Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature

doi:10.1007/s40618-022-01758-x

Case Reports

. 2022 Aug;45(8):1465-1481.

doi: 10.1007/s40618-022-01758-x. Epub 2022 Feb 11.

Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature

C Campana^#¹, F Nista^#¹, L Castelletti², M Caputo^{3

4}, E Lavezzi⁵, P Marzullo^{3

6}, A Ferrero³, G Gaggero⁷, F R Canevari⁸, D C Rossi⁹, G Zona⁹, A Lania⁵, D Ferone^{1

10}, F Gatto¹¹

Affiliations

¹ Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.
² Department of Radiology, Ospedale di Lavagna, Lavagna, Italy.
³ Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
⁴ Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
⁵ Endocrinology Unit, IRCCS Humanitas Research Hospital and Humanitas University, Rozzano, Italy.
⁶ Laboratorio di Ricerche Metaboliche, IRCCS Istituto Auxologico Italiano, Piancavallo, Verbania, Italy.
⁷ Department of Clinical Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁸ Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.
⁹ Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹⁰ Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
¹¹ Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy. fedgatto@hotmail.it.

^# Contributed equally.

PMID: 35147925
DOI: 10.1007/s40618-022-01758-x

Case Reports

Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature

C Campana et al. J Endocrinol Invest. 2022 Aug.

. 2022 Aug;45(8):1465-1481.

doi: 10.1007/s40618-022-01758-x. Epub 2022 Feb 11.

Authors

Affiliations

¹ Endocrinology Unit, Department of Internal Medicine and Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy.
² Department of Radiology, Ospedale di Lavagna, Lavagna, Italy.
³ Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
⁴ Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.
⁵ Endocrinology Unit, IRCCS Humanitas Research Hospital and Humanitas University, Rozzano, Italy.
⁶ Laboratorio di Ricerche Metaboliche, IRCCS Istituto Auxologico Italiano, Piancavallo, Verbania, Italy.
⁷ Department of Clinical Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
⁸ Unit of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, Genoa, Italy.
⁹ Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
¹⁰ Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy.
¹¹ Endocrinology Unit, IRCCS Ospedale Policlinico San Martino, 16132, Genoa, Italy. fedgatto@hotmail.it.

^# Contributed equally.

PMID: 35147925
DOI: 10.1007/s40618-022-01758-x

Abstract

Purpose: Parasellar ectopic pituitary adenomas (pEPAs) are extremely rare tumors located out of the sella turcica. PEPAs are heterogeneous entities in terms of anatomical localization and secretion of anterior pituitary hormones.

Methods: Multicenter retrospective study. Clinical charts' consultation of patients diagnosed with parasellar lesions, to identify all subjects fulfilling the diagnostic criteria of parasellar EPAs. Systematic review of the literature focused on the medical management of prolactin-secreting pEPAs and on the prevalence of radiological bone invasion in pEPAs.

Results: We identified four cases of pEPAs: (1) 54-year-old female with a prolactin-secreting suprasellar EPA successfully treated with cabergoline; (2) 74-year-old male with a non-functioning EPA of the sphenoidal sinus treated with endoscopic transsphenoidal surgery; (3) 75-year-old female with a giant lesion of the skull base (maximum diameter 7.2 cm) diagnosed as a non-functioning EPA after biopsy; (4) 49-year-old male with a silent corticotroph EPA of the sphenoidal sinus and clivus. Three out of four cases had radiological evidence of invasion of the surrounding bone structures. A systematic review of the literature highlighted that medical therapy can be effective in prolactin-secreting pEPAs. Overall, we found mention of local invasiveness in 65/147 cases (44.2%), confirmed by radiological signs of bone invasion/erosion.

Conclusion: Our experience confirms the heterogeneity of pEPAs in terms of clinical and radiological presentation, as well as hormone secretion. PEPAs show a high frequency of radiological bone invasion, though similar to that of sellar pituitary adenomas. Although extremely rare, pEPAs need to be considered in the differential diagnosis of parasellar lesions.

Keywords: Bone invasion; Cabergoline; Ectopic; Pituitary adenomas; Prolactin.

