Pituitary Neuroendocrine Tumor (PitNET)
P. Aarthi1, Vigneshvarprashanth Umapathy2,*
1Staff nurse, Kauvery Hospital, Tennur, Trichy, India
2Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India
*Correspondence: worldofuv@gmail.com
![MRI-brain-1](https://www.kauveryhospital.com/images/journals/v5i6/MRI-brain-1.png)
![MRI-brain-2](https://www.kauveryhospital.com/images/journals/v5i6/MRI-brain-2.png)
![MRI-brain-3](https://www.kauveryhospital.com/images/journals/v5i6/MRI-brain-3.jpg)
![MRI-brain-4](https://www.kauveryhospital.com/images/journals/v5i6/MRI-brain-4.png)
- MRI brain – Pituitary gland enlargement measuring 1.1cm noted.
- Endoscopic transnasal transsphenoidal surgery – a surgical instrument is placed through the nostril and alongside the nasal septum to access a pituitary tumor [1].
- Histopathology of resected tumor specimen – Section studied showed fragments of a neuroendocrine neoplasm. Tumor is composed of cells arranged in nests, papillae, and acinar pattern. The cells show mild anisonucleosis, having a round nucleus, stippled chromatin, and amphophilic cytoplasm. Mitosis is inconspicuous. No apoplectic change. HPE suggestive of pituitary neuroendocrine tumor.
- Post-op CT brain – Postoperative changes with areas of hemorrhage in the pituitary fossa.
Case Presentation
A 57-year-old lady, known to have type-2 diabetes mellitus and hypertension revealed a history of headache for three years and 2 episodes of seizure over the last two years. She was managed symptomatically in a local hospital. She also revealed a history of being treated for hyponatremia a couple of times in the last 2 years. Due to the recurrence of symptoms, an MRI brain was done, which revealed a sellar lesion – pituitary gland enlargement measuring 1.1cm (Image A). Differential diagnoses of pituitary macroadenoma and craniopharyngioma were considered. Surgery was suggested. However, she came to our hospital for further management. General examination did not reveal any significant finding and eye examination did not reveal a visual field defect. Thyroid hormones, growth hormone, cortisol, follicle-stimulating hormone, luteinising hormone, and prolactin were all within normal range. Endoscopic transnasal transsphenoidal resection of the pituitary tumor (Image B) was done. There were no procedural or post-procedural complications. Resected tumor specimen was sent for histopathology (HPE) (Image C) which showed fragments of neuroendocrine neoplasm suggestive of pituitary neuroendocrine tumor (PitNET). Immunohistochemistry for hormonal markers and transcription factors was advised. Pituitary adenomas account for approximately 10% of all intracranial neoplasms and 30-50% of all pituitary region masses. Pituitary adenomas present either due to hormonal imbalance (both microadenomas and macroadenomas) or mass effect on adjacent structures (macroadenomas), classically the optic chiasm. Pituitary adenomas and pituitary carcinomas are in fact neuroendocrine tumors and gradually the terminology is shifting to pituitary neuroendocrine tumors (PitNET). In the 5th edition (2021) of the WHO classification of CNS tumors, “PitNET” has been added to a pituitary adenoma (rather than replacing it) and it is almost certain that the 5th edition of the WHO classification of tumors of endocrine organs will adopt this new terminology as well [2].
