Ectopic Pituitary Adenoma Research Articles

Coexistence of ectopic pituitary adenoma and empty sella in a patient with acromegaly : A case report and review of literature

Ectopic pituitary adenoma with an empty sella is extremely rare. We report an unusual patient with an ectopic growth hormone-secreting pituitary adenoma in the sphenoid sinus with an empty sella. The association is related to a development disorder of the anterior pituitary tissues. Tumor in the sphenoid sinus was completely removed by endoscopic endonasal transsphenoidal approach. During the follow-up, the patient met the criteria for endocrinological cure.

Ectopic pituitary adenoma of the clivus presenting with apoplexy: case report and review of the literature

Ectopic pituitary adenomas usually occur within sphenoid sinus or nasopharynx, and seldom within the clivus. There is only a single reported example of ectopic adenoma with clinical apoplexy, albeit not from clivus. We report a 78-year-old male with known prostate carcinoma admitted with acute onset of blurred vision, suggestive of apoplexy. Work-up revealed unilateral cranial nerve VI palsy and neuroimaging showed a mass confined to the clivus; sellar region was normal. Preoperative considerations included chordoma, chondrosarcoma, or metastatic prostate carcinoma to bone. Resection was via endoscopic transsphenoidal approach to the clivus. An ectopic null cell pituitary adenoma with bland infarction was identified as the cause of the patient's clinical apoplexy. No antecedent precipitating factors for apoplexy were present; specifically the patient had not received leuprolide preoperatively, a known precipitant of pituitary apoplexy in prostate cancer patients who receive drug. We review the literature on ectopic clival pituitary adenomas, apoplexy in ectopic adenomas, and the link between apoplexy and leuprolide usage.

Ectopic prolactinoma within the sphenoidal sinus associated with empty sella

Background:Pituitary adenomas are a common cause of endocrinal dysfunction, which comprise 10–20% of all intracranial tumors. Although almost all of them arise within the sella turcica, there are some rare cases in which a pituitary adenoma is located outside the intrasellar region, so it is defined as an ectopic pituitary adenoma (EPA).Case Description:We described a case of a 31-year-old male with a serum prolactin (PRL) value of 240 ng/ml Magnetic resonance imaging (MRI) showed a space-occupying mass within the sphenoid sinus (SS) which partially enhanced by gadolinium. MRI did not reveal any sellar floor defect and an empty sella was detected. As dopamine agonist treatment had failed in lowering the serum PRL level, he underwent surgical treatment. A transsphenoidal approach without opening the sellar floor was performed using an operating microscope and the lesion within the SS was completely removed.Conclusion:Although intrasphenoidal EPAs are rare findings, the presence of an endocrine disorder related to pituitary hormones, and a space-occupying mass within the SS associated with either a normal sellar pituitary gland or an empty sella must lead us to suspect this diagnosis.

Ectopic pituitary adenoma presenting as a nasopharyngeal mass: CT and MRI findings

Recent embryologic studies indicate that the adenohypophsis (AH) is derived from the outer margins of the prosencephalic eural plate anterior to the origin of the hypothalamus and eurohypophysis (NH) [1]. And, adenohypophysis migrates from pharyngeo-cranial location to the sellar region. Along this igration route, an ectopic adenohypophysis is possible in the asopharynx [1–5]. However, there are few reported cases of an ctopic pituitary adenoma locating in the nasopharynx [5]. We eviewed the literature and report a very rare ectopic adenoma ocating in the nasopharynx with magnetic resonance imaging MRI) and computed tomography (CT) findings.

Acromegaly due to an ectopic pituitary adenoma in the clivus: case report and review of literature

Pituitary adenomas rarely originate outside the sella turcica. Ectopic locations include the suprasellar region, sphenoid sinus, cavernous sinus and clivus. We describe a 50-year-old female who presented with clinical signs and biochemical evidence of acromegaly. Pituitary MRI demonstrated a 2 mm hypointense lesion on the right side of the pituitary gland. However upon drilling of the upper clival bone to expose the sella during endoscopic transsphenoidal surgery, soft tumor-like tissue was encountered within the clivus. Exploration of the sella, including the area of hypointensity noted on preoperative imaging, did not identify any other abnormality. Immunohistochemical examination of the fully resected tumor demonstrated growth hormone immunoreactivity. Failed preoperative diagnosis of this rare ectopic GH-producing tumor was compounded by the presence of a misleading pituitary abnormality consistent with a microadenoma. The epidemiology and pertinent literature of this uncommon condition is discussed.

