Mixed somatotroph adenoma-gangliocytoma: A rare sellar combined tumor

Abstract

Introduction: Gangliocytomas are rare entities that correspond to less than 1% of the brain tumors, and can be present in the sellar region or more frequently in association with a pituitary adenoma. Hormonal overexpression has also been described in this tumor association leading to endocrine syndromes. Case Report: We report a case of a 23-year-old female diagnosed with a pituitary macroadenoma. The first symptoms were unilateral amaurosis and contralateral reduced visual acuity. On physical examination, she had unilateral amaurosis and galactorrhea, while the laboratory showed hyperprolactinemia and hypogonadotropic hypogonadism. Eight months after starting cabergoline and without any follow-up visit, the patient was subject to an emergency transsphenoidal surgery due to pituitary apoplexy. At this moment, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) previously collected were checked and acromegaly was diagnosed [GH 10.68 µg/dL; IGF-1 2.25 ULN (the upper limit of normality)]. Histopathology revealed a mixed somatotroph adenomagangliocytoma with areas of apoplexy. Unfortunately, surgery did not cure acromegaly, and clinical treatment