Giant plurihormonal pituitary adenoma in a child – case study

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Elżbieta Moszczyńska ◽  
Wiesława Grajkowska ◽  
Maria Maksymowicz ◽  
Joanna Malicka ◽  
Mieczysław Szalecki ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Middle Cranial Fossa ◽  
Thyroid Stimulating Hormone ◽  
Somatostatin Analogue ◽  
Tall Stature ◽  
Pituitary Macroadenoma ◽  
Hand Tremor ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri ◽  
Plurihormonal Pituitary Adenoma

Abstract Objectives To describe the case of a 12-year-old girl with a rare plurihormonal pituitary macroadenoma secreting prolactin (PRL), growth hormone (GH), thyroid-stimulating hormone (TSH), and alpha subunit (α-SU). Case presentation The patient experienced recurrent headaches and progressing loss of vision in one eye. During the examination, abnormalities such as tall stature, coarse facial features, enlarged feet and hands, tachycardia, hand tremor, hyperhidrosis, galactorrhea, and goiter were observed. Head magnetic resonance imaging (MRI) revealed a solid tumor in the anterior and middle cranial fossa, measuring 80 × 50 × 55 mm. A stereotactic biopsy revealed plurihormonal Pit-1 positive pituitary adenoma secreting PRL, GH, and TSH. A pituitary hyperfunction with PRL, GH, TSH, and α-SU excess was diagnosed. The patient was successfully treated pharmacologically with dopamine agonists and somatostatin analogue, and a decrease of tumor volume (30%) was achieved. Conclusions When neurosurgery is not possible, long-term pharmacological treatment of plurihormonal pituitary macroadenoma can be a safe and relatively effective alternative.

Extracranial meningioma presenting as a tumour of the external auditory meatus: a case report

1997 ◽  
Vol 111 (2) ◽  
pp. 148-151 ◽  
Author(s):  
Reiko Tsunoda ◽  
Takashi Fukaya
Keyword(s):  
Temporal Bone ◽  
Rare Case ◽  
External Auditory Meatus ◽  
Middle Cranial Fossa ◽  
External Meatus ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri ◽  
Extracranial Meningioma ◽  
Operative Findings ◽  
Intradural Space

AbstractA rare case of extracranial meningioma presenting as a tumour of the external auditory meatus is reported. Biopsy indicated a diagnosis of meningioma, but the radiological appearance was unusual. For example, computed tomography (CT) scans showed an unenhanced tumour mainly located in the squamous part of the temporal bone which expanded into the external meatus destroying the temporal bone. Magnetic resonance imaging (MRI) revealed that the tumour did not extend into the intradural space.This meningioma, had an obvious tendency for extracranial development. According to the operative findings, the tumour arose from the middle cranial fossa dura and extended through the air cells of the temporal bone into the external meatus, instead of growing intracranially.Secondary extracranial meningiomas of the temporal bone usually have a large intracranial component and cause neurological symptoms. However, this was a very rare case of a small meningioma causing no symptoms except for conductive hearing loss.

scholarly journals Challenges in the functional diagnosis of thyroid nodules before surgery for TSH-producing pituitary adenoma

2021 ◽  
Vol 2021 ◽  
Author(s):  
Keita Tatsushima ◽  
Akira Takeshita ◽  
Shuji Fukata ◽  
Noriaki Fukuhara ◽  
Mitsuo Yamaguchi-Okada ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Thyroid Hormone ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Thyroid Stimulating Hormone ◽  
Somatostatin Analogue ◽  
Postoperative Phase ◽  
List Type ◽  
Thyroid Scintigraphy ◽  
Serum Tsh

