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GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review.

Tamura R, Takahashi S, Emoto K, Nagashima H, Toda M, Yoshida K - Case Rep Neurol Med (2015)

Bottom Line: A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI.In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration.If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

ABSTRACT
Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

No MeSH data available.


Related in: MedlinePlus

(a) Sagittal T1-weighted MRI of the head shows a suprasellar, high-intensity mass suspected to represent RCC. PA located below the RCC shows isointensity. (b) Sagittal T2-weighted MRI of the head shows isointense RCC and isointense PA. (c) Contrast-enhanced axial MRI shows nonenhancing RCC. In contrast, the normal pituitary gland shows strong enhancement. (d) Contrast-enhanced coronal MRI shows slight compression of the optic chiasma by RCC. And it shows an intrasellar PA of 9 mm in diameter located on the left of normal gland and suprasellar RCC of 12 mm in diameter that compressed stalk to the right side.
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fig1: (a) Sagittal T1-weighted MRI of the head shows a suprasellar, high-intensity mass suspected to represent RCC. PA located below the RCC shows isointensity. (b) Sagittal T2-weighted MRI of the head shows isointense RCC and isointense PA. (c) Contrast-enhanced axial MRI shows nonenhancing RCC. In contrast, the normal pituitary gland shows strong enhancement. (d) Contrast-enhanced coronal MRI shows slight compression of the optic chiasma by RCC. And it shows an intrasellar PA of 9 mm in diameter located on the left of normal gland and suprasellar RCC of 12 mm in diameter that compressed stalk to the right side.

Mentions: A 53-year-old man had high height from the cradle and also realized his protruding chin. He presented to our hospital with slight paralysis of the right upper extremity. His height was 181 cm that was within the limits of 2 standard deviations. Head MRI showed left lacunar infarction of the basal ganglia, as well as a suprasellar mass. The suprasellar mass was hyperintense on T1-weighted MR image (Figure 1(a)) and also isointense on T2-weighted MR image (Figure 1(b)). These findings for the suprasellar mass were compatible with RCC, and he was referred to the neurosurgical outpatient clinic for management. At the neurosurgical outpatient clinic, neurological examination revealed only slight right hemiparesis due to lacunar infarction. No visual disturbance was apparent (Figures 2(a) and 2(b)). Physical examination revealed typical features of acromegaly, such as soft tissue swelling visibly resulting in enlargement of the feet, pronounced brow protrusion, and enlargement of the tongue and teeth spacing. At this time, MRI was reviewed by a neurosurgeon, and an intrasellar mass other than the suprasellar lesion was identified. The patient underwent hormonal laboratory testing as well as MRI with intravenous infusion of gadolinium (Gd). Hormonal laboratory testing showed GH of 8.4 ng/mL, somatomedin C of 607 ng/mL (85~240 ng/mL), FSH of 7.9 mIU/mL, LH of 2.2 mIU/mL, testosterone of 4.43 ng/mL, TSH of 2.2 μIU/mL, FT3 of 3.2 pg/mL, FT4 of 1.8 ng/mL, serum cortisol of 14.5 μg/dL, and serum prolactin of 17.5 ng/mL.


GH-Producing Pituitary Adenoma and Concomitant Rathke's Cleft Cyst: A Case Report and Short Review.

Tamura R, Takahashi S, Emoto K, Nagashima H, Toda M, Yoshida K - Case Rep Neurol Med (2015)

