Toxoplasmosis presenting as panhypopituitarism in a patient with the acquired immune deficiency syndrome

      This paper is only available as a PDF. To read, Please Download here.


      A 57-year-old man with a prior episode of lymphatic toxoplasmosis presented with signs of anterior panhypopituitarism, which was confirmed by standard endocrinologic evaluation. The diagnosis of central nervous system toxoplasmosis was established by brain biopsy after nondlagnostic serologic and radiographic studies. At autopsy, the anterior pituitary was necrotic, with Toxoplasma abscesses in neighboring brain structures. Clinical and laboratory data met the criteria for the acquired immune deficiency syndrome. Although this is the first reported case of toxoplasmosis presenting as panhypopituitarism, future cases may be identified since central nervous system toxoplasmosis is being recognized more frequently in patients with immunodeficiency.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Frohman LA
        Diseases of the anterior pituitary.
        in: Felig P Baxter JD Broadus AE Frohman LA Endocrinology and metabolism. McGraw-Hill, St. Louis1981: 151-231
        • Gottlieb MS
        • Schroff R
        • Schanker HM
        • et al.
        Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. Evidence of a new acquired cellular immunodeficiency.
        N Engl J Med. 1981; 305: 1425-1431
        • Masur H
        • Michelis MA
        • Greene JB
        • et al.
        An outbreak of community-acquired Pneumocystis carinii pneumonia. Initial manifestation of cellular immune dysfunction.
        N Engl J Med. 1981; 305: 1431-1438
        • Siegal FP
        • Lopez C
        • Hammer GS
        • et al.
        Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions.
        N Engl J Med. 1981; 305: 1439-1444
        • Follansbee SE
        • Busch DF
        • Wofsy CB
        • et al.
        An outbreak of Pneumocystis carinii pneumonia in homosexual men.
        Ann Intern Med. 1982; 96: 705-713
        • Urmacher C
        • Myskowski P
        • Ochoa Jr, M
        • Kris M
        • Safai B
        Outbreak of Kaposi's sarcoma with cytomegalovirus infection in young homosexual men.
        Am J Med. 1982; 72: 569-575
        • Pitchenik AE
        • Fischl MA
        • Dickinson GM
        • et al.
        Opportunistic infections and Kaposi's sarcoma among Haitians: evidence of a new acquired immunodeficiency state.
        Ann Intern Med. 1983; 98: 277-284
        • Luft BJ
        • Conley F
        • Remington JS
        Outbreak of central-nervous-system toxoplasmosis in Western Europe and North America.
        Lancet. 1983; I: 781-784
        • Borst GC
        • Michenfelder HJ
        • O'Brian JT
        Discordant cortisol response to exogenous ACTH and insulin-induced hypoglycemia in patients with pituitary disease.
        N Engl J Med. 1982; 306: 1462-1464
        • Kovacs K
        Necrosis of anterior pituitary in humans.
        Neuroendocrinology (Basel). 1969; 4: 179-241
        • Carey RM
        • Kimball AC
        • Armstrong D
        • Lieberman PH
        Toxoplasmosis. Clinical experiences in a cancer hospital.
        Am J Med. 1973; 54: 30-38
        • Townsend JJ
        • Wolinsky JS
        • Baringer JR
        • Johnson PC
        Acquired toxoplasmosis. A neglected cause of treatable nervous system disease.
        Arch Neurol. 1975; 32: 335-343
        • Ghatak NR
        • Sawyer DR
        A morphologic study of opportunistic cerebral toxoplasmosis.
        Acta Neuropathol (Berl). 1978; 42: 217-221
        • Best T
        • Finlayson M
        Two forms of encephalitis in opportunistic toxoplasmosis.
        Arch Pathol Lab Med. 1979; 103: 693-696
        • Horowitz SL
        • Bentson JR
        • Benson F
        • Davos I
        • Pressman B
        • Gottlieb MS
        CNS toxoplasmosis in acquired immunodeficiency syndrome.
        Arch Neurol. 1983; 40: 649-652
        • Yermakov V
        • Rashid RK
        • Vuletin JC
        • Pertschuk LP
        • Isaksson H
        Disseminated toxoplasmosis. Case report and review of the literature.
        Arch Pathol Lab Med. 1982; 106: 524-528
        • Gransden WR
        • Brown PM
        Pneumocystis pneumonia and disseminated toxoplasmosis in a male homosexual.
        Br Med J. 1983; 286: 1614
        • Löwenberg B
        • van Gijn J
        • Prins E
        • Polderman AM
        Fatal cerebral toxoplasmosis in a bone marrow transplant recipient with leukemia.
        Transplantation. 1983; 35: 30-34
        • Bernard P-M
        • Fenasse R
        • Zafiropoulo A
        • Amichot J-L
        • Laugier M
        Diabete insipide par toxoplasmose acquise.
        Marseille Med. 1969; 106: 173-174
        • Santucci A
        • Aguglia F
        • Federico M
        • de Mattia G
        Sindromi neuroendocrine ad eziologia toxoplasmica: considerazioni cliniche e terapeutiche.
        Clin Ter (Roma). 1980; 94: 3-19
        • McLeod R
        • Berry PF
        • Marshall Jr, WH
        • Hunt SA
        • Ryning FW
        • Remington JS
        Toxoplasmosis presenting as brain abscesses. Diagnosis by computerized tomography and cytology of aspirated purulent material.
        Am J Med. 1979; 67: 711-714
        • Alenghat JP
        • Morris JH
        • Kido DK
        • Rumbaugh CL
        Computed tomography in opportunistic cerebral toxoplasmosis: report of two cases.
        Comput Tomogr. 1981; 5: 231-237
        • Menges H-W
        • Fischer E
        • Valavanis A
        • Schubiger O
        Case report. Cerebral toxoplasmosis in the adult.
        J Comput Assist Tomogr. 1979; 3: 413-416
        • Post MJD
        • Chan JC
        • Hensley GT
        • Huffman TA
        • Moskowitz LB
        • Lippmann S
        Toxoplasma encephalitis in Haitian adults with acquired immunodeficiency syndrome: a clinical-pathologic-CT correlation.
        AJR. 1983; 140: 861-868
        • Green JA
        • Spruance SL
        • Cheson BD
        Favorable outcome of central nervous system toxoplasmosis occurring in a patient with untreated Hodgkin's disease.
        Cancer. 1980; 45: 808-810
        • Anderson SE
        • Remington JS
        The diagnosis of toxoplasmosis.
        South Med J. 1975; 68: 1433-1443
        • Lane CH
        • Masur H
        • Edgar LC
        • Whalen G
        • Rook AH
        • Fauci AS
        Abnormalities of B-cell activation and immunoregulation in patients with the acquired immunodeficiency syndrome.
        N Engl J Med. 1983; 309: 453-458
        • Friedman-Kien A
        • Laubenstein L
        • Marmor M
        • et al.
        Kaposi's sarcoma and Pneumocystis pneumonia among homosexual men—New York City and California.
        Morbid Mortal Weekly Rep. 1981; 30: 305-308