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Brain/Pituitary Tumors Community
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PITUITARY MACROADENOMA

Hi, my husband recently found out that the approx. size of the enhancing mass was 2.2cm in longitudinal extent, 1.9cm AP and approx. 1.6cm in transverse diameter.  The mass extended superiorly into the suprasellar cistern and was slightly lobulated in appearance at its superior surfance.  The pituatary stalk itself could not be demonstrated on the sequences and the cavernous sinuses were well demonstrated with normal appearances and without involvement with the cavernous sinus.  The scans through the pituatary gland region does reveal the mass positioned within the pituatary fossa which was intermediate signal intensity on the T1 study, high signal intensity on the T2 study and did enhance fairly intensely with contrast medium on the post Gadolinium studies.  The internal carotid artery was well demonstrated within the cavernous sinuses.  Pse. explain how big is this tumour.  What is the best treatment option.  Regards, SHENAAZ


This discussion is related to Acromegaly My MRI results Please tell me what you think.
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Avatar universal
COMMUNITY LEADER
Hi there....
As far as pituitary tumors go, sadly this is on the larger side hence the *macro* adenoma call by the radiologist. I am only a layman (aka not a doc) so my read is not perfect but a guess - it says the tumor has grown up around the stalk (the stalk cannot be seen in the images) and the cavernous sinus is clear which is good.

I however cannot really tell if the tumor is near your optic chasm or if it is wrapped around the carotid - it does seem by what the report says the thing has pretty much filled the pituitary fossa which can be good in making it much easier to remove.

Treatments can vary based on type of tumor - has your husband done any blood, urine and/or saliva testing to determine the type of tumor? Some tumors can respond quite well to medications and the tumor can reduce in size with the medications and not require surgery or lower the risks in surgery.

Surgery may be the only option for certain types of tumors and if the tumor does not respond to medications (if that is an option). They should go through the nose and you should find a surgeon who is very very very very very skilled - as in has done more than 500 surgeries lifetime and more than 50 this year and has done quite a few of the macro tumors as they are more difficult and can have more potential for complications. Surgical skill is THE biggest factor in outcome of the patient - of course sometimes the anatomy of the tumor can work against him/her but you want the best to do it so don't mess around do all you can to get the #1 surgeon.

In the event that some of the tumor is left behind which is common in larger tumors where a surgeon cannot and should not get too close to say the carotids or the optic nerve, radiation is common. I would research the types and get the best type and not take what they have but what is best as the pituitary tumor is deep and some types do impact all tissues on the way in.

Please keep us posted on his health, type of tumor and let us know if you have more questions. There are resources in the health pages that may help. I also suggest you get copies of everything from MRIs to labs.
Avatar universal
Hi, thank u so much for your comment.  No tests have yet been done only mri scan.  Awaiting to see neuro by next week.  Tks, Shenaaz.
Avatar universal
COMMUNITY LEADER
I would not see a "neuro" for this - please seek out a neuro-endo at a pituitary center for the proper course of treatment. A neurologist is not properly trained to treat pituitary and may not suggest the proper routes.

This requires specialized treatments - try a university or larger hospital. A regular endo may *say* they treat pituitary, but they may or may not do it well - so you really need a pituitary center so that your husband gets the proper testing (testing needs to be at the proper time, lab error is a huge factor! it kept me from being diagnosed for years!) and monitoring after removal as these beasts can come back as well as he will almost surely need one or more hormone replacements for life, living and quality of life - this is not something to play with.
Avatar universal
OK thank you for your advice.  The s-prolactin results were 19.7 ng/ml.
Avatar universal
COMMUNITY LEADER
Without a range (every lab in every country differs) it makes it hard to tell! If that is elevated and that turns out to be the tumor, medications should be tried first as medications can (but not always) work on prolactinomas. There are two options (but may be three depending on your country that I know about).

They may want to debulk the tumor - but meds can work before surgery to reduce the size of the tumor as well. I would make sure that they do ALL the hormones as while prolactin can be elevated (or low), it can be the pressure of the tumor aka mass effect and not really the tumor. So it is important to get a really really good endo as well as the #1 surgeon around.
Avatar universal
Thank you so much for further advice.  Numerous blood tests were done today.  Hoping to get results tmrw.  Unfortunately in the Republic of South Africa, there is no Pituatary Centre, but I am trying to get an appointment at a good endocronologist.  I dont know if we have a neuro-endoc in this Country.  Will keep you informed.  Thanks.
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