A pitfall in diagnosing Cushing’s disease: ectopic ACTH-producing pituitary adenoma in the sphenoid sinus

Flitsch, Jörg; Schmid, SM; Bernreuther, Christian; Winterberg, B; Ritter, Michael M.; Lehnert, Hendrik; Burkhardt, Till

doi:10.1007/s11102-014-0591-8

Cited by 13 publications

(4 citation statements)

References 17 publications

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“…A subset of pituitary adenoma, microadenomas, are too small to be detected with diagnostic imaging such as magnetic resonance imaging (MRI), but the presentation of clinical symptoms triggered by the overproduction of pituitary hormones suggests the presence of a pituitary tumor. [38,39] Cushing syndrome is observed in patients affected by ACTH secreting adenomas. [39] The ability to directly localize the tumor during pituitary surgery through the detection of hormone levels differing between malignant and normal tissues would significantly enhance surgical precision and allow preservation of healthy functioning gland.…”

Section: Resultsmentioning

confidence: 99%

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Profiling of adrenocorticotropic hormone and arginine vasopressin in human pituitary gland and tumor thin tissue sections using droplet-based liquid-microjunction surface-sampling-HPLC–ESI-MS–MS

et al. 2015

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Described here are the results from the profiling of the proteins arginine vasopressin (AVP) and adrenocorticotropic hormone (ACTH) from normal human pituitary gland and pituitary adenoma tissue sections using a fully automated droplet-based liquid microjunction surface sampling-HPLC-ESI-MS/MS system for spatially resolved sampling, HPLC separation, and mass spectral detection. Excellent correlation was found between the protein distribution data obtained with this droplet-based liquid microjunction surface sampling-HPLC-ESI-MS/MS system and those data obtained with matrix assisted laser desorption ionization (MALDI) chemical imaging analyses of serial sections of the same tissue. The protein distributions correlated with the visible anatomic pattern of the pituitary gland. AVP was most abundant in the posterior pituitary gland region (neurohypophysis) and ATCH was dominant in the anterior pituitary gland region (adenohypophysis). The relative amounts of AVP and ACTH sampled from a series of ACTH secreting and non-secreting pituitary adenomas correlated with histopathological evaluation. ACTH was readily detected at significantly higher levels in regions of ACTH secreting adenomas and in normal anterior adenohypophysis compared to non-secreting adenoma and neurohypophysis. AVP was mostly detected in normal neurohypophysis as anticipated. This work demonstrates that a fully automated droplet-based liquid microjunction surface sampling system coupled to HPLC-ESI-MS/MS can be readily used for spatially resolved sampling, separation, detection, and semi-quantitation of physiologically-relevant peptide and protein hormones, such as AVP and ACTH, directly from human tissue. In addition, the relative simplicity, rapidity and specificity of the current methodology support the potential of this basic technology with further advancement for assisting surgical decision-making.

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Section: Resultsmentioning

confidence: 99%

“…[38,39] Cushing syndrome is observed in patients affected by ACTH secreting adenomas. [39] The ability to directly localize the tumor during pituitary surgery through the detection of hormone levels differing between malignant and normal tissues would significantly enhance surgical precision and allow preservation of healthy functioning gland.…”

Section: Resultsmentioning

confidence: 99%

Profiling of adrenocorticotropic hormone and arginine vasopressin in human pituitary gland and tumor thin tissue sections using droplet-based liquid-microjunction surface-sampling-HPLC–ESI-MS–MS

et al. 2015

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“…It is hypothesized that the embryological development of the anterior pituitary is likely responsible for the formation of EPAs in characteristic locations. 6 The adenohypophysis originates from the upper mucous membranes of the buccopharyngeal membrane. As the sphenoid develops, an infolding of the buccopharyngeal membrane, referred to as Rathke pouch, denotes the beginnings of the adenohypophysis.…”

Section: Pathogenesis and Clinical Manifestationmentioning

confidence: 99%

“…Medical therapy with dopamine agonists such as bromocriptine or cabergoline is indicated for patients with prolactinomas as first-line therapy. 6,[11][12][13] Patients that are poor surgical candidates or have unresectable tumors can be considered for radiotherapy. 14 When evaluating patients with suspected EPAs, a careful history and physical examination are critical to assess for endocrinological dysfunction as the large majority of EPAs present with hormone immunoreactivity, particularly…”

Section: Managementmentioning

confidence: 99%

Ectopic Pituitary Adenomas Presenting as Sphenoid or Clival Lesions: Case Series and Management Recommendations

et al. 2016

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Background An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup. Methods Retrospective chart review. Results Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus. There were four females and five males. Median age was 60 years old (range, 36-73 years). The most common presenting symptom was headache (56%). Five (56%) patients presented with a mass arising from the clivus while four (44%) presented with a mass in the sphenoid. Six (67%) patients demonstrated biochemical evidence of hypersecretion on full endocrinology panel. All masses showed evidence of enhancement with gadolinium with a propensity for adjacent bone involvement. Lesions also had a predilection for growth toward the cavernous sinus, carotid artery, or sellar floor. Surgical intervention was performed in eight patients (89%). In eight patients (89%), tumors demonstrated immunoreactivity to prolactin. Conclusions Pituitary adenomas can rarely present as an isolated sphenoid or clival mass. Lesions displayed similar magnetic resonance imaging findings with an erosive growth pattern toward the sellar floor, cavernous sinus, or adjacent carotid artery. Patients with clival or parasellar lesions with comparable features should have a preoperative workup which includes prolactin level and alert the physician to consider an ectopic pituitary adenoma in the differential to prevent unnecessary surgery and potential complications.

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Ectopic Pituitary Adenoma

Bonneville

2016

MRI of the Pituitary Gland

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A pitfall in diagnosing Cushing’s disease: ectopic ACTH-producing pituitary adenoma in the sphenoid sinus

Abstract: Ectopic pituitary adenoma tissue causing Cushing's disease is extremely rare but a potential cause for surgical failure or re-evaluation.

Cited by 13 publications

References 17 publications

Profiling of adrenocorticotropic hormone and arginine vasopressin in human pituitary gland and tumor thin tissue sections using droplet-based liquid-microjunction surface-sampling-HPLC–ESI-MS–MS

Profiling of adrenocorticotropic hormone and arginine vasopressin in human pituitary gland and tumor thin tissue sections using droplet-based liquid-microjunction surface-sampling-HPLC–ESI-MS–MS

Ectopic Pituitary Adenomas Presenting as Sphenoid or Clival Lesions: Case Series and Management Recommendations

Ectopic Pituitary Adenoma

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