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Komić L, Kruljac I, Mirošević G, Gaćina P, Pećina HI, Čerina V, Gajski D, Blaslov K, Rotim K, Vrkljan M. SPONTANEOUS RESOLUTION OF A NONFUNCTIONING PITUITARY ADENOMA OVER ONE-MONTH PERIOD: A CASE REPORT. Acta Clin Croat 2021; 60:317-322. [PMID: 34744285 PMCID: PMC8564843 DOI: 10.20471/acc.2021.60.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient’s symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.
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Affiliation(s)
| | - Ivan Kruljac
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Gorana Mirošević
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Petar Gaćina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Hrvoje Ivan Pećina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vatroslav Čerina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Domagoj Gajski
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Kristina Blaslov
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Krešimir Rotim
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Milan Vrkljan
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
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Kirigin Biloš LS, Kruljac I, Radošević JM, Ćaćić M, Škoro I, Čerina V, Pećina IH, Vrkljan M. Empty Sella in the Making. World Neurosurg 2019; 128:366-370. [PMID: 31128314 DOI: 10.1016/j.wneu.2019.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pituitary apoplexy may occur when a large tumor compresses or outgrows its nutrient supply, resulting in ischemic necrosis and hemorrhage. Although once deemed a neurosurgical emergency, increasing evidence suggests that conservative management of pituitary apoplexy leads to favorable neuro-ophthalmologic and endocrinologic outcomes as well. Spontaneous remission after pituitary apoplexy has been described in functioning pituitary adenomas, but it is a rare occurrence in nonfunctioning tumors. CASE DESCRIPTION We report a man that presented with pituitary apoplexy of a nonfunctioning pituitary macroadenoma that was managed conservatively and treated hormonally for hypopituitarism during a 2-year follow-up period, with serial neuroimaging demonstrating significant tumor volume reduction with almost complete resolution resulting in partial empty sella. In addition, a short literature review was performed pertaining to the management of pituitary apoplexy with emphasis on a more conservative approach. CONCLUSIONS A subset of patients with pituitary apoplexy without altered consciousness and nonprogressive or mild ophthalmologic deficits may be managed conservatively; however, lifelong periodic assessment, preferably by a specialized multidisciplinary pituitary team, is essential until clinical outcomes become clear.
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Affiliation(s)
- Lora Stanka Kirigin Biloš
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia.
| | - Ivan Kruljac
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Jelena Marinković Radošević
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Miroslav Ćaćić
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ivan Škoro
- Department of Neurosurgery, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Vatroslav Čerina
- Department of Neurosurgery, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Ivan Hrvoje Pećina
- Department of Radiology, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | - Milan Vrkljan
- Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
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Bier G, Hempel JM, Grimm F, Ernemann U, Bender B, Honegger J. Quantification of specific growth patterns and frequency of the empty sella phenomenon in growth hormone-secreting pituitary adenomas. Eur J Radiol 2018; 104:79-86. [PMID: 29857870 DOI: 10.1016/j.ejrad.2018.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/22/2018] [Accepted: 05/07/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess and quantify the prevalence and co-occurence of a sellar floor lowering and empty sella phenomenon in patients with GH (growth hormone)-secreting pituitary adenoma. METHODS A total number of 159 acromegalic patients were included in this study, as well as two control groups (150 patients with non-GH-secreting adenomas and 50 patients without pituitary adenomas). Magnetic resonance images of all patients were evaluated for presence of an empty sella, downward and lateral tumor extension, and maximum superoinferior diameter of the mass. Additionally, these values were correlated with growth hormone and IGF-1 levels. RESULTS The empty sella phenomenon was detected significantly more often in patients with a GH-secreting adenoma with a prevalence of 22% vs. 5.3% in non-GH-secreting adenomas (p < 0.001) or 8% in the healthy control group (p = .036). Moreover, GH-secreting adenomas presented with a significant rate of downward tumor extension (74.8% vs. 35.5%; p < 0.001), whose extent correlated inversely but weakly with the GH hormone level (r = - 0.17; p = .036). It was also found that a decreased superoinferior diameter and higher ratio of intrasellar to suprasellar extension are predictive quantitative values for the presence of a GH-secreting adenoma (area under curve, 0.712). CONCLUSIONS GH-secreting pituitary adenomas are frequently associated with an empty sella phenomenon. Moreover, GH-secreting adenomas are frequently accompanied by an enhanced, quantitatively measurable impression of the sellar floor. Hypothetically, this is caused by tumor-induced local bone remodeling processes.
