Tags

Type your tag names separated by a space and hit enter

[Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report].
No Shinkei Geka. 2002 Jun; 30(6):623-8.NS

Abstract

OBJECTIVE

We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos.

CASE

This 70-year-old woman presented an ophthalmologist with progressive left-sided exophthalmos over the previous 2 months. Bone window CT scan revealed extensive bony destructions of the skull base including the clivus, sphenoid sinus and medial aspect of the middle cranial fossa. Gd-DTPA MRI revealed an abnormal enhancement lesion in the sphenoid sinus, but no abnormal enhancement was seen in the sella turcica. Since these findings suggested malignant tumors of the cranial base, several biopsies through the transnasal route were carried out to confirm the diagnosis. This procedure caused the complication of cerebrospinal fluid (CSF) leakage. Because the biopsy specimen revealed a PRL producing adenoma (serum PRL-level 645.7 ng/ml), the patient was admitted to our department. On admission neurological examination showed an exophthalmos with external ocular movement disorders and disturbance of visual acuity on the left side. She underwent transsphenoidal surgery to remove the tumor and to reconstruct the sphenoid sinus and the sellar floor. Surgical exploration revealed a yellowish and soft tumor underneath the normal mucous membrane in the sphenoid sinus. The sellar floor was destructed extensively, but the dura mater of the pituitary fossa was intact except for a small pin-hole which was thought to be produced during the several biopsy procedures. No surgical procedure was applied to the intrasellar region. The sphenoid sinus was packed with a piece of fascia and fat applied with the aid of fibrin glue to prevent CSF leakage.

RESULT

The patient followed a satisfactory postoperative course. Her visual acuity disturbance and exophthalmos disappeared one year after surgery. Postoperative serum PRL level remained high (66.9 ng/ml), but, subsequently, was normalized (9.5 ng/ml) with a bromocriptine therapy (15 mg daily).

CONCLUSION

As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos.

Authors+Show Affiliations

Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article
Review

Language

jpn

PubMed ID

12094689

Citation

Sakakibara, Yohtaro, et al. "[Unilateral Exophthalmos Caused By a Prolactin Producing Ectopic Pituitary Adenoma: Case Report]." No Shinkei Geka. Neurological Surgery, vol. 30, no. 6, 2002, pp. 623-8.
Sakakibara Y, Sekino H, Taguchi Y, et al. [Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report]. No Shinkei Geka. 2002;30(6):623-8.
Sakakibara, Y., Sekino, H., Taguchi, Y., & Tadokoro, M. (2002). [Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report]. No Shinkei Geka. Neurological Surgery, 30(6), 623-8.
Sakakibara Y, et al. [Unilateral Exophthalmos Caused By a Prolactin Producing Ectopic Pituitary Adenoma: Case Report]. No Shinkei Geka. 2002;30(6):623-8. PubMed PMID: 12094689.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Unilateral exophthalmos caused by a prolactin producing ectopic pituitary adenoma: case report]. AU - Sakakibara,Yohtaro, AU - Sekino,Hiroaki, AU - Taguchi,Yoshio, AU - Tadokoro,Mamoru, PY - 2002/7/4/pubmed PY - 2002/7/13/medline PY - 2002/7/4/entrez SP - 623 EP - 8 JF - No shinkei geka. Neurological surgery JO - No Shinkei Geka VL - 30 IS - 6 N2 - OBJECTIVE: We report a case of a patient with a prolactin (PRL) producing ectopic pituitary adenoma presenting a unilateral exophthalmos. CASE: This 70-year-old woman presented an ophthalmologist with progressive left-sided exophthalmos over the previous 2 months. Bone window CT scan revealed extensive bony destructions of the skull base including the clivus, sphenoid sinus and medial aspect of the middle cranial fossa. Gd-DTPA MRI revealed an abnormal enhancement lesion in the sphenoid sinus, but no abnormal enhancement was seen in the sella turcica. Since these findings suggested malignant tumors of the cranial base, several biopsies through the transnasal route were carried out to confirm the diagnosis. This procedure caused the complication of cerebrospinal fluid (CSF) leakage. Because the biopsy specimen revealed a PRL producing adenoma (serum PRL-level 645.7 ng/ml), the patient was admitted to our department. On admission neurological examination showed an exophthalmos with external ocular movement disorders and disturbance of visual acuity on the left side. She underwent transsphenoidal surgery to remove the tumor and to reconstruct the sphenoid sinus and the sellar floor. Surgical exploration revealed a yellowish and soft tumor underneath the normal mucous membrane in the sphenoid sinus. The sellar floor was destructed extensively, but the dura mater of the pituitary fossa was intact except for a small pin-hole which was thought to be produced during the several biopsy procedures. No surgical procedure was applied to the intrasellar region. The sphenoid sinus was packed with a piece of fascia and fat applied with the aid of fibrin glue to prevent CSF leakage. RESULT: The patient followed a satisfactory postoperative course. Her visual acuity disturbance and exophthalmos disappeared one year after surgery. Postoperative serum PRL level remained high (66.9 ng/ml), but, subsequently, was normalized (9.5 ng/ml) with a bromocriptine therapy (15 mg daily). CONCLUSION: As far as we are aware, this is the first case report of an ectopic pituitary adenoma causing unilateral exophthalmos. Although it is extremely rare, pituitary adenomas should be kept in mind in a differential diagnosis of exophthalmos. SN - 0301-2603 UR - https://www.unboundmedicine.com/medline/citation/12094689/[Unilateral_exophthalmos_caused_by_a_prolactin_producing_ectopic_pituitary_adenoma:_case_report]_ L2 - https://www.diseaseinfosearch.org/result/9688 DB - PRIME DP - Unbound Medicine ER -