Elsevier

World Neurosurgery

Volume 84, Issue 5, November 2015, Pages 1495.e1-1495.e4
World Neurosurgery

Case Report
Sellar Toxoplasmosis and Nonfunctioning Pituitary Adenoma

https://doi.org/10.1016/j.wneu.2015.05.029Get rights and content

Background

Sellar toxoplasmosis is associated with congenital infections or immunodeficiency. The finding of Toxoplasma bradycysts in a pituitary adenoma is very unusual.

Case Description

An otherwise healthy 27-year-old woman presented with secondary amenorrhea and moderately elevated prolactin levels. A macroprolactinoma was suspected on magnetic resonance imaging, and cabergoline was initiated. Although dopamine levels decreased, the tumor did not show significant shrinkage; after 2 years, transsphenoidal resection was indicated to clarify the diagnosis and to cure hyperprolactinemia. Histology showed an inactive pituitary adenoma and Toxoplasma bradycysts. Seropositivity for Toxoplasma gondii, but neither immunodeficiency nor intracerebral spread, was found. During a postoperative follow-up period of 15 months, the patient did not show any recurrence.

Conclusions

Sellar toxoplasmosis in conjunction with pituitary adenoma is extremely rare. Nonfunctioning lesions should be suspected in cases of sellar masses and moderate hyperprolactinemia.

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.

References (24)

  • K.A. Joiner et al.

    Toxoplasma gondii: a protozoan for the nineties

    Infect Immun

    (1993)
  • B.J. Luft et al.

    Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. Members of the ACTG 077p/ANRS 009 Study Team

    N Engl J Med

    (1993)
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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.

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