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      Macroprolactinoma appearing after resolution of hydrocephalus

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          Abstract

          Summary

          The role of mechanical forces influencing the growth of a pituitary adenoma is poorly understood. In this paper we report the case of a young man with hyperprolactinaemia and an empty sella secondary to hydrocephalia, who developed a macroprolactinoma following the relief of high intraventricular pressure.

          Learning points:
          • The volume of a pituitary tumour may be influenced not only by molecular but also by local mechanical factors.

          • Intratumoural pressure, resistance of the sellar diaphragm and intracranial liquid pressure may play a role in the final size of a pituitary adenoma.

          • The presence of hydrocephalus may hide a pituitary macroadenoma.

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          Most cited references6

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          Advances in the treatment of prolactinomas.

          Prolactinomas account for approximately 40% of all pituitary adenomas and are an important cause of hypogonadism and infertility. The ultimate goal of therapy for prolactinomas is restoration or achievement of eugonadism through the normalization of hyperprolactinemia and control of tumor mass. Medical therapy with dopamine agonists is highly effective in the majority of cases and represents the mainstay of therapy. Recent data indicating successful withdrawal of these agents in a subset of patients challenge the previously held concept that medical therapy is a lifelong requirement. Complicated situations, such as those encountered in resistance to dopamine agonists, pregnancy, and giant or malignant prolactinomas, may require multimodal therapy involving surgery, radiotherapy, or both. Progress in elucidating the mechanisms underlying the pathogenesis of prolactinomas may enable future development of novel molecular therapies for treatment-resistant cases. This review provides a critical analysis of the efficacy and safety of the various modes of therapy available for the treatment of patients with prolactinomas with an emphasis on challenging situations, a discussion of the data regarding withdrawal of medical therapy, and a foreshadowing of novel approaches to therapy that may become available in the future.
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            Monitoring and interpretation of intracranial pressure

            M Czosnyka (2004)
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              MICROSURGICAL ANATOMY OF THE DIAPHRAGMA SELLAE AND ITS ROLE IN DIRECTING THE PATTERN OF GROWTH OF PITUITARY ADENOMAS

              To evaluate the anatomic aspects of the diaphragma sellae and its potential role in directing the growth of a pituitary adenoma. Twenty cadaveric heads were dissected and measurements were taken at the level of the diaphragma sellae. The diaphragma sellae is composed of two layers of dura mater. There is a remarkable variation in the morphology of the diaphragm opening. The average anteroposterior distance of the opening was 7.26 mm (range, 3.4–10.7 mm) and the average lateral-to-lateral distance was 7.33 mm (range, 2.8–14.1 mm). The variability in the diameter of the opening of the diaphragma sellae could explain the growth of pituitary tumors toward the cavernous sinus or toward the suprasellar region.
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                Author and article information

                Journal
                Endocrinol Diabetes Metab Case Rep
                Endocrinol Diabetes Metab Case Rep
                EDM
                Endocrinology, Diabetes & Metabolism Case Reports
                Bioscientifica Ltd (Bristol )
                2052-0573
                19 April 2017
                2017
                : 2017
                : 16-0157
                Affiliations
                [1 ]Division of Endocrinology
                [2 ]Fundacion de Endocrinologia
                [3 ]Division of Neurosurgery , Hospital de Clínicas, Universidad de Buenos Aires, Buenos AiresArgentina
                Author notes
                Correspondence should be addressed to O D Bruno; Email: bodomingo@ 123456intramed.net
                Article
                EDM160157
                10.1530/EDM-16-0157
                5409935
                3a7886eb-c5b0-4910-ba4a-4d3c28fa07ed
                © 2017 The authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                : 9 March 2017
                : 21 March 2017
                Categories
                Unique/Unexpected Symptoms or Presentations of a Disease

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