(a) Sagittal T1-weighted MRI of the head shows a suprasellar, high-intensity mass suspected to represent RCC. PA located below the RCC shows isointensity. (b) Sagittal T2-weighted MRI of the head shows isointense RCC and isointense PA. (c) Contrast-enhanced axial MRI shows nonenhancing RCC. In contrast, the normal pituitary gland shows strong enhancement. (d) Contrast-enhanced coronal MRI shows slight compression of the optic chiasma by RCC. And it shows an intrasellar PA of 9 mm in diameter located on the left of normal gland and suprasellar RCC of 12 mm in diameter that compressed stalk to the right side.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4389828&req=5

fig1: (a) Sagittal T1-weighted MRI of the head shows a suprasellar, high-intensity mass suspected to represent RCC. PA located below the RCC shows isointensity. (b) Sagittal T2-weighted MRI of the head shows isointense RCC and isointense PA. (c) Contrast-enhanced axial MRI shows nonenhancing RCC. In contrast, the normal pituitary gland shows strong enhancement. (d) Contrast-enhanced coronal MRI shows slight compression of the optic chiasma by RCC. And it shows an intrasellar PA of 9 mm in diameter located on the left of normal gland and suprasellar RCC of 12 mm in diameter that compressed stalk to the right side.
Mentions: A 53-year-old man had high height from the cradle and also realized his protruding chin. He presented to our hospital with slight paralysis of the right upper extremity. His height was 181 cm that was within the limits of 2 standard deviations. Head MRI showed left lacunar infarction of the basal ganglia, as well as a suprasellar mass. The suprasellar mass was hyperintense on T1-weighted MR image (Figure 1(a)) and also isointense on T2-weighted MR image (Figure 1(b)). These findings for the suprasellar mass were compatible with RCC, and he was referred to the neurosurgical outpatient clinic for management. At the neurosurgical outpatient clinic, neurological examination revealed only slight right hemiparesis due to lacunar infarction. No visual disturbance was apparent (Figures 2(a) and 2(b)). Physical examination revealed typical features of acromegaly, such as soft tissue swelling visibly resulting in enlargement of the feet, pronounced brow protrusion, and enlargement of the tongue and teeth spacing. At this time, MRI was reviewed by a neurosurgeon, and an intrasellar mass other than the suprasellar lesion was identified. The patient underwent hormonal laboratory testing as well as MRI with intravenous infusion of gadolinium (Gd). Hormonal laboratory testing showed GH of 8.4 ng/mL, somatomedin C of 607 ng/mL (85~240 ng/mL), FSH of 7.9 mIU/mL, LH of 2.2 mIU/mL, testosterone of 4.43 ng/mL, TSH of 2.2 μIU/mL, FT3 of 3.2 pg/mL, FT4 of 1.8 ng/mL, serum cortisol of 14.5 μg/dL, and serum prolactin of 17.5 ng/mL.

Bottom Line: A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI.In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration.If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

ABSTRACT
Concomitant pituitary adenoma (PA) and Rathke's cleft cyst (RCC) are rare. In some cases, such PA is known to produce pituitary hormones. A 53-year-old man was admitted to our hospital with a diagnosis of lacunar infarction in the left basal ganglia. Magnetic resonance imaging (MRI) incidentally showed a suprasellar mass with radiographic features of RCC. When he consulted with a neurosurgical outpatient clinic, acromegaly was suspected based on his appearance. A diagnosis of growth hormone- (GH-) producing PA was confirmed from hormonal examinations and additional MRI. Retrospectively, initial MR images also showed intrasellar mass that is compatible with the diagnosis of PA other than suprasellar RCC. The patient underwent endonasal-endoscopic removal of the PA. Since we judged that the RCC of the patient was asymptomatic, only the PA was completely removed. The postoperative course of the patient was uneventful and GH levels gradually normalized. Only 40 cases of PA with concomitant RCC have been reported to date, including 13 cases of GH-producing PA. In those 13 cases, RCC tended to be located in the sella turcica, and suprasellar RCC like this case appears rare. In a few cases, concomitant RCCs were fenestrated, but GH levels normalized postoperatively as in the cases without RCC fenestration. If radiographic imaging shows typical RCC, and PA is not obvious at first glance, the possibility of concomitant PA still needs to be considered. In terms of treatment, removal of the RCC is not needed to achieve hormone normalization.

No MeSH data available.


Related in: MedlinePlus