Pituitary apoplexy / macroadenoma

Case contributed by A.Prof Frank Gaillard

Presentation

Rapid visual loss and headache.

Patient Data

Age: 40
Gender: Male

The fossa is enlarged, and remodelled and filled with soft tissue, denser on the left. The scout demonstrates prominence of the frontal sinuses, nose and jaw. 

A pituitary macroadenoma is present with a small amount of central high T1 signal consistent with blood. 

 

Pituitary function tests

  • THYROID FUNCTION
    • FT4 10.9 pmol/L 9.0-26.0
    • FT3 3.6 pmol/L 3.5-6.5
    • TSH 0.52 mIU/L 0.1-4.0
  • REPRODUCTIVE HORMONES
    • LH 4.5 IU/L 1.5-9.3
    • FSH 8.8 IU/L 1.4-18.1
    • Testos 1.5L nmol/L 7-28
    • Prolactin 21L mIU/L 45-375
  • GROWTH HORMONES
    • IGF-1 141.0H nmol/L 14.2-36.9
    • ACTH - EDTA Plasma ACTH * pmol/L <20
  • CORTISOL
    • Pl Cortisol 14L nmol/L 120-650

The patient went onto have a transphenoidal resection.

Histology

 

MICROSCOPIC DESCRIPTION:

Paraffin sections show fragments of a moderately hypercellular adenoma. Tumour cells have uniform round and oval nuclei and variable amount of pale granular eosinophilic cytoplasm. These are arranged in diffuse sheets within a vascular stroma. No mitotic figures are identified. Areas of haemorrhagic infarction are present in specimens 1&2. No normal anterior pituitary tissue is included. Immunohistochemistry shows patchy weak staining in viable cells for growth hormone. There is also strong perinuclear staining for CAM5.2 in the majority of tumour cells. A moderate number of cells show staining for prolactin. No staining for ACTH, LH, FSH, TSH, GFAP or S-100 protein is seen. The topoisomerase labelling index is approximately 1%.

DIAGNOSIS:

Pituitary adenoma with partial haemorrhagic infarction and immunohistochemical profile suggestive of sparsely granulated growth hormone secreting adenoma.

Case Discussion

Although typically acromegaly is encountered with patients with GH secreting microadenomas, in this case the low level secretions resulted in a macroadenoma being present by the time the diagnosis was made. 

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Case information

rID: 28968
Case created: 24th Apr 2014
Last edited: 15th Jul 2017
Inclusion in quiz mode: Included

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