J Neurol Surg B Skull Base 2017; 78(02): 120-124
DOI: 10.1055/s-0036-1592081
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Ectopic Pituitary Adenomas Presenting as Sphenoid or Clival Lesions: Case Series and Management Recommendations

Bobby A. Tajudeen
1   Department of Otorhinolarygology–Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
,
Edward C. Kuan
2   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Nithin D. Adappa
3   Department of Otorhinolarygology–Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Joseph K. Han
4   Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, United States
,
Rakesh K. Chandra
5   Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
,
James N. Palmer
3   Department of Otorhinolarygology–Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
David W. Kennedy
3   Department of Otorhinolarygology–Head and Neck Surgery, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Marilene B. Wang
2   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Jeffrey D. Suh
2   Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
› Author Affiliations
Further Information

Publication History

27 May 2016

26 July 2016

Publication Date:
09 September 2016 (online)

Abstract

Background An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup.

Methods Retrospective chart review.

Results Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus. There were four females and five males. Median age was 60 years old (range, 36–73 years). The most common presenting symptom was headache (56%). Five (56%) patients presented with a mass arising from the clivus while four (44%) presented with a mass in the sphenoid. Six (67%) patients demonstrated biochemical evidence of hypersecretion on full endocrinology panel. All masses showed evidence of enhancement with gadolinium with a propensity for adjacent bone involvement. Lesions also had a predilection for growth toward the cavernous sinus, carotid artery, or sellar floor. Surgical intervention was performed in eight patients (89%). In eight patients (89%), tumors demonstrated immunoreactivity to prolactin.

Conclusions Pituitary adenomas can rarely present as an isolated sphenoid or clival mass. Lesions displayed similar magnetic resonance imaging findings with an erosive growth pattern toward the sellar floor, cavernous sinus, or adjacent carotid artery. Patients with clival or parasellar lesions with comparable features should have a preoperative workup which includes prolactin level and alert the physician to consider an ectopic pituitary adenoma in the differential to prevent unnecessary surgery and potential complications.

Note

No financial disclosures. No conflicts of interests to disclose.


 
  • References

  • 1 Liu B, Zhuang Z, Luo J, Wang Y. A case report of an ectopic clival growth hormone adenoma associated with an empty sella and a review of the literature. Clin Neurol Neurosurg 2013; 115 (12) 2533-2536
  • 2 Bhatoe HS, Kotwal N, Badwal S. Clival pituitary adenoma with acromegaly: case report and review of literature. Skull Base 2007; 17 (4) 265-268
  • 3 Konar S, Devi BI, Yasha TC, Shukla DP. Clival tumor presenting with acromegaly. Neurol India 2013; 61 (2) 186-187
  • 4 Kusano Y, Horiuchi T, Oya F , et al. Ectopic pituitary adenoma associated with an empty sella: a case report and review of the literature. J Neuroimaging 2013; 23 (1) 135-136
  • 5 Nishiike S, Tatsumi KI, Shikina T, Masumura C, Inohara H. Thyroid-stimulating hormone-secreting ectopic pituitary adenoma of the nasopharynx. Auris Nasus Larynx 2014; 41 (6) 586-588
  • 6 Flitsch J, Schmid SM, Bernreuther C , et al. A pitfall in diagnosing Cushing's disease: ectopic ACTH-producing pituitary adenoma in the sphenoid sinus. Pituitary 2015; 18 (2) 279-282
  • 7 Wang H, Yu W, Zhang Z, Xu W, Zhang F, Bao W. Ectopic pituitary adenoma in the spheno-orbital region. J Neuroophthalmol 2010; 30 (2) 135-137
  • 8 Hou L, Harshbarger T, Herrick MK, Tse V. Suprasellar adrenocorticotropic hormone-secreting ectopic pituitary adenoma: case report and literature Review. Neurosurgery 2002; 50 (3) 618-625
  • 9 Yang BT, Chong VF, Wang ZC, Xian JF, Chen QH. Sphenoid sinus ectopic pituitary adenomas: CT and MRI findings. Br J Radiol 2010; 83 (987) 218-224
  • 10 Liu W, Zhou H, Neidert MC , et al. Growth hormone secreting pituitary microadenomas and empty sella - An under-recognized association?. Clin Neurol Neurosurg 2014; 126: 18-23
  • 11 Gesundheit N, Petrick PA, Nissim M , et al. Thyrotropin-secreting pituitary adenomas: clinical and biochemical heterogeneity. Case reports and follow-up of nine patients. Ann Intern Med 1989; 111 (10) 827-835
  • 12 Molitch ME. Prolactin-secreting tumors: what's new?. Expert Rev Anticancer Ther 2006; 6 (Suppl. 09) S29-S35
  • 13 Molitch ME. Nonfunctioning pituitary tumors and pituitary incidentalomas. Endocrinol Metab Clin North Am 2008; 37 (1) 151-171 , xi
  • 14 Miller BA, Ioachimescu AG, Oyesiku NM. Contemporary indications for transsphenoidal pituitary surgery. World Neurosurg 2014; 82 (6, Suppl) S147-S151