Invasive Pituitary Macroadenoma Research Articles

SAT604 An Extensively Invasive Giant Prolactinoma Associated With CDH23 Mutation

Abstract Disclosure: B. Alghamdi: None. L.A. Alobaid: None. M. Alswailem: None. E.O. Othman: None. M. Dababo: None. O. Alsagheir: None. A.S. Alzahrani: None. Pituitary adenomas (PA), renamed recently pituitary neuroendocrine neoplasms, are common and prolactinomas are the most common subtype of these tumors. The vast majority of PA are sporadic but they can also be due to germline (∼ 5%), mosaic (<1%) or somatic mutations (∼40%). PA with germline mutations might be part of a syndrome such as MEN1 or apparently sporadic, either due to de novo mutations or because of low penetrance of the underlying gene (e.g. AIP). Among the several genes that have been identified, CDH23 was reported to be associated with familial PA in a single study that included 12 families with PA (33% of them had CDH23 variants) and 125 sporadic PA (15 (12%) of them harbored CDH23 variants) compared to only 0.8% of 260 healthy controls. In this report, we describe a middle-aged woman who was incidentally found to have a huge macroprolactinoma with extensive invasion. Genetic testing revealed a novel germline CDH23 variant. Case report: A 53-year-old woman who with hypertension, diabetes and chronic renal insufficiency diagnosed 4 years before. She accidentally fell down on the back of her head. A CT and subsequent MRI scans of the head showed a huge mass extensively involving the Sella, suprasellar space, the cavernous sinuses and middle fossae. This mass extends inferiorly to the sphenoid and parasellar sinuses, nasopharynx, and appears at the nostrils. The patient reported chronic headaches, snoring and congested nose, and worsening hearing and vision over the last 4 years. She denied history of galactorrhea and her periods ceased 8 years before. She never got married and has no children. Her family history is negative for any pituitary or other tumors. The mass was initially thought to be a nasopharyngeal cancer. However, a bedside biopsy from the protruding mass in the right nostril revealed a pituitary tissue strongly positive for prolactin and weakly positive for growth hormone (GH). An undiluted serum prolactin level was 47 ug/l (3.4-24). After several dilutions for the hook effect, the level was 578,000 ug/l (3.4-24). IGF-1 253 ng/ml (93-245), random GH 4.7 ng/ml, TSH 1.9 mU/l (0.4-4.2), FT4 11.4 pmol/l (12-22), AM cortisol 235 nmol/l (159-620), ACTH 27.6 (5-60). Whole exome sequencing followed by Sanger sequencing revealed a novel variant in CDH23 (c.2621C>A, p.Ala874Asp). Several in silico analyses suggest that this variant is pathogenic and it is assigned variant of unknown significance (VUS) according to American College of Medical Genetics (ACMG) classification. It is not reported in EXAC and 1000G databases. All other known PA-associated genes and cancer-associated genes revealed no pathogenic variants. Conclusion: We report a massive prolactinoma, likely due to a novel CDH23 variant. This is the second report on the likely pathogenic role of this gene in PA. In the case reported here, it is associated with a huge and highly invasive pituitary macroadenoma. Presentation: Saturday, June 17, 2023

An Unexpected Headache: Pituitary Apoplexy in a Patient Admitted with Diabetes Ketoacidosis (DKA)

Background: Pituitary apoplexy is a clinical problem resulting from abrupt pituitary ischemia or hemorrhage. A small proportion of pituitary adenomas manifest as an apoplectic crisis, with pan hypopituitarism, vomiting, nausea, headache, ophthalmoplegia, and visual impairment being the most common symptoms.
 Case Report: A 32-year-old diabetic Asian male presented to the emergency department with symptoms of polyuria, polydipsia, persistent vomiting, and diffused abdominal pain. He also reported a recent fever and severe headache, as well as self-limited episodes of blurring of vision and diplopia three months prior. Upon admission, his vitals were stable and he was fully conscious and oriented, though irritable and anxious. On examination, he was found to have third cranial nerve palsy and a dilated pupil with no light reflex. Laboratory tests revealed diabetic ketoacidosis (DKA). A CT scan of the brain revealed a possible invasive pituitary macro adenoma and the patient was referred for further evaluation. He also tested positive for COVID-19. Treatment for DKA was initiated and an MRI scan was scheduled for further evaluation. However, the patient's condition worsened and he was transferred to the ICU, where he was intubated and an MRI indicated a hemorrhagic mass in the pituitary gland. The patient was diagnosed with pituitary apoplexy, and he also received treatment with antibiotics and antiviral medication for suspected encephalitis.
 Conclusion: Pituitary apoplexy is a serious condition that requires immediate evaluation and treatment. It can cause permanent damage or death if left untreated. Treatment options include surgery and conservative management with frequent monitoring.