Summary A 50-year-old woman with thyroid-stimulating hormone (TSH)-producing pituitary adenoma (TSHoma) was diagnosed due to symptoms of thyrotoxicosis. Preoperatively, she showed thyrotoxicosis with the syndrome of inappropriate secretion of TSH (SITSH) and had a 5 cm nodule in her thyroid gland. Octreotide was administered preoperatively, which helped lower her serum TSH level but not her thyroid hormone level. These findings were atypical for a patient with TSHoma. The TSHoma was completely resected, and the TSH level dropped below the sensitivity limit shortly after surgery. Interestingly, however, thyroid hormone levels remained high. A clear clue to the aetiology was provided by consecutive thyroid scintigraphy. Although preoperative thyroid scintigraphy did not show a hot nodule and the mass was thought to be a non-functional thyroid nodule, the nodule was found to be hot in the postoperative phase of TSH suppression. By focusing on the atypical postoperative course of the TSHoma, we were able to conclude that this was a case of TSHoma combined with an autonomously functioning thyroid nodule (AFTN). Learning points The diagnosis of autonomously functioning thyroid nodules (AFTNs) depends on suppressed serum TSH levels. If thyroid hormones are resistant to somatostatin analogue therapy or surgery for TSHoma, complications of AFTN as well as destructive thyroiditis need to be considered. It is important to revisit the basics when facing diagnostic difficulties and not to give up on understanding the pathology.

scholarly journals Molecular Profile of a Pituitary Rhabdomyosarcoma Arising From a Pituitary Macroadenoma: A Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Jinci Lu ◽  
Liam Chen
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Radiation Treatment ◽  
Clinical Symptoms ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Molecular Profile ◽  
Pituitary Macroadenoma ◽  
Incidental Discovery ◽  
Magnetic Resonance Imaging Mri

Pituitary sarcoma arising in association with pituitary adenoma is an uncommon finding. Most cases of secondary sarcoma have been noted to arise with a median interval of 10.5 years post radiation. In this case report, we describe a 77-year-old man with an incidental discovery of a pituitary macroadenoma on magnetic resonance imaging (MRI) and underwent radiotherapy. Three years after radiation treatment, there was an acute change in clinical symptoms and increase in tumor size and mass effect on the optic chiasm which prompted surgical resection. A pituitary adenoma along with a separate spindle-cell sarcomatous component was identified in histology. Immunohistochemical stain for muscle markers confirmed a development of pituitary rhabdomyosarcoma (RMS). Molecular profiling of the tumor identified mutations in TP53, ATRX, LZTR1, and NF1. Despite its rarity, characterization of pituitary RMS with immunohistochemistry and molecular studies may provide an insight to its pathophysiological relationship with pituitary adenoma.

A-84 Interdisciplinary Collaboration: Neuropsychology’s Role in Elucidating Neurocognitive Symptoms in a Patient with Arachnoid Cyst

2021 ◽  
Vol 36 (6) ◽  
pp. 1130-1131
Author(s):  
Katelyn Yunes ◽  
Carolina Posada
Keyword(s):  
Cystic Lesion ◽  
Interdisciplinary Collaboration ◽  
Mass Effect ◽  
Middle Cranial Fossa ◽  
Optic Chiasm ◽  
Pituitary Macroadenoma ◽  
Cognitive Changes ◽  
Recent Onset ◽  
Magnetic Resonance Imaging Mri ◽  
Psychotic Features

Abstract Objective Arachnoid cysts (ACs) are typically cerebrospinal fluid-filled abnormalities that occur within the central nervous system. ACs are uncommon (prevalence rate of 1.2%), and typically occur within the left hemisphere middle cranial fossa or posterior fossa. Symptoms vary depending on location and size but often include headaches, weakness, cognitive changes, and hydrocephalus. We present an unusual case of a 68-year-old right-handed woman with 13 years of education who was admitted to the hospital following overdose. During a previous admission, Patient was found to have a large arachnoid cystic lesion and right-sided weakness, but was determined not to require acute intervention. Neuropsychology was consulted to assess current cognitive functioning. Method Patient was initially diagnosed with a severe major depressive episode with new-onset psychotic features following an overdose of baclofen and Tylenol. Suicide attempt was denied. Magnetic Resonance Imaging (MRI) confirmed previously identified arachnoid cystic lesion (Figure 1) causing mass effect. Patient’s MRI also revealed pituitary macroadenoma (Figure 2) that caused subtle distortion along the optic chiasm. Results The results (Table 1) suggested an abnormal cognitive profile characterized by deficits on measures of language, visuoperception, memory, and abstract reasoning in the context of relatively intact auditory attention and working memory. Conclusions The extent and severity of Patient’s deficits are likely attributable to the cystic lesion, with recent onset of visual hallucinations likely caused by location of pituitary macroadenoma. This case highlights the importance of having access to a neuropsychological inpatient consultation service to assist with clarification of symptom etiology and facilitation of appropriate diagnosis and intervention.

