Endocrine Abstracts

Background: Pituitary adenomas are usually benign epithelial tumors and they are the most common cause of sellar masses from the third decade on, accounting for up to 10% of all intracranial neoplasms. Pituitary adenomas typically present with neurologic symptoms, clinical findings of hormonal abnormalities or as an incidental finding on magnetic resonance imaging (MRI). Double pituitary adenomas are very rare, and they account for 1% of all pituitary adenomas in autopsy series and up to 2% in large surgical series. In this case report we planned to present a case of double pituitary adenoma that was rare.

Case: A 53-year-old female patient was admitted to another center 6 years ago because of menstrual irregularity. Due to the high prolactin levels and the presence of pituitary adenoma on sella MRI, treatment with cabergoline 1 mg/week was started. The patient applied to our polyclinic after using the drup for one year. Patient complained of frequent menstrual irregularity when she referred to our outpatient clinic. She had no galactorrhea. Anterior pituitary hormone examinations revealed that prolactin was 73.3 ng/ml, LH was 5.4 mIU/ml, FSH was 13 mIU/ml, estradiol was 200 pg/ml and progesterone was <0.1 ng/ml. Other anterior pituitary hormones were normal. The sella MRI revealed a 5 mm sized adenoma. The patient was not considered as prolactinoma. Considering that the patient was in the premenopausal state, monitoring without medication was planned. Prolactin levels were gradually decreased in follow-up. After 1 year FSH: 46.7 mIU/ml, LH: 16 mIU/ml and PRL: 35 ng/ml were detected as compatible with menopause. Control sella MRI revealed a 4 mm sized adenoma that caused a convexity to the suprasternal cistern in the left pituitary gland. At the same time, another adenoma with a diameter of approximately 4 mm was observed in the right pituitary gland, near the cavernous sinüs. Monitoring of the patient without medication is continued.

Conclusions: Multipl pituitary adenomas are defined as simultaneous, morphologically or immunocytologically, distinct tumors. These tumors usually are microadenomas and most of them are clinically silent. Double or multiple pituitary adenomas confirmed by preoperative imaging or intraoperative exploration in particular, are considerably rare. MRI are able to identify multiple adenomas in only a few cases. Detailed preoperative imaging will prevent surgery failure in patients whom operation planned.