Diagnosis and Treatment > Investigation > Gonadotrophins

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Ramez Ibrahim Royal Hallamshire Hospital, Sheffield, UK

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Atul Kalhan University Hospital of Wales, Cardiff, UK

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Alistair Lammie Cardiff University, Cardiff, UK

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Christine Kotonya Bronglais Hospital, Aberystwyth, UK

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Ravindra Nannapanenni University Hospital of Wales, Cardiff, UK

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Aled Rees Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, UK

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Summary

A 30-year-old female presented with a history of secondary amenorrhoea, acromegalic features and progressive visual deterioration. She had elevated serum IGF1 levels and unsuppressed GH levels after an oral glucose tolerance test. Magnetic resonance imaging revealed a heterogeneously enhancing space-occupying lesion with atypical extensive calcification within the sellar and suprasellar areas. Owing to the extent of calcification, the tumour was a surgical challenge. Postoperatively, there was clinical, radiological and biochemical evidence of residual disease, which required treatment with a somatostatin analogue and radiotherapy. Mutational analysis of the aryl hydrocarbon receptor-interacting protein (AIP) gene was negative. This case confirms the relatively rare occurrence of calcification within a pituitary macroadenoma and its associated management problems. The presentation, biochemical, radiological and pathological findings are discussed in the context of the relevant literature.

Learning points

  • Calcification of pituitary tumours is relatively rare.

  • Recognising calcification in pituitary adenomas on preoperative imaging is important in surgical decision-making.

  • Gross total resection can be difficult to achieve in the presence of extensive calcification and dictates further management and follow-up to achieve disease control.

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