Ectopic Pituitary Adenoma Associated with an Empty Sella: A Case Report and Review of the Literature

A case of ectopic pituitary adenoma in the sphenoid sinus associated with an empty sella is reported. The coexistence of an ectopic pituitary adenoma and an empty sella is quite rare. The diagnosis was made with an intraoperative finding of the intact dura mater of the sellar floor. In the present case, the hypointense line that coated the pituitary gland was clearly demonstrated on 3-tesla T2-weighted magnetic resonance imaging. The hypointense line is considered to be the pituitary capsule and was critical in diagnosing this rare entity.

Clinical Characteristics of Ectopic Pituitary Adenoma of the Sphenoid Sinus

Ectopic pituitary adenoma of the sphenoid sinus is rarely encountered by general physicians and otolaryngologists. Recently this disease has been identified using CT, MRI, and other imaging examinations. Ectopic pituitary adenomas of the sphenoid sinus are considered to be benign and slow-growing with mild or no symptoms. On the other hand, primary sphenoidal carcinoma is also a rare disease, the chief complaint for which is usually headache or nasal bleeding as a result of invasion around the organs. CT and MRI imaging cannot differentiate sphenoidal carcimona from ectopic pituitary adenomas of the sphenoid sinus. A diagnosis of ectopic pituitary adenoma of the sphenoid sinus may be suspected when a patient has slight complaints such as slight headache, regardless of the findings of imaging examinations. Histological examinations are necessary for the differential diagnosis of the ectopic pituitary adenomas of the sphenoid sinus and sphenoidal carcimona. The prognosis of an ectopic pituitary adenomas of the sphenoid sinus is good if the adenomas are removed by surgery.

Ectopic Pituitary Adenoma in Persistent Craniopharyngeal Canal

An ectopic location of pituitary adenoma is rare. Nasopharyngeal location of ectopic pituitary adenoma has been attributed to remnants of the Rathke pouch. We describe an interesting case of ectopic pituitary adenoma in the setting of partially persistent craniopharyngeal canal. Embryological basis of ectopic pituitary adenoma and craniopharyngeal canal have been discussed.

Ectopic Pituitary Adenoma in the Spheno-Orbital Region

Ectopic pituitary adenomas (EPAs) are rare tumors that most often occur in the sphenoid sinus or suprasellar region. We describe a 66-year-old man who presented with unilateral proptosis and an ipsilateral abduction deficit caused by an EPA in the spheno-orbital region. The tumor was completely excised with elimination of proptosis and restoration of full ocular ductions. There were no complications. Diagnosis of a hormonally inactive EPA was reached on the basis of immunohistochemical studies of the operative specimen. This is the first documented case of an EPA in this location. It may have originated from Rathke pouch remnant cells in the lateral wall of the sphenoid sinus.

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Ectopic pituitary adenomas (EPAs) are rare lesions. The purpose of this study was to describe the CT and MRI features of sphenoid sinus EPAs. Eight patients with histology-proven EPAs in the sphenoid sinus, all of whom underwent CT and MRI, were reviewed retrospectively. The following imaging features were analysed: (i) size, (ii) margin, (iii) CT attenuation characteristics and (iv) MRI signal intensity. In addition, the involvement of adjacent structures and the time-intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI were analysed. All EPAs had well-defined margins and showed no relationship to the intrasellar pituitary gland. The mean size was 28 mm (range, 20-46 mm). On non-enhanced CT, the lesions appeared isodense to grey matter in 7 (88%) patients and hypodense in 1 (12%) patient. Only two patients underwent post-contrast CT, and they showed moderate enhancement. On T1 weighted images, EPAs appeared isointense in 6 (75%) patients and hypointense in 2 (25%). On T2 weighted images, the lesions appeared hyperintense in 2 (25%) patients and isointense in 6 (75%). EPAs showed mild to moderate heterogeneous contrast enhancement and exhibited a cribriform-like appearance. Two patients underwent DCE MRI; the TIC showed a rapidly enhancing and slow washout pattern. The following features were also seen: an empty sella, bone changes and involvement of the cavernous sinus (5 patients; 62.5%). In conclusion, a high index of suspicion for EPA and a familiarity with the imaging findings may help to diagnose this rare entity accurately.

