THE MULTIMODAL MANAGEMENT OF GROWTH HORMONE-SECRETING PITUITARY MACROADENOMA

Tabita Larisa Cazac1, Ioana Andreea Dărămuş1, C. D. Păunescu2

1The University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
2Department of Neurosurgery, The “Bagdasar-Arseni” Emergency Hospital, Bucharest, Romania

Corresponding author: Tabita Larisa Cazac
Phone no. 0040766323590
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Abstract

The expansive processes of the sellar region include tumors of mesenchymal, neural or epithelial origin, along with cystic and inflammatory processes. From the epithelial sellar tumors, almost 90 % are represented by pituitary adenomata – benign tumors which develop from the adenohypophyseal cells, accounting for approximately 10–15% of all intracranial expansive processes. According to the clinical criteria, the pituitary adenomata can be classified as endocrine-inactive or non-producing adenomata, and endocrine-active or producing adenomata. The non-producing adenomata represent approximately 39–50% of all pituitary tumors; the prolactinomata represent approximately 6.1%; the growth hormone producing adenomata approximately 27.9%; the adenocorticotropic hormone producing adenomata 6%; the thyrotropic producing hormone adenomata 0.4%; and the follicle-stimulating or luteinizing producing hormone adenomata are extremely rare. The surgical approach used on a large scale today in pituitary and suprasellar tumors is the transnasal transsphenoidal approach, which is less invasive compared to the standard transcranial approach and has got excellent results so far. The purpose of this article is to illustrate the main data about pituitary tumors, based on a case report presentation. At the same time, we aim to keep track of the latest information in the specialty literature, and focus on the neurosurgical aspects. The therapeutic strategy in the case of a 24-year-old female patient diagnosed with a growth hormone-secreting pituitary macroadenoma, with a suprasellar extension and an infrasellar one in the sphenoidal sinus and with invasion in the right cavernous sinus.

Keywords: cranial basis, transnasal transsphenoidal approach, sellar tumors, hypophysis, growth hormone (GH), acromegaly, gamma knife.

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