Giant Hemorrhagic Prolactinoma with Sparse Prolactin Expression Presenting with Thalamic Infarction—A Case Report

2014 ◽  
Vol 10 (02) ◽  
pp. 124
Author(s):  
Ali GENC ◽  
Halil Ibrahim SUN ◽  
Burcu KASAPOGLU ◽  
Pinar Oz ◽  
Murat Aydın SAV ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Expression Patterns ◽  
Pituitary Tumors ◽  
Mass Effect ◽  
Immunocytochemical Staining ◽  
Cerebral Stroke ◽  
Cell Adenoma ◽  
Endocrine Activity ◽  
Intracranial Neoplasms ◽  
Thalamic Infarction

Pituitary tumors are the most common form of intracranial neoplasms. However, clinically relevant pituitary tumors presenting with disturbances of hormonal secretion or mass effect are rare and they only represent about 10 % of all surgically resected intracranial neoplasms. Prolactinomas are the most common types of pituitary adenomas. Generally, hormonal expression patterns provided by immunohistochemistry (IHC) studies are correlated with the clinical features and endocrine activity of the patients. Nonetheless, exceptions occur where the immunocytochemical staining is not concordant with the clinical picture. Pituitary adenomas presenting with apoplexy are well known. However, pituitary adenomas causing cerebral stroke and resulting in hemiplegia are unusual. Here, we report an unusual case of prolactinoma with cerebral stroke and sparse prolactin (PRL) expression. A 25-year-old woman complaining of amenorrhea, dysphasia, and left hemiplegia presented with serum PRL level in excess of 4,700 ng/ml. Pre-operational radiology images revealed a giant macroadenoma and a thalamic infarct due to carotid compression. Transcranial surgery was performed. IHC study of the adenoma revealed no hormonal expression other than sparse PRL immunoreactivity. Therefore, a sparsely granulated PRL cell adenoma was diagnosed. The patient is still under follow-up with continuing cabergoline treatment.

scholarly journals The PI3K/AKT/mTOR pathway in the pathophysiology and treatment of pituitary adenomas

2014 ◽  
Vol 21 (4) ◽  
pp. R331-R344 ◽  
Author(s):  
Eric Monsalves ◽  
Kyle Juraschka ◽  
Toru Tateno ◽  
Sameer Agnihotri ◽  
Sylvia L Asa ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Human Cancer ◽  
Tumor Biology ◽  
Pituitary Tumors ◽  
Mass Effect ◽  
Therapeutic Approaches ◽  
Hormone Production ◽  
New Therapeutic Approaches ◽  
Wide Range

Pituitary adenomas are common intracranial neoplasms. Patients with these tumors exhibit a wide range of clinically challenging problems, stemming either from results of sellar mass effect in pituitary macroadenoma or the diverse effects of aberrant hormone production by adenoma cells. While some patients are cured/controlled by surgical resection and/or medical therapy, a proportion of patients exhibit tumors that are refractory to current modalities. New therapeutic approaches are needed for these patients. Activation of the AKT/phophotidylinositide-3-kinase pathway, including mTOR activation, is common in human neoplasia, and a number of therapeutic approaches are being employed to neutralize activation of this pathway in human cancer. This review examines the role of this pathway in pituitary tumors with respect to tumor biology and its potential role as a therapeutic target.

Endocrine Silent Pituitary Tumors

2018 ◽  
Author(s):  
Harminder Singh ◽  
Smeer Salam ◽  
Theodore H. Schwartz
Keyword(s):  
Pituitary Adenomas ◽  
Case Series ◽  
Pituitary Tumors ◽  
Visual Outcome ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Pituitary Hormones ◽  
Pituitary Dysfunction ◽  
Normal Pituitary Gland ◽  
Field Disturbance

Pituitary adenomas are the most common intracranial neoplasms in adults, with a prevalence of 7% to 17%. Clinically, they can be divided into 2 categories based on whether they secrete pituitary hormones: functional (secretory) and nonfunctional (nonsecretory or endocrine silent) adenomas. The biologic latency of nonfunctional (endocrine silent) adenomas makes them usually diagnosed at the stage of macro (>1 cm) and giant (>4 cm) adenomas. Because these tumors are nonfunctioning, their primary symptoms are due to mass effect, particularly on the optic chiasm and normal pituitary gland and stalk superiorly, and the cavernous sinus laterally. Visual field disturbance is the most common presenting complaint, followed by pituitary dysfunction and headaches. Surgical outcomes, therefore, are aimed at determining visual outcome in addition to rates of gross total resection, recurrence, and postoperative pituitary dysfunction. Several recent case series have documented the increased success of the endonasal endoscopic transsphenoidal approach for resecting nonfunctioning pituitary adenomas, particularly in relation to the classic open cranial and microsurgical transsphenoidal techniques.