References
Mayo clinic, Endoscopic transnasal transsphenoidal surgery, Available from: https://www.mayoclinic.org/diseases-conditions/acromegaly/multimedia/endoscopic-transnasal-transsphenoidal-surgery/img-20006940
Radiopaedia article, Pituitary adenoma/ PitNET, Available from: https://radiopaedia.org/articles/pituitary-adenomapitnet
![Aarthi](https://www.kauveryhospital.com/images/journals/v5i6/Aarthi.jpg)
Ms. P. Aarthi
Staff Nurse
![Vigneshvarprashanth](https://www.kauveryhospital.com/images/journals/v5i6/Vigneshvarprashanth.jpg)
Dr. Vigneshvarprashanth Umapathy
Resident Internal Medicine
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- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE Chapters 3 and 4 – Learning from Experience
- Changing trends a challenge to the already trained
- Journal scan
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- EDITORIAL
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- PREGNANCY POST-RENAL TRANSPLANT
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- THE AMBUSH A TEAM APPROACH
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- A STUDY ON PRESENTATION AND OUTCOME OF BULL GORE INJURIES IN A GROUP OF TERTIARY CARE HOSPITALS
- A CASE OF INTERNUCLEAR OPHTHALMOPARESIS AS THE FIRST MANIFESTATION OF MULTIPLE SCLEROSIS
- GRANULOMATOSIS WITH POLYANGITIS AND LUNG INVOLVMENT (WEGENER’S DISEASE)
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- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- Chapter 4: Diagnostic process often reversed
- Journal scan: A review of 25 recent papers of immediate clinical significance, harvested from major international journals
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- ஆரோக்கியம் நம் கையில்
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- Esomeprazole induced Hypoglycemia
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- How to Practice Academic Medicine and Publish from Developing Countries? A Practical Guide, Springer Nature, 2022
- WINTNCON 2022 – Scientific Program
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- Role of Artificial Intelligence in improving EHR/EMR and Medical Coding and billing
- Monoclonal Antibodies: Edrecolomab and Abciximab
- Atlas of haematology and hematooncology
- Journal scan
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- What doctors must learn: Doctor, look beyond science
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- I Whisper Secrets In My Ear
- EDITORIAL
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- Mismatched Haploidentical Bone Marrow Transplantation in a 10-year-old boy with relapsed refractory acute lymphoblastic leukemia, at Trichy
- ST-Segment Elevation is not always Myocardial Infarction
- Acyanotic Congenital Heart Disease, repaired, evolves into a Cyanotic Congenital Heart Disease and presents with an atrial tachycardia
- Family medicine – caring for you for the whole of your life. A Lost and Found Art
- The Principles and Practice of Family Medicine
- Complete Heart Block
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- The First Ever National Award Comes to Kauvery Hospital Chennai & Heart City for Safety and Workforce Category in IMC RBNQA Milestone Merits Recognition 2022
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- PRE-OPERATIVE CHAPTERS 7 AND 7 – LEARNING FROM EXPERIENCE
- Chapter 5: Super-specialist – boon or bane
- Journal scan: A review of 42 recent papers of immediate clinical significance, harvested from major international journals
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- Iron Deficiency Anemia, Post MVR
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- Long term use of Amiodarone in Cardiac patients: A Clinical Audit
- Statistical Independent Events and Probability
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- EDITORIAL
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- CLINICAL AUDIT: AN INTRODUCTION
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- CLINICAL REVIEW MEET 16TH NOV 2023: CHALLENGES IN SETTING UP A NEW HSCT CENTRE IN A TIER-2 CITY IN INDIA
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- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
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- A CLINICAL AUDIT: ON THE MANAGEMENT OF ECTOPIC PREGNANCY
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- SCAPULA FRACTURES: DO WE NEED TO FIX THEM?
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- METHOTREXATE INDUCED MUCOSITIS AND PANCYTOPENIA: A CONSEQUENCE OF MEDICATION ERROR IN A PSORIASIS PATIENT
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- LIMB SALVAGE IN EXTREMITY VASCULAR TRAUMA: OUR EXPERIENCE
- MANAGEMENT OF URETHRAL CATHETER RELATED PAIN IN RENAL TRANSPLANT RECIPIENTS: A CLINICAL AUDIT
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- PATIENTS STORY: DIGNITY MATTERS
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- VIDEO PRESENTATION- CT CORONARY ANGIOGRAPHY
- DRUG INDUCED HYPERKALEMIA
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- CARDIOMYOPATHY AND ITS ECHO FINDINGS
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- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காணும் பொங்கலும் மனித மன மாற்றமும்
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- PREVALENCE OF STREPTOCOCCUS PNEUMONIAE SEROTYPES IN AND AROUND TRICHY AND ITS CLINICAL RELEVANCE
- ANAESTHETIC MANAGEMENT OF A PATIENT WITH HUGE GOITER: A CASE REPORT
- EUGLYCEMIC DIABETIC KETOACIDOSIS A RARE CAUSE FOR DELAYED EXTUBATION
- SUCCESSFUL PREGNANCY IN ASD PATIENT – COMPLICATED BY SEVERE PULMONARY ARTERIAL HYPERTENSION
- ENDOCRINE COMPLICATION OF GROWTH HORMONE SECRETING TUMOR: A CASE REPORT
- EFFICACY OF EARLY DIAGNOSIS AND DEVELOPMENT APPROACHES OF PAEDIATRIC OCCUPATIONAL THERAPY ON ACUTE DISSEMINATED ENCEPHALOMYELITIS: A CASE REPORT
- POST OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- CHAPTER 12. MILES TO GO – BEFORE TEACHING BECOMES LEARNING
- JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காவேரி – 25
- POEM – மண்ணில் பிறந்தது சாதிப்பதற்குத்தான்