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Sarcoidosis within a Pituitary Adenoma

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Abstract

A 54 year old man presented with frontal headaches for one year. A CT scan of the head revealed a pituitary mass. He denied a change in vision or galactorrhea, but did have decreased frequency of erections and a recent episode of renal stones. On physical exam, the cranial nerves were normal. Visual field exam revealed mild bilateral temporal defects. The genitalia were normal and the testes were soft. Laboratory evaluation revealed: Na, 134 mM/l; K, 6.7 mM/l; Cl, 104 mM/l; HCO3,22 mM/l; BUN, 47 mg/dl; Cr, 8.3 mg/dl; Ca, 12.5 mg/dl; Phos, 5.5 mg/dl; prolactin, 32.0 ng/ml; T4,4.46 μg/dl; TSH, 2.07 μU/ml; LH, 18.1 mIU/ml; FSH 3.2 mIU/ml; α subunit 1.6 ng/ml; testosterone 255 ng/dl; cortisol, 20.3 μg/dl; cortisol after 250 μg cortrosyn, 38.5 μg/dl (time 60 minutes); growth hormone, 1.4 ng/ml; IGF-1, 47 ng/ml; PTH, <1 pg/ml; 25-hydroxyvitamin D, 14 ng/ml; 1,25-dihydroxyvitamin D, 69 pg/ml. These results were felt to be consistent with a non-PTH-mediated hypercalcemia, such as humoral hypercalcemia of malignancy, or a vitamin D-mediated hypercalcemia, such as lymphoma, sarcoidosis or tuberculosis. Head MRI demonstrated a 3.5 × 3.5 × 2.5 cm heterogeneous mass enlarging the sella, deforming the clivus and compressing the cavernous sinus, basilar artery and left side of the optic chiasm. There was a small focus of high signal in the superior part of the mass on the T1-weighted image from either a proteinaceous cyst with early calcium deposition or sub-acute blood. These radiographic findings were felt to be consistent with a pituitary adenoma. The patient was treated with intravenous hydration and thyroxine 50 μg daily and underwent a transsphenoidal resection of the pituitary lesion. Pathologic examination revealed a pituitary adenoma with multiple granulomas and crystalline material; this was consistent with sarcoid within the adenoma. Post-operatively, the serum LH fell to 5.5 mIU/ml. A subsequent transbronchial biopsy revealed multiple non-caseating granulomas. A serum ACE level was elevated at 132.6 U/l. He received oral prednisone 60 mg daily with resolution of the hypercalcemia. Neurosarcoidosis occurs in 5 to 15% of patients with sarcoidosis and can involve the hypothalamus and pituitary gland. This is the first reported case of sarcoidosis occurring within a pituitary adenoma.

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References

  1. Bell NH, Stern PH, Pantzer E, Sinha TK, DeLuca HF. Evidence that increased circulating 1 alpha, 25-dihydroxyvitamin D is the probable cause for abnormal calcium metabolism in sarcoidosis. J Clin Invest 1979;64(1):218–225.

    Google Scholar 

  2. Reichel H, Koeffler HP, Barbers R, Norman AW. Regulation of 1,25-dihydroxyvitamin D3 production by cultured alveolar macrophages from normal human donors and from patients with pulmonary sarcoidosis. J Clin Endocrinol Metab 1987;65(6):1201–1209.

    Google Scholar 

  3. Evron E, Goland S, von derWalde J, Schattner A, Sthoeger ZM. Idiopathic calcitriol-induced hypercalcemia.Anew disease entity? Arch Intern Med 1997;157(18):2142–2145.

    Google Scholar 

  4. Papapoulos SE, Clemens TL, Fraher LJ, Lewin IG, Sandler LM, O'Riordan JL. 1,25-dihydroxycholecalciferol in the pathogenesis of the hypercalcaemia of sarcoidosis. Lancet 1979;1(8117):627–630.

