PITUITARY ADENOMA (PRESENTATION OF THREE CASE STUDIES)

Ike Elezi, Xheladin Çeka, Piro Paparisto, Dëshira Nasufi, Vladimir Gurra

Abstract

Pituitary tumors are among the most frequent cerebral tumors ecountered in clinical practice with an incidence of 15% of all intracranial tumors, most of them being adenomas. Prolactinomas are the most frequent pituitary adenomas caused by autonomic hyperproduction of prolactin by lactotroph cells. The incidence of prolactinomas varies with age and sex. About 1 in 10 000 people will develop a prolactinoma for which the clear cause is not known. Prolactinoma occurs in both sexes, but are more common in women. Our First case study is a 35 years old female patient complaining profuse sweting, gaining weight, enlargment of hand and feet and intermitent headaches. Facial examination reveals an enlargment of supraorbitaly arches, prognatia, enlargment of the space between the teeth, as well enalargment of the ears, nose, lips and macroglossia. Enlargment of extremities were noted, as well as a change in voice, which was proved by the patient. After MRI examination was found a lesion with dimensions 3 x 2x 1.5 cm with moderate uptake of the contrast at a selar and supraselar possition. The lesion was distended to nearby structures withouth involvment of optic chiasma. Based on the laboratory data, physical examination and imaging results the diagnosis was Pituitary Grouth hormone secreting macroadenoma or Acromegalia.The patient started treatmentn with oral hypoglicemiants (Metformine 500 mg) and rezectional transsphenoidal surgery was sugested (TSS). In our second case we had a 17-year-old girl with menarche at the age of 14, irregular cycle (every 6 months) and menstrual pain. She was admitted to our clinic for further examination. Ultrasound of ovary and uterus resulted normal, but the laboratory examination resulted with hyperprolactinemia. MRI of the head revealed a pituitary lesion 1.0 x 1.2 cm, with displacement of the left pituitary infundibulum and with the aspect of pituitary macroadenoma. After treatment to restrict the tumor, the patient underwent transnasal, transsphenoidal surgery. The intervention removed the pituitary macroadenoma and the postoperatory MRI confirmed the removal. The patient is clinically well. The third case was a young woman of 34 years old who was presented at our clinic with an irregular cycle (every 6 month). Laboratory examination and imaging confirmed our suspect of hyperprolactinemia and pituitary macroadenoma as a 1.5 x 1.7 cm mass, which was exerting pressure on the optic chiasma. After non-invasive treatment the patient went through transsfenoidal surgery, but her hormonal level were still unstable. After two years she went through another endoscopic surgical intervention, which was followed by stabilization of hormonal levels with the exception of GH, which remained low. Four days after surgery the patient developed pneumococcal meningitis which was treated sucessfully. Other than the impossibility of another pregnancy, the patient is feeling well today.

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