Hazra Darpanarayan, Chandy Gina Maryann, Chakraborty Indranil, Ghosh Amit
Department of Emergency Medicine, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India.
Department of Emergency Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
Asian J Neurosurg. 2024 Dec 20;20(2):362-366. doi: 10.1055/s-0044-1801282. eCollection 2025 Jun.
Ectopic pituitary adenoma (EPA) is an extraordinarily rare condition characterized by the presence of a pituitary adenoma outside the intrasellar region. Although EPA may share similarities with typical pituitary adenomas in morphology, radiological findings, immunohistochemistry, and hormonal activity, it can present with either nonspecific or specific endocrine symptoms. A 37-year-old female school teacher with persistent and worsening headaches underwent neuroimaging, which revealed a sizable extra-axial solid mass in the right parasellar region, extending into the cavernous sinus, base of the skull, and sphenoid sinus. This mass was initially indicative of a cavernous sinus meningioma. Laboratory investigations, including a pituitary hormone profile, yielded normal results. Despite the lack of typical symptoms, the patient underwent an elective right temporal craniotomy and subtotal tumor resection, which exposed both extra-axial and intra-axial components. Immunohistochemistry analysis confirmed the presence of a pituitary adenoma with atypical features. Postoperatively, the patient recovered well, and adjuvant stereotactic radiosurgery was used to address the residual lesion. During the 1-year follow-up, the patient remained free of symptoms. This case highlights the diagnostic complexities associated with nonfunctioning EPAs and underscores the importance of a comprehensive approach to ensure accurate diagnosis, effective treatment, and sustained patient well-being.
异位垂体腺瘤（EPA）是一种极为罕见的疾病，其特征是在鞍内区域以外存在垂体腺瘤。尽管EPA在形态、影像学表现、免疫组织化学和激素活性方面可能与典型垂体腺瘤有相似之处，但它可能表现为非特异性或特异性内分泌症状。一名37岁的女性学校教师，头痛持续且加重，接受了神经影像学检查，结果显示右侧鞍旁区域有一个较大的轴外实性肿块，延伸至海绵窦、颅底和蝶窦。这个肿块最初提示为海绵窦脑膜瘤。包括垂体激素水平检测在内的实验室检查结果正常。尽管缺乏典型症状，患者仍接受了择期右颞开颅手术及肿瘤次全切除术，术中发现了轴外和轴内成分。免疫组织化学分析证实为具有非典型特征的垂体腺瘤。术后患者恢复良好，采用辅助立体定向放射外科治疗残留病变。在1年的随访期间，患者无症状。该病例突出了无功能EPA诊断的复杂性，并强调了采用综合方法以确保准确诊断、有效治疗和患者持续健康的重要性。
