Unsuspected Recurrent Pituitary Adenoma Presenting as an Orbital Mass

Ophthalmic Plastic and Reconstructive Surgery
Vol. 17, No. 2, pp 140–143 ©2001 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.

Francesco P. Bernardini, M.D.,* Robert C. Kersten, M.D.,Muhammad Moin, M.D., and Dwight R. Kulwin, M.D.

*Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.; and Department of Ophthalmology, University of Genoa, Genoa, Italy

Purpose: Orbital invasion of pituitary tumors is rare and usually accompanied by optic nerve head pallor and visual loss. We describe a case of unilateral massive orbital invasion by a recurrent pituitary tumor with preserved visual acuity and normal optic nerve appearance.

Methods:
Case report.

Results:
Progressive proptosis developed 15 years after transphenoidal removal of a pituitary tumor. Based on the radiological appearance and the clinical history, the patient was suspected to have a sphenoid wing meningioma secondary to previous radiation treatment.

A combined neurosurgical and orbital approach was used to remove the intraorbital mass, which extended from the cranial cavity through the superior orbital fissure and the optic canal. Histopathologic examination demonstrated a recurrent nonsecreting pituitary adenoma.

Conclusions:
Orbital extension of a recurrent pituitary adenoma should be considered in the differential diagnosis of progressive proptosis even in the absence of significant optic neuropathy.

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