RESUMO
Gallbladder duplication is a rare event, with an incidence at autopsy of about 1/4000, with very few documented symptomatic cases reported. Preoperative diagnosis and differentiation of this malformation are important to prevent inadvertent damage to the biliary system, a complicated postoperative course, and repeat surgery. We present a case of true gallbladder duplication found incidentally during abdominal ultrasonography (US). The diagnosis was made with US and the Y-type duplication was demonstrated with magnetic resonance cholangiopancreatography (MRCP).
Assuntos
Vesícula Biliar/anormalidades , Adulto , Vesícula Biliar/diagnóstico por imagem , Humanos , Masculino , UltrassonografiaRESUMO
OBJECTIVE: To describe two brothers with hypopituitarism who had been born by breech delivery and to discuss whether this condition corresponds to a familial form or to a pituitary stalk section as a result of the breech delivery. METHODS: We present the clinical, biochemical, and magnetic resonance imaging (MRI) characteristics of two Mexican brothers, 19 and 21 years old, with hypopituitarism and a history of breech delivery. RESULTS: Physical examination of both patients showed short stature with normal body proportions, an obviously younger appearance than that expected for their chronologic age, high-pitched voice, irregularly positioned teeth, no axillary or pubic hair, and prepubertal genitalia. Biochemical testing showed low thyroxine and free thyroxine values with inadequate or normal thyrotropin, low basal testosterone, and mildly increased serum prolactin levels. Stimulation tests showed a normal and a delayed thyrotropin response to thyrotropin-releasing hormone, subnormal serum cortisol, considerably blunted growth hormone (GH) response to insulin-induced hypoglycemia, and absence of GH response to GH-releasing hormone in both cases. MRI showed an ectopic neuropituitary gland. In case 1, a caudal portion of a very thin pituitary stalk was observed, suggesting the preservation of a vascular component of the stalk. Because both parents of these brothers shared the major histocompatibility complex haplotype HLA-A*2301, B*3501, DRB1*0407, DQA1*03, DQB1*0201, consanguinity was suggested. CONCLUSION: The phenotype of these patients differs from that described in families with POU1F1 (Pit-1) and PROP1 mutations. These cases are most likely related to an autosomal recessive gene mutation that warrants further research. To our knowledge, this is the first report of hypopituitarism in two brothers born by breech delivery.