SUPRAORBITAL CRANIOTOMY APPROACH IN ENDOCRINE-INACTIVE PITUITARY ADENOMAS
A non-functioning pituitary adenoma is one of the most common endocrine tumors with a benign pattern in the majority of cases. We present the case of a 69 years old female admitted to the endocrinology department for visual field defects, dizziness, memory disorder, bradylalia, bradypsychia. During the medical examination, the patient presented a syncopal event, with abundant sweating and temporo-spatial disorientation. Magnetic Resonance Imaging revealed a pituitary macroadenoma of 23/33.3/37 mm with two spherical lesions overlapped (“snowman” shape), with mass effect on the cavernous sinuses extending to the posterior wall of the left sphenoid sinus. Visual field examination showed significant narrowing to both eyes. The hormonal profile revealed gonadotropic insufficiency and low Insulin-like Growth Factor 1 with normal prolactin and cortisol levels. Thyroid hormonal evaluation highlighted primary hypothyroidism due to autoimmune thyroiditis. Two weeks later, adenomectomy was performed by supraorbital craniotomy. After discharge, she received the thyroid hormone replacement therapy initiated preoperatively and specific therapy for associated pathology: diabetes mellitus type 2, osteoporosis, and hyperlipidemia. Pituitary surgery is the first line treatment for the majority of patients with symptomatic endocrine-inactive adenomas. A further multidisciplinary close check-up is periodically recommended.