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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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An aggressive poorly differentiated plurihormonal Pit-1-positive adenoma
Mark R Postma1, Jos M A Kuijlen2, Astrid G W Korsten3
1Department of Endocrinology, Medical Imaging Center.
Endocrinology, Diabetes & Metabolism Case Reports
|October 21, 2021
Summary
This study highlights a rare, aggressive pituitary tumor subtype. Multimodality treatment, including temozolomide chemotherapy, showed effectiveness, but further targeted therapies are needed for aggressive pituitary adenomas.
Area of Science:
- Endocrinology
- Oncology
- Neurosurgery
Background:
- A 35-year-old woman presented with a rapidly growing pituitary mass causing ptosis and diplopia.
- Laboratory results suggested acromegaly, but phenotypic traits were absent.
Purpose of the Study:
- To describe the management of a patient with a poorly differentiated, plurihormonal Pit-1-positive pituitary adenoma.
- To evaluate the efficacy of multimodality treatment for aggressive pituitary tumors.
Main Methods:
- Surgical debulking, radiotherapy, and somatostatin analogue therapy were initiated.
- Tumor progression led to a switch in somatostatin analogues and subsequent temozolomide chemotherapy.
Main Results:
- Initial treatment with radiotherapy and a somatostatin analogue suppressed growth hormone (GH) but led to hypocortisolism and diabetes mellitus.
- Temozolomide chemotherapy resulted in an excellent biochemical and radiological response.
- Ptosis and diplopia symptoms persisted despite treatment.
Conclusions:
- Poorly differentiated plurihormonal Pit-1-positive adenomas are aggressive pituitary tumors.
- A multidisciplinary approach is crucial for managing aggressive pituitary tumors.
- Temozolomide is a first-line chemotherapy, but novel targeted therapies are required.
