Parathyroid Adenoma

Parathyroid adenomas are noncancerous, benign tumors of the parathyroid gland. The parathyroid gland controls calcium use by the body, as well as its removal. This is done by producing parathyroid hormone (PTH). PTH controls calcium, phosphorous, and Vitamin D in the body. 

Women over the age of 60 are at the highest risk for parathyroid adenomas. Excessive radiation to the neck and head may also increase this risk. Parathyroid adenomas may be due to genetics. The most common type of parathyroid adenoma is hyperparathyroidism, which increases calcium levels in the blood.

Sometimes there are no visible or noticeable symptoms. Parathyroidism is often discovered from blood tests done for other medical exams. Some symptoms that may suggest a parathyroid adenoma are fractures, confusion, constipation, kidney stones, lethargy, muscle pain, and nausea.

Treatment may include surgery or estrogen replacement for post-menopausal women.

Tests for diagnosis are 24 hour urine tests, bone density exam, or an ultrasound of the neck.

Achondroplasia

Achondroplasia is a disorder concerning bone growth. The most common term for this is dwarfism. It is considered an autosomal dominant trait. If the child has a parent with achondroplasia, they have a 50% chance to get it. If both of the child's parents have the condition, they have a 75% chance to get it. A child can also get it from a spontaneous mutation. There is a 1 in 15,000 to 40,000 chance of achondroplasia in newborns. The mutation is present in the FGFR3 gene, which, provides instructions to make proteins involved in the maintenance of bone and brain tissue.

Symptoms of achondroplasia include: spinal kyphosis/lordosis, spinal stenosis, short stature, short arms and legs, prominent forehead, large ratio of head-to-body, decrease in muscle tone, and bowed legs.

Tests to examine achondroplasia are a prenatal ultrasound during pregnancy. An excessive amount of amniotic fluid will be surrounding the fetus. X-rays of long bones in newborns will also reveal this disorder.

Some complications of achondroplasia are clubbed feet and hydrocephalus.

There really isn't any treatment for achondroplasia except if the spinal stenosis, kyphosis, or lordosis becomes a problem.

Sinusitis

There are four air-filled facial sinuses in the human body. Of these are: frontal, ethmoidal, sphenoidal, and maxillary. When excess fluid and bacteria is built up into these sinuses, inflammation and swelling may occur. This is known as sinusitis.

Sinusitis may be caused by cilia that do not work properly in disposing of mucus, colds and allergies which block of the openings of the sinuses, deviated nasal septum, nasal bone spurs, or nasal polyps. There are three stages: acute, sub-acute, and chronic. Acute sinusitis is less than 4 weeks and is usually caused by a bacterial infection. Sub-acute is between 4 and 12 weeks long. And chronic is any symptoms lasting longer than three months.

Hay fever, cystic fibrosis, smoking, large adenoids, change in altitude, day care, tooth infection, and a weakened immune system from HIV or chemotherapy may put one at an increased risk for sinutsitis

Symptoms may include: bad breath, loss of smell, cough, fatigue, fever, headaches, nasal congestion and discharge, sore throat and constant runny nose.

CT is the best way to visualize sinusitis. MRI may be used if the cause is a suspected tumor or fungal infection. Nasal endoscopy may also help determine the diagnosis.

Treatment of sinusitis may include but are not limited to:an increase in fluids, use of a humidifier, nasal saline sprays, inhale steam, acetaminophen, ibuprofen, allergy shot, or surgery (typically for chronic sinusitis).

Complications of sinusitis are abscesses, bone infections, meningitis, and skin infections around the eye.

Optic Nerve Glioma

Optic nerve glioma is a slow-growing benign tumor. It may affect one or both optic nerves as well as the optic chiasm. The cause seems to be unknown. It usually occurs in children under the age of 20.

Symptoms include, but are not limited to: involuntary eyeball movement, vision loss, squinting, and one or both eyes bulging out. If not treated, optic nerve glioma may cause permanent loss of vision which may be limited to peripheral.

Different ways to diagnose optic nerve gliomas are with a cerebral angiography, CT or MRI. The tissue may be removed during surgery or a biopsy of the tissue may be taken to determing the type of tumor. Visual field tests are also used to determine the location and how invasive the tumor may be. An MRI  with contrast (gadolinium), T1 weighted with fat saturation is the best diagnostic test for visualizing optic nerve gliomas.

Treatment may include a complete removal of the tissue. Partial removal may also be utilized to reduce the size of the tumor and the pressure it's causing. Radiation therapy or chemotherapy may also be an effective mode of tretment. Corticosteroids may be prescribed to reduce swelling and inflammation while radiation therapy is being used.

Pubmedhealth (March 2010) Optic nerve glioma. Retrieved from http://www.ncbi.nih.gov/pubmedhealth/PMH0002019/

Woodcock, Richard (June 2009). Optic nerve glioma imaging. Retrieved from http://emedicine.medscape.com/article/383533-overview

Cushing's Disease

Cushing's Disease is a condition where the pituitary gland releases too much adrenocortitropic hormone (ADCH). This excessive production is caused by a tumor or growth. ATCH stimulates the production and the release of corticol, which is released in the body when it is exposed to stress. Cortisol helps maintain blood pressure, decreases the body's immune system inflammatory response, balances insulin, and regulates carbohydrates, fats, and protein. The body is then exposed to corisol for too long which may cause the symptoms. Another reason that the body may be exposed to cortisol for an excessive amount of time is for people that may be taking glucocorticoids, which is a steroid hormone. It is most common in adults between the ages of 20 and 50. People who are obese with type II diabetes are at high risk for this disease.