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References

1. Vasilev V, Rostomyan L, Daly AF et al (2016) MANAGEMENT OF ENDOCRINE DISEASE: pituitary “incidentaloma”: neuroradiological assessment and differential diagnosis. Eur J Endocrinol 175(4):R171–R184. https://doi.org/10.1530/EJE-15-1272 - DOI - PubMed
1. Cuny T, Barlier A, Feelders R et al (2015) Medical therapies in pituitary adenomas: current rationale for the use and future perspectives. Ann Endocrinol (Paris) 76(1):43–58. https://doi.org/10.1016/j.ando.2014.10.002 - DOI
1. Shuman W, Loewenstern J, Pai A et al (2019) Variability in clinical presentation and pathologic implications of ectopic pituitary tumors: critical review of literature. World Neurosurg 122:397–403. https://doi.org/10.1016/j.wneu.2018.10.200 - DOI - PubMed
1. Gatto F, Perez-Rivas LG, Olarescu NC et al (2020) Diagnosis and treatment of parasellar lesions. Neuroendocrinology 110(9–10):728–739. https://doi.org/10.1159/000506905 - DOI - PubMed
1. Sasano N, Wakasa H (1963) Pituitary carcinoma presenting as nasopharyngeal tumors with reference to ectopic origin. A report of three cases. Tohoku J Exp Med 78:352–362. https://doi.org/10.1620/tjem.78.352 - DOI - PubMed

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[1] Vasilev V, Rostomyan L, Daly AF et al (2016) MANAGEMENT OF ENDOCRINE DISEASE: pituitary “incidentaloma”: neuroradiological assessment and differential diagnosis. Eur J Endocrinol 175(4):R171–R184. https://doi.org/10.1530/EJE-15-1272 - DOI - PubMed

[2] Vasilev V, Rostomyan L, Daly AF et al (2016) MANAGEMENT OF ENDOCRINE DISEASE: pituitary “incidentaloma”: neuroradiological assessment and differential diagnosis. Eur J Endocrinol 175(4):R171–R184. https://doi.org/10.1530/EJE-15-1272 - DOI - PubMed

[3] Cuny T, Barlier A, Feelders R et al (2015) Medical therapies in pituitary adenomas: current rationale for the use and future perspectives. Ann Endocrinol (Paris) 76(1):43–58. https://doi.org/10.1016/j.ando.2014.10.002 - DOI

[4] Cuny T, Barlier A, Feelders R et al (2015) Medical therapies in pituitary adenomas: current rationale for the use and future perspectives. Ann Endocrinol (Paris) 76(1):43–58. https://doi.org/10.1016/j.ando.2014.10.002 - DOI

[5] Shuman W, Loewenstern J, Pai A et al (2019) Variability in clinical presentation and pathologic implications of ectopic pituitary tumors: critical review of literature. World Neurosurg 122:397–403. https://doi.org/10.1016/j.wneu.2018.10.200 - DOI - PubMed

[6] Shuman W, Loewenstern J, Pai A et al (2019) Variability in clinical presentation and pathologic implications of ectopic pituitary tumors: critical review of literature. World Neurosurg 122:397–403. https://doi.org/10.1016/j.wneu.2018.10.200 - DOI - PubMed

[7] Gatto F, Perez-Rivas LG, Olarescu NC et al (2020) Diagnosis and treatment of parasellar lesions. Neuroendocrinology 110(9–10):728–739. https://doi.org/10.1159/000506905 - DOI - PubMed

[8] Gatto F, Perez-Rivas LG, Olarescu NC et al (2020) Diagnosis and treatment of parasellar lesions. Neuroendocrinology 110(9–10):728–739. https://doi.org/10.1159/000506905 - DOI - PubMed

[9] Sasano N, Wakasa H (1963) Pituitary carcinoma presenting as nasopharyngeal tumors with reference to ectopic origin. A report of three cases. Tohoku J Exp Med 78:352–362. https://doi.org/10.1620/tjem.78.352 - DOI - PubMed

[10] Sasano N, Wakasa H (1963) Pituitary carcinoma presenting as nasopharyngeal tumors with reference to ectopic origin. A report of three cases. Tohoku J Exp Med 78:352–362. https://doi.org/10.1620/tjem.78.352 - DOI - PubMed

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Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature

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Clinical and radiological presentation of parasellar ectopic pituitary adenomas: case series and systematic review of the literature

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