Endocrine Abstracts

Introduction: Pituitary neuroendocrine tumors (PitNET) represent 15.5% of primary brain tumors and they can be clinically functioning or non-functioning. Although they are mostly benign, PitNET may be invasive in 30-45% of cases and aggressive in at least 15%. Here, we report the case of a patient who presented a multiple and rapid recurrence of a non-functional pituitary macroadenoma.

Observation: A 42-year-old man was admitted initially for headaches, monocular blindness and Knosp grade 3A macrodenoma on MRI. Biochemial analysis didn’t reveal hormones deficiencies nor hypersecretions. He underwent a transphenoidal resection with a visual improvement. Histologic diagnosis was a null cell adenoma with Ki67 index = 4% and a positive p53. Based on the new classification of PitNET, it was proliferative and invasive tumor, classsified garde 2b. Six months later, he deveolpped a tumor regrowth with visual impairment (diplopia), for which he underwent a partiel resection and an adjuvant radiotherapy was planned. Before starting the radiotherapy, he was readmitted 6 months later for a complete ptosis of the right eye and an increase in size of his non-functionning pituitary macroadenoma.

Discussion: This case showed that invasive and proliferative non-functionning pituitary adenomas can have an unpredictable rapid recurence and an agressive behaviour than usual. Null cell adenoma are known to be more aggressive than the other types of tumors with a mean time to recurrence of 15.9 months. In our case, the time to recurrence was 6 months only between the first and second surgeries. Selecting the high risk of recurrence tumors is essential to avoid their impacts and to improve the quality of life of patients.