Pituitary stone resulting in visual dysfunction and spontaneous rhinorrhea in nonfunctioning pituitary adenoma: illustrative case

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Takuya Kanemitsu ◽  
Naokado Ikeda ◽  
Masao Fukumura ◽  
Satoshi Sakai ◽  
Hidehiro Oku ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Tumor Size ◽  
Illustrative Case ◽  
Increased Intracranial Pressure ◽  
Csf Rhinorrhea ◽  
Vp Shunt ◽  
Nonfunctioning Pituitary Adenoma ◽  
Transnasal Surgery ◽  
Bone Trabeculae

BACKGROUNDCalcifications in pituitary adenomas are rare, being found in only 5.4%–25% of reported cases. These are divided into eggshell-like calcifications around the tumor and nodular calcifications at the center of the tumor, the latter of which are called “pituitary stones” (PSs).OBSERVATIONSThe authors report the case of a 60-year-old male with a nonfunctional pituitary adenoma with PSs and asymptomatic ventricular dilatation who presented with spontaneous cerebrospinal fluid (CSF) rhinorrhea and rapid visual aggravation without an increase in tumor size over the course of 4 years. After endoscopic transnasal surgery, his visual acuity immediately improved temporarily. It was believed that the increased intracranial pressure due to secondary hydrocephalus resulted in visual aggravation; thus, a ventriculoperitoneal (VP) shunt was created. After creation of the VP shunt, the patient’s visual acuity improved gradually and completely. Histological findings showed that adenoma cells were observed among the lamellar bone trabeculae. To the best of the authors knowledge, this is the first report of osteoid metaplasia–type PSs in nonfunctioning pituitary adenoma.LESSONSPSs formed near the sellar floor and caused spontaneous CSF rhinorrhea due to direct mechanical stress on the dura mater and optic nerves, which may have caused meningitis and secondary hydrocephalus that resulted in visual impairment independent of tumor size.

scholarly journals Papillary craniopharyngioma in a patient following resection of nonfunctioning pituitary adenoma: illustrative case

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
David J. Park ◽  
Akash Mishra ◽  
Danielle Golub ◽  
Jian Y. Li ◽  
Karen S. Black ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Visual Field Defects ◽  
Illustrative Case ◽  
Nonfunctioning Pituitary Adenoma ◽  
First Case ◽  
Initial Surgery ◽  
Suprasellar Region ◽  
Management Recommendations ◽  
Lost To Follow Up ◽  
Transsphenoidal Resection

BACKGROUNDAlthough craniopharyngioma and pituitary adenoma are common tumors of the sellar or suprasellar region, the development of papillary craniopharyngioma in the same sellar region after resection of a nonfunctioning pituitary adenoma has not been reported.OBSERVATIONSHere the authors report the first case of craniopharyngioma that developed long after resection of a pituitary adenoma. A 66-year-old male patient underwent endoscopic transsphenoidal resection for a large sellar mass, which histopathologically confirmed the diagnosis of a pituitary adenoma. He had an excellent recovery after surgery. For several years, he had no clinical or imaging evidence of tumor recurrence and then was lost to follow-up. Seven years after the initial surgery, the patient returned with a one-month history of visual field defects, and imaging confirmed a heterogeneous, cystic suprasellar mass. Endoscopic transsphenoidal resection of the tumor was performed, and histological examination showed it to be a papillary craniopharyngioma.LESSONSNeurosurgeons should be aware that after pituitary adenoma resection, a recurrent mass could be a craniopharyngioma, with implications for very different management recommendations.

scholarly journals Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas

2020 ◽  
pp. 1-7
Author(s):  
Soo Heon Kim ◽  
Cheol Ryong Ku ◽  
Minkyun Na ◽  
Jihwan Yoo ◽  
Woohyun Kim ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Tumor Size ◽  
Thyroid Stimulating Hormone ◽  
Early Postoperative Period ◽  
En Bloc ◽  
Rare Type ◽  
Csf Rhinorrhea ◽  
Extracapsular Dissection ◽  
Stimulating Hormone

