scholarly journals Giant Pituitary Adenoma Presenting With Disinhibition: A Case Report of a 25-Year-Old Male

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A583-A584
Author(s):  
Saleen Nottingham ◽  
Veronica Boyle ◽  
Jade Tamatea ◽  
Stephen Andrew du Toit ◽  
Louise Wolmarans ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Features ◽  
Visual Loss ◽  
Tumour Size ◽  
Frontal Lobes ◽  
Oral Glucose ◽  
Octreotide Lar ◽  
Giant Pituitary Adenoma ◽  
Suprasellar Region ◽  
The Brain

Abstract Background: Giant growth hormone secreting pituitary adenomas (defined by a diameter >4cm) are rare and difficult to treat (1). These typically invade surrounding structures, making surgery challenging or impossible (1). This report highlights a giant mammosomatotrophinoma with an unusual clinical presentation. Clinical Case: A 25-year-old male presented with personality changes, disinhibition and executive dysfunction progressing over a 3 to 4-year period. Further enquiry elicited a history of increasing headaches and significant visual loss, on the background of unilateral childhood visual loss in the contralateral eye. He was noted to have clinical features of acromegaly and complete temporal visual field loss in the left eye. On initial testing plasma IGF-1 was 137 nmol/L (reference interval [RI] 13-43nmol/L), GH >100 ug/L and prolactin 23,900 mIU/L (RI 0-400mIU/L). GH remained >100ug/L at 120 minutes after a 75g oral glucose load. He has hypogonadotropic hypogonadism, however thyrotropic and corticotropic function remained normal. MRI of the brain with contrast revealed an 8.0 x 7.1 x 7.4 cm mass arising from the pituitary fossa, extending into the suprasellar region and displacing both frontal lobes. The mass encased the basilar and right internal carotid arteries. It was deemed inoperable due to its exceptionally large size and encasement of vascular structures. Medical treatment was initiated with cabergoline (3.5mg per week in divided doses) and octreotide LAR, initially 30mg then increased to 60mg 4-weekly. A weaning course of steroids was initiated for oedema of his optic nerve. Within one month of treatment there was improvement of clinical symptoms of headaches, sweating, irritable mood and disinhibition with associated modest biochemical improvement (reduction of IGF-1 to 129 nmol/L and prolactin reduction to 2119 mIU/L). MRI of the brain revealed a reduction in the size of the adenoma to 7.8 x 7.1 x 6.3 cm, with a reduction in the mass effect on the frontal lobes. The patient continues medical management and close clinical monitoring with the aim of ongoing tumour shrinkage to allow reassessment for possible surgical debulking. Conclusion: This unique case of a GH and prolactin co-secreting giant pituitary adenoma posed a therapeutic challenge due to the significant surgical risk, limiting treatment to aggressive medical therapy. The cognitive and behavioral changes experienced due to tumour size and location added to the management complexity. Although early on in the treatment course, there is improvement of symptoms and tumour size on cabergoline and octreotide LAR injections. (1) Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: histological types, clinical features and therapeutic approaches. Endocrine. 2018 Sep;61(3):407-421.

scholarly journals Restoration of fertility in a woman with giant prolactinoma in response to cabergoline treatment

2019 ◽  
Vol 2019 ◽  
Author(s):  
L I Astaf’eva ◽  
Y G Sidneva ◽  
B A Kadashev ◽  
P L Kalinin ◽  
G A Melnichenko ◽  
...  
Keyword(s):  
Tumour Size ◽  
List Type ◽  
Healthy Children ◽  
Giant Pituitary Adenoma ◽  
Primary Amenorrhoea ◽  
Giant Prolactinoma ◽  
Vacuum Aspiration ◽  
Tumour Shrinkage ◽  
Mri Scans ◽  
The Brain

