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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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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 |
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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 |
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