Resection of Fibrous Dysplasia of the Sphenoid Bone and a Concomitant Calcified Pituitary Adenoma via an Endoscopic Endonasal Transsphenoidal Approach

Abstract

Background: Although pituitary adenomas have been described in association with polyostotic fibrous dysplasia in McCune-Albright Syndrome, no such relationship has been described with monostotic fibrous dysplasia. The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and concomitant pituitary adenoma in a 25-year-old male. To the authors’ knowledge this is the first such case reported in the literature. Clinical presentation, pathology, and surgical approach are described in detail. Case Description: A 25-year-old male initially presented with headaches, gynecomastia, and galactorrhea. Magnetic Resonance Imaging (MRI) revealed a sellar/suprasellar mass possibly consistent with a calcified pituitary adenoma or craniopharyngioma and a cranial base lesion obstructing the sphenoid sinus consistent with fibrous dysplasia. Both lesions were accessible via an endoscopic transnasal approach. The patient underwent resection of the affected sphenoid bone which allowed appropriate exposure for subsequent resection of the pituitary lesion without major complication. Pathology and immunohistochemical studies confirmed the diagnoses and postoperative imaging revealed gross total resection of the adenoma. Conclusions: The authors describe a case of monostotic fibrous dysplasia of the sphenoid bone and pituitary adenoma. Resection of such dual lesions can be both safe and efficacious via an endoscopic endonasal transsphenoidal approach.