Unusual MRI finding of multiple adenomas in the pituitary gland: A case report and review of the literature

Salvatore Cannavò, Lorenzo Curtò, Andrea Lania, Katia Saccomanno, Francesco M. Salpietro, Francesco Trimarchi

Research output: Contribution to journalArticle

Abstract

The simultaneous occurrence of multiple adenomas in the pituitary gland is a rare event. We report the coexistence of three non functioning pituitary microadenomas in a 37-year-old woman, referred to us for oligomenorrhea and headache. Biochemical evaluation revealed prolactin (131 U/liters), follicle- stimulating hormone (4.1 U/liters), luteinizing hormone (3.9 U/liters), 17β- estradiol (74 pg/mL), free (2.0 pg/mL) and total testosterone (0.5 ng/mL), dehydroepiandrosterone-sulfate (3.5 μg/mL), 17OH-progesterone (0.8 ng/mL), cortisol (13.1 μg/dL), free triiodothyronine (4.8 pmol/L), free thyroxine (18.5 pmol/liters), thyrotropin (1.6 mU/L), and growth hormone (0.2 ng/mL) levels in the normal range, as for as the response to dynamic endocrine tests. MRI showed an enlarged sella turcica, occupied by three distinct hypointense areas that measured less than 5 mm in diameter in the left, medium and right side of the pituitary, respectively. This finding was confirmed 6 months later by a second MRI that revealed also a light increase in microadenomas dimensions. The patient, therefore, underwent neurosurgery by transfenoidal approach. Histologic examination showed no morphologic differences between the specimens obtained from the different microadenomas. Immunohistochemistry evaluation revealed a positive staining for the common α-subunit of glycoproteic hormones and negative for the other pituitary hormones tested, while electron microscopy showed cells with a poor secretory apparatus and a variable grade of cell differentiation. In conclusion, we report the fifth case described with multiple pituitary adenomas diagnosed in vivo and the first with three coexisting tumors revealed by MRI before neurosurgery. The occurrence of multiple pituitary tumors emphasizes the role of pituitary and extrahypophiseal factors in the clonal expansion of genetically altered cells.

Original languageEnglish
Pages (from-to)633-636
Number of pages4
JournalMagnetic Resonance Imaging
Volume17
Issue number4
DOIs
Publication statusPublished - May 1999

Keywords

  • Headache
  • Pituitary adenoma
  • Transphenoidal microsurgery

ASJC Scopus subject areas

  • Biophysics
  • Clinical Biochemistry
  • Structural Biology
  • Radiology Nuclear Medicine and imaging
  • Condensed Matter Physics

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