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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Pituitary apoplexy within a macroprolactinoma.
Alastair Watt1, Louis Pobereskin, Bijay Vaidya
1A Watt is Acting Consultant Endocrinologist at the Department of Endocrinology, Royal Devon & Exeter Hospital, Exeter, UK.
Nature Clinical Practice. Endocrinology & Metabolism
|September 18, 2008
Summary
Pituitary apoplexy in a macroprolactinoma can cause severe symptoms. Conservative management with cabergoline effectively treated this condition, resolving symptoms and reducing tumor size.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Oncology
Background:
- A 61-year-old female presented with sepsis secondary to a urinary tract infection.
- She developed acute headache, visual disturbance, and right third nerve palsy.
Observation:
- Magnetic resonance angiography and CT scans revealed a large lesion superiorly from the clivus to the right cerebral peduncle.
- MRI identified a large pituitary adenoma with hemorrhage, initially suspected as a primary or metastatic brain tumor.
Findings:
- Pituitary function tests showed a markedly elevated serum prolactin level and hypopituitarism.
- The diagnosis was pituitary apoplexy within a macroprolactinoma.
Implications:
- Conservative management with cabergoline, steroid replacement, and fluid/electrolyte balance led to symptom resolution.
- The patient experienced improvement in headache and third nerve palsy, with normalized prolactin levels and reduced adenoma size on MRI.
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