OBJECTIVE: To describe a case of solitary intrasellar plasmacytoma in a patient with a preoperative diagnosis of a nonfunctioning pituitary adenoma. METHODS: A case of a solitary intrasellar plasmacytoma is presented, in which the clinical and laboratory findings are detailed and the response to treatment is discussed. Pertinent reports from the literature are reviewed. RESULTS: A 53-year-old woman came to the neurology clinic with complaints of frontal headaches and intermittent blurry vision. Physical examination showed no remarkable findings. Computed tomography revealed an enhancing sellar and suprasellar mass, with extension into the sphenoid and cavernous sinuses. The patient had a preoperative diagnosis of a clinically nonfunctioning pituitary adenoma and underwent transsphenoidal resection. The biopsy specimen was heavily infiltrated with abnormal plasma cells, which stained exclusively for lambda light chain immunoglobulins. An extensive investigation failed to show evidence of multiple myeloma. In view of these findings, the diagnosis of solitary extramedullary plasmacytoma was made. Postoperatively, the patient received radiotherapy to the pituitary and has remained free of disease for 7 years. Review of the world literature disclosed only 17 previous reports of patients in whom a solitary plasmacytoma or multiple myeloma first appeared as a sellar mass. In each case, the plasmacytoma mimicked a clinically nonfunctioning pituitary adenoma. CONCLUSION: Parasellar plasmacytomas are often mistaken for a nonfunctioning pituitary adenoma. The diagnosis is difficult to make in the absence of overt systemic myeloma. Nevertheless, normal pituitary function associated with severe destruction of the pituitary fossa, cranial neuropathies, and diabetes insipidus are clues that the primary lesion is outside the pituitary gland itself. The current patient is unique in terms of prolonged survival in the absence of systemic myeloma. Perhaps those patients with progression of disease did not have extramedullary tumors because such lesions rarely progress to overt myelomatous disease.

Journal Article↗

PubMedDate not supplied

Self-regulation in individuals with type II diabetes.

A model for self-regulation of diabetes was tested which proposed that individuals monitor their disease status by comparing their current state with their standard of well-being. When a discrepancy is experienced and associated with a change in blood glucose, action is taken to relieve the symptom and thereby regulate blood glucose. Two variables of the self-regulatory process (symptom-associating and action-taking) were tested through semi-structured interviews of 173 subjects who had Type II diabetes. Most (85%) subjects associated their symptoms with a change in blood glucose levels. Of subjects who associated symptoms with elevated blood glucose, 77% took action; of subjects who associated symptoms with lowered blood glucose, 89% took action. Only sex and insulin use were related to symptom associating and action taking. There was no relation between metabolic control measured by glycosylated hemoglobin and symptom association and action taking.

Adult↗

PubMedDate not supplied

Insulinoma.

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Blood Glucose↗