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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 520-525
DOI: 10.1055/s-0042-1757434
Case Report

Ectopic Intrasphenoidal Growth Hormone Releasing Pituitary Adenoma Associated with an Intracranial Aneurysm

Hernando Cifuentes-Lobelo
1   Department of Neurosurgery, Hospital Infantil Universitario de San José – Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Colombia
,
Marcelo A. Castañeda-Duarte 
1   Department of Neurosurgery, Hospital Infantil Universitario de San José – Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Colombia
,
Diego Ruiz-Diaz 
2   Medical School, Hospital Infantil Universitario de San José – Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Colombia
,
William Cortes-Lozano
1   Department of Neurosurgery, Hospital Infantil Universitario de San José – Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Colombia
› Author Affiliations Funding None.
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Abstract

Pituitary adenomas are a type of of the most frequent intracranial tumors. These tumors can extend outside the sella, but very rarely originate ectopically to the sellar region. A 71-year-old patient presented to our institution, with prior clinical history of noncontrolled arterial hypertension and new-onset high-intensity pulsatile headache. Upon suspicion of a hypertensive emergency with probable brain compromise, a nonenhanced computed tomography of the head was performed. A mass within the sphenoid sinus was found. Endocrinological workup demonstrated a significant elevation of the growth hormone. As an incidental finding, a brain aneurysm was evidenced, which was treated endovascularly prior to the mass treatment. Subsequently, the patient successfully underwent a gross total resection through an endonasal transsphenoidal approach. Histopathological results were consistent with a pituitary ectopic adenoma. A postoperative improvement in levels of somatomedin C was documented postoperatively.

Keywords

adenoma - pituitary gland - ectopic - sphenoid sinus - acromegaly - hypophyseal fossa


