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CASE REPORT
Year : 2011  |  Volume : 8  |  Issue : 3  |  Page : 17-20

Asymptomatic invasive giant pituitary adenoma coincidentally associated with large multinodular goiter


Consultant Endocrine, Diabetes & Metabolic Physician, Jaslok Hospital & Research Centre, Mumbai, India

Correspondence Address:
V Gupta
Consultant Endocrine, Diabetes & Metabolic Physician, Jaslok Hospital & Research Centre, Mumbai
India
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Source of Support: None, Conflict of Interest: None


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Aim: The aim is to describe a very rare case of invasive giant benign pituitary adenoma that was noted incidentally during workup for large benign multinodular goiter. Results: The patient presented with an enlarged mass in the neck that was cosmetically disfiguring. There was no evidence of any compressive symptoms. The mass was felt to arise from the thyroid gland, nodular, firm without obvious lymph-adenoapthy Imaging studies revealed diffusely enlarged thyroid mass with large well marginated calcific mass involving left lobe displacing carotid sheath and extending superiorly causing compression of trachea. There was also small lcm sized non-necrotic lymph node at level 1 at right side of neck Histopathology revealed follicular adenoma on background of multinodular goiter .Coincidentally imaging studies revealed a large heterogeneous enhancing mass involving sella and suprasellar region with destruction of walls of sella extending into right cavernous sinus, pre-pontine cistern, sphenoid sinus and anteriorly into posterior ethmoid air cells bilaterally. Baseline pituitary functions were well preserved. Bitemoral hemianopia was seen on perimetry. Histopathology confirmed a benign non-functioning pituitary adenoma. The thyroid mass was surgically excised first followed by removal of pituitary mass. An initial unsuccessful transphenoidal approach to remove the pituitary mass was followed by transcranial approach. Post-operatively course was complicated by 3rd nerve palsy without any diabetes insipidus or hypopituitarism. Conclusion: Asymptomatic clinical presentation of the giant invasive pituitary adenoma is rare. The combination of two benign endocrine gland lesions is very rare.


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