Pituitary Tumors

2017 ◽  
Author(s):  
Toral R. Patel ◽  
Viviane S. Tabar
Keyword(s):  
Radiation Therapy ◽  
Natural History ◽  
Pituitary Adenomas ◽  
Disease Process ◽  
Pituitary Tumors ◽  
Mass Effect ◽  
Intracranial Tumors ◽  
Local Mass ◽  
Less Invasive ◽  
History Presentation

Pituitary adenomas are among the most common intracranial tumors. The vast majority of these lesions are benign; however, many will require treatment due to local mass effect or hormone oversecretion. This chapter discusses the natural history, presentation, workup, and management of pituitary adenomas. Advances in surgical, medical, and radiation therapy are also reviewed. An improved understanding of this disease process will result in the adoption of less invasive and more efficacious treatments.

scholarly journals Epigenetic dysregulation in pituitary tumors

2019 ◽  
Vol 6 (3) ◽  
pp. IJE19
Author(s):  
Omair A Shariq ◽  
Kate E Lines
Keyword(s):  
Dna Methylation ◽  
Pituitary Adenomas ◽  
Histone Deacetylase Inhibitors ◽  
Somatic Mutations ◽  
Functional Characterization ◽  
Pituitary Tumors ◽  
Preclinical Studies ◽  
Significant Morbidity ◽  
Intracranial Neoplasms

Pituitary tumors are common intracranial neoplasms associated with significant morbidity due to hormonal dysregulation and neurologic symptoms. Somatic mutations are uncommon in sporadic pituitary adenomas, and only few monogenic conditions are associated with pituitary tumors. However, increasing evidence suggests that aberrant epigenetic modifications are found in pituitary tumors. In this review, we describe these mechanisms, including DNA methylation, histone modification and microRNA expression, and the evidence supporting their dysregulation in pituitary tumors, as well as their regulation of pro-tumorigenic genes. In addition, we provide an overview of findings from preclinical studies investigating the use of histone deacetylase inhibitors to treat pituitary adenomas and the need for further studies involving epigenetic drugs and functional characterization of epigenetic dysregulation.

Ultrastructural Immunocytochemistry of Five Rat Pituitary Adenomas

1980 ◽  
Vol 38 ◽  
pp. 724-725
Author(s):  
D. J. McComb ◽  
N. Ryan ◽  
E. Horvath ◽  
K. Kovacs ◽  
E. Nagy ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Electron Microscopic ◽  
Electron Microscopic Immunocytochemistry ◽  
Transmission Electron ◽  
Rat Pituitary ◽  
Radiation Induced ◽  
Group 5 ◽  
Group 2 ◽  
Microscopic Techniques

Conventional light and electron microscopic techniques failed to clarify the cellular composition and derivation of spontaneous and induced, intrasellar and transplanted pituitary adenomas in rats (1). In the present work, electron microscopic immunocytochemistry was applied to evaluate five adenohypo-physial tumors using a technique described by Moriarty and Garner (2). Spontaneously occurring pituitary adenomas (group 1) were harvested from aging female Long-Evans rats. R-Amsterdam rats were treated with 2 x 1.0 mg estrone acetate (HogivaI) s.c. weekly for 6 months. Pituitary adenomas in excess of 30 mg were removed from these animals to make up the tumors of group 2. Groups 3 and 4 consisted of estrogen-induced autonomous transplan¬ted pituitary tumors MtT.WlO and MtT.F4. Group 5 was a radiation-induced transplanted autonomous pituitary tumor MtT.W5. The tumors of groups 3,4 and 5 were allowed to proliferate in host rats 6-8 weeks prior to removal for processing. Tissue was processed for transmission electron microscopy (glutaraldehyde fixation, OsO4 postfixation and epoxy resin embedding), and electron microscopic immunocytochemistry (3% paraformaldehyde fixation and Araldite embedding).

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.

Clinical and genetic characteristics in patients under 30 years with sporadic pituitary adenomas

2021 ◽  
Author(s):  
Idoia Martinez de LaPiscina ◽  
Nancy Portillo Najera ◽  
Itxaso Rica ◽  
Sonia Gaztambide ◽  
Susan M Webb ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Tumour Size ◽  
Young Patients ◽  
Mass Effect ◽  
Comparative Genomic ◽  
Clinical Value ◽  
Genetic Characteristics ◽  
Novel Variants ◽  
Disease Penetrance ◽  
Healthy Family

