Diagnosis Of Pituitary Macroadenoma Research Articles

Pituitary macroadenoma with panhypopituitarism masquerading as schizophrenia: a diagnostic dilemma managed conservatively

Introduction and importance: Secretory pituitary macroadenoma also known as prolactinoma are benign neoplasm comprising very minimal cases of intracranial masses. Among the various presentation suggestive of panhypopituitarism, psychosis, and features of schizophrenia is very rarely seen. In the majority of cases, neurosurgical intervention for the excision of tumor is considered a standard treatment modality but conservative management with dopamine agonist and steroids have also been shown to provide an optimal level of care also improving the quality of level of patient. Case presentation: A 42-year-old Asian male presented with a history of talking to self, delusion of persecution, over talkativeness, hallucination, increased suspiciousness, and history of lost and found in the streets where he was working as a migrant worker. The patient was initially managed in line of schizophrenia with the antipsychotics drug of choice. On further assessment there was no improvement of psychiatric symptoms but they further deteriorated with additional neuropsychiatric symptoms; hence, MRI brain was carried out. Following which, the diagnosis of pituitary macroadenoma was confirmed and further more hormonal analysis was done, which showed findings suggestive of panhypopituitarism. The patient was then managed conservatively with dopamine agonist and steroids, which showed rapid improvement of psychiatric symptoms with a massive reduction in the size of the pituitary macroadenoma. Clinical discussion: With the incidence of 100 per million cases pituitary adenomas are considered locally invading with the characteristic compression of the surrounding structure, presenting as visual hallucinations, olfactory hallucinations, episodes of losing time, apathy, and features suggestive of adrenal insufficiency, hypogonadotrophic hypogonadism, and symptoms secondary to hormonal imbalance such as hypothyroidism. Psychiatric symptomatic presentations are considered a very rare presentation in cases of pituitary macroadenoma. Also, psychiatric features and symptoms of psychosis are associated with prolcatinomas through idiopathic mechanism and the basic casualty has not been established. Surgical intervention such as trans-sphenoidal resection of the mass can be undertaken in case where mass effects is present but long-term remission and prognosis is found not to be fruitful. Conservative treatment with dopamine agonist such as cabergoline and steroids also plays a meaningful role in abrupt management in such cases. Conclusion: Pituitary macroadenoma presenting as a patient of schizophrenia is noted very rarely in medical literature; hence, investigations in view of neurosurgical diagnosis in cases presenting as psychosis should be considered for ideal holistic management. Conservative management can also be a breakthrough treatment modality in complete recovery of pituitary macroadenoma.

Accuracy of magnetic resonance imaging in evaluation of sellar and juxtasellar tumors

Background: Sellar and parasellar/juxtasellar regions are complex areas of the brain, and different varieties of tumors can occur in this area. Preoperative noninvasive diagnosis with magnetic resonance imaging (MRI) is essential for treatment planning. Aim of the Study: The aim of this study is to characterize MRI features of the sellar and juxtasellar tumors and to correlate MRI diagnosis with histopathological diagnosis in order to evaluate the efficiency of MRI. Materials and Methods: Patients with sellar and juxtasellar lesions who were operated during September 2015–August 2017 and the pathological reports were compared with the MRI findings retrospectively. Results: A total of 50 patients were enrolled in the study, and the mean age of presentation was 34.6 years. MRI-based radiological diagnosis showed 21 cases of pituitary macroadenoma, 15 cases of craniopharyngioma, 9 cases of meningioma, 2 cases of germinoma, 1 case of glioma, and 2 cases of epidermoid cysts. Histopathological correlation revealed MRI accuracy of 94.12%, 94%, 100%, 98%, 100%, and 100% for the diagnosis of pituitary macroadenoma, craniopharyngioma, meningioma, germinoma, glioma, and epidermoid cyst, respectively. One case each of pituitary macroadenoma and germinoma diagnosed on MRI comes out to be as craniopharyngioma after final histopathological correlation, whereas one case of craniopharyngioma turned out to be macroadenoma after final histopathological examination. Conclusions: The present study revealed a strong correlation between MRI and histopathological diagnosis for sellar and juxtasellar tumors. MRI is the modality of choice for characterizing sellar and suprasellar lesions.

