Craniopharyngioma with hyperprolactinaemia due to a prolactinoma.

Abstract

SUMMARY A case is presented in which a histologically proven prolactin secreting pituitary macroadenoma was associated with a large suprasellar craniopharyngioma. The pre-operative prolactin concentration was 8180mU/l. Although hyperprolactinaemia up to 3000mU/l in patients with a craniopharyngioma is usually due to stalk compression, greater values may indicate an associated prolactinoma.Craniopharyngioma may be associated with moderate hyperprolactinaemia, galactorrhoea and disturbance of the hypothalamo-pituitary-gonadal axis.' 4 However, in these cases as serum prolactin concentrations are usually less than 3000 mU/l (150ng/ml) and histo-pathological studies do not show prolactin secreting adenomata, the elevated levels are probably due to stalk compression.5 We report the first case in which a large suprasellar craniopharyngioma was associated with a prolactin secreting pituitary adenoma. Case reportA 61-year-old man presented with a 9 month history of gradually deteriorating vision and difficulty with lateral vision while driving. In addition, he had noted reduced libido for 10 years, intermittent headaches for 2 years and cold intolerance for 2 months. He shaved daily and had no other symptoms suggestive of endocrine dysfunction. Hypertension had been diagnosed 7 years previously and treated with oxprenolol. His previous health had otherwise been satisfactory. There was a family history of ischaemic heart disease but not of neurological or endocrinological problems.Examination revealed a corrected visual acuity of N/2 on the right and N/14 on the left, a bitemporal hemianopia, with a left lower quadrantic nasal field defect and bilateral pallor of the optic discs. He was moderately obese with nor- Initial investigations showed an increased cardiac diameter of 16cm without evidence of pulmonary oedema, a normal 12 lead ECG and normal plasma electrolytes, serum calcium, blood glucose and serum protein concentrations. Tests of endocrine function showed a serum prolactin concentration of 8180 mU/1 (normal range for males < 150) and a serum testosterone of 5-6 nmol/l (normal range for males 10-38). The results of other endocrine investigations were normal (table). A plain skull radiograph was normal without evidence of pituitary fossa enlargement or abnormal calcification and a CT brain scan revealed a non-enhancing, low density area in the left suprasellar region, with a normal sella. Bilateral carotid angiography showed an avascular space-occupying lesion in the suprasellar region with elevation and posterior displacement of the anterior cerebral arteries. As the radiological findings were consistent with a craniopharyngioma and the results of endocrine function tests were unavailable at that stage the lesion was explored, under hydrocortisone cover, using a subfrontal approach via a coronal flap. This revealed a cystic craniopharyngioma, confirmed histologically, which was subtotally resected leaving a fragment of the capsule which was adherent to the optic nerve. No tumour was seen arising from the sella.F...

Collision Tumors of the Sella: Craniopharyngioma and Silent Pituitary Adenoma Subtype 3: Case Report

“…An exhaustive search of the literature revealed only eight previously reported cases [6][7][8][9][10][11][12][13]. Their clinicopathologic features are summarized in Table 1.…”

“…The eight published cases all involved an adamantinomatous [6][7][8][9][10][11][12][13] craniopharyngioma. Among the pituitary adenomas were five PRL cell adenomas [6-8, 12, 13], including two microadenomas [6,8], one acromegalyassociated GH adenoma [10], one LH/FSH cell adenoma [9], and adenoma not otherwise classified [11].…”

Collision lesions of the sella: co-existence of craniopharyngioma with gonadotroph adenoma and of Rathke’s cleft cyst with corticotroph adenoma

“…A review of the literature reveals six such cases [11][12][13][14][15][16]. Immunohistochemical studies had been performed in three instances, all of which confirmed a diagnosis of prolactinoma.…”

“…The co-existence of craniopharyngioma and pituitary adenoma has rarely been reported [11][12][13][14][15]. Most remarkable is: (a) triple collision of an adenoma, craniopharyngioma and chordoma in the sellar region [16], (b) a germinoma followed four years later by a craniopharyngioma [17], (c) a contiguous intrasellar chordoma with a suprasellar craniopharyngioma [18] and (d) a cystic astrocytoma of the temporal lobe with a craniopharyngioma [19].…”

Pituitary adenoma with craniopharyngioma component

“…Coexistence of pituitary adenoma and craniopharyngioma is rare, with about 5 cases reported [3][4][5][6][7]. Aside from these cases, in which pituitary adenoma and craniopharyngioma components are distinct from each other, 2 additional cases, in which the 2 components are admixed, were recently reported [8,9].…”