Suprasellar Adrenocorticotropic Hormone-secreting Ectopic Pituitary Adenoma: Case Report and Literature Review

Hou, Lewis C.; Harshbarger, Todd; Herrick, Maie Kaarsoo; Tse, Victor

doi:10.1097/00006123-200203000-00035

Cited by 41 publications

(42 citation statements)

References 49 publications

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“…During the ingrowth of Rathke's pouch, pituitary tissues can be retained in the sphenoid sinus and remain separate from the normal pituitary gland [1-4, 6, 8]. The sphenoid sinus is the most common site for EPA, followed by the suprasellar region; other less common sites include the cavernous sinus, parasellar region, clivus, nasal cavity, nasopharynx, temporal bone and third ventricle [6]. Embryological rests may show hormonal activity, respond to change in endocrine feedback, and have the potential to develop adenomas [3,4,8].…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Yang¹,

Chong²,

Wang³

et al. 2010

BJR

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“…It has been suggested that EPAs could arise along the cranial migration route of Rathke's pouch toward the hypothalamus, after its development as an invagination of the primitive oral cavity during the third week of gestation; remnants of this pharyngopituitary canal in bone areas, for example, could explain EPAs in the clivus or sphenoid bone 4,5 . Surgical resection of the adenoma causing acromegaly has been the traditional approach, although normalization of IGF-1 and GH levels is observed in only 40-70% of patients 1 …”

Section: Discussionmentioning

confidence: 99%

Ectopic growth hormone-secreting pituitary adenoma involving the clivus treated with octreotide: role of magnetic resonance imaging in the diagnosis and clinical follow-up

Ferraz-Filho

Torres

Teixeira

et al. 2012

Arq. Neuro-Psiquiatr.

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Ectopic pituitary adenomas (EPAs) are rare neoplasms, mainly described in the sphenoid sinus (SS) and suprasellar region; hormone-secreting EPAs with clival involvement have been rarely reported. We describe a case of a pharmacologically treated GH-secreting EPA involving the clivus and SS, with satisfactory clinical outcome and tumor size reduction. As transsphenoidal resection is the standard approach, post-treatment imaging findings in the nonsurgical management of this entity, to our knowledge, have not been reported before. CASE REPORTA 30-year-old woman presented with clinical signs and symptoms of acromegaly for the past one year. A hormonal profile confirmed acromegaly [plasma IGF-1 level >500 ng/mL (94-309 ng/mL), GH=218 ng/mL (<5 ng/mL) and prolactin=7 ng/mL (3-29 ng/mL)]; an oral glucose tolerance test revealed no suppression of GH values. With suspicion of a pituitary adenoma, a brain MRI was performed, which revealed, however, a 3.0 x 2.0 cm enhancing mass lesion on both T1-and T2-weighted images involving the clivus and SS, well demarcated from the normal pituitary, which was cranially displaced (Fig 1). After a careful exclusion of other rare causes of acromegaly, association of clinical, laboratorial and imaging findings were consistent with a GH-secreting EPA.Despite appropriate medical counseling, the patient refused surgical treatment. Therefore, pharmacological treatment with octreotide, a somastotatin analogue, was indicated in association with a close follow-up. The patient presented stabilization of IGF-1 levels and random measurements of GH showed safe levels <2.0 μg/L, confirming an adequate response 1,2

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“…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. This symptom gradually resolved after removal of the tumor and stereotactic radiosurgery.…”

Section: Introductionmentioning

confidence: 99%

“…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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Suprasellar Adrenocorticotropic Hormone-secreting Ectopic Pituitary Adenoma: Case Report and Literature Review

Abstract: Ectopic pituitary adenomas should be considered in the differential diagnosis for all patients with Cushing's syndrome. Furthermore, surgical approaches should be chosen carefully once the diagnosis of ectopic pituitary adenoma is made.

Cited by 41 publications

References 49 publications

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings

Ectopic growth hormone-secreting pituitary adenoma involving the clivus treated with octreotide: role of magnetic resonance imaging in the diagnosis and clinical follow-up

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

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