Pituitary Macroadenoma May be a Tentative Diagnosis in a Young Patient With Anemia

A 25-year-old young man presented to our emergency room with a 3-month history of progressive headache and being easily tired. The familial and personal history of the patient was not significant. On examination, he appeared generally weak. The neurological examination revealed no visual defects, decreased muscle power, or other neurological deficits. Laboratory studies showed normocytic anemia with serum hemoglobin 12.7 g/dL. Magnetic resonance imaging (MRI) of brain was performed, which disclosed a 1.9 cm sellar mass that caused compression and mild elevation of the optic chiasm. The diagnosis of pituitary macroadenoma was established. Therefore, navigator-assisted endoscopic transnasal transsphenoidal approach to remove the tumor was performed and postoperative recovery was uneventful. A definitive diagnosis of a gonadotroph adenoma is made by pathologic evaluation of the tumor. We emphasize that pituitary adenoma should be a tentative diagnosis in a male patient with normocytic and normochromic anemia with hypogonadism. The anemia is associated with hypogonadism and tumor size, and improves following treatment that increases testosterone level. Headache may be the only neurological sign.

Sellar Atypical Teratoid/Rhabdoid Tumor: Any Preoperative Diagnostic Clues?

ABSTRACT Objective: Our objectives were to describe a rare adult-onset sellar atypical teratoid/rhabdoid tumor (AT/RT) and to identify preoperative diagnostic clues for this aggressive tumor. Methods: A case report and review of the relevant literature. Results: A 36-year-old female presented with headache for 1 month and blurry vision for 6 days. Imaging identified a large sellar mass with suprasellar extension that was indistinguishable from a pituitary adenoma. Hormonal studies revealed hypopituitarism and hyperprolactinemia. A presumptive diagnosis of pituitary macroadenoma was made, but the histologic, immunohistochemical, electron microscopic, and cytogenetic studies of the tumor supported a diagnosis of AT/RT. Despite multiple surgical resections, radiation, and chemotherapy, the tumor recurred and regrew relentlessly. The patient died 2.5 years after presentation. Conclusion: This case highlights the importance of suspecting aggressive sellar masses in management planning and prognosis counseling....

A case of pituitary macro-adenoma with acromegaly and visual field defects

A 45-year-old female visited our medical out-patient department with a history of gradual increase in the thickness of her skin and prominence of lower jaw and forehead in the past 10 years. Hormonal assay revealed unsuppressed growth hormone levels (7.86 ng/ml) with oral glucose load at 1 hour. Magnetic resonance imaging (MRI) of brain showed pituitary macroadenoma. Perimetric examination revealed visual field defects. Clinical, hormonal, imaging, and perimetric studies together confirmed the diagnosis of pituitary macroadenoma with acromegaly and pressure effects.

Risperidone-induced acromegaly: a case report

Today, considering their adverse side effects, the first-generation antipsychotics have been replaced by the new-generation antipsychotics (also known as second-generation antipsychotic agents). The superiority of new-generation antipsychotics compared with first-generation antipsychotic agents in terms of side effects, especially movement disorders, are acknowledged by clinicians. But in recent years during the use of second-generation antipsychotic agents, endocrine side effects have been noteworthy. In our study with a diagnosis of paranoid schizophrenia treated with risperidone for 14 years and operated with the diagnosis of pituitary macroadenoma, a 32-year-old female patient is presented in the light of the literature examining the framework of the history of disease.

Retraction Note to: Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transferred to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma.

RETRACTED ARTICLE: Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transferred to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma.

Management of pituitary adenoma with mass effect in pregnancy: a case report.

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transfered to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma.

Management of pituitary adenoma with mass effect in pregnancy: a case report

A middle aged primigravida was managed at the University of Nigeria Teaching Hospital, Enugu, Nigeria for a pituitary macroadenoma. She was admitted at 33 weeks gestational age following a history of blurred vision and generalized headache, worse on bending down. After neurological consultation and investigations, a diagnosis of pituitary macroadenoma with mass effect was entertained. A plan for neurosurgery after delivery was made and the patient put on bromocriptine to reduce tumour size. Premature labour at 35 weeks resulted in caesarean delivery of a live baby. She was managed in the intensive care unit for three days where oral bromocriptine was resumed before she was transfered to the postnatal ward. Within ten hours of the transfer, she developed accelerated hypertension with encephalopathy and had a cardiac arrest shortly afterwards. This rare case highlights both the possible role of bromocriptine as a cause of postpartum hypertension and the possible development of a sudden catastrophic intramoural infarction or hemorrhage (pituitary apoplexy) in a patient with a macroadenoma.

Sinonasal inverted papilloma mimicking a pituitary macroadenoma

We report the rare entity of an inverted papilloma arising from the sphenoid sinus that we expected to be a pituitary tumour on the basis of history, examination and pre-operative investigations, especially MRI appearance. Inverted sinonasal papilloma should be considered in the differential diagnosis of pituitary macroadenoma invading the sphenoid sinus.