LBODP072 Squamous Cell Carcinoma Or Fungal Infection? An Unusual Presentation Of Anterior Hypopituitarism

Abstract Introduction Intracranial squamous cell carcinomas are rare tumours with a poor prognosis. Lack of specific imaging characteristics mandates a high index of clinical suspicion and ultimately histopathological confirmation. Chronic invasive fungal rhinosinusitis (CIFRS) is often difficult to distinguish from Sino nasal squamous cell carcinomas (SNSCC) in clinical practice. Our case draws attention to the fact that biopsy results are necessary in discriminating between the two entities, due to the diagnostic conundrum in context of Anterior Hypopituitarism. Case detailsWe report a case of 78-year-old lady who presented with a 3-month history of increasing headache, lethargy and confusion. There was no change in urinary habit. On examination she had right sided ptosis and restricted eye movements with a reported 4-week duration. Primary care physicians referred her for ophthalmic assessment. Past medical history was significant for absent vision in the affected eye due to Ischaemic optic neuropathy since 2018. A CT Angiogram was organised which revealed a large soft tissue mass that could not be differentiated from the optic chiasma. Differentials included chondrosarcoma, chordoma, invasive pituitary macroadenoma and skull base Plasmacytoma. Subsequent MRI imaging suggested appearances could be consistent with aggressive fungal sinusitis. Endocrine investigations showed partial anterior hypopituitarism. ManagementEmpiric treatment was started with Intravenous anti-fungals and steroids, alongside appropriate pituitary hormone replacement. Her case was discussed in the Skull Base Multi-disciplinary Team (MDT) meeting. She was then transferred to the regional tertiary centre for surgical intervention, where she underwent debridement of the Ethmoid sinus, Sphenoid Sinus and Anterior base of skull for presumed chronic invasive fungal sinusitis. Post-operative imaging displayed satisfactory debulking of the central skull base tumour. Histopathology from sphenoid sinus reported invasive squamous cell carcinoma. The post-operative imaging and histopathology results were discussed in the regional MDT and considering the advanced stage a decision was made for best supportive care. Within 2 months neurological symptoms progressed and further imaging demonstrated radiological tumour progression. Discussion Sinonasal Squamous cell carcinoma (SNSCC) is a rare tumour and thus pose difficulty in detection. Presentation usually occurs at an advanced stage since initial symptoms are nonspecific and the tumour remains indolent for many months to years. There is limited evidence in relation to detection and follow up of these cases. Clinical presentation and radiological appearance can be varied. This case highlights the need for histological confirmation of the diagnosis to guide appropriate treatment pathways and ensure compassionate, appropriate care. Presentation: No date and time listed

Complex treatment of invasive corticotropic pituitary macroadenoma - Case report

Introduction: Cushing's disease is a hypercortisolemic state caused by the excess secretion of corticotropin by the pituitary adenoma. Cushing's disease is diagnosed on the basis of clinical and laboratory signs of hypercortisolemia and the presence of an MRI pituitary adenoma. Pituitary surgery represents the first-line therapy, but it is non-curative in one third of patients, requiring additional treatments. Second-line treatments include pharmacotherapy, pituitary radiotherapy and bilateral adrenalectomy.
 Case report: A 57-year-old patient with clinical symptoms of hypercortisolemia was admitted to the Endocrinology Clinic due to dizziness and headache. Laboratory tests and MRI confirmed Cushing's disease caused by invasive pituitary macroadenoma. The tumor was not completely resected through the sphenoid sinus. Disease symptoms were remitted and hormone levels were stabilized. After 2 years, the underlying disease was relapsed. A second tumor removal operation was performed. The tumor was incompletely removed. The disease has progressed.. The patient was referred for stereotaxic CyberKnife radiotherapy.
 Conclusion: Cushing's disease should be diagnosed and treated in a specialized endocrinology center, and the success of treatment depends on a multidisciplinary team of physicians consisting of an endocrinologist, neurosurgeon and neuroradiologist.About 50% of untreated patients die within 5 years of the disease due to complications of hypercortisolemia. Surgical treatment is effective in the case of microadenomas, while in the case of macroadenomas, it may turn out to be ineffective when the tumor is highly invasive. If subsequent surgeries are unsuccessful, treatment with radiotherapy or pharmacotherapy should be given.

