Spontaneous Resolution Of A Nonfunctioning Pituitary Adenoma Over One-month Period: A Case Report
Komić, L., Kruljac, I., Mirošević, G., Gaćina, P., Pećina, H. I., Čerina, V., Gajski, D., Blaslov, K., Rotim, K., & Vrkljan, M. (2021). SPONTANEOUS RESOLUTION OF A NONFUNCTIONING PITUITARY ADENOMA OVER ONE-MONTH PERIOD: A CASE REPORT. Acta clinica Croatica, 60(2), 317–322. https://doi.org/10.20471/acc.2021.60.02.21
View Original Source →Abstract
Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient’s symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.
Case Details
Disease Location
Pituitary gland
Personal Characteristics
54-year-old man
Clinical Characteristics
Presented to the emergency neurological department with acute onset of severe headache in the frontal area with pulsatile character, associated with vomiting, photophobia and sonophobia. The patient had been taking paracetamol in the last six hours, without any relief of symptoms. CT with contrast showed a 16x12x16 mm mass of heterogeneous density and a central hyperdense area located in the sellar and suprasellar region, consistent with pituitary macroadenoma with signs of hemorrhage. A 12x9 mm meningioma in the parasagittal left frontal lobe was also reported. The patient was diagnosed with hemorrhagic pa. Antiedematous therapy with 24 mg of dexamethasone was initiated. Laboratory findings were consistent with central hypogonadism. The patient’s symptoms resolved after conservative treatment with dexa- methasone within two days. MRI was performed to show a 16x13x18 mm mass with high signal intensity on t1-weighted images and heterogeneous post-contrast imbibition lo- cated in the sellar and suprasellar region. The mass obliterated the suprasellar cistern and spread to the optic chiasm without compressing it. Consistent with pituitary macroadenoma with signs of hemorrhage
Remission Characteristics
Preoperative MRI, which was performed exactly 28 days after the first one, showed the pituitary of appropriate dimensions for age, without any signs of adenoma, discretely raised right half of the adenohypophysis with the visible dominant high intensity signal on t1-weighted images, size 7x2x6 mm, with mixed signal intensity on t2-weighted images. At the 3-month follow-up an endocrinological re-evaluation was consistent with normal function of all pituitary cells. Repeated MRI showed a distinctly thinned pituitary gland leaning broadly against the bottom of the sella, consistent with the partially empty sella, without any signs of adenoma
Treatment & Mechanisms
Proposed Remission Mechanisms
Most likely because of infarction, hem- orrhage and necrosis.
Clinical Treatment
Dexamethasone 24mg