MRI finding of simultaneous coexistence of growth hormone-secreting pituitary adenoma with intracranial meningioma and carotid artery aneurysms: report of a case

Abstract

Coexistence of pituitary adenoma, intracranial meningioma and cerebral aneurysm has never been described. We report on a patient with GH-secreting pituitary macroadenoma associated with a right frontal meningioma and with two intracavernous asymptomatic aneurisms. A 61-year-old woman was referred to our Endocrine Unit 13 years after a right frontal craniotomy for a pituitary tumour. Endocrine investigation showed high levels of IGF-1 (560 ng/ml) and increased basal serum GH (56 ng/ml) levels, not suppressed after OGTT. MRI showed persistence of a homogeneously enhancing intra- and suprasellar lesion, compressing the visual pathways, with bilateral intracavernous invasion and simultaneous coexistence of a right intracavernous internal carotid artery (ICA) aneurysm in direct contact with the pituitary tumour. Somatostatin analog treatment normalized GH and IGF-1 levels. Eight months later, the patient underwent a balloon ICA occlusion with disappearance of the right ICA aneurysm. One year later, a new MRI confirmed the presence of the pituitary mass showing also a right intracranial frontal meningioma and a new ICA aneurysm on the left side. Previous studies have suggested that prolonged GH hypersecretion could play a role in the genesis of intracranial aneurysms, inducing atherosclerotic and/or degenerative modification of the arterial walls. Other aetiological factors include a mechanical effect due to a direct contact between adenoma and aneurysm. Coexistence of pituitary adenoma and intracranial meningioma is a rare event, but also for this association it has been suggested that GH or other growth factors could play a role in appearance or in growth of meningioma. In our case, meningioma appeared and grew, despite the effective treatment of acromegaly.

Prolactinoma associated with an ependymoma in the fourth ventricle: A case report and review of the literature

“…Therefore, the present study of prolactinoma associated with ependymoma in the fourth ventricle represents a unique case. Similar genetic mutations have been identified in pituitary adenomas and ependymomas, and these mutations appear to be essential in the formation and progression of the two tumor types (10,13). Furthermore, in neurofibroma (type 2), a mutation in NF2, a tumor suppressor gene located at chromosome position 22q12, has been associated with the formation of various intracranial tumors, including meningiomas, gliomas and vestibular schwannomas (16).…”

“…However, various gene mutations have been identified in pituitary adenomas and other intracranial tumors, such as gliomas and meningiomas, that have different roles in each tumor type. For example, gene mutations identified in pituitary adenomas include the deletion of segments from chromosomes 1p, 2q, 4, 5, 6, 11q, 12q, 13q and 18q (10,17), and the overexpression of genes on chromosomes 9q, 16p, 17p, 19 and 20q (16,18). Furthermore, there have been a greater number of gain-of-function than loss-of-function mutations associated with pituitary adenomas (10,16,17).…”

“…For example, gene mutations identified in pituitary adenomas include the deletion of segments from chromosomes 1p, 2q, 4, 5, 6, 11q, 12q, 13q and 18q (10,17), and the overexpression of genes on chromosomes 9q, 16p, 17p, 19 and 20q (16,18). Furthermore, there have been a greater number of gain-of-function than loss-of-function mutations associated with pituitary adenomas (10,16,17). In ependymomas, deletion of chromosome 22, and overexpression of genes on chromosomes 1, 6, 7, 9-13, 16, 17, 19 and 20, have been detected (19).…”

“…For example, Curto et al (10) reported a case of pituitary adenoma associated with meningioma and an aneurysm, and demonstrated that growth hormones may have had a role in tumor development. Similarly, Fernandez et al (8) reported a case of pituitary adenoma associated with astroma in which insulin-like growth factor was involved.…”

“…However, numerous reports have described incidences of pituitary adenoma concomitant with other types of cranial cavity tumor, such as meningioma (2)(3)(4), medulloblastoma (5), neurinoma (6), craniopharyngioma (7), astrocytoma (8) and glioma (9). While the etiology and underlying mechanisms for the development of these tumors remain unclear, it has been proposed that genomic and endocrine disorders, as well as radiation therapy and embryogenesis, may be important factors (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The majority of pituitary adenomas concomitant with other cranial tumors are diagnosed by MRI or CT, current treatment strategies include the simultaneous or staged resection (12).…”