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Functioning ectopic supradiaphragmatic pituitary adenomas
E H Dyer1, T Civit, J P Abecassis
1Department of Neurosurgery, Cochin Hospital, Paris, France.
Neurosurgery
|March 1, 1994
Summary
Rare functional pituitary adenomas located above the pituitary gland present diagnostic and treatment challenges. These supradiaphragmatic tumors, including ACTH and prolactin-secreting adenomas, often require specialized surgical approaches beyond the standard transsphenoidal route.
Area of Science:
- Endocrinology
- Neurosurgery
- Pathology
Background:
- Pituitary adenomas typically originate within the sella turcica.
- Adenomas located outside the gland are rare, often linked to developmental anomalies.
- Suprasellar adenomas are usually clinically nonfunctioning and may arise from ectopic pituitary cells.
Observation:
- This study details four cases of functional pituitary adenomas exclusively in the supradiaphragmatic region.
- Tumors included three adrenocorticotrophic hormone (ACTH)-secreting and one prolactin-secreting adenoma.
- These functional adenomas were located superior to the diaphragma sellae.
Findings:
- The observed functional adenomas were confined to the supradiaphragmatic area, distinct from typical intrasellar origins.
- Initial treatment attempts via the transsphenoidal approach were unsuccessful due to the tumors' location.
- This suggests a specific embryological origin or migration pattern for these ectopic functional adenomas.
Implications:
- The findings highlight the existence of rare, functional pituitary adenomas in the supradiaphragmatic region.
- Standard transsphenoidal surgery may be inadequate for these anatomically distinct tumors.
- Further research into the embryogenesis and optimal surgical strategies for supradiaphragmatic pituitary adenomas is warranted.