scholarly journals Double Pituitary Adenoma —Two Case Reports—

1996 ◽  
Vol 36 (11) ◽  
pp. 818-821 ◽  
Author(s):  
Seiji KANNUKI ◽  
Keizo MATSUMOTO ◽  
Toshiaki SANO ◽  
Yasumi SHINTANI ◽  
Hiroshi BANDO ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Case Reports ◽  
Double Pituitary Adenoma

Unusual double pituitary adenoma: A case report

2010 ◽  
Vol 61 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Fabio Rotondo ◽  
Nasima Khatun ◽  
Bernd W. Scheithauer ◽  
Eva Horvath ◽  
Thomas R. Marotta ◽  
...  
Keyword(s):  
Case Report ◽  
Pituitary Adenoma ◽  
Double Pituitary Adenoma

scholarly journals SAT-269 A Rare Case of Functioning Gonadotroph Producing Pituitary Macroadenoma in Teenage Male

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Siroj Dejhansathit ◽  
Subhanudh Thavaraputta ◽  
Genevieve LaPointe ◽  
Ana Marcella Rivas Mejia
Keyword(s):  
Transcription Factor ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Complete Blood Count ◽  
Case Reports ◽  
Biologically Active ◽  
Total Testosterone ◽  
Sellar Mass ◽  
Delay In Diagnosis ◽  
Orbitozygomatic Approach

Abstract Background: Unlike nonfunctioning gonadotroph pituitary adenomas, functioning gonadotroph pituitary adenomas (FGA) are an uncommon type of pituitary tumors that secrete biologically active gonadotropins (LH, FSH, or both). Clinical Case: A 23-year-old man with no previous medical history presented to the emergency department with three months history of progressive decreased vision and decreased libido. He denied headache, seizure, erectile dysfunction, or weakness. On physical examination, his visual acuity was significantly reduced on the right eye and was only able to perceive light. He had a visual field narrowing on the left eye. Gynecomastia was noted bilaterally and testicles were found to be enlarged (Orchidometer >25 mL). Complete blood count was significant for hemoglobin of 19.2 g/dL (N, 13.7-17.5 g/dL), and hematocrit of 57.0% (N, 40.1-51.0%). Pituitary function tests were as follow: FSH >200.0 mIU/mL (N, 1.5-12.4 mIU/mL), LH 17.0 mIU/mL (N, 1.7-8.6 mIU/mL), total testosterone 41.3 nmol/L (N, 8.6-29.0 nmol/L), free testosterone 1.263 nmol/L (N, 0.148-0.718 nmol/L), and bioavailable testosterone 29.609 (N, 2.110-8.920 nmol/L). Prolactin, TSH, GH, and ACTH were all within the normal range. Magnetic resonance imaging (MRI) showed a sellar mass involving the planum sphenoidal measuring 5.8 x 5.2 x 5.6 cm with optic chiasm displaced superiorly, in addition, subfalcine herniation with mild hydrocephalus was also noted. The patient underwent orbitozygomatic approach resection of the pituitary tumor. Histological examination was consistent with a pituitary adenoma. Cells stained positive for transcription factor steroidogenic factor 1 (SF 1), FSH, LH, and alpha-subunit consistent with a gonadotroph adenoma. They were negative for transcription factor Pit 1 stain and the remaining pituitary hormones including ACTH, GH, prolactin, and TSH stain. Postsurgical hormone assessment showed a significant decline in FSH and LH to 2.3 and 0.4 mIU/mL, respectively and testosterone level decreased to < 0.087 nmol/L on postoperative day 18. The patient’s vision improved postoperatively prior to discharge but he lost follow up thereafter. Conclusion: Most patients with functioning gonadotroph pituitary adenoma present with large tumors that are detected based on the occurrence of symptoms of compression that result from the enlarging sellar mass. Most patients, particularly men and postmenopausal women, do not develop symptoms of hormone excess and the lack of symptomatology results in delay in diagnosis. Our patients presented with significant polycythemia which resulted from excess testosterone and could have prompted earlier tumor detection if he had presented in an earlier stage. The incidence of polycythemia in male patients with functioning gonadotroph pituitary adenoma has previously been described in the literature in a few case reports.

