title: Occurrence of extensive spherical amyloid deposits in a prolactin-secreting pituitary macroadenoma: a radiologic-pathologic correlation.
abstract: Pituitary adenomas are the most common tumors of the sellar region, but the occurrence of spherical amyloid deposits in a pituitary adenoma is rare. We describe the clinical features, radiologic characteristics, and pathologic findings of 45-year-old man who presented with galactorrhea, hypogonadism, and hyperprolactinemia who had a pituitary adenoma with extensive spherical amyloid deposits. Approximately 30 cases have been reported, almost exclusively in patients with prolactinomas. Treatment with dopaminergic agonists will result in the expected reduction in prolactin levels; however, in most cases, macroadenomas with spherical amyloid deposits fail to decrease in size. The source of the amyloid deposits in prolactinomas is not clearly defined but may be due to abnormal processing of prolactin or its prohormone. These adenomas with spherical amyloid have a characteristic appearance on magnetic resonance imaging with low or heterogeneous intensity on T1 and low intensity on T2-weighted images. Following infusion of gadolinium, there is enhancement of the periphery but not most of the tumor mass. These magnetic resonance imaging characteristics are different than those of typical pituitary adenomas. These differences should alert clinicians to the possibility of extensive spherical amyloid deposits in a prolactin-secreting pituitary adenoma, which may have important clinical implications. In this report, we correlate the radiologic finds with the pathology and compared them with other sellar and parasellar lesions.
authors.affiliation: Department of Medicine, Section of Endocrinology and Metabolism, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA. slevin@lsuhsc.edu
authors.forename: Steven N
authors.initials: SN
authors.lastname: Levine
authors.forename: Shmaila
authors.initials: S
authors.lastname: Ishaq
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.forename: Jon D
authors.initials: JD
authors.lastname: Wilson
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gonzalez-Toledo
mesh_terms: D005260:Female; D019786:Gadolinium DTPA; D005687:Galactorrhea; D006801:Humans; D006966:Hyperprolactinemia; D007006:Hypogonadism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D058225:Plaque, Amyloid; D011388:Prolactin / Q000378:metabolism; D015175:Prolactinoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D011388:Prolactin; D019786:Gadolinium DTPA
keywords: Amyloid; Magnetic resonance imaging; Pituitary adenoma; Prolactin; Prolactinoma