The sleeping giant: An atypical case of a giant Pituitary Adenoma presenting as Acromegaly with minimal symptoms of mass effect
https://doi.org/10.15605/jafes.034.02.S130
- Author:
Catherine Jordan
1
;
Carmen Carina Cabrera
1
;
Evelyn Esposo
1
;
Reynaldo Rosales
1
;
Rachelle Diane Maravilla
1
Author Information
1. St Lukes Medical Center-Quezon City, Philippines
- Publication Type:Other Types
- Keywords:
GH secreting
- MeSH:
Acromegaly;
Pituitary Neoplasms
- From:
Journal of the ASEAN Federation of Endocrine Societies
2019;34(2):76-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:This is a case of patient with giant pituitary adenoma (GPA) presenting with acromegalic features, minimal symptoms of mass effect who underwent surgical resection via transcranial approach with minimal surgical morbidity.
Case:A 40-year-old female presented with typical acromegalic features over 14 years, occasional mild frontal headaches and blurred vision. She had elevated growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Cranial MRI revealed a 6.4x7x5.5 cm lobulated pituitary mass with cystic degeneration, areas of necrosis with mass effect on several intracranial structures. Excision via craniotomy reduced mass size to 5.9x5.8x4.7 cm. Histopathology revealed a mixed GH- and prolactin-secreting pituitary adenoma. She was maintained on bromocriptine and underwent radiotherapy. Repeat IGF-1 levels remained elevated but symptoms did not progress
Conclusion:This is a case of a patient with GPA with minimal symptom of mass effect, with no hormonal improvement post-surgery and radiotherapy. Ideally, a multi-staged surgery can be done with optimization of medical management. In the absence of these medications locally and reluctance of patient for re-surgery, the team opted to monitor tumor size, hormone levels and maximize management of co-morbidities.
- Full text:2131-Article Text-19141-1-10-20220611.pdf