OBJECTIVEThyroid-stimulating hormone (TSH)–secreting pituitary adenoma (TSHoma) is a rare type of pituitary adenoma; thus, little is known about TSHomas. The purpose of this study was to analyze clinical characteristics and therapeutic outcomes of TSHomas based on a single-center experience. The authors also searched for reliable preoperative and early postoperative factors that could predict long-term endocrinological remission.METHODSThe clinical, radiological, and pathological characteristics and surgical and endocrinological outcomes of 31 consecutive cases of TSHomas that were surgically treated between 2005 and 2017 were reviewed retrospectively. Preoperative factors were evaluated for their ability to predict long-term remission by comparing remission and nonremission groups. TSH and free thyroxine levels were measured at 2, 6, 12, 18, and 24 hours after surgery to determine whether they could predict long-term remission.RESULTSGross-total removal of tumor was achieved in 28 patients (90.3%), and 26 patients (83.9%) achieved endocrinological remission by surgery alone based on long-term endocrinological follow-up (median 50 months, range 32–81 months). The majority of the tumors were solid (21/31, 67.7%), and en bloc resection was possible in 16 patients (51.6%). Larger tumor size and tumor invasion into cavernous sinus and sphenoid sinus were strong predictors of lower rates of endocrinological remission. Immediate postoperative TSH level at 12 hours after surgery was the strongest predictor, with a 0.62 μIU/mL cutoff. Postoperative complications included CSF rhinorrhea in one patient and epistaxis in another patient, who underwent additional surgical treatment for the complications.CONCLUSIONSTumor size and extent are major prognostic factors for both extent of resection and endocrinological remission. The consistency of TSHomas was more likely to be solid, which makes extracapsular dissection more feasible. Long-term remission of TSHomas could be predicted even during the early postoperative period.

Intrasellar Paraganglioma Presenting as Nonfunctioning Pituitary Adenoma

1999 ◽  
Vol 123 (5) ◽  
pp. 429-432
Author(s):  
Demetrios Sambaziotis ◽  
George Kontogeorgos ◽  
Kalman Kovacs ◽  
Eva Horvath ◽  
Athanassios Levedis
Keyword(s):  
Magnetic Resonance Imaging ◽  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Physical Examination ◽  
Sellar Region ◽  
Resonance Imaging ◽  
Sellar Mass ◽  
Electron Microscopic ◽  
Nonfunctioning Pituitary Adenoma

Abstract Paragangliomas arising in the sellar region are rare. We report a case of intrasellar paraganglioma of a 54-year-old man who presented with gradually decreasing visual acuity. Physical examination revealed bitemporal hemianopsia with no apparent signs of endocrinologic dysfunction. Magnetic resonance imaging revealed a large sellar mass believed to be a nonfunctioning pituitary adenoma. The tumor was removed transsphenoidally and submitted for histologic examination. The morphologic features, based on histologic, immunocytochemical, and electron microscopic analyses, were consistent with the diagnosis of paraganglioma. The diagnostic morphologic features and the immunocytochemical profile of the tumor are reported.

Primary Pituitary Malignant Lymphoma Was Difficult to Differentiate from Nonfunctioning Pituitary Adenoma: A Case Report

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Yuta Murakami ◽  
Shinya Jinguji ◽  
Yugo Kishida ◽  
Taku Sato ◽  
Tadashi Watanabe ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Malignant Lymphoma ◽  
Nonfunctioning Pituitary Adenoma

scholarly journals Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

2021 ◽  
Author(s):  
Rishi Raj ◽  
Ghada Elshimy ◽  
Aasems Jacob ◽  
P. V. Akhila Arya ◽  
Dileep C. Unnikrishnan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Pituitary Adenoma ◽  
Gnrh Agonist ◽  
Tumor Size ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Surgery ◽  
Laboratory Evaluation ◽  
The Mean

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

Cerebrospinal Fluid Dynamics and Rhinorrhea: The Role of Shunting in Repair

1983 ◽  
Vol 91 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Arnold Komisar ◽  
Stephen Weitz ◽  
Robert J. Ruben
Keyword(s):  
Intracranial Pressure ◽  
Surgical Repair ◽  
Skull Fracture ◽  
Increased Intracranial Pressure ◽  
Csf Rhinorrhea ◽  
Initial Management ◽  
Parasellar Region ◽  
Csf Leakage ◽  
Pathophysiologic Mechanisms

CSF rhinorrhea can have many causes: traumatic, neoplastic, and iatrogenic origins are common. Most traumatic rhinorrhea ceases after a trial of conservative management. While obvious erosion or traumatic destruction of vital structures may be the underlying cause, other pathophysiologic mechanisms may be working in the formation of CSF rhinorrhea, which may require the combined skills of the otolaryngologist and the neurosurgeon. Leakage of CSF is seen in “high-pressure rhinorrhea,” a pathophysiologic state wherein the underlying problem is poor CSF resorption. The result is increased intracranial pressure and eventual rhinorrhea or otorrhea. Areas of CSF leakage correspond to sites of congenital weakness in the cribriform plate region, the parasellar region, or the temporal bone. Weak areas in old base-of-skull fracture sites may leak with increased intracranial pressure. The initial management should stress correction of the deranged pathophysiology, namely shunting. Surgical repair is secondary to controlling the abnormal CSF dynamics.

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