Acromegaly with negative pituitary MRI and no evidence of ectopic source: The role of transphenoidal pituitary exploration?

Sameera Daud, Amir Hamrahian, Robert J. Weil, Marwan Hamaty, Richard A. Prayson, Leann Olansky

Research output: Contribution to journalArticle

Abstract

Growth hormone (GH) producing adenomas of the pituitary gland are usually macroadenomas (>10 mm in size). Often these adenomas are locally invasive by the time of diagnosis. Acromegaly secondary to a very small pituitary microadenoma not visualized on pituitary magnetic resonance (MR) imaging is rare. We report a patient with acromegaly and an unremarkable pituitary MR imaging who had negative work up for ectopic growth hormone-releasing hormone (GHRH) or GH secreting tumors. Transsphenoidal pituitary exploration revealed a pituitary adenoma located on the left side of the sella against the medial wall of the cavernous sinus extending posteriorly along the floor of the sella all the way to the right side. The acromegaly was treated with resection of the pituitary adenoma and normalization of serum insulin-like growth factor 1 (IGF-1) and GH levels. In a patient with acromegaly and unremarkable pituitary MR imaging, with no evidence of ectopic GH and GHRH production, transsphenoidal pituitary exploration is a reasonable approach and may result in clinical improvement and biochemical cure in the hand of experienced surgeon. This approach may avoid long term medical treatment with its associated cost.

Original languageEnglish (US)
Pages (from-to)414-417
Number of pages4
JournalPituitary
Volume14
Issue number4
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

Fingerprint

Acromegaly
Growth Hormone
Ectopic Hormones
Growth Hormone-Releasing Hormone
Magnetic Resonance Imaging
Pituitary Neoplasms
Adenoma
Cavernous Sinus
Somatomedins
Pituitary Gland
Hand
Costs and Cost Analysis
Serum
Neoplasms
Therapeutics

Keywords

  • Acromegaly
  • Growth hormone
  • MRI negative
  • Pituitary microadenoma
  • Transsphenoidal pituitary exploration

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Acromegaly with negative pituitary MRI and no evidence of ectopic source : The role of transphenoidal pituitary exploration? / Daud, Sameera; Hamrahian, Amir; Weil, Robert J.; Hamaty, Marwan; Prayson, Richard A.; Olansky, Leann.

In: Pituitary, Vol. 14, No. 4, 01.12.2011, p. 414-417.

Research output: Contribution to journalArticle

Daud, Sameera ; Hamrahian, Amir ; Weil, Robert J. ; Hamaty, Marwan ; Prayson, Richard A. ; Olansky, Leann. / Acromegaly with negative pituitary MRI and no evidence of ectopic source : The role of transphenoidal pituitary exploration?. In: Pituitary. 2011 ; Vol. 14, No. 4. pp. 414-417.
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