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05-JULY-2009 NAHLAH MAHMOUD AGHA 51 YEARS
HUGE GH-SECRETING PITUITARY ADENOMA WITH ACROMEGALY.
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The patient came to the
clinic 29-June-2009 complaining of headache with
acromegalic features for more than 2 years with
starting impaired vision the last year.
of the sella performed
huge pituitary adenoma
with massive supra and
On examination: the patient
is right handed with acromegalic features and
bitemporal hemianopsia. She has amenorrhea for
12 years with glactorrhea right breast. TSH was
, GH was 61 ng/ml . She had also folic acid aneamea.
Bifrontal monoflap craniotomy
with reflection of the bone flap to the right
was performed. During that the frontal sinuses
were violated to obtain flush level with the
anterior fossa plane. The dura was opened
parallel to the anterior edge of the bony
defect. The falx cerebri was bisected interiorly
with preservation of all draining veins.
Mobilization of both olfactory tracts off the
mediobasal of the frontal lobes down to the
trigones. The tumor was pushing both optic
nerves laterally. The tumor was attacked from
the median plane and it was rubbery with
cartilage consistency. Piecemeal resection of
the tumor and the capsule of the tumor was
detached from both optic nerves and the
cavernous sinuses both sides. The capsule of the
tumor was the pituitary gland and it was
preserved and it was clear to see the pituitary
stalk forming after removing the
suprasellar part of the tumor. Check of the
right cavernous sinus showed no remnants and it
was possible to see the basilar artery from the
left. Routine closure of the wound.
Smooth postoperative recovery
and the patient sent for ICU.
The patient has acromegalic
features which must put the diagnosis from far.
of the olfactory tracts
yield 85% functional
to the materials during
29 years of practice.