Clival Ectopic Pituitary Adenoma Mimicking a Chordoma: Case Report and Review of the Literature

Background. Purely ectopic pituitary adenomas are exceedingly rare. Here we report on a patient that presented with an incidental clival mass thought to be a chordoma. Endonasal resection, tumor pathology, and endocrinology workup revealed a prolactinoma.Case Presentation. A 41-year-old male presented with an incidental clival lesion presumed to be a chordoma. On MRI it involved the entire clivus, extended laterally to the petroclival junction, and invaded the cavernous sinuses bilaterally, encasing both internal carotid arteries, without direct extension into the sella. Intraoperatively, it was clear that the tumor originated from the clivus and that the sellar dura was completely intact. Frozen-section pathology was consistent with a pituitary adenoma. Immunostaining was positive for synaptophysin and prolactin with a low Ki-67 index, suggestive of a prolactinoma. Additional immunohistochemical stains seen in chordomas (EMA, S100, and Brachyury) and other metastatic tumors were negative. A postoperative endocrine workup revealed an elevated serum prolactin of 881.3 ng/mL (normal < 20).Conclusions. In conclusion, it is crucial to maintain an extensive differential diagnosis when evaluating a patient with a clival lesion. Ectopic clival pituitary adenomas, although rare, may warrant an endocrinological workup preoperatively as the majority may respond to medical treatment.

Download Full-text

Successful pregnancy after operation in an infertile woman caused by luteinizing hormone-secreting pituitary adenoma: case report and literature review

BMC Endocrine Disorders ◽

10.1186/s12902-020-00677-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Zhang ◽

Cheng Chen ◽

Min Lin ◽

Kan Deng ◽

Huijuan Zhu ◽

...

Keyword(s):

Case Report ◽

Pituitary Adenoma ◽

Literature Review ◽

Pituitary Adenomas ◽

Sella Turcica ◽

Infertile Woman ◽

Mass Treatment ◽

Successful Pregnancy ◽

Case Presentation ◽

Transsphenoidal Resection

Abstract Background Functional gonadotroph adenomas (FGAs) are rare adenomas that most commonly secrete FSH. However, solitary LH-secreting pituitary adenomas are unusual. Case presentation A 30-year-old woman with elevated LH and normal FSH presented with inability to conceive. An MRI revealed an enlarged sella turcica and an intrasellar mass. Treatment with transsphenoidal resection led to normalization of LH and estradiol, as well as successful pregnancy. And we reviewed 6 cases of LH-secreting pituitary adenomas from 1981 to 2020. Conclusions Our case is unique because of the LH-secreting pituitary adenoma without FSH hypersecretion. This case indicates that pituitary adenoma should be considered when other diseases causing infertility have been excluded.

Download Full-text

Ki-67/MIB-1 and Recurrence in Pituitary Adenoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1735874 ◽

2021 ◽

Author(s):

Kent Tadokoro ◽

Colten Wolf ◽

Joseph Toth ◽

Cara Joyce ◽

Meharvan Singh ◽

...

Keyword(s):

Systematic Review ◽

Pituitary Adenoma ◽

Recurrence Rate ◽

Pituitary Adenomas ◽

Cellular Proliferation ◽

Published Data ◽

Ki 67 ◽

Institutional Data ◽

Mib 1

Abstract Objectives Ki-67/MIB-1 is a marker of cellular proliferation used as a pathological parameter in the clinical assessment of pituitary adenomas, where its expression has shown utility in predicting the invasiveness of these tumors. However, studies have shown variable results when using Ki-67/MIB-1 association with recurrence. The purpose of this study is to determine if a high Ki-67/MIB-1 labeling index (LI) is predictive of recurrence in pituitary adenomas. Methods A retrospective chart review was performed for patients undergoing pituitary adenoma resection with at least 1 year of follow-up. Additionally, systematic data searches were performed and included studies that correlated recurrence rate to Ki-67/MIB-1 LI. Our institutional data were included in a synthesis with previously published data. Results Our institutional review included 79 patients with a recurrence rate of 26.6%. We found that 8.8% of our patients had a high Ki-67/MIB-1 LI (>3%); however, high Ki-67/MIB-1 was not associated with recurrence. The systematic review identified 244 articles and 49 full-text articles that were assessed for eligibility. Quantitative analysis was performed on 30 articles including our institutional data and 18 studies reported recurrence by level of Ki-67/MIB-1 LI. Among studies that compared Ki-67/MIB-1 ≥3 vs. <3%, 10 studies reported odds ratios (OR) greater than 1 of which 6 were statistically significant. A high Ki-67/MIB-1 had higher odds of recurrence via the pooled odds ratio (OR = 4.15, 95% confidence interval [CI]: 2.31–7.42). Conclusion This systematic review suggests that a high Ki-67/MIB-1 should prompt an increased duration of follow-up due to the higher odds of recurrence of pituitary adenoma.

