Endocrine Abstracts

Introduction: Ectopic pituitary adenomas (EPAs) are extremely rare intracranial tumors. Since 1909, few cases has been reported in the literature. We report a case of clivus prolactinoma.

Case report: A 52-year-old women with a history of infertility, presented one year ago at the emergency with headaches and a sudden decreased visual acuity. The pituitary MRI revealed an arachnoidocele, pituitary adenoma of the left cavernous lodge measuring 20×18×17 mm, with ectopic development in the clivus. Pituitary workup showed a hyperprolactinemia at 225 ng/ml, a cortisol level 60 min after synacthen at 517.3 nmol/l, but a peripheral hypothyroidism with a high TSH level at 9.6 μUI/ml and a low FT4 level at 12.2 pmol/l normal range (12–22). The evolution was marked by a spontaneous resolution of hedaches and total visual recovery. Thus, a medical treatement was decided. The patient has recieved dopamin agonists with prolactin normalisation but persistance of the same tumor’s size.

Conclusion: Clival tumors represent 1% of intracranial neoplasms. EPAs are thought to originate from remnants of the embryological migratory path of the pituitary gland. In the literature review, the most diagnostic presentation of clival adenomas are headache. Focal neurological deficits can be seen in case of the compression of adjacent structures. Clival adenomas are functional in 75% of cases, prolactin-secretion is the most frequent. Pharmacotherapy is the first line treatment but the results are discordants.