spontaneous regression of nonfunctioning pituitary macroadenoma: A case report

Abstract

A case involving a 13-year-old girl with nonfunctioning pituitary macroadenoma is discussed. The patient visited the hospital for checkup after experiencing a head injury secondary to syncope. A computed tomography (CT) scan revealed a pituitary mass with mildly higher density. Magnetic resonance imaging (MRI) with contrast enhancement showed that the mass contained a hyperintense area and it elevated the optic chiasm. The patient had blurred vision in her right eye. No endocrinological abnormalities were found. When the patient was admitted for surgical removal of the mass 1 month later, her visual acuity had improved. A repeat MRI showed that the size of the pituitary mass had dramatically reduced. During the following 2 years, the mass showed further reduction in size and did not re-grow. Since symptoms of pituitary apoplexy were not observed, we believe that asymptomatic apoplexy occurring at the time of the first visit may have caused regression of the tumor.

Case Details

Disease Location

Suprasellar mass

Personal Characteristics

13-year-old female

Clinical Characteristics

Patient presented to the hospital with head trauma after syncope. Ros positive for reduced vision in right eye and decreased color perception in upper part of right eye. CT, MRI confirmed pituitary adenoma. Hormonal profile normal. Patient scheduled for surgery after a months, admission MRI showed regression of the lesion and visual changes now normal. Repeat after 4 months and 2 years from initial visit remain negative.

Remission Characteristics

Spontaneous regression of tumor and visual symptoms up to 2 years from initial dx/visit. Apoplexy ruled out clincially and on imaging.

Treatment & Mechanisms

Proposed Remission Mechanisms

Possible microhemorrhage, possible physiological enlargement followed by regression.