    Google Scholar 

  5. Freda PU, Post KD. Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 1999;28(1):81–117, vi.

    Google Scholar 

  6. Klibanski A. Nonsecreting pituitary tumors. Endocrinol Metab Clin North Am 1987;16(3):793–804.

    Google Scholar 

  7. Snyder PJ, Johnson J, Muzyka R. Abnormal secretion of glycoprotein alpha-subunit and follicle-stimulating hormone (FSH) beta-subunit in men with pituitary adenomas and FSH hypersecretion. J Clin Endocrinol Metab 1980;51(3):579–584.

    Google Scholar 

  8. Snyder PJ, Bashey HM, Kim SU, Chappel SC. Secretion of uncombined subunits of luteinizing hormone by gonadotroph cell adenomas. J Clin Endocrinol Metab 1984;59(6):1169–1175.

    Google Scholar 

  9. Snyder PJ. Gonadotroph cell adenomas of the pituitary. Endocr Rev 1985;6(4):552–563.

    Google Scholar 

  10. Beckers A, Stevenaert A, Mashiter K, Hennen G. Folliclestimulating hormone-secreting pituitary adenomas. J Clin Endocrinol Metab 1985;61(3):525–528.

    Google Scholar 

  11. Oppenheim DS, Kana AR, Sangha JS, Klibanski A. Prevalence of alpha-subunit hypersecretion in patients with pituitary tumors: Clinically nonfunctioning and somatotroph adenomas. J Clin Endocrinol Metab 1990; 70(4):859–864.

    Google Scholar 

  12. Djerassi A, Coutifaris C, West VA, Asa SL, Kapoor SC, Pavlou SN, Snyder PJ. Gonadotroph adenoma in a premenopausal woman secreting follicle-stimulating hormone and causing ovarian hyperstimulation. J Clin Endocrinol Metab 1995;80(2):591–594.

    Google Scholar 

  13. Snyder PJ, Sterling FH. Hypersecretion of LH and FSH by a pituitary adenoma. J Clin Endocrinol Metab 1976; 42(3):544–550.

    Google Scholar 

  14. Faggiano M, Criscuolo T, Perrone L, Quarto C, Sinisi AA. Sexual precocity in a boy due to hypersecretion of LH and prolactin by a pituitary adenoma. Acta Endocrinol (Copenh) 1983;102(2):167–172.

    Google Scholar 

  15. Ambrosi B, Bassetti M, Ferrario R, Medri G, Giannattasio G, Faglia G. Precocious puberty in a boy with a PRL-, LH-and FSH-secreting pituitary tumour: Hormonal and immunocytochemical studies. Acta Endocrinol (Copenh) 1990;122(5):569–576.

    Google Scholar 

  16. Donovan JL, Nesbit GM. Distinction of masses involving the sella and suprasellar space: Specificity of imaging features. AJR Am J Roentgenol 1996;167(3):597–603.

    Google Scholar 

  17. Freda PU, Silverberg SJ, Post KD, Wardlaw SL. Hypothalamicpituitary sarcoidosis. Trends Endocrinol Metab 1992;3:321–325.

    Google Scholar 

  18. Sommer N, Weller M, Petersen D, Wietholter H, Dichgans J. Neurosarcoidosis without systemic sarcoidosis. Eur Arch Psychiatry Clin Neurosci 1991;240(6):334–338.

    Google Scholar 

  19. Mayer SA, Yim GK, Onesti ST, Lynch T, Faust PL, Marder K. Biopsy-proven isolated sarcoid meningitis. Case report. J Neurosurg 1993;78(6):994–996.

    Google Scholar 

  20. Sherman JL, Stern BJ. Sarcoidosis of the CNS: Comparison of unenhanced and enhanced MR images. AJNR Am J Neuroradiol 1990;11(5):915–923.

    Google Scholar 

  21. Lexa FJ, Grossman RI. MR of sarcoidosis in the head and spine: Spectrum of manifestations and radiographic response to steroid therapy. AJNR Am J Neuroradiol 1994;15(5):973–982.