Download Full-text

The efficacy of dopamine agonist therapy in a young man with a giant prolactinoma: case report

Problems of Endocrinology ◽

10.14341/probl2017634231-235 ◽

2017 ◽

Vol 63 (4) ◽

pp. 231-235

Author(s):

Alexandr I. Tsiberkin ◽

Tatiana L. Karonova ◽

Anna B. Dalmatova ◽

Elena N. Grineva

Keyword(s):

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Young Patients ◽

Young Male ◽

Serum Prolactin ◽

Agonist Therapy ◽

Giant Prolactinoma ◽

Dopamine Agonist Therapy ◽

History Of

Prolactinomas are the most common of hormone secreting pituitary adenomas. Patients with prolactinomas generally have a benign prognosis. An algorithm is currently available for managing of this disease. Giant prolactinoma larger than 40 mm with severe invasive growth account for about 2—3% of the prolactin-secreting pituitary adenomas and evidence about management of such patients is limited. This case illustrates progress of a giant prolactin-secreting pituitary adenoma up to 70 mm in young male with a family history of prolactinomas in the absence of the adequate therapy for 8 years after initial diagnosis. After evaluation, it was decided to prescribe medical treatment. Cabergoline therapy started after evaluation appeared to be effective and had lead to significant decrease of serum prolactin level and shrinkage of pituitary adenoma. Described case emphasize the crucial role of identification of hyperprolactinemia among young patients on early stages of the disease. Our observation implies that treatment with dopamine agonists might be effective even in cases with giant prolactinomas.

Download Full-text

Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

Neurosurgical FOCUS ◽

10.3171/2020.3.focus2080 ◽

2020 ◽

Vol 48 (6) ◽

pp. E10 ◽

Cited By ~ 1

Author(s):

Tyler Cardinal ◽

Martin J. Rutkowski ◽

Alexander Micko ◽

Mark Shiroishi ◽

Chia-Shang Jason Liu ◽

...

Keyword(s):

Pituitary Adenoma ◽

Medical Therapy ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Cranial Nerves ◽

Elevated Serum ◽

Tumor Control ◽

Tumor Diameter ◽

Endoscopic Endonasal ◽

Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

Download Full-text

Association of Ki-67 Labelling Index and IL-17A with Pituitary Adenoma

BioMed Research International ◽

10.1155/2018/7490585 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Brigita Glebauskiene ◽

Rasa Liutkeviciene ◽

Alvita Vilkeviciute ◽

Inga Gudinaviciene ◽

Aurelija Rocyte ◽

...

Keyword(s):

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Immunohistochemical Analysis ◽

Serum Levels ◽

Labelling Index ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Ki 67 ◽

Tissue Samples ◽

Median Serum

The aim of the present study was to determine if the Ki-67 labelling index reflects invasiveness of pituitary adenoma and to evaluate IL-17A concentration in blood serum of pituitary adenoma patients. The study was conducted in the Hospital of Lithuanian University of Health Sciences. All pituitary adenomas were analysed based on magnetic resonance imaging findings. The suprasellar extension and sphenoid sinus invasion by pituitary adenoma were classified according to Hardy classification modified by Wilson. Knosp classification system was used to quantify the invasion of the cavernous sinus. The Ki-67 labelling index was obtained by immunohistochemical analysis with the monoclonal antibody, and serum levels of IL-17A were determined by enzyme-linked immunosorbent assay (ELISA). Sixty-nine PA tissue samples were investigated. Serum levels of IL–17A were determined in 60 patients with PA and 64 control subjects. Analysis revealed statistically significantly higher Ki-67 labelling index in invasive compared to noninvasive pituitary adenomas. Median serum IL-17A level was higher in the pituitary adenoma patients than in the control group. Conclusion. IL-17A might be a significant marker for patients with pituitary adenoma and Ki-67 labelling index in case of invasive pituitary adenomas.

