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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Unusual coincidence of a pituitary adenoma and an aspergilloma of the sphenoid sinus

Meeting Abstract

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  • Hajrullah Ahmeti - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • Katharina Balschun - Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H. Maximilian Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • Andreas M. Stark - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 025

doi: 10.3205/14dgnc420, urn:nbn:de:0183-14dgnc4205

Published: May 13, 2014

© 2014 Ahmeti et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Pituitary adenomas account for approximately 10% of all intracranial neoplasms. We present a case with acute manifestation of pituitary adenoma and sphenoid sinus aspergilloma. Isolated aspergilloma of the sphenoid sinus is very rare, usually more than one paranasal sinus is affected. Coexistance might be caused by immodepression by elevated cortisol.

Method: We present a case of extraordinary rare coincidence of a hormonally inactive pituitary adenoma and aspergilloma of the sphenoid sinus treated by transphenoidal resection.

Results: A 60-year-old man presented with acute visual impairment. The patient reported restricted libido for several months. There was no history of immunosuppression. Neurological examination revealed acute vision impairment and a lateral visual-field defect on the right side. Magnetic resonance imaging (MRI) of the head showed pituitary adenoma with intratumoral bleeding and consecutive compression of the optic chiasm. Additionally mucosa swelling, possibly tumor extension was noticed within the sphenoid sinus. Hormonal analysis later showed a deficite of thyroid-stimulating hormone (TSH), cortisol and testosterone. The patient underwent emergency evacuation of the adenoma and the hematoma via a microsurgical transsphenoidal transnasal approach. Herein, the sella was still clearly separated from the sphenoid sinus by the bony sella floor, removed mucosa swelling turned out to be incidental aspergilloma. Antimycotics were applied for five weeks. Postoperative MRI revealed complete tumor resection. Histological examination revealed a hormonally inactive pituitary adenoma and an aspergilloma. Replacement therapy with L-thyroxine, hydrocortisone and testosterone was initiated. The postoperative course was normal. Visual impairment resolved completely.

Conclusions: The coincidence of pituitary adenoma and aspergilloma is extremely rare. However, it should be considered in cases with sphenoid sinus mucosal lesions as differential diagnosis to tumor extension. In our case, surgical resection of both lesions via a transsphenoidal approach was uncomplicated.