A friend with persistent Cushing's had her fourth pituitary surgery this past Monday. The neurosurgeon found an 8-9 mm tumor in her sinus cavity that was definitely a Cushing's tumor. This trouble spot had a tail of tissue trailing back to her pituitary to a small spot of abnormal cells.
The neurosurgeon believes that just a few microscopic cells fell during her first pituitary surgery and started a growth of abnormal ACTH cells that caused her Cushing's. The patient had this abnormality in her sinus MRI and no doctor related it to her prior history of transsphenoidal pituitary resection. In fact, pervious pituitary surgeries, while done transsphenoidally (across the sphenoid sinus), were done sublabial (under the lip). This surgery was done endoscopically or through the nose, and this offered the surgeon visual access to the tumor that may have been hiding there since her first pituitary surgery 20 years prior.
Several other Cushies with persistent Cushing's have commented since Monday that they too have a "cyst" in their sinus cavity. Many will now ask their neurosurgeons to examine these suspicious areas more closely as possible source of abnormal ACTH cells which cause Cushing's.
****
A case of ectopic pituitary adenoma occurring in the sphenoid sinus
Neurological surgery (2011)
Abstract
Ectopic pituitary adenomas are relatively rare tumors. We present a case of ectopic pituitary adenoma occurring in the sphenoid sinus. A 63-year-old woman was referred to our hospital complaining of headache. She had no endocrinological abnormalities. Magnetic resonance imaging showed a tumor in the sphenoid sinus, adjacent to the sellar floor and appearing as a low-signal on T1-weighted image and a high signal on T2-weighted image. No connection between the normal pituitary gland and tumor was observed. Using an endonasal-transsphenoidal approach assisted with neuro-endoscopy, we performed total removal of the tumor. No connection between the normal pituitary gland and the tumor was found. Histopathological analysis showed a pituitary adenoma. As demonstrated by our case report, differential diagnosis of a tumor occurring in the sphenoid sinus must include consideration of the existence of an ectopic pituitary adenoma.