An Unusual Case of Ectopic Adrenocorticotropin Secretion

A 55-yr-old man presented with clinical features suggesting slowly evolving Cushing’s syndrome that was confirmed by an elevated level of 24 h urinary free cortisol: 341 g (N 50 g) and impaired plasma cortisol suppression (166 nmol/liter, 6 g/dl) after overnight 1 mg dexamethasone. Pituitary dependent Cushing’s disease was suggested by unsuppressed plasma ACTH levels with an obvious increase (6.1 to 12.2 pmol/liter, 30.5 to 61 pg/ml) after iv CRH injection, and in addition, significant response of cortisol and ACTH (5.6 to 20.5 pmol/liter, 28 to 102.5 pg/ml) after desmopressin injection. Magnetic resonance imaging (MRI) of the pituitary region showed a normal pituitary gland (Fig. 1A). On the right side of the sphenoidal sinus, an apparent 6-mm septal “polyp” was seen (Fig. 1). Inferior petrosal sinus sampling revealed a 4.4-central/peripheral ACTH gradient 2 min after CRH injection. Therefore, an occult pituitary ACTH-secreting microadenoma was suspected (1). Neurosurgery was performed by the transnasal and transeptal approach, the mucosal polyp was first removed, then the intact sellar floor was opened, but no adenoma was identified despite extensive pituitary dissection (2). Microscopical examination of sections of the “small sphenoidal polyp” revealed an endocrine tumor with sheets and nests of adenoma cells with basophilic cytoplasm and round nucleus. Immunostaining demonstrated an ACTH cell adenoma (Fig. 2) and normal tissue in the pituitary biopsies (3). Immediate postoperative corticotropic insufficiency was observed. One year later the patient had normal urinary free cortisol and circadian rhythm of plasma cortisol with a negative desmopressin test demonstrating remission of Cushing’s disease. Ectopic pituitary adenoma can develop from Rathke’s pouch remnants (4), more often in sphenoidal localization (5). This case demonstrates that a small ectopic pituitary adenoma, frankly separated from pituitary, can present the same hormonal regulation than pituitary corticotropic adenoma with even results of inferior petrosal sinus sampling consistent with a pituitary source of ACTH, a finding compatible with the venous drainage of sphenoidal sinus mucosa. Numerous publications have emphasized the pitfalls of pituitary MRI in ACTH-dependant

Ectopic pituitary adenoma presenting as midline nasopharyngeal mass

Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke's pouch. We discuss a case of a lady who presented to our unit with 2months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt's cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.

Asymptomatic non-functioning ectopic pituitary adenoma in the suprasellar region: A case report

Asymptomatic non-functioning ectopic pituitary adenomas (EPAs) are extremely rare. To our knowledge, this is the first case report of an asymptomatic non-functioning EPA in the suprasellar region treated by cranio-orbital skull base surgery. EPAs should be considered in the differential diagnosis and histological confirmation is necessary.

Cyclic Cushing syndrome due to an ectopic pituitary adenoma

A 39-year-old man was referred to an endocrinology clinic for evaluation of his Cushing syndrome. He had gained 20 kg over 5 years and complained of intermittent headaches and easy bruisability. His medical history included a left foot fracture associated with minimal trauma 2 years earlier, hypertension, and stable Crohn disease with no use of exogenous glucocorticoids for at least 10 years. Measurements of plasma adrenocorticotropic hormone, 24 h urine free cortisol excretion, late-night salivary cortisol, serum cortisol levels before and after corticotropin-releasing hormone administration during a dexamethasone suppression/corticotropin-releasing hormone-stimulation test, pituitary MRI, and inferior petrosal sinus sampling. Cyclic Cushing syndrome secondary to an ectopic pituitary adenoma. The cyclic nature of Cushing syndrome was suggested by the absence of hypercortisolemia during inferior petrosal sinus sampling, and was confirmed by multiple 24 h urine free cortisol measurements. The patient underwent transsphenoidal surgery, during which a 5 mm firm, round, midline sphenoid sinus lesion was identified and resected. In preoperative imaging studies, this lesion had been interpreted as being a mucosal polyp. At microscopic examination, the lesion was found to be a pituitary adenoma, which stained diffusely with antiadrenocorticotropic-hormone antibodies. Explorations of the sella and pituitary did not reveal any abnormalities. Postoperatively, the patient became hypocortisolemic and his cushingoid features resolved. His adrenal function normalized 3 months after surgery. At 18 months, the patient continued to be symptom-free with normal levels of urinary-free cortisol and midnight salivary cortisol.

Successful treatment of Cushing’s disease caused by ectopic intracavernous microadenoma

Adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas are sometimes difficult to visualize, even with high-quality magnetic resonance imaging, due to their small size and variable location. Sampling the cavernous or inferior petrosal sinus is helpful for confirming the central origin of a tumor, but ectopic corticotroph adenomas in the paraseller region also typically exhibit a high central/peripheral plasma ACTH ratio. We experienced an extremely rare case of Cushing's disease caused by an ACTH-secreting microadenoma located entirely inside the left cavernous sinus attached to the medial wall (ectopic pituitary adenoma) that was not visible by preoperative MRI. In this case, the microadenoma was completely removed and an endocrinologic cure was achieved. This case reveals that in addition to meticulous sectioning of the pituitary gland, bilateral periglandular inspection with visualization of the medial wall of the cavernous sinus and of the diaphragm should always be performed to detect ectopic parasellar microadenomas when no adenoma is visible by preoperative MRI.

ECTOPIC SUPRASELLAR GROWTH HORMONE-SECRETING PITUITARY ADENOMA

Ectopic pituitary adenomas are rare. We present an unusual case of an ectopic growth hormone-secreting pituitary adenoma in the suprasellar space. A 31-year-old man presented with a history of chronic headache and typical clinical signs of acromegaly. Magnetic resonance imaging scans revealed a suprasellar mass not arising from the normal looking pituitary gland. The patient underwent gross total removal of the tumor through a pterional approach. At the time of follow-up, he met the criteria of endocrinological cure. Histological examination showed a growth hormone-secreting pituitary adenoma Although uncommon, growth hormone-secreting pituitary adenomas are encountered in the suprasellar region. They should be added to the differential diagnosis of tumors in this location.

Pre‐morbid morphological conditions of the human pituitary

The clinically silent premorbid conditions of the pituitary, in particular preneoplastic features, were morphologically and statistically investigated within a control population at autopsy. A higher percentage of premorbid states were found, which was speculated to be a basis of possible later clinical lesions. They were as follows in 228 pituitary specimens: incidentalomas in 3% (potential pituitary adenomas), aberrant salivary gland cell clusters in the pars intermedia in 8.8% (potential salivary gland cysts or carcinomas in the sellar region), residual Rathke's cleft cells in 3.2-6.8% (potential craniopharyngiomas), meningothelial aggregates in the pituitary capsule in 4.0% (potential meningiomas), one case also had ciliated epithelial cell fragments in the anterior lobe, one case each of granular cell and nerve cell group in the posterior lobe, and two cases of telangiectasia. Furthermore, aberrant anterior pituitary cells were found in the leptomeniges of the peri-pituitary region as a possible basis of an intracranial ectopic pituitary adenoma. Silent premorbid conditions were not infrequently found (up to 8.8%). In particular, the "basis" of the possible neoplasm was pre-existent, so that some triggers are necessary (e.g., pituitary tumor transforming gene, hormonal stimuli, etc.) for it to become manifest, although there was no direct morphological evidence in our findings to alter to the lesions.

Ectopic Pituitary Adenoma with an Empty Sella

Ectopic Pituitary Adenoma with an Empty Sella

Extracranial Thyroid-Stimulating Hormone–Secreting Ectopic Pituitary Adenoma of the Nasopharynx

Extracranial Thyroid-Stimulating Hormone–Secreting Ectopic Pituitary Adenoma of the Nasopharynx

Acromegaly due to an ectopic pituitary adenoma in the sphenoid sinus

An ectopic pituitary adenoma, exclusively involving the sphenoid sinus, associated with a normal size pituitary gland and an empty sella is a rare clinical entity. Only four cases have been found in the literature. We describe the case of a 47-year-old woman with clinical and biochemical acromegaly. Computed tomography (CT) appeared to show expansion of the sellar floor inferiorly into the sphenoid sinus, and magnetic resonance imaging (MRI) demonstrated an empty sella and a mass lesion confined to the sphenoid sinus. The tumor was totally resected by taking a transnasal endoscopic approach and the dura mater of the base of the pituitary fossa was confirmed intact.