Artikel
Ectopic pituitary adenoma presenting as a clival tumor – a case report
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Autoren
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Sami Ridwan
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Anna Bohrer
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Alexander Grote
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
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Matthias Simon
- Evangelisches Krankenhaus Bielefeld, Klinik für Neurochirurgie, Bielefeld, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: To describe a case of a rare pituitary adenoma of ectopic origin presenting as a clival lesion. The majority of ectopic pituitary adenomas are located in the sphenoid sinus. Adenomas located in the clivus are rare and data are scarce in the literature. Depending on the hormonal activity of their tumors, patients present with symptoms of pituitary dysfunction, e.g. or may remain asymptomatic for a long period of time.
Methods: We describe the clinical symptoms, neuroimaging and pituitary hormone studies, and treatment of an 86-year-old female patient who primarily presented with sleep apnea and was later referred to our department for diagnostic work-up and treatment of a suspected clival tumor.
Results: The patient was transferred to our neurosurgical department after computed tomography (CT) and magnetic resonance imaging (MRI) studies were obtained by a general practitioner. Clinically, the patient presented with symptoms and complaints due to suspected sleep apnea. The initial CT scan of the paranasal sinuses revealed a clival lesion of 4x3x3 cm, which was verified by MR imaging. A CT angiogram revealed no obstruction of the carotid arteries. Pituitary hormone levels were within normal limits. The differential diagnosis included chordoma and metastatic cancer amongst other histologies. Because of advanced age the patient was scheduled for a navigation assisted transsphenoidal microsurgical biopsy rather than a tumor resection. Intraoperative frozen section pathology unexpectedly revealed the diagnosis of pituitary adenoma. In light of these results a gross total resection of the lesion was performed limited by suspected tumor infiltration of the right cavernous sinus and an abnormally medial course of the right carotid artery. The sella was never opened. The patient quickly recovered from surgery. After surgery, pituitary hormone levels remained within normal limits and no electrolyte disorders were detected. Postoperative MR imaging revealed only minimal residual tumor in the right cavernous sinus.
Conclusion: Ectopic pituitary adenomas are rare but can present as clival lesions.
