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Washington University Experience | NEOPLASM (SELLAR) | Pituitary Adenoma - Pituitary Neuroendocrine Neoplasm | Somatotroph | 3A0 Case 3 History
The patient is a 39-year-old man with carpal tunnel syndrome and hypertension, a work-up for which revealed acromegaly. The patient originally presented in 2012, when he had low testosterone levels and was reportedly found to have hyperprolactinemia. A macroadenoma was identified on imaging studies at that time. Since 2012, for two years the patient has been on a testosterone supplement. He developed gynecomastia in spring 2014. MR imaging performed in September 2014 shows a large sellar/suprasellar mass measuring 4.1 x 3.9 x 3.1 cm, causing mass effect on the optic chiasm, occupying the entire sella, extending to the right of midline encasing the right cavernous internal carotid artery and involving the right cavernous sinus. Laboratory work-up in August 2014 showed elevated GH of 50.6, elevated IGF-1 of 894 (normal, 53-331), elevated prolactin of 51.5 (normal 2-18), normal ACTH, FSH, TSH, and free T4. Visual field testing performed in early September 2014 shows left temporal hemianopsia and right superior temporal loss. Operative procedure: Endoscopic transnasal resection of pituitary adenoma.
