MRI appearances of an ectopic pituitary adenoma: case report and review of the literature

Slonim, Suzanne M.; Haykal, Hani A.; Cushing, Gary W.; Freidberg, Stephen R.; Lee, A. K.

doi:10.1007/bf00588720

Cited by 51 publications

(26 citation statements)

References 19 publications

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“…The solid areas of EPAs show strong enhancement and, when juxtaposed with the relatively low signal intensity of secretion-filled spaces, result in a characteristic cribriform pattern, which may be an important suggestive sign. Sphenoid sinus EPAs with relatively large cyst formation, necrosis, haemorrhage or proteinaceous secretions were reported to be seldom seen [1][2][3][4]. However, three cases with cysts were identified in the present series.…”

Section: Discussioncontrasting

confidence: 47%

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Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Yang¹,

Chong²,

Wang³

et al. 2010

BJR

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ABSTRACT. Ectopic pituitary adenomas (EPAs) are rare lesions. The purpose of this study was to describe the CT and MRI features of sphenoid sinus EPAs. Eight patients with histology-proven EPAs in the sphenoid sinus, all of whom underwent CT and MRI, were reviewed retrospectively. The following imaging features were analysed: (i) size, (ii) margin, (iii) CT attenuation characteristics and (iv) MRI signal intensity. In addition, the involvement of adjacent structures and the time-intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI were analysed. All EPAs had well-defined margins and showed no relationship to the intrasellar pituitary gland. The mean size was 28 mm (range, 20-46 mm). On non-enhanced CT, the lesions appeared isodense to grey matter in 7 (88%) patients and hypodense in 1 (12%) patient. Only two patients underwent post-contrast CT, and they showed moderate enhancement. On T 1 weighted images, EPAs appeared isointense in 6 (75%) patients and hypointense in 2 (25%). On T 2 weighted images, the lesions appeared hyperintense in 2 (25%) patients and isointense in 6 (75%). EPAs showed mild to moderate heterogeneous contrast enhancement and exhibited a cribriform-like appearance. Two patients underwent DCE MRI; the TIC showed a rapidly enhancing and slow washout pattern. The following features were also seen: an empty sella, bone changes and involvement of the cavernous sinus (5 patients; 62.5%). In conclusion, a high index of suspicion for EPA and a familiarity with the imaging findings may help to diagnose this rare entity accurately.

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Section: Discussioncontrasting

confidence: 47%

“…A review of the English literature has shown, to date, fewer than 40 cases [1][2][3][4][5][6]. Furthermore, some authors think a pre-operative diagnosis of EPA is often difficult to make.…”

mentioning

confidence: 99%

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Yang¹,

Chong²,

Wang³

et al. 2010

BJR

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“…Regarding Cushing's disease due to corticotropinomas, the ratio of circulating ACTH (pg/ml by IRMA) to cortisol (mg/dl) was found to be 2.4 to 2.6 or 5.1 to 5.5 in cases of microadenoma or macroadenoma, respectively [30]. Based on this finding, the present case [7.25 to 12.1] and the other three [8.08, 12.0 and 8.0] out of 16 EAPA cases documented (see Table 1) were shown to have relatively high ratios of ACTH (pg/ml) to cortisol (mg/dl) com- pared to common Cushing's diseases, although these three cases, unlike our case, were reported to have completely overt Cushingoid features including moon face, truncal obesity, skin striae, pigmentation and atrophy, cervicodorsal hump, hypertension and diabetes mellitus [4,13,15]. Although the discrepancy of clinical symptoms and endocrine profile could be related to the individual sensitivity to cortisol, it is also possible that an aberrant less-active ACTH molecule exists in the plasma of these EAPA patients [31].…”

Section: Discussionmentioning

confidence: 52%

“…1A and B). On her endocrine examinations, plasma ACTH level was markedly increased (196 to 280 pg/ml; normal, 9-52) but the serum cortisol level was not remarkable (23 to 27 mg/dl; normal [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Daily secretion of ACTH and cortisol lacked the normal circadian rhythm (Fig.…”

Section: Case Reportmentioning

confidence: 99%

An Aberrant ACTH-producing Ectopic Pituitary Adenoma in the Sphenoid Sinus

et al. 2004

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Abstract.A 32-year-old woman with an ectopic adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma (EAPA) is presented. She had rapidly gained weight and suffered recurrent facial acne for a few years but lacked the typical Cushingoid features. Endocrine examinations revealed that her plasma ACTH was markedly high (196 to 280 pg/ml) without showing normal circadian rhythm and failed to respond to corticotropin-releasing hormone stimulation. Her cortisol levels ranged from 22 to 30 mg/dl throughout observation but low doses (1 and 2 mg) of dexamethasone failed to suppress either ACTH or cortisol level. Magnetic resonance imaging study revealed a 3-cm mass occupying the sphenoidal sinus with partial enhancement by gadolinium, which was separated from the normal pituitary in the sella region. The tumor resected by transsphenoidal surgery was histologically diagnosed as an ACTH-producing pituitary adenoma. After surgery her weight gain and acne remitted in accordance with decreases in plasma ACTH. Analysis of patient plasma by gel filtration method revealed the existence of big ACTH molecules eluted with a peak of authentic 1-39 ACTH, suggesting that this biologically less-active ACTH might be the reason why overt features of Cushing's syndrome failed to develop in this case. Although EAPA is clinically rare in parasellar disorders, the presence of ectopic pituitary adenoma should be considered in such cases showing ACTH hypersecretion without typical Cushingoid features.

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“…Intracranial and extracranial locations are known, 4,6,[10][11][12][13][14][15][16][17][18][19][21][22][23] most often in the suprasellar region 6,12,13,15,16) or the sphenoid sinus. 4,6,10,14,22) Only four of 65 (6.2%) reported ectopic pituitary adenomas have been found in the cavernous sinus. 6) We present a case of adrenocorticotropic hormone (ACTH)-positive ectopic pituitary adenoma in the cavernous sinus manifested as sudden onset of oculomotor nerve paresis and did not cause Cushing's syndrome.…”

Section: Introductionmentioning

confidence: 99%

Ectopic Pituitary Adenoma in the Cavernous Sinus Causing Oculomotor Nerve Paresis-Case Report-

Hata

Inoue

Katsuta

et al. 2003

Neurol. Med. Chir.(Tokyo)

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A 24-year-old woman presented with a rare adrenocorticotropic hormone (ACTH)-positive pituitary adenoma in the cavernous sinus, manifesting as sudden onset of oculomotor nerve paresis. Neuroimaging revealed a tumor in the cavernous sinus bulging into the subdural space. There was no continuity between the tumor and the pituitary gland in the sella turcica. Gross total removal of the tumor was performed through the orbitozygomatic approach followed by stereotactic radiosurgery. The oculomotor nerve paresis was resolved. Histological examination revealed an adenoma positive for ACTH. Ectopic pituitary adenoma occurs mostly in the sphenoid sinus or the suprasellar region. This extremely rare case of ectopic macroadenoma in the cavernous sinus manifested as oculomotor nerve paresis without signs of Cushing's syndrome.

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MRI appearances of an ectopic pituitary adenoma: case report and review of the literature

Cited by 51 publications

References 19 publications

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

An Aberrant ACTH-producing Ectopic Pituitary Adenoma in the Sphenoid Sinus

Ectopic Pituitary Adenoma in the Cavernous Sinus Causing Oculomotor Nerve Paresis-Case Report-

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