• Federica Penner, Nunzia Prencipe, Valentina Pennacchietti, Paolo Pacca, Valeria Cambria, Diego Garbossa, and Francesco Zenga.
• Section of Neurosurgery, Division of Neuroscience, University of Turin, Turin, Italy. Electronic address: federica.penner@gmail.com.
• World Neurosurg. 2019 Feb 1; 122: 544-548.

BackgroundGiant pituitary adenomas are rare tumors that can have a devastating impact on a patient's life. They require a well-studied therapeutic approach that often combines different strategies.Case DescriptionA 29-year-old woman was diagnosed with the largest GH-secreting pituitary adenoma reported in the literature, to the best of the author's knowledge. The tumor was removed with a combined approach: endoscopic endonasal transsphenoidal and transcortical transventricular. All available acromegaly drugs were used. After 2 surgeries, a large part of the tumor was removed. Both postoperative courses were uneventful. Because the disease was still active, medical therapy was initiated. The combination of pasireotide, pegvisomant, and cabergoline permitted satisfactory control of hormonal levels.ConclusionsGiant adenomas, >4 cm, are rare pituitary tumors. Therefore in order to achieve the best clinical results, they require complex management that involves a multidisciplinary team of ear, nose, and throat surgeons; endocrinologists; radiation therapists; ophthalmologists; and neurosurgeons.Copyright © 2018 Elsevier Inc. All rights reserved.

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