Pituitary Stone or Calcified Pituitary Tumor? Three Cases and Literature Review

Abstract

Introduction:Pituitary stone or pituitary calculus is a scientific enigma characterized by a large calcification in the pituitary sella. It can be discovered incidentally or in a patient with endocrine and/or neurological problems. Its mechanism is not understood. In this article, we described three patients harboring a large pituitary calcification.Case Presentation:The first case was observed in a 27-year-old woman who consulted for secondary amenorrhea. The second case concerned a woman who consulted for infertility, and the third one was observed in an 11-year and nine-month-old girl who was sent to our department for short stature. Clinical examination was normal in both adults. The pediatric case had dwarfism with lack of pubertal development. Hormonal assessment showed hyperprolactinemia in both women and thyrotroph and somatotroph deficits in the child. Radiologic exploration discovered pituitary calcifications measuring 10, 11, and 45 mm without any cystic or solid mass.Conclusions:Radiological findings pleaded for a pituitary stone, but calcified adenomas in women, and calcified craniopharyngioma in the pediatric case could not be excluded, as our three patients were not operated on.

A Case of a Pituitary Stone

“…However, the term pituitary "stone" was coined by Glasser and J o u r n a l P r e -p r o o f Earll in their 1968 JAMA letter (2). The differential diagnosis of a calcified lesion in the sella turcica includes craniopharyngioma, meningioma, aneurysm, Rathke's cleft cyst, and pituitary adenoma; very rarely it represents a de novo pituitary stone 1 . The pathogenesis is incompletely understood, though it is attributed to local effects of pituitary tumors, inflammation, hemorrhage, amyloid deposits, or infection (1).…”

“…It is a rare but well-recognized radiographic entity that arises de novo or secondary to pathologic intrasellar lesions. 1 Schwartz and Ellis described a pituitary calculus in their 1951 text on the skull and brain radiography. 2 However, the term pituitary “stone” was coined by Glasser and Earll reference the original text by Schwartz and Ellis from 1951 in their 1968 JAMA letter.…”

“… 2 The differential diagnosis of a calcified lesion in the sella turcica includes craniopharyngioma, meningioma, aneurysm, Rathke cleft cyst, and pituitary adenoma; very rarely, it represents a de novo pituitary stone. 1 The pathogenesis is incompletely understood, although it is attributed to local effects of pituitary tumors, inflammation, hemorrhage, amyloid deposits, or infection. 1 Calcification may result from progressive tumor enlargement with central ischemic effects and osteoid metaplasia or by degenerative changes following pituitary apoplexy.…”

“… 1 The pathogenesis is incompletely understood, although it is attributed to local effects of pituitary tumors, inflammation, hemorrhage, amyloid deposits, or infection. 1 Calcification may result from progressive tumor enlargement with central ischemic effects and osteoid metaplasia or by degenerative changes following pituitary apoplexy. 3 Calcification may arise secondary to tumor compression and increased sellar pressure.…”

Pituitary tumour fibroblast-derived cytokines influence tumour aggressiveness

“…Fibroblasts are mediators of fibrosis due to their ability to secrete collagen, hyaluronan, proteoglycans and other extracellular matrix-related proteins (Kalluri & Zeisberg 2006, Cirri & Chiarugi 2012. A correlation between collagen-producing cell number and fibrous deposition degree was seen in PitNETs, with thyrotrophinomas displaying the highest number of collagen-producing cells and fibrous matrix (Tofrizal et al 2016), in line with their recognised firm consistency (Yamada et al 2014) which may hinder surgical resection (Chentli & Safer-Tabi 2015). Thus, a drug able to target TAFs and reduce the fibrotic process may be valuable in improving outcomes in patients with PitNETs.…”