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Affiliation(s)
- Georg Bier
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany.
| | - Johann-Martin Hempel
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Florian Grimm
- Department of Neurosurgery, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Benjamin Bender
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, D-72076 Tuebingen, Germany
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Sasagawa Y, Hayashi Y, Tachibana O, Oishi M, Fukui I, Iizuka H, Nakada M. Clinical characteristics of acromegalic patients with empty sella and their outcomes following transsphenoidal surgery. Pituitary 2017; 20:403-408. [PMID: 28233140 DOI: 10.1007/s11102-017-0798-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the clinical characteristics of acromegalic patients with empty sella (ES, herniation of the subarachnoid space within the sella turcica) and the impact of ES on transsphenoidal surgery in such patients. METHODS Seventy-eight patients, newly diagnosed with acromegaly who underwent transsphenoidal surgery were included. ES was defined as the pituitary gland and adenoma occupying less than 50% of the sella turcica on midsagittal magnetic resonance (MR) imaging. RESULTS Twelve patients (15.4%), predominantly female (10 women, p = .047), had ES in preoperative MR imaging. ES patients had smaller mean tumor diameter (6.3 mm) than non-ES patients (11.2 mm, p = .001). In preoperative MR imaging, occult adenoma was found in three (25%) ES and three (4.5%) non-ES patients (p = .044). Intraoperative cerebrospinal fluid (CSF) leakage was more frequent in the ES patients than in the non-ES patients (58.3 vs. 25.8%, p = .024). This led to an increased rate of sellar floor reconstruction using abdominal fat and/or postoperative lumber drainage in the ES patients (ES: 41.7 vs. non-ES: 16.7%, p = .063). Endocrinological remission after surgery was more frequent in the non-ES patients (72.7%) than in the ES patients (58.3%) (p = .248). CONCLUSIONS Co-existence of acromegaly with ES is not rare, and is associated with occult adenoma, intra/postoperative CSF leakage, and a worse endocrinological outcome after transsphenoidal surgery; although, the underlying mechanism remains unclear.
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Affiliation(s)
- Yasuo Sasagawa
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hideaki Iizuka
- Department of Neurosurgery, Kanazawa Medical University, KanazawaIshikawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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Pineyro MM, Furtenbach P, Lima R, Wajskopf S, Sgarbi N, Pisabarro R. Brain and Optic Chiasm Herniation into Sella after Pituitary Tumor Apoplexy. Front Endocrinol (Lausanne) 2017; 8:192. [PMID: 28824551 PMCID: PMC5545576 DOI: 10.3389/fendo.2017.00192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/24/2017] [Indexed: 11/13/2022] Open
Abstract
Brain and optic chiasm herniation has been rarely reported following dopamine agonist treatment for large prolactinomas. We report a case of brain and optical chiasm herniation, secondary to an empty sella due to apoplexy of a prolactinoma, and we focus on the specific presentation of this case. A 32-year-old female presented to a neurologist complaining of headaches. Her past medical history was significant for acute vision loss in both eyes accompanied by right third nerve palsy when she was 16 years old. She does not recall any endocrine or imaging evaluation at that time and she had spontaneous partial recovery of left eye vision within 3 months, with permanent blindness of right eye. She did not return to any follow-up until her neurologist consultation. Brain magnetic resonance imaging (MRI) revealed herniation of frontal lobe and optic chiasm into the pituitary sella, as well as a pituitary hypointense lesion measuring 5 mm × 5 mm after gadolinium injection. Prolactin levels were 206 ng/ml (4.79-23.3 ng/ml). Repeated prolactin was 258 ng/ml (4.79-23.3 ng/ml). She was started on bromocriptine 2.5 mg/day. Prolactin levels and menstrual cycles normalized. A repeat brain MRI performed 5 months later showed disappearance of pituitary mass, with no changes in brain and chiasmal herniation. To our knowledge, this is the first reported case of brain associated with chiasm herniation secondary to pituitary apoplexy of a prolactinoma. In conclusion, this case highlights that frontal lobe herniation in combination with optic chiasm herniation can be a complication of pituitary tumor apoplexy. Long-term surveillance of patients with pituitary apoplexy is warranted to detect delayed complications.
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Affiliation(s)
- Maria M. Pineyro
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- *Correspondence: Maria M. Pineyro,
| | - Patricia Furtenbach
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ramiro Lima
- Neurocirugía, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Saul Wajskopf
- Neurocirugía, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Nicolas Sgarbi
- Imagenología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Raul Pisabarro
- Clínica de Endocrinología y Metabolismo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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