Coexisting Pituitary Adenoma and Suprasellar Meningioma: A Coincidence or Causation Effect? Report of Two Cases and Review of Literature

Abstract

Background and Importance:The coexistence of pituitary adenoma and another type of brain tumor is a very rare clinical scenario. Even though such a presentation can be an incidental event but the possible pathogenesis of coexistence of different lesions in the sella and suprasellar region has not yet been elucidated. Case Presentation: Two cases of concomitant sellar and suprasellar region tumors are reported. A 37-year-old lady with Prolactinoma and a suprasellar meningioma and a 42-year-old Acromegalic man with suprasellar meningioma and a pituitary adenoma (PA). Conclusion Both meningiomas were removed transcranially while the Prolactinoma could be managed medically and the growth hormone (GH) secreting adenoma was removed trans-sphenoidally. The visual problems and hormonal imbalances of both patients improved postoperatively and there has been no sign of recurrence of the lesions after a mean of five years follow up. The literature is reviewed on this topic and the possible pathogenesis and management protocol of similar lesions are discussed.

Perfil Epidemiológico Acerca Da Morbimortalidade De Traumatismo Cranioencefálico Em Alagoas E No Nordeste Brasileiro

“…Even though meningiomas and PAs are among the most common types of brain tumors -15-25% and 10-23%, respectively -the coexistence of both is a rare clinical scenario. (MORTAZAVI et al, 2015).…”

“…The latter is a possible mechanism that may explain the growth of a meningioma due to GH-secreting PA, inducing arachnoid cap cells transformation into a meningioma. (MAIURI et al, 2005;MORTAZAVI et al, 2015;THEODROS et al, 2015).…”

Coexistence of GH-Producing Pituitary Macroadenoma and Meningioma in a Patient with Multiple Endocrine Neoplasia Type 1 with Hyperglycemia and Ketosis as First Clinical Sign

“…Radiotherapy is known to play a role in the appearance of intracranial tumors, but in cases such as ours, without prior exposition to radiotherapy, the origin is still unclear. Some authors suggest that it may happen by sheer chance, whereas others describe theories that may explain this association [ 8 , 10 ]. Suzuki et al suggest an involvement of the activation of signaling pathways for the receptor tyrosine kinases [ 12 ], and Friend et al showed that meningioma may express GH and IGF1 receptors [ 13 ].…”

“…Suzuki et al suggest an involvement of the activation of signaling pathways for the receptor tyrosine kinases [ 12 ], and Friend et al showed that meningioma may express GH and IGF1 receptors [ 13 ]. Although there are cases described in the literature of an association of meningioma with functioning and nonfunctioning pituitary adenomas, in the case of functioning adenomas, GH-producing varieties seem to predominate [ 9 , 10 , 14 ]. It remains to be seen whether GH itself or an overexpression of IGF1 receptors in these tumors induces a transformation into a meningioma.…”