Received date: June 06, 2015; Accepted date: June 08, 2015;Published date: June 16, 2015
Citation: Valea A, Carsote M (2015) From Headache to Aggressive Pituitary Macro Adenoma. Primary Health Care 5:i102. doi:10.4172/2167-1079.1000i102
Copyright: © 2015 Valea A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Pituitary macroadenomas (PM) are rare, slowly growing tumors. The clinical onset is related to pituitary insufficiency symptoms, visual field defects, headache, etc .
We present an unusual case of PM with a very low clinical profile despite the large volume.51-year male with irrelevant medical history accused mild headache from time to time since the last several years. He did not ask for a clinical examination and decided to take a general practitioner control only when he had a small seizure episode (absence type). Further neurological and then imagery scan pointed a large pituitary mass of 7 by 4 centimeters (cm) with lateral and supra- sellar extension (up to the level of third ventricule) (Figure 1). The endocrine assays showed mild central hypothyroidism and hypogonadism associated with non-specific complains that the patient ignored up to this moment (Table 1). After transfenoidal hypophysectomy the pathological report confirmed the pituitary adenoma with an imunohistochemistry Ki67 proliferation index of 10%. Close follow-up was recommended.
|FSH (Follicle Stimulating Hormone)||3||1.5-12.4||mUI/mL|
|Total plasma testosterone||8.5||9.9-27||nmol/L|
|TSH (Thyroid Stimulating Hormone)||1||0.5-4.5||µIU/mL|
|IGF1(Insulin Growth Factor 1)||78||66-225||ng/mL|
|Morning plasma ACTH (Adrenocorticotrophic hormone)||24||3-46||pg/mL|
|Plasma morning cortisol||120||171-536||nmol/L|
Table 1: The endocrine parameters in a newly discovered pituitary mass: mild secondary hypothyroidism and hypogonadism.
Aggressive pituitary features are indicated by the large diameters and a high Ki67 value (more than 1% in this type of tumors); and also by male sex, supra- sellar and cavernous sinus invasion . Despite the fact than one third of hyphophyseal tumors associated headache the diagnosis may be delayed .
This case highlights the importance of health care and education in presenting for a routine medical control even in cases of unspecific complains as headache.
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