title: Ectopic Acromegaly Arising from a Pituitary Adenoma within the Bony Intersphenoid Septum of a Patient with Empty Sella Syndrome.
abstract: OBJECTIVE
  To describe the work-up and treatment of rare ectopic acromegaly caused by a biopsy-proven somatotroph pituitary adenoma located within the bony intersphenoid septum of a patient with empty sella syndrome (ESS).
  
  
  METHODS
  We report the presentation, clinical course, diagnostic work-up, and lesion localization and treatment challenges encountered in a 55-year-old patient, with a brief review of relevant literature.
  
  
  RESULTS
  A 55-year-old African-American man presented with acromegaly and ESS. Attempts to definitively localize the causative tumor were unsuccessful, though petrosal sinus sampling supported central growth hormone production and imaging suggested bone-enclosed subsellar pituitary tissue. Endoscopic endonasal transphenoidal exploration was undertaken with resection of a somatotroph pituitary microadenoma, and subsequent clinical improvement and biochemical remission. Retrospective review revealed the patient's pituitary to have been located ectopically within a unique bony intersphenoid septum.
  
  
  CONCLUSIONS
  This report describes the first known case of an ectopic pituitary adenoma located within the midline bony intersphenoid septum, which we postulate to have resulted from anomalous embryological pituitary migration. Intra-intersphenoid septal tumors should be considered in cases of apparent central acromegaly with ESS or absence of tumor tissue within the paranasal sinuses or other peripheral locations.
  Acromegaly, ESS, pituitary adenoma, sphenoid sinus septum.
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, United States.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Arzamendi
authors.affiliation: Department of Neurological Surgery, UC Davis Medical Center, Sacramento, California, United States.
authors.forename: Kiarash
authors.initials: K
authors.lastname: Shahlaie
authors.affiliation: Department of Radiology, UC Davis Medical Center, Sacramento, California, United States.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Latchaw
authors.affiliation: Department of Pathology, UC Davis Medical Center, Sacramento, California, United States.
authors.forename: Mirna
authors.initials: M
authors.lastname: Lechpammer
authors.affiliation: Division of Endocrinology, Diabetes & Metabolism, Department of Internal Medicine, UC Davis Medical Center, Sacramento, California, United States.
authors.forename: Hasmik
authors.initials: H
authors.lastname: Arzumanyan
keywords: acromegaly; empty sella syndrome; pituitary adenoma; sphenoid sinus septum