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Primary Healthcare: Open Access
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From Headache to Aggressive Pituitary Macro Adenoma

Ana Valea1 and Mara Carsote2*

1Iuliu Hatieganu University of Medicine and Pharmacy & Clinical Country Hospital, Cluj-Napoca, Romania

2Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania

Corresponding Author:
Mara Carsote
Carol Davila University of Medicine
and Pharmacy & C.I. Parhon National Institute
of Endocrinology, Bucharest, Romania
Tel: +40213172041
E-mail: [email protected]

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 Macroadenoma; Headache; Ki67.

Pituitary macroadenomas (PM) are rare, slowly growing tumors. The clinical onset is related to pituitary insufficiency symptoms, visual field defects, headache, etc [1].

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.


Figure 1: Magnetic Resonance Imagery showing a pituitary adenoma of 7 by 4 cm in an adult male; transverse plane at different levels (yellow arrow).

Parameter Level Normal ranges Units
FSH (Follicle Stimulating Hormone) 3 1.5-12.4 mUI/mL
Total plasma testosterone 8.5 9.9-27 nmol/L
Prolactin 90 98-456 µIU/mL
TSH (Thyroid Stimulating Hormone) 1 0.5-4.5 µIU/mL
FreeT4 9 10.6-22.7 pmol/L
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 [2]. Despite the fact than one third of hyphophyseal tumors associated headache the diagnosis may be delayed [3].

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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