Endoscopic Removal of a Giant Pituitary Adenoma: A UCSF Case Study

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A patient’s giant pituitary adenoma was successfully removed at UC San Francisco via endoscopic transsphenoidal surgery, a technique that offers exceptional visualization.

A 74-year-old man hospitalized with pneumonia was found to be hyponatremic with low cortisol levels. An MRI scan revealed a 4.8-centimeter giant pituitary adenoma. The patient had a history of blindness in the right eye and was experiencing progressive vision loss in the left eye with central 20/100 acuity. The patient’s hormonal workup showed panhypopituitarism and he was started on cortisol replacement therapy.

The patient was referred to the California Center for Pituitary Disorders at UCSF, where a specialized neurosurgery and neuroendocrine consultation led to the decision to move forward with surgery. An endoscopic endonasal approach was undertaken by neurosurgeon Manish Aghi, MD, PhD, and otolaryngologist Ivan El-Sayed, MD. Using 30-degree angled endoscopes, they were able to visualize the anterior extent of the tumor.

While the tumor extended anteriorly from the sellar/suprasellar space into the frontal lobe, it did not grow along the bony tuberculum and planum of the anterior skull base. Instead, there was a cuff of frontal lobe below the anterior extent of the tumor. Aghi used the angled endoscope to clean out all the anterior tumor, working at a 30-degree angle without causing any trauma to the frontal lobe underneath the tumor.

The patient was hospitalized for three days. Since the surgery, he has been taking levothyroxine to combat fatigue. The patient’s vision is slightly improved from its preoperative state and his energy is expected to improve over the next few months as the empty resection cavity collapses over time, further decompressing the frontal lobes.

Symptoms improved or cured in 90% of patients

“The endonasal approach has revolutionized pituitary surgery,” Aghi said. “It is extremely minimally invasive. We’re able to gain access to the pituitary gland within less than an hour and the tumor removal takes less than two hours.

“UCSF is the preeminent place in the world for pituitary tumors,” he said. “Our endocrinologists and neurosurgeons each see more than a dozen patients a day who come to us seeking our insight into pituitary tumors. Each of us will operate on five to six patients with pituitary tumors a week. We’re able to improve or cure symptoms for 90% of these patients.”

UCSF Medical Center is ranked No. 1 in the nation for neurology and neurosurgery in the 2021-2022 Best Hospitals survey by U.S. News & World Report.

Neurology and neurosurgery research and treatment take place within the UCSF Weill Institute for Neurosciences.

To learn more

California Center for Pituitary Disorders

Phone: (415) 353-7500 | Fax: (415) 353-2889

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