The son of the patient came 7 days ago, telling that his father after diarrhea attack got fainting and headache. CT-scan performed to him showed sellar mass.

MRI of the sella with endocrine and visual functions were performed and a huge chromophobe pituitary adenoma with massive infrasellar extension and compressing the chiasm upward and the pituitary stalk posteriorly. Bitemporal hemianopsia with panhypopituitarism were identified. The patient is not known to have diabetes mellitus nor arterial hypertension. He is claiming that he has headache for more than 10 years and not noticing the visual defects.

The son was urging not to tell his father about the tumor, for what his request was accepted.

Trans-sphenoidal approach through the left nostril was performed and using image-intensifier the retractors were inserted anterior to the sphenoid sinus, which was drilled and opened. The floor of the widened sella was opened and the pituitary gland was exposed 10X10 mm.  The tumor was opened and removal of the friable tumor was done. Some fragments were sent for biopsy and the remaining parts were sucked easily. It was possible to see the wall of the tumor cavity, which is actually is the pituitary gland. Insertion of Omnipaque to the tumor bed was performed and check was performed with image-intensifier. Further insertion of the contrast to the sphenoid sinus was done to rule out the presence of considerable remnants. No CSF leak was noted during the procedure.

Routine closure of the wound and smooth postoperative recovery and the patient sent to the ward.

The tumor could be coincidental finding during investigation for diarrhea, but considering that it has huge volume with signs of panhypopituitarism and visual defects, surgery was indicated.

Frontal lobe syndrome could have place, since the patient was sent to the theater to wash the wax from his ear, as urged his son, this hold the suspicion of frontal lobe syndrome, because a patient with normal frontal lobes will ask many times, why to wash the wax under G.A. and from the nose?

For more information about pituitary adenomas click here!