During the recent monthly meeting at the Endocrine and Metabolism Research Institute, Dr. Zahra Nouri, a subspecialist in endocrinology and metabolism, presented three clinical cases of pituitary tumors, including refractory prolactinoma, silent corticotroph adenoma, and an incidental pituitary tumor. These cases underscored the critical importance of accurate diagnosis, timely intervention, and a multidisciplinary approach in managing patients with complex pituitary disorders.

Case Summaries

1. Refractory Prolactinoma: The first case involved a 45-year-old patient with a longstanding history of prolactinoma. Despite undergoing two transsphenoidal surgeries in 2005 and 2018 and receiving high doses of cabergoline (up to 7 mg per week), the patient continued to experience progressive tumor growth. Dr. Nouri discussed the criteria for aggressive and dopamine agonist-resistant tumors and reviewed treatment options based on the latest guidelines from the Pituitary Society (2023) and the European Society of Endocrinology (2025). The proposed treatment plan included increasing the cabergoline dose to 11 mg per week, re-surgery, radiotherapy, and the use of temozolomide.
2. Silent Corticotroph Adenoma: The second case involved a 48-year-old woman diagnosed with a pituitary macroadenoma who presented with recurring headaches post-surgery in 2024. The discussion centered on differentiating silent corticotroph adenoma from other inactive pituitary tumors. Dr. Nouri highlighted the pathological features of quiescent corticotroph adenoma, noting its immunoreactivity, greater invasion of the cavernous sinus, and more aggressive clinical behavior compared to typical quiescent adenomas. He emphasized the significance of evaluating proliferative markers such as Ki-67, mitotic count, and p53 staining in determining the necessity for adjuvant treatments like radiotherapy or chemotherapy.
3. Incidental Pituitary Tumor: The third case involved a 40-year-old man with a history of childhood epilepsy, where an incidental pituitary tumor was identified during a seizure-related workup. The discussion focused on the timing of surgery and its impact on improving visual fields in patients with optic chiasm involvement. Dr. Nouri reviewed the latest guidelines from the Endocrine Society and the Pituitary Society, outlining surgical indications that include visual field defects, other visual impairments, apoplexy with visual impairment, significant tumor growth, and refractory headaches. He stressed the necessity of timely intervention to prevent irreversible optic nerve damage.

The session concluded with an engaging discussion among attendees regarding the diagnostic criteria and treatment approaches for the presented cases. The importance of a multidisciplinary approach in managing complex pituitary tumors was a key takeaway, highlighting the collaborative efforts required to enhance patient outcomes in this challenging area of endocrinology.