Cystic Optic Glioma

Neurosurgery ◽  
1990 ◽  
Vol 26 (1) ◽  
pp. 133-136 ◽  
Author(s):  
David J. Gower ◽  
Michael Pollay ◽  
Robert M. Shuman ◽  
Roger A. Brumback
Keyword(s):  
Third Ventricle ◽  
Middle Cranial Fossa ◽  
Optic Glioma ◽  
Resonance Imaging ◽  
Gadolinium Enhancement ◽  
Mri Scan ◽  
Macroscopic Appearance ◽  
The Third ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri

Abstract A pilocytic astrocytoma of the optic nerve, chiasm, hypothalamus, or third ventricle is a relatively common tumor of childhood. This case report illustrates such a tumor, originating from this location, which is unusual because of the association with two very large cystic extensions into the middle cranial fossa and into the third ventricle. The massive size and extent of this tumor and cysts was demonstrated on a magnetic resonance imaging (MRI) scan, with gadolinium enhancement. This case illustrates a novel macroscopic appearance for a pilocytic glioma of the anterior third ventricle. The purpose of this report is to alert clinicians to the varied morphology this tumor may present as we apply increasingly our improved radiological, operative, and histopathological techniques. (Neurosurgery 26:133-137, 1990)

scholarly journals Cerebellopontine angle facial schwannoma relapsing towards middle cranial fossa

2011 ◽  
Vol 1 (2) ◽  
pp. 32 ◽  
Author(s):  
Takafumi Nishizaki ◽  
Norio Ikeda ◽  
Shigeki Nakano ◽  
Takanori Sakakura ◽  
Masaru Abiko ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Middle Cranial Fossa ◽  
Petrous Bone ◽  
Middle Fossa ◽  
Facial Spasm ◽  
History Of ◽  
Staged Operation ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri

Facial nerve schwannomas involving posterior and middle fossas are quite rare. Here, we report an unusual case of cerebellopontine angle facial schwannoma that involved the middle cranial fossa, two years after the first operation. A 53-year-old woman presented with a 3-year history of a progressive left side hearing loss and 6-month history of a left facial spasm and palsy. Magnetic resonance imaging (MRI) revealed 4.5 cm diameter of left cerebellopontine angle and small middle fossa tumor. The tumor was subtotally removed via a suboccipital retrosigmoid approach. The tumor relapsed towards middle cranial fossa within a two-year period. By subtemporal approach with zygomatic arch osteotomy, the tumor was subtotally removed except that in the petrous bone involving the facial nerve. In both surgical procedures, intraoperative monitoring identified the facial nerve, resulting in preserved facial function. The tumor in the present case arose from broad segment of facial nerve encompassing cerebellopontine angle, meatus, geniculate/labyrinthine and possibly great petrosal nerve, in view of variable symptoms. Preservation of anatomic continuity of the facial nerve should be attempted, and the staged operation via retrosigmoid and middle fossa approaches using intraoperative facial monitoring, may result in preservation of the facial nerve.

scholarly journals An undiagnosed TSH-secreting pituitary macroadenoma found during pregnancy

2021 ◽  
Vol 2021 ◽  
Author(s):  
Chi-Hong Ng ◽  
Wing-Sun Chow ◽  
Karen Siu-Ling Lam ◽  
Chi-Ho Lee
Keyword(s):  
Pituitary Adenoma ◽  
Thyroid Function ◽  
Thyroid Stimulating Hormone ◽  
Specific Reference ◽  
List Type ◽  
Reference Ranges ◽  
Pituitary Macroadenoma ◽  
Tsh Secretion ◽  
Inappropriate Tsh Secretion ◽  
Work Up

