Dense calcification in a GH-secreting pituitary macroadenoma

Abstract

SummaryA 30-year-old female presented with a history of secondary amenorrhoea, acromegalic features and progressive visual deterioration. She had elevated serum IGF1 levels and unsuppressed GH levels after an oral glucose tolerance test. Magnetic resonance imaging revealed a heterogeneously enhancing space-occupying lesion with atypical extensive calcification within the sellar and suprasellar areas. Owing to the extent of calcification, the tumour was a surgical challenge. Postoperatively, there was clinical, radiological and biochemical evidence of residual disease, which required treatment with a somatostatin analogue and radiotherapy. Mutational analysis of the aryl hydrocarbon receptor-interacting protein (AIP) gene was negative. This case confirms the relatively rare occurrence of calcification within a pituitary macroadenoma and its associated management problems. The presentation, biochemical, radiological and pathological findings are discussed in the context of the relevant literature.Learning points Calcification of pituitary tumours is relatively rare.Recognising calcification in pituitary adenomas on preoperative imaging is important in surgical decision-making.Gross total resection can be difficult to achieve in the presence of extensive calcification and dictates further management and follow-up to achieve disease control.

Pituitary Stone or Calcified Pituitary Tumor? Three Cases and Literature Review

“…The prevalence of calcified pituitary adenomas varies from 0.2% to 14%. Lactotroph ( 3 , 5 , 8 ) and somatotroph adenomas ( 6 ) are the most concerned ones. Non-secreting and gonadotroph adenomas are seldom calcified ( 9 ).…”

“…Pituitary lithiasis may be asymptomatic and discovered accidentally with a normal pituitary function ( 2 ), or after exploration of an endocrine disorder such as gonadal abnormalities in adults and short stature in children. Hyperprolactinemia may be another occasion of discovery ( 6 ). In other cases, the pituitary stone may be discovered after developing neurologic symptoms such as acute headaches and/or vomiting suggestive of pituitary apoplexy ( 2 ) as in our second observation.…”

“…According to Brahim et al, somatotroph adenomas can also be calcified ( 6 ). Garg et al reported a calcified non-secreting adenoma ( 2 ).…”

“…Hyperprolactinemia, observed in people with pituitary calcifications, can be explained by stalk compression secondary to the calcification. The latter leads to obstruction of pituitary vessels and lack of dopamine inhibition ( 6 ). Nonfunctioning pituitary tumors can also be calcified totally or partially and induce hyperprolactinemia; this is why they are called pseudoprolactinomas ( 2 ).…”

Gigantism in a McCune-Albright’s syndrome with calcified GH-releasing pituitary adenoma: Case report and literature review

“…The hypersecretion of GH due to a pituitary hyperplasia or Pituitary Adenoma (PA) is a rare condition that only can be proven in 20–30% of patients with MAS [ [3] , [4] , [5] ]. On the other hand, the presence of a calcification in a PA is an uncommon feature that appears radiologically in 0.2–14% of the cases [ 6 , 7 ], and it has been slightly more common in the microscopic analysis, ranging from 5.4 to 25% [ 8 , 9 ]. Nevertheless, the presence of dystrophic calcification associated to PA is a very rare condition that has been described in 6.75% of the series [ 10 ], but never in the context of a MAS.…”