Case ReportSellar Toxoplasmosis and Nonfunctioning Pituitary Adenoma
Introduction
We present a rare case of a healthy woman with a pituitary tumor, who was medically treated for hyperprolactinemia; on transsphenoidal resection of the sellar mass, Toxoplasma gondii bradycysts within a nonfunctioning pituitary adenoma were found. T gondii, an obligate intracellular parasite of the phylum Apicomplexa, causes chronic infections in one third of the human population (7). It may infect a great variety of cell types including epithelial cells and blood leukocytes (10). Intracranial infections with T gondii are mainly diagnosed after congenital transmission and in patients with immunodeficiencies (11). The co-occurrence of sellar toxoplasmosis with a pituitary adenoma and hyperprolactinemia may be extremely rare; nevertheless, this report may raise awareness of clinicians to reconsider the differential diagnoses of hyperprolactinemia before long-lasting drug therapies are indicated.
Section snippets
Case Description
Informed consent for submission of this case report was obtained from the patient. A 27-year-old woman presented with secondary amenorrhea, which was noted 9 months after discontinuing oral contraceptives. Blood tests revealed an elevation of prolactin (PRL) to 121 μg/L (normal range, 4.8–23.3 μg/L) and insufficiency of the gonadotroph and corticotroph axes. A “hook effect” (i.e., false low levels 3, 16) was excluded. Magnetic resonance imaging (MRI) showed an intrasellar, partially
Discussion
Sellar toxoplasmosis in conjunction with a pituitary adenoma is extremely rare, and only 2 cases have been described in the literature (24). Both of the reported patients harbored prolactinomas, which were eventually surgically resected. As in the present case, these patients presented with sellar tumors on MRI suggestive of pituitary adenomas. The histologic finding of T gondii pseudocysts came as a surprise. Although the radiologic pattern of cerebral toxoplasmosis has been described and
Conclusions
The conjunction of sellar toxoplasmosis and pituitary adenoma is extremely rare. Hormonally nonfunctioning lesions, including this rare pathology, may be included in the differential diagnosis of patients with sellar masses >10 mm in diameter and PRL levels <150 μg/L.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.