scholarly journals Nonfunctioning Pituitary Adenoma That Changed to a Functional Gonadotropinoma

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Gerson Geovany Andino-Ríos ◽  
Lesly Portocarrero-Ortiz ◽  
Carlos Rojas-Guerrero ◽  
Alejandro Terrones-Lozano ◽  
Alma Ortiz-Plata ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Medical Condition ◽  
Case Reports ◽  
Progressive Increase ◽  
Complete Resection ◽  
Point Of View ◽  
Serum Estradiol ◽  
Secondary Amenorrhea ◽  
Nonfunctioning Pituitary Adenoma

Objective. Pituitary adenomas can be classified as clinically functional or silent. Depending on the reviewed literature, these are the first or second place in frequency of the total pituitary adenomas. Even rarer is the presence of a functional gonadotropinoma since only very few case reports exist to date. The conversion of a clinically silent to functional pituitary adenoma is extraordinarily rare; the mechanisms that explain these phenomena are unknown or not fully understood. Methods. We report the case of a woman who initially had a nonfunctional gonadotropinoma and in the course of her medical condition showed biochemical changes in her hormonal pituitary profile compatible with a functional gonadotropinoma. Results. We considered that the patient had a functional gonadotropinoma due to the hyperestrogenemia in the context of secondary amenorrhea, resolving the hyperestrogenemia after almost complete resection of the tumor. Conclusion. It is necessary to point out from a clinical and/or biochemical point of view the change in functionality that a nonfunctional pituitary adenoma may have. In the case of our patient, the suspicion of this change in functionality became evident when we found an increase in the FSH/LH ratio and a progressive increase in serum estradiol concentrations when the patient had amenorrhea.

scholarly journals SAT-276 Co-Secreting TSH and Growth Hormone Pituitary Adenoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Hatem Eid
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Case Reports ◽  
Somatostatin Analogs ◽  
Signs And Symptoms ◽  
Pituitary Hormones ◽  
Oral Glucose ◽  
Pituitary Macroadenoma ◽  
Α Subunit

Abstract Introduction: Secreting pituitary adenoma is exceedingly rare. Less than 15 cases having been reported. Its clinical presentation and diagnosis is challenging. We report a case of pituitary macroadenoma, with features of acromegaly and hyperthyroidism. Case report: A 75 years’ old man presented with new onset atrial fibrillation. He had high FT4 with normal TSH. His ultrasound scan of the neck showed a solitary nodule. He had ablation twice and was started on bisoprolol and anticoagulant. He had MRI scan for headaches and this showed a pituitary macroadenoma. He had high IGF-1. His oral glucose tolerance showed failure of GH suppression. His FT4 was persistently high with normal TSH and he had high a subunits. This suggested the diagnosis of TSH and GH secreting pituitary adenoma. Discussion: TSH-secreting pituitary adenomas are rare and not uncommonly, they co-secrete other pituitary hormones including growth hormones. Somatotrophs and lactotrops share common transcription factors with thyrotrophs. TSH-secreting adenomas are benign but 60% of them are locally invasive. TSH-secreting pituitary adenomas typically present with either symptoms of tumor growth like headache or visual field disturbance or symptoms of hyperthyroidism. Thyroid nodules are common in patients with TSHomas. In patients with TSH-secreting pituitary adenomas, majority will need only surgery and radiation. The medical treatment used to normalize TSH and FT4 levels is somatostatin analogs. This is effective in about 90% of patients with TSH secreting pituitary adenomas TSHoma should be differentiated from resistance to thyroid (RTH). The main difference between TSHoma and RTH is the presence of signs and symptoms of hyperthyroidism in patients with TSHoma, absence of a family history, normal thyroid hormone levels in family members, and the presence of an elevated glycoprotein α-subunit in patients with pituitary tumor. Reference: H Adams and D Adams. A case of a co-secreting TSH and growth hormone pituitary adenoma presenting with a thyroid nodule. EDM case reports 2018 [email protected]