Download Full-text

Serum prolactin in patients with hypothalamus and pituitary disorders

Journal of Neurosurgery ◽

10.3171/jns.1981.55.2.0194 ◽

1981 ◽

Vol 55 (2) ◽

pp. 194-199 ◽

Cited By ~ 38

Author(s):

Per Olov Lundberg ◽

Per Olof Osterman ◽

Leif Wide

Keyword(s):

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Single Case ◽

Geometric Mean ◽

High Serum ◽

Serum Prolactin ◽

Content Type ◽

Sellar Tumor ◽

Very High ◽

Fine Print

✓ Serum prolactin concentrations were studied in 115 patients with anatomically defined disorders in the hypothalamo-pituitary region. Fifty of the patients had expansively growing pituitary adenomas; in 17 of them (13 females and four males) the prolactin values were slightly raised (15 to 100 µg/liter), and in 13 (11 females and two males) they were over 100 µg/liter. The frequency of elevated prolactin values was higher for females than for males. Fifteen patients with invasively growing pituitary adenomas had very high serum prolactin levels (range 1230 to 31,500 µg/liter, geometric mean 3150 µg/liter). In a single case of malignant pituitary adenoma, the serum prolactin was at the lower level of detection. Of 49 further patients with suprasellar meningiomas, craniopharyngiomas, or other expansive or destructive lesions of the hypothalamus and sellar region, 15 had slightly raised prolactin values (maximum 114 µg/liter). Eight of these 49 patients had sellar destruction, with a roentgenological picture similar to that in patients with invasive pituitary adenomas. Among these eight patients, the maximum prolactin value was 67 µg/liter. It is concluded that moderately raised serum prolactin values (up to 100 µg/liter) in a patient with a sellar tumor does not prove that the tumor is a prolactinoma. A serum prolactin value of 100 to 1000 µg/liter strongly indicates a prolactin-producing tumor. In a patient with sellar destruction, a serum prolactin value of over 1000 µg/liter is proof that the destruction is caused by an invasive pituitary adenoma.

Download Full-text

Rare location of a colloid cyst - case presentation

Romanian Neurosurgery ◽

10.1515/romneu-2015-0011 ◽

2015 ◽

Vol 22 (1) ◽

pp. 94-100

Author(s):

D. Păunescu ◽

M. Gorgan ◽

V. Ciubotaru ◽

Ligia Tătăranu

Keyword(s):

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Colloid Cyst ◽

Sellar Region ◽

Case Presentation ◽

Therapeutic Challenge ◽

Nonfunctioning Pituitary Adenoma ◽

Rare Location

Abstract Not only pituitary adenomas, but also a number of tumors may arise from within the sella presenting a diagnostic and therapeutic challenge at a multidisciplinary specialist level. This article presents a case of a colloid cyst located in sellar region, with overlapping symptoms of a nonfunctioning pituitary adenoma.

Download Full-text

Endoscopic endonasal transsphenoidal surgery: experience with 50 patients

Journal of Neurosurgery ◽

10.3171/jns.1997.87.1.0044 ◽

1997 ◽

Vol 87 (1) ◽

pp. 44-51 ◽

Cited By ~ 456

Author(s):

Hae-Dong Jho ◽

Ricardo L. Carrau

Keyword(s):

Cavernous Sinus ◽

Cushing’S Disease ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Elevated Serum ◽

Cushing's Disease ◽

Serum Prolactin ◽

Subtotal Resection ◽

Operating Microscope ◽

Endoscopic Endonasal

✓ An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as the tool for visualization. This study focuses on 50 patients (28 females and 22 males) with a median age of 38 years (range 14–88 years). Initially, four patients underwent operation via a sublabial—transseptal approach using a rigid endoscope in conjunction with an operating microscope. The 48 subsequent operations were performed through a nostril using only rigid endoscopes. Forty-four patients had pituitary adenomas and six had various other lesions. Thirteen patients had microadenomas, 16 had intrasellar macroadenomas, nine had macroadenomas with suprasellar extension, and six had invasive macroadenomas involving the cavernous sinus. Seven patients had recurrent pituitary adenomas and 25 had hormonesecreting adenomas (eight patients with Cushing's disease and 17 patients with prolactinomas). Among the eight patients with Cushing's disease, seven had resolution of hypercortisolism clinically and chemically. Of the 17 patients with prolactinomas, 10 improved clinically with normal serum prolactin levels, four improved clinically with elevated serum prolactin levels, and three had residual tumors in the cavernous sinus. Among the 19 patients with nonsecreting adenomas, 16 underwent total resection and three subtotal resection leaving residual tumor in the cavernous sinus. Postoperatively, all patients who had undergone endonasal endoscopic surgery had unobstructed nasal airways with minimal discomfort. More than half of the patients required only an overnight hospitalization.

