- What is the diagnosis?
This is a pituitary adenoma. There is a monotonous appearance of small round cells seen at low power (image 6.1). At high power (image 6.2) can be seen the bland appearance of the nuclei and the vascular nature of this neoplasm, typical for endocrine neoplasms.
- Why did this lesion present such clinical symptoms?
Some symptoms such as headache and visual field disturbances result just from the pressure effects of this neoplasm growing in the sella turcica.
- Why did the lesion seen in image 6.3 not produce any symptoms, while the lesion in image 6.4 did?
The lesion in image 6.3 is a tiny "microadenoma" too small to produce pressure symptoms and probably secreting prolactin, which would not necessarily have clinically identifiable effects in a man. The "macroadenoma" in image 6.4 would destroy the sella turcica and compress surrounding structures such as the optic chiasm, leading to headaches and visual disturbances.
- What are some other syndromes associated with lesions of this
nature?
Amenorrhea-galactorrhea and infertility can occur from prolactin secretion in a woman, acromegaly can result from growth hormone secretion, Cushing disease from corticotropin secretion, and hyperthyroidism from TSH secretion.
- What can be done for therapy?
Many symptomatic prolactinomas will respond to therapy with bromocriptine, a dopamine agonist that suppresses prolactin secretion and often reduces the size of the tumor. Resection of tumors that are symptomatic from mass effect or other hormone secretion can be resected, often by a transsphenoidal route