Untreated Non-Functioning Pituitary Adenoma Causing Spontaneous Cerebrospinal Fluid Rhinorrhea: A Case Report

2020 ◽  
Vol 103 (9) ◽  
pp. 960-963
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenoma ◽  
Transsphenoidal Surgery ◽  
Case Reports ◽  
Medical Attention ◽  
Nasal Discharge ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Presenting Symptoms ◽  
Csf Leakage

Cerebrospinal fluid (CSF) leakage is common with traumatic brain injury or after transsphenoidal surgery (TSS). In contrast, spontaneous rhinorrhea caused by pituitary adenoma (PA) without prior treatment is rather unusual. Moreover, cases of non-functioning PA (NFPA) who seek medical attention without visual or hormonal symptoms but with watery nasal discharge, mistaken for rhinitis, and misled to delayed diagnosis, are extremely rare. The authors presented a case of spontaneous CSF rhinorrhea, confirmed by clinical, laboratory, and radiographic studies, caused by NFPA. Endoscopic TSS came across a typical PA, and subsequently, the sellar defect was successfully repaired. Pathological diagnosis of NFPA was established. The patient had an uncomplicated postoperative course and complete resolution of her presenting symptoms. A short review of prior case reports is also provided. Keywords: Spontaneous cerebrospinal fluid rhinorrhea, Pituitary adenoma, Non-functioning, Endoscopic transsphenoidal surgery

scholarly journals Endocrine tumors: Thyrotropin-secreting pituitary adenoma: a structured review of 535 adult cases.

2021 ◽  
Author(s):  
Carlien de Herdt ◽  
Eva Philipse ◽  
Christophe De Block
Keyword(s):  
Pituitary Adenoma ◽  
Cohort Studies ◽  
Case Reports ◽  
Case Series ◽  
Postoperative Treatment ◽  
Visual Field Defects ◽  
Somatostatin Analogue ◽  
Endocrine Tumors ◽  
Residual Tumour ◽  
Mesh Terms

Background and Aims: Thyrotropin-stimulating pituitary adenoma (TSHoma) are a rare entity, occurring in 1 per million people. We performed a systematic review of 535 adult cases summarizing the clinical, biochemical, hormonal and radiological characteristics of TSHoma. Furthermore, we discuss the current guidelines for diagnosis and treatment. Methods A structured research was conducted using Pubmed with the following MeSH terms: “thyrotropin secreting pituitary adenoma” OR “TSHoma” OR “thyrotropinoma”. Results Our analysis included 535 cases originating from 18 case series, 5 cohort studies and 91 case reports. Mean age at diagnosis was 46 years. At presentation 75% had symptoms of hyperthyroidism, 55.5% presented with a goitre and 24.9% had visual field defects. Median TSH at diagnosis was 5.16 (3.20-7.43) mU/L with a mean fT4 of 41.5±15.3 pmol/L. The majority (76.9%) of the TSHoma were macroadenoma. Plurihormonality was seen in 37.4% of the adenoma with a higher incidence in macroadenoma. Surgical resection of the adenoma was performed in 87.7% patients of which 33.5% had residual pituitary adenoma. Postoperative treatment with a somatostatin analogue led to a stable disease in 81.3% of the cases with residual tumour. We noticed a significant correlation between the diameter of the adenoma and residual pituitary adenoma (r=0.490, p<0.001). However, in patients pre-operatively treated with somatostatin analogue this correlation was absent. Conclusion TSHoma are a rare cause of hyperthyroidism and are frequently misdiagnosed. Based on our structured analysis of case series, cohort studies and case reports, we conclude that the majority of TSHoma are macroadenoma being diagnosed in the 5-6th decade of life and presenting with symptoms of hyperthyroidism. Plurihormonalitiy is observed in one third of TSHoma. Treatment consists of neurosurgical resection and SSA in case of surgical failure.

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

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.

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