurg
JT  - Asian journal of neurosurgery
JID - 101564712
PMC - PMC7869304
OTO - NOTNLM
OT  - Adenoma
OT  - hemorrhage
OT  - infarction
OT  - multiple endocrine neoplasia 1
OT  - pituitary
OT  - subarachnoid
OT  - thalamic
OT  - transsphenoidal
COIS- There are no conflicts of interest.
EDAT- 2021/03/13 06:00
MHDA- 2021/03/13 06:01
PMCR- 2020/12/21
CRDT- 2021/03/12 07:19
PHST- 2020/03/22 00:00 [received]
PHST- 2020/05/02 00:00 [revised]
PHST- 2020/07/29 00:00 [accepted]
PHST- 2021/03/12 07:19 [entrez]
PHST- 2021/03/13 06:00 [pubmed]
PHST- 2021/03/13 06:01 [medline]
PHST- 2020/12/21 00:00 [pmc-release]
AID - AJNS-15-1020 [pii]
AID - 10.4103/ajns.AJNS_100_20 [doi]
PST - epublish
SO  - Asian J Neurosurg. 2020 Dec 21;15(4):1020-1023. doi: 10.4103/ajns.AJNS_100_20. 
      eCollection 2020 Oct-Dec.