Summary A 32-year-old woman presented with primary amenorrhoea, prolactin (PRL) level of 154 150 mIU/L and was diagnosed with a giant pituitary adenoma measuring maximum 6.2 cm. Cabergoline (CAB) treatment at a dose of 0.5 mg/week was prescribed to the patient. The treatment decreased the tumour size after 3 months (MRI scans of the brain) and brought back to normal the level of the PRL (345 mIU/L) after 6 months of CAB treatment. After 7 months of CAB treatment, menarche was achieved, and after 12 months, the patient became pregnant. She discontinued taking CAB at 4-week gestation. The pregnancy resulted in a missed miscarriage at 6–7 weeks; an abortion was conducted by the vacuum aspiration method. The MRI scans of the brain did not show any tumour enlargement. After 18 months from the start of the treatment the patient got pregnant for the second time. At 25-week gestation an MRI scan of the brain was conducted which did not show any increase in the tumour size. At 38 weeks the patient delivered a healthy full-term girl via C-section. The patient chose not to breastfeed and resumed CAB therapy after the delivery. During the treatment, the PRL level returned to the normal range and the menstrual cycle was restored. After 3 years the patient got pregnant for the third time. The patient did not receive CAB during the pregnancies; the examination did not show any tumour enlargement. Further MRI scans did not show any tumour growth. CAB therapy was effective in normalization of the PRL level, tumour shrinkage, menarche and pregnancy-induction which led to the birth of healthy children in a woman with primary amenorrhoea and a giant prolactinoma invading the skull base bones. Learning points: Giant prolactinomas are very rarely found in women. Cabergoline therapy can be effective in the normalization of the PRL level, tumour shrinkage, menarche induction in a woman with primary amenorrhoea, and giant prolactinoma. Cabergoline therapy can be effective in pregnancy induction which leads to the birth of children in a woman with giant prolactinoma. Cabergoline discontinuation did not trigger tumour enlargement during pregnancy.

scholarly journals Seesaw nystagmus caused by giant pituitary adenoma: case report

2006 ◽  
Vol 64 (1) ◽  
pp. 139-141 ◽  
Author(s):  
Frederico Castelo Moura ◽  
Allan Christian Pieroni Gonçalves ◽  
Mário Luiz Ribeiro Monteiro
Keyword(s):  
Pituitary Adenoma ◽  
Visual Loss ◽  
Rare Occurrence ◽  
Resonance Imaging ◽  
Large Tumor ◽  
Giant Pituitary Adenoma ◽  
Cranial Nerve Palsies ◽  
Giant Pituitary Adenomas ◽  
Endocrine Symptoms ◽  
Bitemporal Hemianopia

Giant pituitary adenomas are uncommonly large tumors, greater than 4 cm in size that can produces endocrine symptoms, visual loss and cranial nerve palsies. We report the rare occurrence of seesaw nystagmus as the presenting sign of giant pituitary adenoma. A 50-year-old man presented with headache associated with visual loss and seesaw nystagmus. Perimetry revealed bitemporal hemianopia and magnetic resonance imaging showed a giant pituitary adenoma. After surgery, nystagmus disappeared. Our case is relevant in understanding its pathogenesis since it documents seesaw nystagmus in a patient bitemporal hemianopia due to a large tumor but without mesencephalic compression.

Giant pituitary adenoma: histological types, clinical features and therapeutic approaches

Endocrine ◽  
2018 ◽  
Vol 61 (3) ◽  
pp. 407-421 ◽  
Author(s):  
Pedro Iglesias ◽  
Víctor Rodríguez Berrocal ◽  
Juan José Díez
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Features ◽  
Therapeutic Approaches ◽  
Giant Pituitary Adenoma ◽  
Histological Types

Abstract #873: Association of Patterns in the Oral Glucose Tolerance Test and Different Clinical Features in Patients with Insulinoma

2005 ◽  
Vol 11 ◽  
pp. 28
Author(s):  
Fanny Rodriguez Vallejo ◽  
Juan Manuel Rios Torres ◽  
Francisco J. Gomez-Pérez ◽  
Juan A. Rull Rodrigo ◽  
Bernardo Pérez Enriquez
Keyword(s):  
Glucose Tolerance ◽  
Oral Glucose Tolerance Test ◽  
Clinical Features ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Oral Glucose Tolerance

Evaluation of Fine Feeding System and Angioarchitecture of Giant Pituitary Adenoma

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Adenoma ◽  
Feeding System ◽  
Giant Pituitary Adenoma