Summary Thyroid stimulating hormone (TSH)-secreting pituitary adenoma (TSHoma) is an uncommon cause of thyrotoxicosis, and is even rarer when found during pregnancy. Our patient presented with thyrotoxicosis accompanied by an inappropriately normal TSH level at 10 weeks of gestation during work-up of surgical termination of pregnancy (STOP). Subsequent investigations performed after STOP confirmed the presence of a TSH-secreting pituitary macroadenoma. She was initially treated with anti-thyroid drugs for biochemical control, followed by trans-sphenoidal surgery after STOP had been performed. Her thyroid function completely normalized after the trans-sphenoidal surgery. Our case illustrated the importance of recognizing the syndrome of inappropriate TSH secretion and highlighted several pregnancy-related aspects in the diagnosis and management of TSHoma during pregnancy. Learning points: This case report illustrates the need to raise awareness in recognizing the syndrome of inappropriate TSH secretion. Illustrate the different hormone tests available for reaching the diagnosis of TSH-secreting pituitary adenoma. Highlight the physiological changes in the thyroid status during pregnancy and the importance of using trimester-specific reference ranges for assessment of thyroid function during pregnancy. Describe the challenges in the management of TSH-secreting pituitary adenoma during pregnancy.

scholarly journals Lesions Mimicking Small Vestibular Schwannomas

2017 ◽  
Vol 78 (06) ◽  
pp. 447-453 ◽  
Author(s):  
Rudolf Hagen ◽  
Desiree Ehrmann-Müller ◽  
Brigitte Bison ◽  
Thomas Günthner-Lengsfeld ◽  
Camelia-Maria Monoranu ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Clinical Symptoms ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
University Hospital ◽  
Vestibular Schwannomas ◽  
Preoperative Imaging ◽  
Preoperative Magnetic Resonance ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri

Objective Most tumors of the internal auditory canal and cerebellopontine angle (CPA) are vestibular schwannomas (VSs). Preoperative diagnosis is based on typical clinical symptoms and radiological findings. In rare cases, histopathology can, however, show different results. Design This is a retrospective chart and database review. Setting The study was conducted at a tertiary skull base referral center at a university hospital. Participants A total of 207 consecutive cases of VS surgery via the middle cranial fossa approach performed between December 2005 and January 2015 were reviewed. Main Outcome Measures The main outcome measures were definitive histologic findings in 198 specimens, analysis of preoperative magnetic resonance imaging (MRI) and computed tomography. Results Histopathology revealed three meningiomas and two cases of lipochoristomas. Clinical presentation was typical for VS in all five cases. In preoperative MRI, all tumors were suspected to be VSs. Retrospective analysis of the preoperative imaging did not lead to a modification of the diagnosis. Intraoperative findings showed increased adherence of the tumor to the adjacent tissue in two of the five cases. Conclusion CPA lesions other than VSs are unusual but have to be taken into account. In very small tumors, imaging still remains difficult.

Bilateral Ossicular Head Dehiscence Into the Middle Cranial Fossa

2018 ◽  
Vol 127 (3) ◽  
pp. 209-212
Author(s):  
Sameer A. Alvi ◽  
Joel W. Jones ◽  
Jim Lin
Keyword(s):  
Ossicular Chain ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Tegmen Tympani ◽  
Ossicular Chain Reconstruction ◽  
History Of ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri ◽  
Operative Findings ◽  
The Right

Objectives: To describe a unique case of bilateral dehiscence of the malleus and incus heads into the middle fossa making contact with the temporal lobes, along with its clinical implications. Methods: An analysis of a patient case and review of pertinent literature were performed. Results: A patient with a history of right-sided mastoidectomy for cholesteatoma was evaluated for persistent conductive hearing loss. On computed tomography (CT) and magnetic resonance imaging (MRI), the patient had a complete dehiscence of the tegmen tympani on the right, with ossicular heads being located above the floor of the middle cranial fossa. A similar finding to a milder degree was noted on the left. The patient underwent revision tympanoplasty with mastoidectomy with removal of the incus and ossicular chain reconstruction and middle fossa craniotomy for repair of the right epitympanic dehiscence. Conclusions: We present some of the unique imaging and operative findings involved in an unusual presentation of encephalocele in which the bilateral malleus and incus heads rise above the level of the middle fossa floor.

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