amphotericin-b and Pituitary-Neoplasms

We report a case of invasive sphenoid sinus aspergillosis clinically presenting as a pituitary mass.. After exploration via the trans-sphenoidal approach and subsequent treatment with amphotericin-B, Ga-67 brain SPECT was performed twice to monitor the therapeutic effect.. Three months after antifungal treatment, Ga-67 brain SPECT showed partial resolution of the lesion in the sella turcica region. The patient continued with fluconazole treatment for another 2 months and received another Ga-67 brain SPECT, which showed complete clearing of the previous lesion.. Ga-67 brain SPECT may play a potentially useful role in monitoring the therapeutic effect of treatment of invasive sphenoid sinus aspergillosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Brain; Diagnosis, Differential; Fluconazole; Follow-Up Studies; Gallium Radioisotopes; Humans; Male; Paranasal Sinus Diseases; Pituitary Neoplasms; Radiopharmaceuticals; Sella Turcica; Sphenoid Sinus; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Invasive aspergillosis of the paranasal sinuses is an uncommon, but well-recognized, form of fungal infection. We describe an elderly female patient with invasive aspergillosis of the sphenoid sinus and associated osteomyelitis of the skull base, with clinical presentation as a pituitary mass. Postoperative gallium scan showed intense uptake in the sphenoid sinus, which resolved after treatment with amphotericin-B. This case demonstrates some of the pathologic and clinical features of invasive aspergillosis and suggests a potential role for gallium-67 imagining in monitoring clinical response to therapy.

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus; Diagnosis, Differential; Female; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Pituitary Gland; Pituitary Neoplasms; Sphenoid Sinusitis

1. The regulation of large-conductance, calcium- and voltage-dependent potassium (BK) channels by protein kinase C (PKC) was investigated in clonal rat anterior pituitary cells (GH4C1), which were voltage clamped at -40 mV in a physiological potassium gradient through amphotericin-perforated patches. 2. Maximal activation of PKC by 100 nM phorbol 12, 13-dibutyrate (PdBu) almost completely inhibited the voltage-activated outward current through BK channels. In contrast PdBu had no significant effect on the residual outward current after block of BK channels with 2 mM TEA or 30 nM charybdotoxin. In single-channel recordings from cell-attached patches, PdBu reduced the open probability of BK channels more than eightfold with no significant effect on mean open lifetime or unitary conductance. 3. The effects of PdBu on BK channels were not mimicked by the 4 alpha-isomer, which does not activate PKC, and were blocked almost completely by 25 microM chelerythrine, a specific, noncompetitive PKC inhibitor. 4. PdBu had no significant effect on the amplitude of the pharmacologically isolated, high voltage-activated calcium current. 5. Inhibition of BK channel activity by PKC provides the first molecular mechanism linking hormonal activation of phospholipase C to sustained excitability in pituitary cells.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Biotransformation; Calcium; Cyclic AMP; Enzyme Activation; Ion Channel Gating; Phorbol 12,13-Dibutyrate; Pituitary Neoplasms; Potassium Channels; Protein Kinase C; Rats; Tumor Cells, Cultured

A man of 74 years of age, suffering from a left-sided ophthalmoplegia and a radiologically detected opacification of the sphenoid sinus with destruction of the bony roof of the sphenoid sinus, was operated on because a malignant tumor was suspected. A destruction of the bony walls of the sphenoid sinus was found. The histological examination of the "glue"-like "tumorous" material revealed an aspergillosis. The patient developed an aspesrgillus meningitis postoperatively. Intrathecally administered Amphotericin B led to an improvement of the meningitis, but caused a fatal renal failure. A review of the literature showed that only 7 cases of aspergillosis of the sphenoid sinus have been reported, 3 of which presented with a tumor-like destruction of the sinus. An aspergilloma of the sphenoid sinus is therefore a rare but important differential diagnosis in patients with a suspected malignancy of the infrasellar region.

Topics: Aged; Amphotericin B; Aspergillosis; Diagnosis, Differential; Humans; Male; Meningitis; Pituitary Neoplasms; Sphenoid Sinus