Response to treatment with temozolomide in cases with invasive pituitary macroadenomas: A single-center experience

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Invasive giant pituitary macroadenoma causing Cushing disease; a case report

Introduction: Cushing disease is a rare entity, and among them, giant pituitary adenomas causing Cushing disease is rarer. Here we present a case of Cushing disease secondary to a giant pituitary macroadenoma. Case report: A 41-year-old female with poorly controlled diabetes mellitus and hypertension diagnosed for six months presented with a history of unintentional weight loss, polyuria and polydipsia for the same duration. There was change in her facial appearance with increased pigmentation, frontal balding and she also noted increase in the size of her abdomen. There were features of proximal muscle weakness. Symptoms of hypothyroidism, hypoadrenalism or hyperprolactinemia were absent, and she was amenorrhoeic following hysterectomy done a year back. Visual impairment, headache, abdominal pain, features suggestive of internal malignancy, especially lung and renal, including features of pheochromocytoma were absent. She denied a family history of similar illness. Her BMI was 20.44 kg/m–2. She had a prominent abdomen, round facies, hirsutism, male pattern hair loss, facial plethora and generalized pigmentation and thinning of skin. She also had hypertension and proximal muscle weakness. Rest of the examination was normal. Investigations revealed hypokalaemia, poorly controlled hyperglycaemia and, non-suppressed overnight dexamethasone suppression test. She had a elevated ACTH level, and a high dose dexamethasone suppression test showed suppression. Pituitary imaging with MRI revealed a 51x 62x 41 mm size sellar and a para sellar mass with heterogeneous echogenicity extending to the right temporal lobe. Further imaging for ectopic ACTH secretion was negative.She underwent transcranial surgery which was unsuccessful due to intraoperative bleeding, and radiotherapy was given postoperatively. Conclusion: Cushing disease due to giant pituitary macroadenomas are rare and may require secondary therapeutic measures in controlling the disease in case of failed surgery.

OR24-5 Aberrant DNA Methylation in Regulatory Genomic Elements Are Associated with Invasive Behavior of Pituitary Macroadenomas: An Integrative Analysis of Epigenome-Wide Studies

A significant proportion of pituitary tumors (PT) invade adjacent structures. Few putative somatic mutations or copy number alterations have been associated with PT invasiveness. DNA methylation abnormalities in regulatory regions are known to impact gene expression and cancer behavior, but have not been fully explored in PT. Herein, we surveyed the genome-wide DNA methylation landscape of regulatory elements (promoter and enhancer) in the invasive behavior of PT. We performed a meta-analysis of genome-wide methylome profiling of invasive (Inv) and noninvasive (NInv) PT from 3 independent cohorts (32 InvPT; 35 NInvPT). Wilcoxon Rank-sum (Δβ=0.2; non-adjusted p-value <0.001) and integrative analyses using bioinformatics tools were performed. We identified 34 differentially methylated probes (DMP) in InvPT that were overall hypomethylated in relation to NInvPT. The DMPs were mainly located in distal/open sea genomic regions (OpS), enriched for enhancer regions (47%). We retrieved 6 invPT-related DMP common among the three cohorts and 4 genes previously reported to be deregulated in association with promoter and gene body methylation alterations (ITPKB; KRT12; DSC2 and LRRK1). The DMPs-associated genes were involved in myeloid cell differentiation; regulation of membrane potential and signaling by receptor tyrosine kinases. In one cohort, we also identified a few DMP in enhancer regions possibly associated with motifs predicted to bind transcription factors associated with proliferation and inflammation. Our analyses showed the association of PT invasiveness and epigenetically regulated genes as well as revealed novel candidates genes known to be therapeutic target in other tumors. These results suggest the role of distinct methylation pattern in regulatory genomic elements in the pathogenesis of invasive pituitary macroadenomas.

Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients.

Extended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks. The link to the video can be found at: https://youtu.be/EkLmt2T8_UE .

Prolonged preoperative treatment of acromegaly with Somatostatin analogs may improve surgical outcome in patients with invasive pituitary macroadenoma (Knosp grades 1\u20133): a retrospective cohort study conducted at a single center

BackgroundThis study aimed to investigate preoperative somatostatin analogs (SSAs) treatment on the surgical outcome in patients with acromegaly.MethodsAn analysis of 358 patients with acromegaly was conducted. The preoperative medical therapy group (81 patients) received SSA treatment for at least 3 months prior to surgery, while the primary surgery group (277 patients) underwent transsphenoidal surgery directly. Follow-up duration was ≥3 months. Tumor invasion was evaluated by magnetic resonance imaging (MRI) and classified according to the Knosp grading system.ResultsMost patients were diagnosed with macroadenoma. Among all patients (Knosp grades 0–4), preoperative SSA therapy did not significantly improve the curative effect of surgery, according to the levels of growth hormone (GH) and/or insulin-like growth factor 1 (IGF-1) markers. In patients with macroadenoma (Knosp grades 1–3), the remission rates were significantly higher in the SSA group compared to the surgery group when considering GH (56.4% vs. 37.3%, P = 0.048) and IGF-1 (43.2% vs. 17.6%, P = 0.004). In the preoperative medical therapy group, long-term use of SSAs (>6 months) led to higher remission rates (GH, 72.2% vs. 51.0%; and IGF-1, 61.1% vs. 29.8%; P = 0.12 and 0.02, respectively].ConclusionsThe long-term preoperative SSAs treatment may improve the surgical curative rate in acromegalic patients with invasive macroadenomas (Knosp grades 1–3).

Benefits of Open Cranial Approaches for Giant Invasive Pituitary Macroadenoma

Benefits of Open Cranial Approaches for Giant Invasive Pituitary Macroadenoma

Endovascular Therapy Using Flow Diversion for Giant Internal Carotid Artery Pseudoaneurysm Arising in the Setting of an Invasive Pituitary Macroadenoma

This report illustrates the unusual occurrence of a pseudoaneurysm arising in the setting of a skull base mass and describes the first reported use of endovascular flow diversion therapy in such a setting. A 63-year-old man with occasional headaches during the preceding month presented with the acute onset of severe left retroorbital headache and oculomotor nerve palsy. Computed tomography (CT) and CT angiogram revealed a destructive skull base mass with an associated giant probable pseudoaneurysm of the cavernous segment of the left internal carotid artery. The patient underwent endoscopic transsphenoidal biopsy with a subsequent diagnosis of prolactinoma. Endovascular therapy utilizing two Pipeline™ flow diversion embolization devices was performed with subsequent resolution of the patient's headache and improvement in his cranial nerve deficits/cavernous sinus syndrome.

Schwannoma in Sellar Region Mimics Invasive Pituitary Macroadenoma

In central nervous system, schwannomas, as ubiquitous tumors, mostly originate from sensory nerves like auditory and trigeminal nerves. However, intrasellar schwannomas are extremely rare. They are often misdiagnosed as pituitary adenomas.We report a rare case of schwannoma in the sellar region—a challenging diagnosis guided by clinical presentations, radiological signs, and postoperative pathological test.We represent a 65-year-old woman who had suffered from headaches, hypothyroidism, and visual disturbance. Her MRI revealed an abnormal sellar region mixed-signal mass lesion with suprasellar, left parasellar, and sellar floor invasiveness. We present detailed analysis of the patient's disease course and review relevant literatures. Written informed consent was obtained from the patient for publication of this article. A copy of the written consent is available for review by the editors of MEDICINE. Because this article does not involve any human or animal trials, there is no need to conduct special ethic review and the ethical approval is not necessary.When surgically treated, her specimen revealed a typical histopathology pattern of schwannoma. The patient's symptoms improved a lot after surgery and he continues to be under observation.Despite its rarity, intrasellar schwannoma should be considered in the differential diagnosis of sellar lesions that mimic pituitary adenomas.

Malignant intrasellar meningioma presenting as an invasive pituitary macroadenoma: A rare case report and literature review.

