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Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease.

Pancoast tumor with synchronous hypofisiary lesion Pancoast tumors represent a rare presentation of lung cancer. Their particular location delays diagnosis and makes resection difficult. Nevertheless recent advances in surgical techniques and multi-modality therapy (chemo-radiation followed by surgery) had increased resection rates and achieved long term survival. We present the case of a 62-year-old woman with an extensive Pancoast tumor and a synchronous hypofisiary lesion. We carried out an exhaustive staging workout determining that the infratentorial lesion was a hypofisiary adenoma. She underwent induction chemo-radiotherapy and posterior surgery. A complete resection was possible with prolonged survival and minimal functional disability. We present the evolution in management of Pancoast tumors and our approach to patients with suspicious metastases in potentially resectable tumors.

Background: Brain metastases are the most common cerebral tumors, have a poor prognosis and their incidence is five times higher than primary brain tumors. Aim: To analyze the survival of patients with the diagnosis of brain metastases, operated in our institution. Patients and methods: We retrospectively reviewed all patients operated from January 1989 to December 2001, whose pathological diagnosis confirmed the presence of cerebral metastases. The death date of each patient was obtained from the analysis of death certificates, obtained from the computerized National Registry. Results: In 46 operated patients, the date of death was determined. In 23 of them, information about primary site of malignancy, type of surgery performed and adjunctive treatment with Holocerebral Radiotherapy (Rt) was obtained. The overall median survival time of the 46 patients was 29 weeks (range 4207). Thirty percent of patients were alive one year after surgery. Among those patients with complete clinical information, the median survival of 16 patients who received postoperative Rt was 41 weeks (range 12207), compared to a survival of 18 weeks (range 872), among those that did not receive Rt (p = 0.04). Conclusions: The median survival for patients operated for cerebral metastases in our institution is 29 weeks. Those who are operated and receive Rt, have a longer survival, than those who did not receive Rt (Rev Méd Chile 2005; 133: 190-4)