Difficulties in cerebrospinal fluid βhCG interpretation in a patient with an infundibular lesion

Endocrinology, Diabetes & Metabolism Case Reports
Alicia R JonesPeter S Hamblin

Abstract

A variety of neoplastic, inflammatory and congenital conditions can cause pituitary stalk thickening. Differentiating between these causes is important as targeted treatment may be offered. Diagnostic work-up consists of a thorough history, examination, biochemical analysis and imaging. We present the case of a 33-year-old male who presented with diabetes insipidus and had pituitary stalk thickening on magnetic resonance imaging. Further investigations revealed an elevated CSF βhCG, which raised the possibility of an intracranial germ cell tumor. However, when repeated on four different assays, the βhCG levels were discordant. On serial imaging, the pituitary stalk thickening reduced slightly, which would be unexpected for a germ cell tumor. This case raises the difficulties interpreting CSF βhCG, as not all immunoassays for βhCG have been validated for use in CSF. The Roche Diagnostics Elecsys and Siemens Centaur assays have been validated for CSF βhCG, and so we advocate using one of these methods. If unavailable or serum/CSF results are ambiguous, serial MRI is appropriate, with pituitary stalk biopsy considered if the stalk measures >6.5 mm or other imaging abnormalities are present. Most adult patients with central diabete...Continue Reading

References

Mar 28, 2013·The Journal of Clinical Endocrinology and Metabolism·Adina F TurcuWilliam F Young
Sep 16, 2015·The Lancet Oncology·Matthew J MurrayJames C Nicholson
Mar 8, 2016·Clinical Endocrinology·Sarah CatfordRosemary Wong
Mar 13, 2016·European Journal of Medical Research·Mingming HuFeng Gu
Jul 14, 2017·Clinical Diabetes and Endocrinology·Alexander Faje

❮ Previous
Next ❯

Methods Mentioned

BETA
X-ray
flow cytometry
biopsy

Related Concepts

Related Feeds

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.