Objective: Pituitary adenomas (PA) are rare in young patients and additional studies are needed to fully understand their pathogenesis in this population. We describe the clinical and genetic characteristics of apparently sporadic PA in a cohort of young patients. Design: Clinical and molecular analysis of 235 patients (age ≤30 years) with a PA. Clinicians from several Spanish and Chilean hospitals provided data. Methods: Genetic screening was performed via next-generation sequencing and comparative genomic hybridization array. Clinical variables were compared among paediatric, adolescent (<19 years) and young adults’ (≥19-30 years) cohorts and types of adenomas. Phenotype-genotype associations were examined. Results: Among the total cohort mean age was 17.3 years. Local mass effect symptoms were present in 22.0% and prolactinomas were the most frequent (44.7%). Disease-causing germline variants were identified in 22 individuals (9.3%), more exactly in 13.1% and 4.7% of the populations aged 0-19 and 19-30 years, respectively; genetically positive patients were younger at diagnosis and had larger tumour size. Healthy family carriers were also identified. Conclusions: Variants in genes associated with syndromic forms of PAs were detected in a large cohort of apparently sporadic pituitary tumours. We have identified novel variants in well-known genes and set the possibility of incomplete disease penetrance in carriers of MEN1 alterations or a limited clinical expression of the syndrome. Despite the low penetrance observed, screening of AIP and MEN1 variants in young patients and relatives is of clinical value.

Protocol for the Examination of Specimens From Patients With Primary Pituitary Tumors

2011 ◽  
Vol 135 (5) ◽  
pp. 640-646 ◽  
Author(s):  
Vania Nosé ◽  
Shereen Ezzat ◽  
Eva Horvath ◽  
Kalman Kovacs ◽  
Edward R. Laws ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Diagnosis And Classification ◽  
Pathology Reporting ◽  
Synoptic Approach ◽  
Clear Information

Abstract In an effort to improve the diagnosis of pituitary tumors, we propose a synoptic approach to pituitary pathology reporting that will provide clear information to endocrinologists, neurosurgeons, neuropathologists, and surgical pathologists to advance the diagnosis and classification of pituitary adenomas.

scholarly journals Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic

2010 ◽  
Vol 68 (4) ◽  
pp. 608-612 ◽  
Author(s):  
Américo Rubens Leite dos Santos ◽  
Roberto Monteiro Fonseca Neto ◽  
José Carlos Esteves Veiga ◽  
José Viana Jr ◽  
Nilza Maria Scaliassi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Hormonal Control ◽  
Subtotal Resection ◽  
Endoscopic Endonasal ◽  
Technical Aspects ◽  
Transphenoidal Approach ◽  
Acth Secreting ◽  
Csf Leaks

OBJECTIVE: Analyse technical aspects, effectiveness and morbidity of the endoscopic endonasal transphenoidal approach for pituitary adenomas. METHOD: From January 2005 to September 2008, 30 consecutive patients underwent endoscopic endonasal resection of pituitary adenomas with a follow up from 3 to 36 months. Their medical charts were retrospectively analysed. RESULTS: There were 18 women and 12 men, mean age 44 years (range 17-65 yr). Among the 30 patients, 23 had macroadenomas and 7 microadenomas. Twelve patients had non-functioning tumors, 9 had ACTH-secreting tumors, 8 had GH-secreting tumors and 1 prolactinoma. Complete resection and hormonal control was achieved in all microadenomas. Macroadenomas were completely removed in 6 patients, subtotal resection in 6 and partial resection in 11. Three patients had diabetes insipidus and 5 had CSF leaks treated with lumbar drainage. CONCLUSION: The endonasal endoscopic approach for pituitary tumors is effective and has low morbidity.

scholarly journals Genetic and metabolic characteristics of familial isolated pituitary adenomas

2013 ◽  
Vol 10 (2) ◽  
pp. 3-10 ◽  
Author(s):  
N S Dalantaeva ◽  
I I Dedov
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Tumors ◽  
Suppressor Gene ◽  
Carney Complex ◽  
Incomplete Penetrance ◽  
Chromosome 11 ◽  
Gene Encoding ◽  
Metabolic Characteristics ◽  
Aryl Hydrocarbon ◽  
Aip Gene

Familial isolated pituitary adenoma (FIPA) – a relatively new term for the disease, which is characterized by an autosomal dominant inheritance with incomplete penetrance, resulting in the development of pituitary tumors with no distinguishing features other endocrine diseases or syndromes, such as, for example, the syndrome multiple endocrine neoplasia type 1 (MEN-1 syndrome) or the Carney complex. FIPA-families account for about 2% of all cases of pituitary adenomas. Among the FIPA-family about 15–20% have mutations in the gene encoding the protein aryl hydrocarbon receptor. This suppressor gene located on the long arm of chromosome 11. Etiological gene for the rest of the greater percentage of FIPA-family is still unknown. Germline mutations in the AIP gene have also been found in patients with early development of pituitary adenomas, mainly secreting growth hormone, much rarely – prolactin and adrenocorticotropic hormone without a clear family history. Such cases are called "simple". Somatic mutations of the AIP gene in pituitary tumors or other sites has not yet been described

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