    Google Scholar 

  22. Guoth MS, Kim J, de Lotbiniere AC, Brines ML. Neurosarcoidosis presenting as hypopituitarism and a cystic pituitary mass. Am J Med Sci 1998;315(3):220–224.

    Google Scholar 

  23. Lipnick RN, Hung W, Pandian MR. Neurosarcoidosis presenting as secondary amenorrhea in a teenager. J Adolesc Health 1993;14(6):464–467.

    Google Scholar 

  24. Vesely DL, Maldonodo A, Levey GS. Partial hypopituitarism and possible hypothalamic involvement in sarcoidosis: Report of a case and review of the literature.AmJ Med1977;62(3):425–431.

    Google Scholar 

  25. Graham E, James DG. Neurosarcoidosis. Sarcoidosis 1988;5(2):125–131.

    Google Scholar 

  26. Stuart CA, Neelon FA, Lebovitz HE. Hypothalamic insuffi-ciency: The cause of hypopituitarism in sarcoidosis. Ann Intern Med 1978;88(5):589–594.

    Google Scholar 

  27. Stuart CA, Neelon FA, Lebovitz HE. Disordered control of thirst in hypothalamic-pituitary sarcoidosis. N Engl J Med 1980;303(19):1078–1082.

    Google Scholar 

  28. Turkington RW, MacIndoe JH. Hyperprolactinemia in sarcoidosis. Ann Intern Med 1972;76(4):545–549.

    Google Scholar 

  29. Caro JF, Glennon JA, Israel HL. Neuroendocrine studies in sarcoidosis. In: Williams WJ, Davies BH, eds. Eighth International Conference on Sarcoidosis and Other Granulomatous Diseases. Cardiff: Alpha Omega Publishers, 1980:587–600.

    Google Scholar 

  30. Branson J, Park J. Sarcoidosis-hepatic involvement: Presentation of case with fatal liver involvement, including autopsy findings and review of the evidence of sarcoid involvement of the liver as found in the literature. Ann Intern Med 1954;40:111–145.

    Google Scholar 

  31. Sasaki H, Harada T, Eimoto T, Matsuoka Y, Okumura M. Concomitant association of thyroid sarcoidosis and Hashimoto's thyroiditis. Am J Med Sci 1987;294(6):441–443.

    Google Scholar 

  32. Winnacker JL, Becker KL, Katz S. Endocrine aspects of sarcoidosis. N Engl J Med 1968;278(9):483–492.

    Google Scholar 

  33. Uehlinger E. Morbid anatomy of sarcoidosis. Am Rev Respir Dis 1961;84:6–13.

    Google Scholar 

  34. Forte MD, Brant WE. Ultrasonographic detection of epididymal sarcoidosis. J Clin Ultrasound 1988;16(3):191–194.

    Google Scholar 

  35. Gerstenhaber BJ, Green R, Sachs FL. Epididymal sarcoidosis: A report of two cases and a review of the literature. Yale J Biol Med 1977;50(6):669–675.

    Google Scholar 

  36. DiCarlo FJ Jr., DiCarlo JP, Robboy SJ, Lyons MM. Sarcoidosis of the uterus. Arch Pathol Lab Med 1989;113(8):941–943.

    Google Scholar 

  37. Cannavo S, Romano C, Buffa R, Faglia G. Granulomatous sarcoidotic lesion of hypothalamic-pituitary region associated with Rathke's cleft cyst. J Endocrinol Invest 1997;20(2):77–81.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Mishaela R. Rubin & Pamela U. Freda

  2. Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Jeffrey N. Bruce

  3. Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA

    Alexander G. Khandji

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  1. Mishaela R. Rubin
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Rubin, M.R., Bruce, J.N., Khandji, A.G. et al. Sarcoidosis within a Pituitary Adenoma. Pituitary 4, 195–202 (2001). https://doi.org/10.1023/A:1015323208789

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