Farfouti M T, Ghabally M, Roumieh G, Farou S, Shakkour M
MRCP (UK), FRCP (London), Department of Neurology, Aleppo University, Faculty of Medicine Aleppo, Syria.
Medical Student, Aleppo University, Faculty of Medicine, Aleppo, Syria.
Oxf Med Case Reports. 2019 Jul 17;2019(7):omz064. doi: 10.1093/omcr/omz064. eCollection 2019 Jul.
Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disease. Although it is well known that patients with myasthenia gravis have a higher incidence of other autoimmune disorders, however, its association with pituitary adenomas is extremely rare. We believe that our case represents the 8 of this association and the 2 case involving a GH-secreting adenoma. Here we report a case of a 45-year old Syrian woman who presented with typical complaints of myasthenia gravis as she was suffering from variable painless and effort-related dysphagia and dysarthria. Her complaints became more evident at the end of the day, while acromegaly only manifested as a 4-month history of headache and a special facies that was noted by the physician. Brain MRI scan demonstrated a 3.21 x 2.42 x 2.35 cm pituitary mass for which the patient underwent a trans-sphenoidal pituitary tumor resection. In addition, postoperative histopathological investigations confirmed the diagnosis of a GH-secreting macroadenoma. On following up, it was observed that her myasthenic symptoms improved significantly on Pyridostigmin and Prednisolone. In conclusion, the presence of headache in a myasthenic patient should raise the attention for other underlying causes including pituitary tumors.
重症肌无力（MG）是一种慢性自身免疫性神经肌肉疾病。虽然众所周知重症肌无力患者患其他自身免疫性疾病的发生率较高，然而，其与垂体腺瘤的关联极为罕见。我们认为我们的病例代表了这种关联的第8例，也是第2例涉及生长激素分泌型腺瘤的病例。在此，我们报告一例45岁的叙利亚女性患者，她出现了重症肌无力的典型症状，表现为无痛性且与用力相关的吞咽困难和构音障碍。她的症状在一天结束时更加明显，而肢端肥大症仅表现为4个月的头痛病史以及医生所注意到的特殊面容。脑部磁共振成像（MRI）扫描显示一个3.21×2.42×2.35厘米的垂体肿块，患者接受了经蝶窦垂体肿瘤切除术。此外，术后组织病理学检查确诊为生长激素分泌型大腺瘤。随访时发现，她的重症肌无力症状在服用吡啶斯的明和泼尼松龙后显著改善。总之，重症肌无力患者出现头痛应引起对包括垂体肿瘤在内的其他潜在病因的关注。
