Pituitary Adenoma in a Cadaver: A Case Report

Background: Pituitary adenomas have a prevalence of 1 in 865 adults to 1 in 2688 adults. A study with the Swedish Cancer Registry found that in a 33-year period between 1958 and 1991, the incidence of pituitary adenoma went from 6 per million to 11 per million. These adenomas can be divided into microadenomas (< 10mm) and macroadenomas (>10mm) with half of the incidence being the former and the other half the latter. Pituitary adenomas can be further divided by immunohistochemistry and functional status. Functional status is determined by whether or not the adenoma has hormone activity. Non-functional adenomas are usually incidental findings through imaging studies or autopsies, and are asymptomatic or paucisymptomatic tumors known as incidentalomas. Less than one percent of incidental tumors found at autopsy are macroadenomas. Functional adenomas can present with a clinical syndrome based on the hormone they secrete. Both functional and non-functional pituitary adenomas may cause symptoms resulting from mass effects, including bitemporal hemianopia, headaches, hypopituitarism, and ophthalmoplegia. Case Information: During a routine cadaver dissection of an undernourished 82-year-old male, removal of the brain and subsequent hemisection of the skull revealed a pituitary adenoma in the area of the sella turcica. The following measurements were gathered with calipers. The measurements of strictly the pituitary adenoma were a width of 13.56 mm and a length (anterior to posterior) of 19.13 mm. The pituitary adenoma with the sella turcica from superior to inferior was 23.73 mm. The measurement of the pituitary gland itself in the sella turcica from anterior to posterior was 13.68 mm. The measurements indicated that the cadaver's pituitary adenoma can be classified as a macroadenoma. The donor had a history of dementia, with the cause of death being senile degeneration of the brain. There was no evidence of surgical procedures, and no other medical conditions were noted. Conclusions: Non-functioning and functioning pituitary adenomas are linked to damaged eyesight, hormonal imbalances, and impaired cognitive function. Functioning adenomas may have a more severe impact on cognitive function overall, as there is an apparent connection to neuroendocrine function. Due to the limited medical history of the cadaver, there is uncertainty regarding the type of pituitary adenoma and the effects it may have had. Various surgical methods have been proven effective for the treatment of pituitary adenomas themselves, including single nostril transsphenoidal microscopic and endoscopic surgery. Procedures are known to generally improve hormonal imbalances and not aggravate cognition. While patients' cognitive functioning post-surgery is not extensively tracked, procedures appear to have minimal effectiveness in improving cognitive function for patients with functioning pituitary adenomas and are nonsignificant for patients with non-functioning adenomas. Research determining the specific mechanisms by which pituitary adenomas affect cognitive functioning could be useful for clinicians and surgeons to determine whether surgical procedures would be effective at improving patients' quality of life. In this aspect, clinical case studies help add to the understanding and future literature of conditions, making them extremely important in the advancement of medicine.