ABSTRACT
Ectopic pituitary adenomas are isolated adenomas located outside the
sella turcica (in variable locations) with a normal-appearing pituitary
gland. These tumors are extremely rare and thought to often arise from
embryological remnants along the route of Rathke’s pouch migration.
Ectopic pituitary adenomas can manifest in variable clinical ways
depending on hormonal activity and involvement of adjacent structures,
which can present a challenge in making a diagnosis and choosing most
appropriate management. In this case study, we report a 47-year-old male
who presented with visual disturbances, headache, generalised weakness
and hyperprolactinemia. Magnetic Resonance Imaging showed a 2 cm mass
located in the clivus invading the sphenoid sinus with an intact
pituitary gland. The patient underwent uncomplicated endoscopic
transsphenoidal surgery, during which the intersphenoid septum was
removed to reach the posterior wall and eradicate the mass successfully,
while maintaining integrity of the pituitary gland. Pathological studies
were consistent with prolactinoma, with no cytological malignant
features. Post-surgery, symptoms notably improved, serum prolactin level
dropped, and patient’s condition was satisfactory on follow-up with no
long-term complications reported. The clival ectopic mass is a rare
condition that it may be located adjacent to important structures and
can be relatively difficult to reach. Therefore, surgery should be
performed carefully to maintain the nearby structures and avoid any
significant complications.
Key message: Ectopic pituitary adenoma is a rare neoplasm,
located in the clivus and could mimic other clival tumors. Diagnosis and
treatment could be challenging. It should be considered within the
differential diagnosis of clival tumors.
Keywords: Ectopic pituitary adenoma; clival tumours;
transsphenoidal surgery; prolactinoma; stalk effect; case report