Treatment of functioning pituitary macroadenoma by endoscopic endonasal transsphenoidal: a case report

ABSTRACT Pituitary macroadenoma is a benign tumor in the pituitary gland, measuring > 1 cm. The frequency of pituitary adenomas ranges from 8 - 10% of all intracranial tumors. It mainly occurs in the anterior pituitary lobe and rarely in the posterior lobe. The majority of cases of pituitary macroadenoma are non-functioning tumors, which produce clinical symptoms due to tumor pressure and do not increase hormonal activity, as in the case with functioning tumors. We report the case, a 40 years old woman, with pituitary macroadenoma giving clinical symptoms of a functioning tumor, namely acromegaly since 4 years ago; characterized by prognathism and large beefy hands and feet. Complaints were accompanied by amenorrhea, intermittent cephalgia, and right oculi hemianopsia. From blood laboratory tests, it was found that the levels of prolactin and growth hormone were increased. The results of MSCT scans and MRI of the head support the presence of a pituitary macroadenoma. Endoscopic endonasal transsphenoidal was performed in this patient, with good results. There was an improvement with the reduction of clinical symptoms and decreased hormone levels, without any complications. Keywords: Pituitary Macroadenoma, Functioning tumor, Endoscopic endonasal transsphenoidal ABSTRAK Makroadenoma hipofise merupakan tumor jinak pada kelenjar hipofise, yang  berukuran > 1 cm. Frekuensi adenoma hipofise berkisar 8 – 10% dari seluruh tumor intrakranial. Terutama terjadi pada lobus anterior hipofise dan jarang pada lobus posterior. Mayoritas kasus makroadenoma hipofise merupakan tumor non-fungsional, yang menimbulkan gejala klinis karena pendesakan oleh tumor dan tidak meningkatkan aktivitas hormonal, seperti hal-nya pada tumor fungsional. Kami melaporkan kasus, seorang wanita berusia 40 tahun, dengan makroadenoma hipofise yang memberikan gejala klinis tumor fungsional, yaitu Akromegali sejak 4 tahun yang lalu; ditandai dengan adanya prognathism dan large beefy hands and feet . Keluhan disertai dengan amenore, cephalgia intermiten dan hemianopsia oculi dextra. Dari pemeriksaan laboratorium darah, ditemukan peningkatan kadar hormon prolactin dan growth hormone. Hasil MSCT scan dan MRI kepala mendukung adanya makroadenoma hipofise. Telah dilakukan endoskopi endonasal transsphenoid pada pasien ini, dengan hasil yang baik. Terjadi perbaikan dengan berkurangnya gejala klinis dan penurunan kadar homon, tanpa disertai komplikasi. Kata Kunci: Makroadenoma hipofise, Tumor fungsional, Endoskopi endonasal transsphenoid