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Clinical Problem Solving: Monster on the HookCase Problems in Neurosurgery

Muh, Carrie R MD*; Boulis, Nicholas M MD*; Chandler, William F MD‡; Barkan, Ariel L MD‡; Mosunjac, Marina B MD†; Oyesiku, Nelson M MD, PhD*

Neurosurgery:
doi: 10.1227/NEU.0b013e318207ac0b
Case Problems: Correspondence
Abstract

BACKGROUND AND OBJECTIVE: Nonfunctioning and functioning pituitary tumors can present in numerous ways. They may be difficult to diagnose correctly and, even with proper treatment, may lead to complications.

METHODS: We present the case of a patient who presented with a large, invasive sellar mass and underwent both medical and surgical treatment for this lesion. The patient's course did not progress as was expected from his initial workup.

RESULTS: The patient's history, physical examination, laboratory values, pathologic specimens, and radiologic findings are discussed. His management before, during, and after medical therapy and surgery is reviewed by pituitary experts from 2 different institutions. Aspects of diagnosis and management of sellar lesions are presented and reviewed in the literature.

CONCLUSION: Neurosurgeons frequently treat patients with sellar lesions and should remember that despite modern laboratory, pathologic, and radiologic techniques, the diagnosis and treatment of these lesions is not always clear.

Author Information

Departments of *Neurological Surgery and †Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia; ‡Department of Neurosurgery, Department of Internal Medicine University of Michigan Health System, Ann Arbor, Michigan

Received, June 9, 2009.

Accepted, August 18, 2010.

Correspondence: Carrie R. Muh, MD, Department of Neurological Surgery, Emory University Hospital, 1365-B Clifton Road, Suite 6200, Atlanta, GA 30322. E-mail: Carrie.Muh@choa.org

Copyright © by the Congress of Neurological Surgeons