title: Anterior and posterior suprasellar extensions of a symmetrical trilobed nonfunctional giant pituitary adenoma in the sagittal plane: a case report and review of literature.
abstract: BACKGROUND
  To the best of our knowledge, the presence of a trilobed nonfunctional giant pituitary adenoma has never been described before in the literature. These tumors present unique diagnostic and therapeutic challenges. Tumors of this etiology can be managed with pharmacologic treatment or aggressive surgical intervention. The following case illustrates an unique visual presentation of a giant pituitary adenoma.
  
  
  METHODS
  We report the case of a 40-year-old Hispanic man who presented with new onset seizures. Radiological imaging showed the presence of a trilobed giant pituitary adenoma extending anterior into the frontal lobe, posterior to the hypothalamus, and inferior. The patient underwent a right pteronial craniotomy to remove majority of his tumor.
  
  
  CONCLUSIONS
  The large size of the tumor should be considered in the differential diagnosis of various other conditions leading to a pituitary region mass such as a craniopharyngioma, pituitary metastasis, pituitary carcinoma, and a meningioma. Careful planning and outlining of therapeutic interventions are needed to rectify this abnormality. Those patients who meet the qualifications of a combined transsphenoidal and transcranial procedure should opt for this method of tumor resection.
authors.affiliation: Medical University of the Americas, 27 Jackson Road, Suite 302, Devens, MA 01434, USA.
authors.forename: Rushabh M
authors.initials: RM
authors.lastname: Vakharia
authors.affiliation: Department of General Surgery PGY-5, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
authors.forename: Roman
authors.initials: R
authors.lastname: Kremen
authors.affiliation: Morehouse School of Medicine, Atlanta, GA, USA.
authors.forename: Ajit
authors.initials: A
authors.lastname: Vakharia
authors.affiliation: Department of Internal Medicine PGY-2, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
authors.forename: Obed
authors.initials: O
authors.lastname: Adarkwah
authors.affiliation: Department of Neurosurgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Anderson
keywords: Dumbbell pituitary; Giant pituitary adenoma; Modified Hardy scheme; Pteronial craniotomy; Suprasellar extension; Transsphenoidal procedure