Publication History

Article published online:
27 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Quitral CR, Contreras RJM. Ectopic pituitary adenoma: Case report and literature review. Rev Otorrinolaringol. Cir Cabeza Cuello 2008; 68 (03) 295-300
    CrossrefGoogle Scholar
  • 2 Molitch ME. Diagnosis and treatment of pituitary adenomas: a review. JAMA 2017; 317 (05) 516-524
    CrossrefPubMedGoogle Scholar
  • 3 la Torre AIbarra-de, Trujillo-Ojeda HM, Silva-Morales F. et al Invasive adenoma in sphenoid sinus and clivus. Arch Neurociencias (México, DF) 2005; 10 (03) 191-195
    Google Scholar
  • 4 Tsuboi M, Adachi H, Miyoshi Y, Aoi M. [A case of ectopic pituitary adenoma localized in the sphenoid sinus]. No Shinkei Geka 1999; 27 (11) 1007-1011
    PubMedGoogle Scholar
  • 5 Pasquini E, Faustini-Fustini M, Sciarretta V. et al. Ectopic TSH-secreting pituitary adenoma of the vomerosphenoidal junction. Eur J Endocrinol 2003; 148 (02) 253-257
    CrossrefPubMedGoogle Scholar
  • 6 Ramírez C, Hernández-Ramirez L-C, Espinosa-de-los-Monteros A-L, Franco JM, Guinto G, Mercado M. Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: a case report and review of the literature. BMC Res Notes 2013; 6: 411
    CrossrefPubMedGoogle Scholar
  • 7 Shuman W, Loewenstern J, Pai A, Bederson J, Shrivastava R. Variability in clinical presentation and pathologic implications of ectopic pituitary tumors: critical review of literature. World Neurosurg 2019; 122: 397-403
    CrossrefPubMedGoogle Scholar
  • 8 González Gómez JC, Hernández Echevarría O, Hernández Silva H. Neuro- ophthalmological manifestations in neuroendocrine diseases. Rev Cuba Oftalmol 2016; 29 (03) 474-481
    Google Scholar
  • 9 Katznelson L, Laws Jr ER, Melmed S. et al; Endocrine Society. Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2014; 99 (11) 3933-3951
    CrossrefPubMedGoogle Scholar
  • 10 Melmed S, Bronstein MD, Chanson P. et al. A consensus statement on acromegaly therapeutic outcomes. Nat Rev Endocrinol 2018; 14 (09) 552-561
    CrossrefPubMedGoogle Scholar
  • 11 Yang BT, Chong VF, Wang ZC, Xian JF, Chen QH. Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings. Br J Radiol 2010; 83 (987) 218-224
    CrossrefPubMedGoogle Scholar
  • 12 Ortiz E, Peldoza M, Monnier E. et al. Ectopic pituitary adenoma of the TSH-secreting sphenoidal sinus with excellent response to somatostatin analogs. Theory of the embryogenesis and literature review from a clinical case. Steroids 2020; 154: 108535
    CrossrefPubMedGoogle Scholar
  • 13 Corenblum B, LeBlanc FE, Watanabe M. Acromegaly with an adenomatous pharyngeal pituitary. JAMA 1980; 243 (14) 1456-1457
    CrossrefPubMedGoogle Scholar
  • 14 Warner BA, Santen RJ, Page RB. Growth of hormone and prolactin secretion by a tumor of the pharyngeal pituitary. Ann Intern Med 1982; 96 (01) 65-66
    CrossrefPubMedGoogle Scholar
  • 15 Madonna D, Kendler A, Soliman AM. Ectopic growth hormone-secreting pituitary adenoma in the sphenoid sinus. Ann Otol Rhinol Laryngol 2001; 110 (01) 99-101
    CrossrefPubMedGoogle Scholar
  • 16 Matsuno A, Katayama H, Okazaki R. et al. Ectopic pituitary adenoma in the sphenoid sinus causing acromegaly associated with empty sella. ANZ J Surg 2001; 71 (08) 495-498
    CrossrefPubMedGoogle Scholar
  • 17 Hori E, Akai T, Kurimoto M, Hirashima Y, Endo S. Growth hormone-secreting pituitary adenoma confined to the sphenoid sinus associated with a normal-sized empty sella. J Clin Neurosci 2002; 9 (02) 196-199
    CrossrefPubMedGoogle Scholar
  • 18 Mitsuya K, Nakasu Y, Nioka H, Nakasu S. Ectopic growth hormone-releasing adenoma in the cavernous sinus–case report. Neurol Med Chir (Tokyo) 2004; 44 (07) 380-385
    CrossrefPubMedGoogle Scholar
  • 19 Gondim JA, Schops M, Ferreira E, Bulcão T, Mota JI, Silveira C. Acromegaly due to an ectopic pituitary adenoma in the sphenoid sinus. Acta Radiol 2004; 45 (06) 689-691
    CrossrefPubMedGoogle Scholar
  • 20 Chan MR, Ziebert M, Maas DL, Chan PS. “My rings won't fit anymore”. Ectopic growth hormone-secreting tumor. Am Fam Physician 2005; 71 (09) 1766-1767
    PubMedGoogle Scholar
  • 21 Bhatoe HS, Kotwal N, Badwal S. Clival pituitary adenoma with acromegaly: case report and review of literature. Skull Base 2007; 17 (04) 265-268
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Guerrero CA, Krayenbühl N, Husain M, Krisht AF. Ectopic suprasellar growth hormone-secreting pituitary adenoma: case report. Neurosurgery 2007; 61 (04) E879 , discussion E879
    CrossrefPubMedGoogle Scholar
  • 23 Kurowska M, Tarach JS, Zgliczyński W, Malicka J, Zieliński G, Janczarek M. Acromegaly in a patient with normal pituitary gland and somatotropic adenoma located in the sphenoid sinus. Endokrynol Pol 2008; 59 (04) 348-351
    PubMedGoogle Scholar
  • 24 Appel JG, Bergsneider M, Vinters H, Salamon N, Wang MB, Heaney AP. Acromegaly due to an ectopic pituitary adenoma in the clivus: case report and review of literature. Pituitary 2012; 15 (Suppl. 01) S53-S56
    CrossrefPubMedGoogle Scholar
  • 25 Hong JF, Ding XH, Wang SS. Coexistence of ectopic pituitary adenoma and empty sella in a patient with acromegaly: a case report and review of literature. Neurol India 2012; 60 (03) 304-306
    CrossrefPubMedGoogle Scholar
  • 26 Wijethunga WMUA, Dissanayake HA, Perera S, Katulanda P. Intra cavernous aneurysm of internal carotid artery masquerading as a pituitary adenoma: a case report. BMC Res Notes 2018; 11 (01) 237
    CrossrefPubMedGoogle Scholar
  • 27 Oshino S, Nishino A, Suzuki T. et al. Prevalence of cerebral aneurysm in patients with acromegaly. Pituitary 2013; 16 (02) 195-201
    CrossrefPubMedGoogle Scholar
  • 28 Paisley AN, O'Callaghan CJ, Lewandowski KC. et al. Reductions of circulating matrix metalloproteinase 2 and vascular endothelial growth factor levels after treatment with pegvisomant in subjects with acromegaly. J Clin Endocrinol Metab 2006; 91 (11) 4635-4640
    CrossrefPubMedGoogle Scholar
  • 29 Seda Jr L, Cukiert A, Nogueira KC, Huayllas MK, Liberman B. Intrasellar internal carotid aneurysm coexisting with GH-secreting pituitary adenoma in an acromegalic patient. Arq Neuropsiquiatr 2008; 66 (01) 99-100
    CrossrefPubMedGoogle Scholar
  • 30 Manara R, Maffei P, Citton V. et al. Increased rate of intracranial saccular aneurysms in acromegaly: an MR angiography study and review of the literature. J Clin Endocrinol Metab 2011; 96 (05) 1292-1300
    CrossrefPubMedGoogle Scholar
  • 31 Luther E, McCarthy DJ, Brunet MC. et al. Treatment and diagnosis of cerebral aneurysms in the post-International Subarachnoid Aneurysm Trial (ISAT) era: trends and outcomes. J Neurointerv Surg 2020; 12 (07) 682-687
    CrossrefPubMedGoogle Scholar
  • 32 Molyneux AJ, Kerr RS, Yu LM. et al; International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005; 366 (9488): 809-817
    CrossrefPubMedGoogle Scholar