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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2022; 83(02): e33-e38
DOI: 10.1055/s-0042-1749389
Case Report

Silent Corticotroph and Somatotroph Double Pituitary Adenoma: A Case Report and Review of Literature

Isabella L. Pecorari 
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Lakshmi Priyanka Mahali
3   Department of Endocrinology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Endocrinology, Montefiore Medical Center, Bronx, New York, United States
,
Abigail Funari
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
,
Roger Fecher
5   Department of Anatomic and Clinical Pathology, Albert Einstein College of Medicine, Bronx, New York, United States
6   Department of Anatomic and Clinical Pathology, Montefiore Medical Center, Bronx, New York, United States
,
Nisha Suda
3   Department of Endocrinology, Albert Einstein College of Medicine, Bronx, New York, United States
4   Department of Endocrinology, Montefiore Medical Center, Bronx, New York, United States
,
Vijay Agarwal
1   Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
2   Department of Neurological Surgery, Montefiore Medical Center, Bronx, New York, United States
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Abstract

Clinically silent double pituitary adenomas consisting of corticotroph and somatotroph cells are an exceedingly rare clinical finding. In this report, we present the case of a 28-year-old man with a 1-year history of recurrent headaches. Imaging revealed a 2.1 (anterior-posterior) × 2.2 (transverse) × 1.3 (craniocaudal) cm pituitary adenoma invading into the left cavernous sinus and encasing the left internal carotid artery. Endoscopic transnasal resection was performed without complications. Immunohistochemical staining revealed a double adenoma consisting of distinct sparsely granulated somatotroph and densely granulated corticotroph cells that were positive for growth hormone and adrenocorticotropic hormone, respectively. Ki-67 index labeling revealed a level of 6% within the corticotroph adenoma. No increase in serum growth hormone or adrenocorticotropic hormone was found, indicating a clinically silent double adenoma. While transsphenoidal surgery remains a first-line approach for silent adenomas presenting with mass effects, increased rates of proliferative markers, such as the Ki-67 index, provide useful insight into the clinical course of such tumors. Determining the Ki-67 index of silent pituitary adenomas could be valuable in predicting recurrence after initial surgical resection and identifying tumors that are at an increased risk of needing additional therapeutic interventions or more frequent surveillance imaging.

Keywords

double pituitary adenoma - somatotroph - corticotroph - Ki-67


Publication History

Received: 17 November 2021

Accepted: 29 March 2022

Article published online:
27 May 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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