Be careful... She has a pituitary gland in her nose

Abstract

In this case report we describe a 38 year-old-female with galactorrhea several months after the birth of an anencephalic child. She had hyperpolactemia and imaging of the pituitary gland revealed a midline defect and a nasopharyngeal mass compatible with a meningo-(hypophyso-) encephalocele and possibly an ectopic teratoma or desmoid. She was treated with dopamine agonists for 10 years and after cessation of therapy her prolactin levels remain normal. The nasopharyngeal mass remained unchanged over time and there were no signs of hypopituitarism. The hyperprolactinemia at presentation was probably caused by earlier pregnancy and stalk dysfunction due to traction by the mass. With decline of pituitary size, after starting dopamine agonists, the traction probably reduced resulting in a normal prolactin level. Our patient was warned against manipulation in de nose, because this could damage the meningo-encephalocele. An MRI will be preformed every 2 years to monitor changes in de mass.

Fig. 1

Midsagittal computer tomography of the head. A heterogeneous nasopharyngeal mass (green arrow) is seen cranially connected by a channel. In this channel a calcified object can be seen (red arrow)

Fig. 2

Midsagittal T1SE MR image after contrast administration of the head. A lesion is seen extending from the hypophyseal region through a bony channel into the nasopharyngeal region (light blue arrow). Linear calcification is seen (dark blue arrow)

Fig. 3

Anterior rhinoscopy; Naso-pharyngeal mass