Download Full-text

Co-Morbidity of Pituitary Adenoma and Frontal Convexity Meningioma: A Case Report and Review of the Literature

International Clinical Neuroscience Journal ◽

10.34172/icnj.2020.17 ◽

2020 ◽

Vol 7 (3) ◽

pp. 153-155

Author(s):

Thi Phuong Hoai Dinh ◽

Dang Thi Mai ◽

Van Tri Truong

Keyword(s):

Pituitary Adenoma ◽

Serum Prolactin ◽

Clinical Scenario ◽

Intracranial Tumors ◽

Review Of The Literature ◽

Resonance Imaging ◽

Case Presentation ◽

Medical Observation ◽

Co Morbidity ◽

Magnetic Resonance Imaging Mri

Instruction: The current study reports a woman with pituitary adenoma and frontal convexity meningioma that was detected accidentally. To the best of our knowledge, this case is considered as a rare clinical scenario. Case Presentation: A 37 years old woman suffering from amenorrhea and galactorrhea had her detail investigation showed hyperprolactinemia. The patient was diagnosed with a prolactinoma, and a frontal convexity meningioma was discovered on magnetic resonance imaging (MRI). The prolactinoma controlled with Bromocriptine therapy, while the meningioma monitored through medical observation. After two months of pharmaceutical medication, her symptoms improved with the decrease in serum prolactin. Conclusion: Thanks to sophisticated MRI techniques, meningioma and prolactinoma were incidentally detected. It should be noted that co-morbidity of prolactinoma and meningioma is very rare. The mechanism of the association between these two familiar types of intracranial tumors has not yet been clarified, which indicates the need for further studies to offer possible targeted treatment for patients.

Download Full-text

Aggressive Cushing disease five years after the treatment of a nonfunctional pituitary adenoma

Problems of Endocrinology ◽

10.14341/probl201662577-78 ◽

2016 ◽

Vol 62 (5) ◽

pp. 77-78

Author(s):

Minodora Betivoiu ◽

Sorina Martin ◽

Iulia Soare ◽

Alexandra Nila ◽

Simona Fica

Keyword(s):

Pituitary Adenoma ◽

Gamma Knife ◽

Pituitary Adenomas ◽

Histopathological Examination ◽

Case Reports ◽

Dependent Diabetes Mellitus ◽

Ki 67 ◽

The Right ◽

Gamma Knife Therapy

Introduction. Cushing's disease (CD) represents 10%–12% of all pituitary adenomas and is seen predominantly in women, with a female-to-male ratio of 8:1. Although most patients with ACTH-secreting adenomas present with benign, small tumors, some have invasive macroadenomas. Rarely, nonfunctional pituitary adenomas (NFPAs) may gain secretory function, but there have been a few case reports of metamorphosis to CD.Case report. We report the case of a 59-year-old female diagnosed in 2007 with a NFPA and panhypopituitarism. She had two transsphenoidal surgeries and Gamma Knife therapy and started replacement treatment with levothyroxine 75mcg/day and prednisone 5mg/day. The postoperative course was favorable and imagistic follow-up between 2007-2014 showed progressive reduction of the residual tumor and empty sella. From personal history we note noninsulin-dependent diabetes mellitus, postmenopausal osteoporosis treated with bisphosphonates. In January 2015 she suffered visual loss on the right eye. Pituitary MRI showed supra and parasellar tumor recurrence of 27/24/17mm, infiltrating the right side of the cavernous sinus, extending around the right internal carotid artery and optic nerve, compressing the optic chiasm. In March 2015 a third transsphenoidal partial excision of the tumor was performed and in August Gamma Knife therapy was repeated. The histopathological examination was consistent with a pituitary adenoma but immunohistochemical staining for ACTH was positive, with Ki-67=25%. She had no non-specific cushingoid features. Laboratory test: glucose=116mg/dl, HbA1c=7.5%, FSH=3.34mIU/ml, LH=0.585mIU/ml TSH=0.044mcIU/ml, FT4=1.13ng/dl. Prednisone replacement therapy was stopped and CD was confirmed: 8AMcortisol=13.3mcg/dl, 23PMcortisol=11.3mcg/dl, ACTH=70.2pg/ml, 8AMcortisol after 1mg dexamethasone overnight=13.8mcg/dl. Ophthalmic exam: blindness in the right eye, slightly decreased visual field in the left eye. Pituitary MRI 8-month postsurgery revealed a 28/31/28mm invasive tumor. We started treatment with Cabergoline 3mg/week and recommended closely biological and imagistic follow-up, hoping for a good response to radiotherapy.Conclusions: Our case stresses the importance of regular, lifelong follow-up of patients with NFPAs. Chiloiro et al have reported that pituitary adenomas with Ki-67≥1.5% have a higher risk of recurrence. Although the characteristics of patients with CD have been well known for decades, the diagnosis and management of this disease are often challenging.

Download Full-text