Endocrine Abstracts

Introduction: Since aggressive pituitary tumors are rare, there are no clear guidelines considering treatment of these tumors. A wide range of treatments have been used, with various success.

Case report 1: A 58-year old lady presented with sudden severe headache and ptosis of the left eye. MRI revealed an expansive intrasellar, suprasellar and bilateral parasellar process with extension to the skull base which was inaccessible for neurosurgery. Pituitary function was intact, with IGF1 slightly above the normal range. A transsphenoidal biopsy was performed, which revealed a pituitary tumor with accompanying necrosis, negative on immunohistochemical staining for pituitary hormones. Octreotide scintigraphy confirmed the presence of somatostatin receptors in the tumor. Treatment with octreotide LAR and cabergoline was initiated. After 3 years of treatment, the patient is in a very good shape with normal pituitary function and reduced size of the tumor on control MRI.

Case report 2: A 55-year-old patient had been transcranially operated because of a large non-secreting pituitary adenoma. Because of tumor regrowth, two reoperations followed 7 and 12 years after the first. Patohistology revealed a pituitary tumor with central necrosis and bone infiltration. At that point elevated levels of serum alkaline phosphatase were observed. Bone scintigraphy revealed numerous osteoblastic metastases, which were confirmed to originate from the pituitary tumor by bone biopsy. The presence of somatostatin receptors in the tumor and metastases was confirmed by octreotide scintigraphy. After 2 years of treatment with zoledronic acid and octreotide LAR (both once monthly), the patient is clinically stable with no further tumor growth on control MRI and the same status of bone metastases on scintigraphy.

Conclusion: We report an aggressive pituitary adenoma and a pituitary carcinoma that were successfully managed by medical treatment. This implies that in such cases medical treatment should be considered before proceeding to more aggressive treatment modalities.