Mixed gangliocytoma-silent somatotroph pituitary adenoma: a rare variant with pregnancy-associated growth

We report a case of mixed gangliocytoma-pituitary adenoma in a woman in the early 30s who presented with an incidental pituitary macroadenoma that demonstrated significant pregnancy-related growth. Initially discovered during investigation for joint pains, the lesion remained stable under surveillance until pregnancy, when it increased in size from 18 mm to 30 mm. Following successful endoscopic transsphenoidal resection, histological examination revealed the characteristic biphasic pattern of a mixed gangliocytoma-pituitary adenoma with a sparsely granulated somatotroph adenoma component. Despite the growth hormone-producing adenomatous component confirmed on histology, the patient remained clinically silent for acromegaly throughout. This case highlights the rare occurrence of silent growth hormone adenoma within a mixed gangliocytoma which represents less than 1% of all pituitary tumours and the challenges in managing such tumours during pregnancy.