Intrasellar meningiomas are rare tumors that have the ability to mimic non-functioning pituitary adenomas. The majority of meningiomas are slow-growing and benign, therefore an intrasellar meningioma with malignant histological features is extremely rare. The present study describes the case of a malignant diaphragm meningioma that was controlled through combined chemotherapy, following subtotal surgical resection. The patient's symptoms ceased and no tumor recurrence was detected at the 3-year follow-up. Hormone levels were also observed as normal. Further investigation of similar cases may aid in achieving an accurate pre-operative diagnosis. This would prove particularly beneficial in regards to intrasellar meningiomas due to their specific location and surgical treatment. The present study analyzes the requirement of chemotherapy for the treatment of these unique tumors.

Thyrotoxicosis with absence of clinical features of acromegaly in a TSH- and GH-secreting, invasive pituitary macroadenoma.

SummaryA 54-year-old woman presented with bi-temporal hemianopia, palpitations, and diaphoresis. An invasive pituitary macroadenoma was discovered. The patient had biochemical evidence of secondary hyperthyroidism and GH excess; however, she did not appear to be acromegalic. Surgical removal of the pituitary mass revealed a plurihormonal TSH/GH co-secreting pituitary adenoma. TSH-secreting adenomas can co-secrete other hormones including GH, prolactin, and gonadotropins; conversely, co-secretion of TSH from a pituitary adenoma in acromegaly is infrequent.Learning points This case highlights an unusual patient with a rare TSH/GH co-secreting pituitary adenoma with absence of the clinical features of acromegaly.Plurihormonality does not always translate into the clinical features of hormonal excess.There appears to be a clinical and immunohistochemical spectrum present in plurihormonal tumors.

Progression of an Invasive ACTH Pituitary Macroadenoma with Cushing's Disease to Pituitary Carcinoma.

Pituitary carcinomas are very rare tumors that in most cases produce prolactin and adrenocorticotropic hormone (ACTH). It is a challenge to diagnosis of a pituitary carcinoma before disclosed symptomatic metastasis. We report the case of a female patient with Cushing's disease who underwent three transsphenoidal surgeries, with pathological findings of common ACTH pituitary adenoma including Ki-67 expression <3%. She achieved hypocortisolism after the 3rd surgery although ACTH levels remained slightly elevated. The patient returned some time later with fast worsening of hypercortisolism. Magnetic resonance imaging showed clivus invasion, which led to a fourth surgery and radiation. This time, immunohistochemistry revealed strong Ki-67 (10% to 15%) and p53 expression. Liver and lumbar spine metastases were found on workup. The patient died after few months due to lung infection. Pituitary carcinomas are rare, and the transformation of an ACTH-secreting pituitary adenoma into a carcinoma is exceptional. The difficulty of defining markers for the diagnosis of carcinoma, before metastasis diagnosis, in order to change the management of the disease, is a challenge.

Endocranial Lesions

Numerous intracranial soft tissue and vascular structures are intimately related to the endocranial surface of the central skull base, including the pituitary gland, the pachymeninges, and multiple cranial nerves. These structures can give rise to pathologies that create imaging abnormalities along the bony surface of the skull base or result in gross changes of the underlying bone: hyperostosis, scalloping, permeation, erosion, or destruction. Large lesions with frank invasion may be difficult to differentiate from intrinsic bone lesions. This article reviews a variety of endocranial lesions affecting the central skull base, including the giant or invasive pituitary macroadenoma and skull base meningioma, and highlights the imaging features for a practical approach to their diagnosis.

Giant macroprolactinoma and pregnancy

Prolactinomas are a common cause of gonadal dysfunction and infertility. We present the case of a 38-year-old woman with history of amenorrhea and infertility. At seven weeks of pregnancy she presented neuro-ophthalmologic complaints of headaches, diplopia, and right ptosis. The work-up study revealed an invasive pituitary macroadenoma with a maximum diameter of 9 cm and serum prolactin of 25,800 ng/mL (3-20). At 12 weeks, she was referred to the Endocrinology Department of the Coimbra University Hospital and started therapy with bromocriptine, initially 5 mg/day and then at crescent doses. Hyperprolactinemia was rapidly and drastically reduced to 254 ng/mL three weeks after taking bromocriptine 15 mg/day. Tumoral volume was reduced and there was improvement of III pair paresis. At 38 weeks, a male healthy baby was born. This is a relevant clinical case that illustrates the efficacy and safety of bromocriptine therapy during pregnancy, even in severe cases like this one.

Transformation of a Silent Adrencorticotrophic Pituitary Tumor Into Central Nervous System Melanoma.