MICROSURGICAL ANATOMY OF THE DIAPHRAGMA SELLAE AND ITS ROLE IN DIRECTING THE PATTERN OF GROWTH OF PITUITARY ADENOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 717-723 ◽  
Author(s):  
Alvaro Campero ◽  
Carolina Martins ◽  
Alexandre Yasuda ◽  
Albert L. Rhoton
Keyword(s):  
Pituitary Adenoma ◽  
Cavernous Sinus ◽  
Dura Mater ◽  
Pituitary Adenomas ◽  
Potential Role ◽  
Pituitary Tumors ◽  
Microsurgical Anatomy ◽  
Suprasellar Region ◽  
Lateral Distance ◽  
Diaphragma Sellae

Abstract OBJECTIVE To evaluate the anatomic aspects of the diaphragma sellae and its potential role in directing the growth of a pituitary adenoma. METHODS Twenty cadaveric heads were dissected and measurements were taken at the level of the diaphragma sellae. RESULTS The diaphragma sellae is composed of two layers of dura mater. There is a remarkable variation in the morphology of the diaphragm opening. The average anteroposterior distance of the opening was 7.26 mm (range, 3.4–10.7 mm) and the average lateral-to-lateral distance was 7.33 mm (range, 2.8–14.1 mm). CONCLUSION The variability in the diameter of the opening of the diaphragma sellae could explain the growth of pituitary tumors toward the cavernous sinus or toward the suprasellar region.

Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Robert M. McFadzean ◽  
David Doyle ◽  
Roy Rampling ◽  
Evelyn Teasdale ◽  
Graham Teasdale
Keyword(s):  
Pituitary Adenoma ◽  
Clinical Diagnosis ◽  
Clinical Features ◽  
Visual Function ◽  
Pituitary Apoplexy ◽  
Diagnostic Errors ◽  
Large Series ◽  
Ocular Motility ◽  
Pathological Findings ◽  
Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

Giant Pituitary Adenoma Manifesting As Homonymous Hemianopia

2007 ◽  
Vol 51 (2) ◽  
pp. 151-153 ◽  
Author(s):  
Masashi Nishimura ◽  
Takuji Kurimoto ◽  
Yoshitaka Yamagata ◽  
Hideyasu Ikemoto ◽  
Norio Arita ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Homonymous Hemianopia ◽  
Giant Pituitary Adenoma

Cocaine Dependence Produce Psychiatric Symptoms - a Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Stankovic ◽  
S. Vucetic-Arsic ◽  
S. Alcaz ◽  
J. Cvejic
Keyword(s):  
Clinical Features ◽  
Male Patient ◽  
Psychiatric Symptoms ◽  
Cocaine Dependence ◽  
Psychotic Symptoms ◽  
Personal Contact ◽  
Outpatient Unit ◽  
Special Hospital ◽  
First Time ◽  
The Brain

Aim:We want to present a polymorphic clinical features like: hallutinations, paranoid ideas, agitation and violence as a result of prolonged cocaine intranasal consumption.Methods:We exposed a 30-year old male patient with ICD-X diagnostic criteria for cocaine dependence (intranasal consumption) that treated in the outpatient unit of Special Hospital of Addicitons, Belgrade, Serbia from April to July 2008. We used the medical records, psychical examination, psychiatric interwievs, standard blood sampling and cocaine urine detections sample (positive).Results:Observations a specific and polymorphic clinical features with presence of psychotic symptoms after cocaine consumptions in our male patient, for the first time after 5 years of cocaine dependence: auditory hallucinations (two- voice speakers), paranoid persecution ideas and suspiciousness, agitation with appearance of vegetative symptomatology (palpitations, sweating, pupil dilatation), extremely violence behavior to other people, complete social reductions (“armed to the outside world”, refused any personal contact and isolated from friends and family, permanent outdoor checking). There was an intensive fear too and impaired judgment.Conclusions:Permanent cocaine consumption can result with produce a numerous of psychiatric symptoms and syndromes as our experience does. It is similar to the findings of other studies and papers reviewed. It is suppose that cocaine has numerous effects on important neurotransmitters in the brain, such as increase as well as the release of dopamine and it related with aggressiveness, hallucinations and other psychiatric symptoms.

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