Symptoms of Cushing's Disease is upper obesity and thin arms and legs, collection of fat between the shoulders, thinning of bone density, round and red face, slow growth rate in children, weak muscles, excessive fatigue, mental changes, acne or skin infection, purple marks on the abdomen, thigh, and breasts, thin skin that may bruise easily, bone pain or tenderness, increase in thirst and urination, and increased blood pressure.

Cushing's disease is easiest seen with MRI. Other tests that help to diagnose this disease are a 24 hour urinary free cortisol level, LDDST, and a CRH test.

Cushing's disease can be treated several ways. Surgery is the most common. It consists of removing the tumor and may be put on a medication that replaces the cortisol production. Radiation and other medications are also alternative modes of treatment.

National Endocrine and Metabolic Disease Information Service (n.d.) Cushing's disease. Retrieved from http://niddk.nih.gov/pubs/cushings/cushings.htm 

Public Med Health (Nov, 2009) Cushing's disease. Retrieved from http://ncbi.nih.gov/pubmedhealth/PMH0001388 

Vestibular Schwannoma

Vestibular Schwannoma is a benign tumor of the inner ear. It grows very slowly and develops from the nerves that contribute to hearing and balance. There are estimated between 13 and 20 annual cases per million. This tumor is a result of an overproduction of Schwann cells that wrap around nerve fibers. While these cells grow, it pushes and adds pressure to these nerves. It may cause unilateral or bilateral hearing loss or ringing in one's ears, dizziness, or a loss of balance. Some symptoms of Vestibular Schwannoma are facial drooping on one side, unsteady walk, or a dilated pupil on one side. If the tumor goes untreated, it may grow large enough to put pressure on the facial nerve and cause numbness in one side or both of the face. It is a tumor that connects the ear to the brain. If it continues to grow even more, the tumor may press against the brain and could potentially become life threatening.

Early detection of Vestibular Schwannoma may be difficult due to subtle symptoms that the person may not realize. MRI with contrast is the best way to visualize this pathology but CT may also be used.

Unilateral Vestibular Schwannoma accounts for about 8% of all skull tumors. Symptoms may occur at any age but they usually appear anywhere from 30 to 60 years old. Bilateral Vestibular Schwannoma affects both hearing nerves and may be associated with a genetic disorder called Neurobibromatosis Type 2. Some scientists believe that unilateral and bilateral Vestibular Schwannoma comes from a loss of function of the gene on chromosome 22. This has an affect on the production of Schwann cells.

Treatment may be, but not limited to, surgical removal, radiation, and monitoring. The majority of cases where patients have Vestibular Schwannoma, the tumor is surgically removed. Sometimes, the growth is growing over the nerve and the nerve will have to be removed as well. This can make symptoms worse and a patient will not be able to recover from this. Radiation may be used to reduce the size and growth if the tumor to prevent it from getting bigger and causing further complications. The last is monitoring. Sometimes the growth is not worth removing if it is not causing harmful symptoms to the patient. At this point, they monitor the growth to see if it is progressively getting worse.

National Institute on Deafness and Other Communication Disorders (June, 2010) Vestibular schwannoma (acoustic neuroma) & neurofibromatosis. Retrieved from http://nidcd.nih.gov/health/hearing/acoustic_neuroma.html

Wernicke's Encepahlopathy

Wernicke's Encephalopathy is a degenerative disease of the brain. It consists of a thiamine (vitamin B1) deficiency. It is a serious neurological disorder that include symptoms such as: muscle atrophy, cold or dry skin, short term memory loss, difficulty swallowing, double vision, abnormal eye movements, inability to form new memories, staggering walk, speech difficulty, or confabulation.

A change in mental status is the most common sign along with confusion, disinterest, or irritation.

Wernicke's was first diagnosed in 1881 by Dr. Carl Wernicke. He described it as, "a triad of acute mental confusion, ataxia, and opthalmoplegia."

Korsakoff Amnestic Syndrome is a later stage and is more chronic than the acute, Wernicke's stage. It constitutes memory loss and confabulation.

Wernicke's develops, largely, in chronic alcoholics, and also among people with prolonged starvation, hypermesis gravidarum, bariatric surgery, and people with HIV-AIDS.

Thiamine helps metabolize carbohydrates. A deficiency in thiamine may kills cells that are thiamine dependent. These cells or enzymes are largely incorporated in cerebral energy which may cause brain tissue damage. Wernicke's may be present among 0.8-2.8% of the general population and as high as 12.5% in the population of chronic alcoholics. Up to 80% of Wernicke's Encephalopathy may be undiagnosed.

Wernicke's is best visualized with an MRI with fluid attenuated inversion recovery. This will demonstrate abnormal hyper-intensity in the gray matter of the brain.

Treatment of Wernicke's includes starting a balanced diet and hydration, starting intravenous thiamin, oral thiamin, or even drug therapy.

MR of Wernicke's

Salen, Phillip (May 2010). Wernicke's Encephalopathy. Retrieved from http://emedicine.medscape.com/article/794583-overview.

Wernicke's Encephalopathy (n.d.). Retrieved from http://www.health-disease.org/neurology-disorders/wernickes-encephalopathy.htm