Silent adrenocorticotrophic pituitary adenomas are nonfunctioning pituitary adenomas that express adrenocorticotrophic hormone (ACTH) but do not cause the clinical or laboratory features of hypercortisolemia. Primary central nervous system (CNS) melanoma is well documented, but rarely originates in the sellar region or pituitary gland. Here we report transformation of an aggressive silent adrenocorticotrophic pituitary adenoma that transformed into CNS melanoma and review other presentations of pituitary melanoma. A 37-year-old woman initially presented with apoplexy and an invasive nonfunctioning pituitary macroadenoma for which she underwent transphenoidal surgery. The patient underwent 3 subsequent surgeries as the tumor continued to progress. Pathology from the first 3 operations showed pituitary adenoma or carcinoma. Pathology from the final surgery showed melanoma and the magnetic resonance imaging characteristics of the tumor had changed to become consistent with CNS melanoma. Dermatologic and ophthalmologic examinations did not identify cutaneous or ocular melanoma. The patient’s disease progressed despite aggressive surgical, medical and radiologic treatment. To our knowledge, this is the first report demonstrating transformation of a primary pituitary tumor into melanoma. The mechanism of tumor transformation is unclear, but it is possible that a mutation in the original ACTH-producing tumor lead to increased cleavage of pro-opiomelanocortin or ACTH into α-melanocyte-stimulating hormone, which in turn stimulated the expression of microopthalmia transcription factor, leading to melanocytic phenotype transformation.

Macroprolactinemia in a Patient with Invasive Macroprolactinoma: A Case Report and Minireview

Background. Macroprolactin, the high-molecular prolactin isoform, is considered to be an inactive in vivo product with extrapituitary origin. Patients with macroprolactinemia are usually asymptomatic, with negative pituitary imaging. Based on these data, most authors do not recommend treatment and long-term followup in subjects with macroprolactinemia. However, there is evidence for overlapping clinical features among subjects with hyperprolactinemia due to monomeric or “big big” PRL isoform. Case Presentation. We present a 35-year-old female patient with secondary amenorrhea, mild obesity, hirsutism, headache and blurred vision. Hormonal evaluation revealed an extreme hyperprolactinemia (PRL = 10 610 mIU/L) almost exclusively due to macroprolactin isoform (MPRL = 10 107 mIU/L; recovery after PEG precipitation 4.7%) and hypogonadotropic hypogonadism. An invasive pituitary macroadenoma was visualized on MRI, and cabergoline therapy was initiated. Disappearance of clinical signs and symptoms, normalization of gonadotropin levels, and restoration of regular ovulatory menstrual cycles after 1 year of treatment are arguments in favor of preserved-macroprolactin bioactivity in this case. The significant decrease in MPRL levels and tumor volume in response to dopamine agonist therapy is suggestive for the tumoral origin of this isoform. Conclusions. Although macroprolactinemia is considered to be a benign condition, pituitary imaging, dopamine agonist treatment, and prolonged followup should be recommended in some particular cases.

Preoperative Lanreotide Treatment Improves Outcome in Patients with Acromegaly Resulting from Invasive Pituitary Macroadenoma

To investigate whether 3 months' preoperative treatment with lanreotide improved outcome in newly diagnosed patients with acromegaly resulting from invasive pituitary macroadenoma. After baseline evaluation, untreated patients were randomized to undergo direct transsphenoidal surgery or lanreotide treatment (30 mg via intramuscular injection every 2 weeks, increased to 30 mg/week at week 8 if growth hormone nadir > 2.5 μg/l), for 3 months prior to surgery. Tumour shrinkage following lanreotide treatment was analysed. Cure was evaluated at 3 months postsurgery by measuring growth hormone and insulinlike growth factor-1 (IGF-1) levels. Preoperative lanreotide treatment significantly reduced mean tumour size. Growth hormone and IGF-1 levels were lower in the pretreatment group than in the direct surgery group at 3 months postsurgery. According to combined growth hormone and IGF-1 levels, significantly more patients were cured by trans-sphenoidal surgery in the pretreatment group compared with the direct surgery group (11 of 24 and five of 25 patients, respectively). Lanreotide treatment for 3 months before trans-sphenoidal surgery effectively reduced tumour size, and improved surgical cure rate, in newly diagnosed patients with acromegaly resulting from invasive pituitary macroadenoma.