Cargando…

A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat

A 26-year-old male presented with facial asymmetry since 11 years of age and painless progressive diminution of vision in the left eye since 16 years of age. He presented with an exacerbation of headaches for the past two months. On examination, he was tall and had acral enlargement, craniofacial de...

Descripción completa

Detalles Bibliográficos
Autores principales: Shah, Ravi, Das, Liza, Dutta, Pinaki, Sood, Ashwani, Bhadada, Sanjay Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576609/
https://www.ncbi.nlm.nih.gov/pubmed/37842388
http://dx.doi.org/10.7759/cureus.45249
_version_ 1785121153040252928
author Shah, Ravi
Das, Liza
Dutta, Pinaki
Sood, Ashwani
Bhadada, Sanjay Kumar
author_facet Shah, Ravi
Das, Liza
Dutta, Pinaki
Sood, Ashwani
Bhadada, Sanjay Kumar
author_sort Shah, Ravi
collection PubMed
description A 26-year-old male presented with facial asymmetry since 11 years of age and painless progressive diminution of vision in the left eye since 16 years of age. He presented with an exacerbation of headaches for the past two months. On examination, he was tall and had acral enlargement, craniofacial deformity, and bilateral asymmetric testicular enlargement. Investigations revealed high insulin-like growth factor 1, non-suppressible growth hormone on oral glucose tolerance tests, and multiple pituitary hormone deficiencies. MRI showed pituitary macroadenoma with craniofacial and sphenoid fibrous dysplasia as well as multiple tuberculomas. Cerebrospinal fluid testing showed high protein, low glucose, and high adenosine deaminase, all consistent with a diagnosis of central nervous system (CNS) tuberculosis. His headache did not respond significantly to either octreotide or zoledronic acid. The patient was then initiated on antitubercular therapy, which led to near-complete resolution of the headache and CNS lesions within three months of therapy. CNS tuberculosis was a masquerader in the index case of acrogigantism due to McCune-Albright syndrome. Headaches may be multifactorial in a given case of acromegaly, and investigating for alternative or additional causes especially when dealing with treatment-refractory cases can be rewarding.
format Online
Article
Text
id pubmed-10576609
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-105766092023-10-15 A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat Shah, Ravi Das, Liza Dutta, Pinaki Sood, Ashwani Bhadada, Sanjay Kumar Cureus Endocrinology/Diabetes/Metabolism A 26-year-old male presented with facial asymmetry since 11 years of age and painless progressive diminution of vision in the left eye since 16 years of age. He presented with an exacerbation of headaches for the past two months. On examination, he was tall and had acral enlargement, craniofacial deformity, and bilateral asymmetric testicular enlargement. Investigations revealed high insulin-like growth factor 1, non-suppressible growth hormone on oral glucose tolerance tests, and multiple pituitary hormone deficiencies. MRI showed pituitary macroadenoma with craniofacial and sphenoid fibrous dysplasia as well as multiple tuberculomas. Cerebrospinal fluid testing showed high protein, low glucose, and high adenosine deaminase, all consistent with a diagnosis of central nervous system (CNS) tuberculosis. His headache did not respond significantly to either octreotide or zoledronic acid. The patient was then initiated on antitubercular therapy, which led to near-complete resolution of the headache and CNS lesions within three months of therapy. CNS tuberculosis was a masquerader in the index case of acrogigantism due to McCune-Albright syndrome. Headaches may be multifactorial in a given case of acromegaly, and investigating for alternative or additional causes especially when dealing with treatment-refractory cases can be rewarding. Cureus 2023-09-14 /pmc/articles/PMC10576609/ /pubmed/37842388 http://dx.doi.org/10.7759/cureus.45249 Text en Copyright © 2023, Shah et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Endocrinology/Diabetes/Metabolism
Shah, Ravi
Das, Liza
Dutta, Pinaki
Sood, Ashwani
Bhadada, Sanjay Kumar
A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title_full A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title_fullStr A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title_full_unstemmed A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title_short A Rare Case of Headache in a Patient With McCune-Albright Syndrome: A Triple Threat
title_sort rare case of headache in a patient with mccune-albright syndrome: a triple threat
topic Endocrinology/Diabetes/Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10576609/
https://www.ncbi.nlm.nih.gov/pubmed/37842388
http://dx.doi.org/10.7759/cureus.45249
work_keys_str_mv AT shahravi ararecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT dasliza ararecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT duttapinaki ararecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT soodashwani ararecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT bhadadasanjaykumar ararecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT shahravi rarecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT dasliza rarecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT duttapinaki rarecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT soodashwani rarecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat
AT bhadadasanjaykumar rarecaseofheadacheinapatientwithmccunealbrightsyndromeatriplethreat