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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 186--187

Clival tumor presenting with acromegaly

Subhas Konar1, Bhavathula Indira Devi1, TC Yasha2, Dhaval P Shukla1,  
1 Department of Neurosurgery, NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore - 560 029, India
2 Department of Neuropathology, NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore - 560 029, India

Correspondence Address:
Dhaval P Shukla
Department of Neurosurgery, NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore - 560 029
India




How to cite this article:
Konar S, Devi BI, Yasha T C, Shukla DP. Clival tumor presenting with acromegaly.Neurol India 2013;61:186-187


How to cite this URL:
Konar S, Devi BI, Yasha T C, Shukla DP. Clival tumor presenting with acromegaly. Neurol India [serial online] 2013 [cited 2020 Oct 29 ];61:186-187
Available from: https://www.neurologyindia.com/text.asp?2013/61/2/186/111150


Full Text

Sir,

A 51-years-old lady presented with coarsening of facial features and amenorrhea since 20 years. She presented with voice change and visual blurring of three months duration. She had features of acromegaly. Examination of ocular fundi showed bilateral optic atrophy and visual acuity was 4/60 in right eye and 6/36 in left eye. Serum growth hormone (GH) was 96 ng/ml and other hormonal profile was normal. Magnetic resonance imaging (MRI) of brain showed a tumor in clivus, sphenoid and left ethmoid sinuses with extension into cavernous sinus till orbital apex, and sella. The tumor was isointense on T1-weighted and T2-weighted images with some areas of blooming on gradient sequences. Pituitary gland was not seen separately [Figure 1]. As she had clinical features of acromegaly for 20 years without visual dysfunction, we presume that the tumor origin was primarily in clivus and then invaded all around. She underwent microscopic transnasal-transsphenoidal decompression of tumor. The tumor could not be removed totally because of multi-compartmental extension. Serum GH level fell to 48 ng/ml in immediate post-operative period. Histology and immunohistochemistry of the excised lesion revealed GH secreting pituitary adenoma [Figure 2]. Except for CSF rhinorrhea, which was managed with lumbar drain, her post-operative period was uneventful and she was sent for radiotherapy for residual tumor.{Figure 1}{Figure 2}

The location of majority of ectopic pituitary tumors is in the sphenoid sinus, cavernous sinus or nasopharynx. [1],[2],[3] Primary clival location is described in only few cases. The majority of ectopic pituitary tumors are biochemically active, secreting adrenocorticotrophic hormone (ACTH) or prolactin (PRL). [1] The GH secreting clival pituitary adenoma is rare [Table 1]. [1],[2],[3],[4] Surgery is required to confirm diagnosis and reduce GH burden in ectopic tumors, which was performed in the majority of reported patients, as well as in our patient. In one report, the ectopic GH secreting adenoma was managed successfully with medical therapy. [4] However, in the absence of clinical and laboratory evidence of hormone hypersecretion, the location and radiologic appearance of ectopic pituitary adenomas can mimic a variety of skull base lesions including chordomas, meningiomas, germ cell tumors, lymphoma and metastases. In such cases surgery should always be done, and tissue should be subjected to immunohistochemistry for neuroendocrine markers and pituitary markers for diagnosis of ectopic pituitary adenomas.{Table 1}

References

1Choi JH, Park MK, Choi SS, Kim KU. Ectopic Growth Hormone-Secreting Pituitary adenoma of the Clivus. J Korean Neurosurg Soc 2006;39:306-9.
2Bhatoe HS, Kotwal N, Badwal S. Clival pituitary adenoma with acromegaly: Case report and review of literature. Skull Base 2007;17:265-8.
3Appel JG, Bergsneider M, Vinters H, Salamon N, Wang MB, Heaney AP. Acromegaly due to an ectopic pituitary adenoma in the clivus: case report and review of literature. Pituitary 2012;15(Suppl 1):S53-6.
4Ferraz-Filho JR, Torres US, Teixeira AC, Castro ML, Dias MA. Ectopic growthhormone-secreting pituitary adenoma involving the clivus treated with octreotide: Role of magnetic resonance imaging in the diagnosis and clinical follow-up. Arq Neuropsiquiatr 2012;70:744-5.