Talk to Neuro Physician on Suspect Case Of Neurosarcoidosis
Asking For Self, Male 38, Karachi
I have thickening of pituitary stalk 4 years ago, panhypopituitarism in these 4 years gradually, bitemporal hemianopia 4 month ago symptoms, now MRI showing this. PET CT is clear, tb clear... igg4 is 18. please make diagnosis and treatment
Prof. Dr. Iftikhar Khawaja - Neurologist
MBBS, DCMT, MRCP | Islamabad
Panhypopituitarism means production of all the pituitary gland hormones is insufficient. You have only told us the diagnosis. What are your symptoms and how are they affecting your life? Best consult an endocrinologist
The imaging based differentials are reasonable, though this is a challenging case. Here are my thoughts on these:
- The lack of meningeal enhancement and the localized disease process makes neurosarcoidosis and IgG4 disease less likely. There are available CSF biomarkers which can help strengthen the above view.
- The 4 year disease course makes CNS lymphoma unlikely given the aggressive nature of disease.
I would consider the possibility of a localized, slow growing tumour.
I think the best option (given the panhypopituitarism and vision issues) would be surgical resection with biopsy. This naturally comes with its risks but is the best bet forward. If you are unwilling for this, then the aforementioned CSF biomarkers and a trial of methylprednisolone would be reasonable.
Good luck!
Patient
Post Owner
But PET CT with gallium dota Tate was clear. ace level is 62 through out 4 years and also had 10 days episode of bells palsy one year ago. CRP levels 10 always.
1 week ago
MBBS, FCPS Neurology*, MRCP (UK) | Peshawar | Book Appointment
18 Positive Reviews
ACE levels are neither specific nor sensitive. I have already detailed why the above differentials are less likely and the best approach forward.
1 week ago
Dr. Shaharyar Abdullah - Neurologist
MBBS, FCPS Neurology, MRCPI Medicine, FEBN, SCE Neurology RCP UK, Diploma in Geriatric Medicine (Ireland),Fellowship in deep brain stimulation and movement disorders (Ireland) ireland | Karachi
1 Positive Reviews
If you have a mass and bitemporal hemianopia, then you need to consult a neurosurgeon who will remove the mass and send a biopsy that will lead to a diagnosis. Don't delay it, please.
Best wishes for your health.
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