The Invasive A
Prolactin-Producing
Per Olov
Pituitary Adenoma
Tumor
Lundberg, MD; B\l=o"\rjeDrettner, MD;
Anders
Hemmingsson, MD; Bj\l=o"\rnStenkvist, MD;
\s=b\ Invasive pituitary adenoma was diagnosed by means of a transnasal aspiration biopsy method in 11 patients with extensive destruction of bone in the sellar region. In most cases the initial symptoms were decrease of libido and potency or amenorrhea-galactorrhea. Later, chiasmatic compression developed in six patients, ocular motor signs in two, and epilepsy in two. Most of the patients had symptoms for many years; in two, the tumor was discovered by chance. They all had very high serum-prolactin values. The patients were treated with irradiation, and the prognosis seems to be relatively favorable. (Arch Neurol 34:742-749, 1977)
the petrous apices and down into the clivus. The tumor grows in an infil¬ trating and destructive manner, but métastases seldom develop. The des¬ ignation "invasive adenomas of the pituitary" has therefore been sug¬ gested. Invasive adenomas have been described from the neurosurgical point of view by Jefferson.1 Large series of pituitary tumor patients usually contain a few cases of this type,2" but the clinical picture, endo¬ crinologie findings, and prognosis of these tumors are incompletely known. The diagnosis may be suspected from the skull x-ray film. Other tumors, however, such as métastases from
slow-
carcinoma, epipharyngeal carcinoma, and malignant chordoma, may have a
adenomas, usually Pituitary growing tumors, occasionally
start to grow in a more aggressive way. In such a case, the tumor's growth often does not take its usual course as a bulge up from the enlarged
sella turcica into the basal cisterns but instead destroys adjacent bone struc¬ tures. Laterally, it may involve the cavernous sinuses. It may extend into
Accepted
for publication March 21, 1977. From the Departments of Neurology (Dr Lundberg), Oto-Rhino-Laryngology (Dr Drett-
ner), Diagnostic Roentgenology (Dr Hemmingsson), Clinical Cytology (Dr Stenkvist), and Clinical Chemistry (Dr Wide), University Hospital, Uppsala, Sweden. Reprint requests to Department of Neurology, University Hospital, Fack, S-750 14, Uppsala, Sweden (Dr Lundberg).
similar
roentgenographic picture.7 A biopsy specimen obtained by a frontal craniotomy is described as being the only way to distinguish these differ¬ ent tumors.
For the last five years, the use of a transnasal aspiration biopsy method at the University Hospital, Uppsala, has made it possible to diagnose 11 cases of invasive pituitary adenomas. This has also given us the opportunity to study the characteristics of this tumor type. All the tumors were prolactin-producing, with extremelyhigh serum-prolactin values. The neu¬ roendocrine aspects and the clinical and roentgenographic picture of these tumors is discussed in this article.
Downloaded From: http://archneur.jamanetwork.com/ by a New York University User on 06/01/2015
Leif Wide, MD
METHODS Transnasal Skull-Base Puncture All the patients were investigated with a transnasal aspiration biopsy of the skull base by a previously described method." After mucosal anesthesia in one nasal cavity, a long, fine needle with a mandrin was introduced in the direction immedi¬ ately below the anterior part of the middle turbinate. The position of the needle was checked by television fluoroscopy in the lateral projection. When the skull base was completely invaded by the tumor, the needle passed without any pressure. Other¬ wise, the needle was rotated under gentle pressure until it passed through the walls of the sphenoid sinus into the tumor area in the region of the sella turcica. The needle was introduced about 1 cm into the tumor, with care taken not to reach the area of the chiasma (Fig 1, bottom right). Material for cytologie examination was obtained by aspiration. No complications from biopsy technique have so far occurred.
Assays Levels of prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), growth hormone (GH), and testosterone in serum were determined by radioimmunologic techniques. Prolactin in serum was measured by a radioimmunosorbent tech¬ nique using rabbit antihuman prolactin antibodies coupled to cyanogen bromideactivated Sephade particles."1" The FSH, Hormone
LH, TSH, and GH levels in serum were determined by a radioimmunosorbent as¬ say with indirectly coupled antibodies.11 The results of the FSH, LH, and GH assays
Fig 1.—Patient 4. Plain lateral roentgeno¬ graphic view of sellar region in 1971 (top left) and 1975 (top right). Note asymmetric enlargement of sella (top left) and exten¬
sive destructions of walls of sella and sphenoid sinus (top right). Diagnosis was made in 1975. Lateral pneumoencephalographic view in 1975 (bottom left) shows obliteration of the suprasellar cisterns by tumor, which is also affecting bottom of third ventricle (arrows). Bottom right, Lateral roentgenographic view shows as¬ piration needle in center of tumor.
