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Published on: January 17, 2018
Unusual spontaneous resolution of a nonfunctioning pituitary macroadenoma: A case report
Oualid Mohammed Hmamouche1, Mehdi Mdarhri1, Marouane Hammoud1
1Department of Neurosurgery, Hassan II University Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco.
Background:
Spontaneous regression of nonfunctioning pituitary macroadenomas is rare, typically linked to pituitary apoplexy caused by infarction or hemorrhage. Regression without apoplexy is exceptional and challenges the standard surgical approach.
Case Description:
We present a 24-year-old woman, 15 months postpartum, with progressive headaches and bitemporal hemianopsia due to a 17 × 17 × 20 mm nonfunctioning pituitary macroadenoma compressing the optic chiasm. Endocrine testing revealed corticotropic and thyrotropic insufficiencies, for which hydrocortisone and levothyroxine were initiated. Surgery was initially declined, but later reconsidered due to persistent symptoms. Preoperative imaging unexpectedly showed complete spontaneous resolution of the lesion, with normalization of visual function and no new endocrine deficits. The patient remained stable at 12-month follow-up.
Conclusion:
This case highlights complete spontaneous regression of a symptomatic macroadenoma without apoplexy, possibly influenced by postpartum hormonal factors. Although surgical decompression remains the standard treatment for lesions causing chiasmal compression, this exceptional case demonstrates that, in rare situations where surgery is declined, repeat imaging and close monitoring may reveal unexpected regression. Careful multidisciplinary evaluation is essential to balance the risks of waiting against the potential for spontaneous resolution.
