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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Double pituitary adenomas
D Iacovazzo1, A Bianchi, F Lugli
1Department of Endocrinology, Catholic University, Policlinico A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy. donatoiacovazzo@gmail.com
Endocrine
|January 18, 2013
Summary
This case study details a rare instance of double pituitary adenomas, one secreting prolactin and the other ACTH, leading to Cushing's disease. Successful surgical removal of the ACTH-producing adenoma resolved symptoms.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Double pituitary adenomas are rare, accounting for up to 2.6% of cases.
- Approximately 3.3% of Cushing's disease patients present with double or multiple pituitary adenomas.
- This report focuses on a unique case of metachronous pituitary adenomas.
Observation:
- A 60-year-old male initially presented with hyperprolactinemia and a pituitary lesion treated with cabergoline.
- The patient later developed symptoms suggestive of Cushing's disease, including weight gain and hypertension.
- Despite initial negative MRI, bilateral inferior petrosal sinus sampling confirmed pituitary origin of ACTH excess.
Findings:
- Histological examination confirmed an ACTH-producing microadenoma, surgically removed.
- The prolactin-secreting adenoma, initially treated with cabergoline, showed shrinkage.
- The patient experienced clinical improvement and secondary hypoadrenalism post-surgery.
Implications:
- This case highlights the diagnostic challenges of multiple pituitary adenomas, particularly when presenting asynchronously.
- It underscores the importance of thorough investigation in patients with persistent or evolving endocrine symptoms.
- The successful management demonstrates the efficacy of combined medical and surgical approaches for complex pituitary adenoma cases.
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