Abstract
A 22-year old woman who suffering from headache, visual disturbance and amenorrhea was admitted to our hospital. Enhanced magnetic resonance imaging revealed a suprasellar cysric tumor, 2×3×2.5cm in diameter, which was observed to be separated from the normal pituitary gland by the diaphragma sellae. The basal values of serum prolactin(PRL)and growth hormone(GH)were in the high range on the endocrinological examinations while the basal value of serum adrenocorticotropic hormone(ACTH), thyroid stimulating hormone(TSH), luteinizing hormone(LH)and follicle stimulating hormone(FSH)were all in the low range. Also each change in the concentration of these hormones showed poorly under the triple stimulation test using an intravenous injection of TRH(500μg), LH-RH(100μg)and human insulin(5 units). During the total removal of the tumor, we confirmed that the tumor was attached to the pituitary stalk and was clearly separated from the normal pituitary gland by the diaphragma sellae. The neuropathological examination of the tumor specimen showed positive for chromophobe pituitary adenoma using hematoxylin-eosin staining, and many tumor cells were also stained positively for PRL or GH by using an immunostaining technique. We concluded that this ectopic suprasellar pituitary adenoma originated from the pars tuberalis of the pituitary stalk and that many of the tumor cells produced PRL or GH. Postoperative endocrinological study indicated a slightly low level for the basal value of serum PRL and the change of serum PRL concentration under the triple stimulation test was poor. On the other hand, the basal values of GH, ACTH, TSH, LH and FSH improved to the normal range, and each change in the concentration of these hormones under the triple stimulation test was normal. The patient recovered from her headache and visual disturbance immediately after surgery, and she regained her regular menstruation at 6 months after surgery. Ectopic suprasellar pituitary adenomas are very rare, and we emphasize that the total removal of the ectopic pituitary functioning adenoma is necessary for neurological and endocrinological improvement.
