title: Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: a case report and review of the literature.
abstract: BACKGROUND
  In more than 98% of cases, acromegaly is due to a GH-secreting pituitary adenoma. The term "ectopic acromegaly" includes neuroendocrine tumors secreting GH releasing hormone (GHRH), usually located in the lungs, thymus and endocrine pancreas. Considerably less frequent are cases of ectopic acromegaly due to GH-secreting tumors located out of the pituitary fossa; except for one isolated case of a well-documented GH-secreting lymphoma, the majority of these lesions are located in the sphenoid sinus.
  
  
  METHODS
  We present the case of a 45 year old woman with acromegaly whose MRI showed an empty sella without evidence of a pituitary adenoma but revealed a large mass within the sphenoid sinus. She underwent transsphenoidal surgery and the excised sphenoid sinus mass, proved to be a GH-secreting adenoma; the sellar floor was intact and no other lesions were found in the pituitary fossa. She required postoperative treatment with somatostatin analogs and cabergoline for clinical and biochemical control.
  
  
  CONCLUSIONS
  This case highlights the importance of carefully evaluating the structures surrounding the sellar area when a pituitary adenoma is not found with currently available imaging techniques. The finding of an intact sellar floor and duramater lead us to conclude that the patient's tumor originated de novo from embryological pituitary remnants. Upon a careful review of the literature and a critical evaluation of our case we found neither clinical nor biochemical features that would distinguish an ectopic from the more common eutopically located somatotrophinoma.
authors.affiliation: Endocrinology Service and Experimental Endocrinology Unit, Hospital de Especialidades Siglo XXI, Instituto Mexicano del Seguro Social, Aristoteles 68, Col, Polanco, 11560 Mexico City, Mexico. moises.mercado@endocrinologia.org.mx.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ramírez
authors.forename: Laura-Cristina
authors.initials: LC
authors.lastname: Hernández-Ramirez
authors.forename: Ana-Laura
authors.initials: AL
authors.lastname: Espinosa-de-los-Monteros
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Franco
authors.forename: Gerardo
authors.initials: G
authors.lastname: Guinto
authors.forename: Moises
authors.initials: M
authors.lastname: Mercado
mesh_terms: D000172:Acromegaly / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D015282:Octreotide / Q000031:analogs & derivatives; D011182:Postoperative Care; D011300:Preoperative Care; D011877:Radionuclide Imaging; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery
chemical_list: C094279:indium-111-octreotide; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D015282:Octreotide