Table 1 .—Normal Values of Some Blood Hormones and TRH and LH-RH Tests Women Hormone
Prolactin FSH LH
TSH GH Testosterone
Men
Prolactin-Producing
Per Olov
Pituitary Adenoma
Tumor
Lundberg, MD; B\l=o"\rjeDrettner, MD;
Anders
Hemmingsson, MD; Bj\l=o"\rnStenkvist, MD;
\s=b\ Invasive pituitary adenoma was diagnosed by means of a transnasal aspiration biopsy method in 11 patients with extensive destruction of bone in the sellar region. In most cases the initial symptoms were decrease of libido and potency or amenorrhea-galactorrhea. Later, chiasmatic compression developed in six patients, ocular motor signs in two, and epilepsy in two. Most of the patients had symptoms for many years; in two, the tumor was discovered by chance. They all had very high serum-prolactin values. The patients were treated with irradiation, and the prognosis seems to be relatively favorable. (Arch Neurol 34:742-749, 1977)
the petrous apices and down into the clivus. The tumor grows in an infil¬ trating and destructive manner, but métastases seldom develop. The des¬ ignation "invasive adenomas of the pituitary" has therefore been sug¬ gested. Invasive adenomas have been described from the neurosurgical point of view by Jefferson.1 Large series of pituitary tumor patients usually contain a few cases of this type,2" but the clinical picture, endo¬ crinologie findings, and prognosis of these tumors are incompletely known. The diagnosis may be suspected from the skull x-ray film. Other tumors, however, such as métastases from
slow-
carcinoma, epipharyngeal carcinoma, and malignant chordoma, may have a
adenomas, usually Pituitary growing tumors, occasionally
start to grow in a more aggressive way. In such a case, the tumor's growth often does not take its usual course as a bulge up from the enlarged
sella turcica into the basal cisterns but instead destroys adjacent bone struc¬ tures. Laterally, it may involve the cavernous sinuses. It may extend into
Accepted
for publication March 21, 1977. From the Departments of Neurology (Dr Lundberg), Oto-Rhino-Laryngology (Dr Drett-
ner), Diagnostic Roentgenology (Dr Hemmingsson), Clinical Cytology (Dr Stenkvist), and Clinical Chemistry (Dr Wide), University Hospital, Uppsala, Sweden. Reprint requests to Department of Neurology, University Hospital, Fack, S-750 14, Uppsala, Sweden (Dr Lundberg).
similar
roentgenographic picture.7 A biopsy specimen obtained by a frontal craniotomy is described as being the only way to distinguish these differ¬ ent tumors.
For the last five years, the use of a transnasal aspiration biopsy method at the University Hospital, Uppsala, has made it possible to diagnose 11 cases of invasive pituitary adenomas. This has also given us the opportunity to study the characteristics of this tumor type. All the tumors were prolactin-producing, with extremelyhigh serum-prolactin values. The neu¬ roendocrine aspects and the clinical and roentgenographic picture of these tumors is discussed in this article.
Downloaded From: http://archneur.jamanetwork.com/ by a New York University User on 06/01/2015
Leif Wide, MD
METHODS Transnasal Skull-Base Puncture All the patients were investigated with a transnasal aspiration biopsy of the skull base by a previously described method." After mucosal anesthesia in one nasal cavity, a long, fine needle with a mandrin was introduced in the direction immedi¬ ately below the anterior part of the middle turbinate. The position of the needle was checked by television fluoroscopy in the lateral projection. When the skull base was completely invaded by the tumor, the needle passed without any pressure. Other¬ wise, the needle was rotated under gentle pressure until it passed through the walls of the sphenoid sinus into the tumor area in the region of the sella turcica. The needle was introduced about 1 cm into the tumor, with care taken not to reach the area of the chiasma (Fig 1, bottom right). Material for cytologie examination was obtained by aspiration. No complications from biopsy technique have so far occurred.
Assays Levels of prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), growth hormone (GH), and testosterone in serum were determined by radioimmunologic techniques. Prolactin in serum was measured by a radioimmunosorbent tech¬ nique using rabbit antihuman prolactin antibodies coupled to cyanogen bromideactivated Sephade particles."1" The FSH, Hormone
LH, TSH, and GH levels in serum were determined by a radioimmunosorbent as¬ say with indirectly coupled antibodies.11 The results of the FSH, LH, and GH assays
Fig 1.—Patient 4. Plain lateral roentgeno¬ graphic view of sellar region in 1971 (top left) and 1975 (top right). Note asymmetric enlargement of sella (top left) and exten¬
sive destructions of walls of sella and sphenoid sinus (top right). Diagnosis was made in 1975. Lateral pneumoencephalographic view in 1975 (bottom left) shows obliteration of the suprasellar cisterns by tumor, which is also affecting bottom of third ventricle (arrows). Bottom right, Lateral roentgenographic view shows as¬ piration needle in center of tumor.
Table 1 .—Normal Values of Some Blood Hormones and TRH and LH-RH Tests Women Hormone
Prolactin FSH LH
TSH GH Testosterone
Men
