Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Book Review
Brief Report
Case Letter
Case Report
Case Series
Commentary
Current Issue
Editorial
Erratum
Guest Editorial
Images
Images in Neurology
Images in Neuroscience
Images in Neurosciences
Letter to Editor
Letter to the Editor
Letters to Editor
Letters to the Editor
Media and News
None
Notice of Retraction
Obituary
Original Article
Point of View
Position Paper
Review Article
Short Communication
Systematic Review
Systematic Review Article
Technical Note
Techniques in Neurosurgery
View/Download PDF

Translate this page into:

Letters to the Editor
6 (
3
); 460-462

Commentary

Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
Address for correspondence: Dr. Lorenzo Curtò, Department of Clinical and Experimental Medicine, Section of Endocrinology, University of Messina, AOU Policlinico “G. Martino” (Pad H, floor 4), Via Consolare Valeria, Messina 98125, Italy. E-mail: curto.loren@libero.it

Read COMMENTARY-ARTICLE associated with this -

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Brain diseases are often discovered in an incidental manner through high-resolution imaging techniques. In some cases, signs or symptoms are absent or not so relevant for the health of the patient while, in other cases, a correct, prompt diagnosis can be crucial for reducing the life-threatening consequences of diseases as in the case of cerebral vascular disease or brain tumor. In the last few years, the prevalence of incidentally discovered brain diseases has increased with the diffusion and technical improvement of high-resolution imaging techniques.

Patients with pituitary adenomas periodically undergo computed tomography (CT) or magnetic resonance imaging (MRI) of the brain, and association of the pituitary lesion with other brain diseases has been frequently reported in literature.

In the presence of concomitant brain morbidities (benign lesions, malignant neoplasms and vascular diseases), treatment must be tailored to the patient, but an adequate knowledge of these coexistences based on their location is an important precondition to planning a correct surgical approach, avoiding life-threatening hemorrhagic complications.

Brain diseases are often discovered incidentally through high-resolution imaging techniques. In some cases, signs or symptoms are absent or not so relevant for the health of the patient while, in other cases, a correct, prompt diagnosis can be crucial for reducing the life-threatening consequences of diseases as in the case of cerebral vascular disease or brain tumor. In the last few years, the prevalence of incidentally discovered brain diseases has increased with the diffusion and technical improvement of high-resolution imaging techniques.

Patients with pituitary adenomas periodically undergo CT or MRI of the brain, and association of the pituitary lesion with other brain diseases has been frequently reported in literature. In addition, an elevated co-prevalence of independent primary tumors has been found in patients with pituitary tumors, both benign and malignant, and in their relatives.[1] Coexistence of pituitary adenoma and intracranial tumor is not a rare event. On the contrary, the simultaneous occurrence of pituitary adenoma and intracranial meningioma, one of the most frequent primary intracranial tumors, accounting for 15–25% of all central nervous system neoplasms, is a rare clinical event.[23] This simultaneous occurrence was usually reported not only in patients with both functioning and nonfunctioning pituitary adenoma after radiotherapy,[45] but also in patients not previously irradiated for a pituitary mass, suggesting that this coexistence may be a casual finding without any relationship between the two diseases. A possible role of growth hormone (GH) or other growth factors in the appearance or growth of meningioma has also been hypothesized but, at the moment, this statement is not fully supported. In some cases, the appearance and growth of meningioma were observed despite effective octreotide treatment, suggesting that SSAs can play a growth-promoting role.[6]

Based on angiography evaluations and autopsy, the incidence of intracranial aneurysms ranges from 1% to 7% with dramatic, life-threatening consequences and a very high risk of death in the case of rupture. The relationship between pituitary adenomas and brain vascular disease is still not clear, but coexistence of pituitary adenoma and cerebral aneurysm (CA) is not so rare an event.[7] Indeed, CAs have been reported in 0.04–7.4% of patients harboring pituitary adenomas.[89] Literature data show that intracranial aneurysms are most frequently associated with acromegaly[1011] suggesting that also in this type of association an important role in the genesis of intracranial aneurysms could be played by prolonged GH hypersecretion through inducing atherosclerotic and/or degenerative modifications in the arterial walls of the circle of Willis.[12] Other possible etiological factors include a mechanical effect due to direct contact between adenoma and aneurysm with vascular infiltration or traction caused by the adenoma adjacent to the arterial wall.[12]

On the contrary, the incidence of arteriovenous malformations (AVM) in patients with cerebral neoplasms is low in comparison with the incidence of CAs in the same patient type (0.1 vs. 0.2–0.7%) and until, the coexistence of AVM and pituitary adenoma has been shown in only five cases.

The recent paper by Yilmaz et al. describes the first case of a 28-year-old woman successfully treated with gamma-knife radiosurgery (GKR) for AVM, concomitant with a nonfunctioning pituitary adenoma in which, after a first GKR had performed for both pathologies, a second-stage GKR was necessary in the 3rd year for the residual AVM bed.[13]

In conclusion, in the presence of concomitant brain morbidities (benign lesions, malignant neoplasms and vascular diseases), treatment must be tailored to the patient, but an adequate knowledge of these coexistences based on their location is an important precondition to planning a correct surgical approach, avoiding life-threatening hemorrhagic complications.

References

  1. , , . Co-prevalence of other tumors in patients harboring pituitary tumors. J Neurosurg. 2014;121:1474-7.
    [Google Scholar]
  2. , , , , , , . Coexistence of growth hormone-secreting pituitary adenoma and intracranial meningioma: A case report and review of the literature. J Endocrinol Invest. 1993;16:703-8.
    [Google Scholar]
  3. , , , . Coincident pituitary adenoma and sellar meningioma. Acta Neurochir (Wien). 2015;157:231-3.
    [Google Scholar]
  4. , , . Radiation-induced meningioma after treatment for pituitary adenoma: Case report and literature review. Neurosurgery. 1990;26:329-31.
    [Google Scholar]
  5. , , . Recurrent prolactinoma and meningioma following irradiation and bromocriptine treatment. Am J Med. 1985;78:153-5.
    [Google Scholar]
  6. , , , , , , . Development of a meningioma in a patient with acromegaly during octreotide treatment: Are there any causal relationships? J Endocrinol Invest. 2003;26:359-63.
    [Google Scholar]
  7. , , , , , , . MRI finding of simultaneous coexistence of growth hormone-secreting pituitary adenoma with intracranial meningioma and carotid artery aneurysms: Report of a case. Pituitary. 2007;10:299-305.
    [Google Scholar]
  8. , , , , . Association between pituitary adenomas and intracranial aneurysms: An illustrative case and review of the literature. Neurol India. 2007;55:410-2.
    [Google Scholar]
  9. , . Pituitary tumors and aneurysms: Case report and review of the literature. Neurosurgery. 1992;30:585-91.
    [Google Scholar]
  10. , , , , , , . Prevalence of cerebral aneurysm in patients with acromegaly. Pituitary. 2013;16:195-201.
    [Google Scholar]
  11. , , , , . Intrasellar aneurysm and a growth hormone-secreting pituitary macroadenoma. Case report. J Neurosurg. 2004;100:557-9.
    [Google Scholar]
  12. , , , , , . A rare case of HGH producing adenoma in direct contact with an IC medial type aneurysm. No Shinkei Geka. 1982;10:747-51.
    [Google Scholar]
  13. , , , , , , . Coexistence of arteriovenous malformation with nonfunctioning pituitary adenoma. J Neurosci Rural Pract. 2015;6:458-60.
    [Google Scholar]

    Fulltext Views
    904

    PDF downloads
    422
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections