Pituitary neuroendocrine tumor

Yashoda K^*

Deputy Nursing Superintendent, Kauvery Hospital, Salem, Tamil Nadu

*Correspondence

Introduction

Pituitary neuroendocrine tumor is benign tumor arising from the pituitary gland. Pituitary apoplexy is a rare, life-threatening medical emergency caused by sudden bleeding (hemorrhage) or loss of blood flow (infarction) into the pituitary gland, most often occurring inside a pre-existing pituitary adenoma. This patient had loss of vision. The Hardy-Wilson classification considered the degree of sellar destruction (grade) and extrasellar extension (stage). Sellar destruction was divided into the following

Grade 0 when the enclosed adenoma is described as a tumor that remains within the anatomical confines of the osteoaponeural sheath of the sella turcica

Grade I the sella turcica is within normal limits in size or focally expanded and the tumor is <10 mm

Grade II tumor ≥ 10 mm and the sella turcica is enlarged but the floor remains intact

Image Source: EPOS, Sellar region masses: Tips and Traps

Grade III a local erosion or destruction of the floor

Grade IV when the entire floor of the sella is diffusely eroded or destroyed, giving a characteristic “phantom sella” with all the boundaries barely visible.

Case Presentation

A 40-year-old female came to ER with complaints of headache, blurring of vision both eyes for 6 months. Her vitals were stable & conscious.
She had gone to several hospitals but her issues did not resolve. She was referred to Kauvery by a patient of Kauvery.
Admitted under Neurosurgeon
No history of seizures / weakness of limbs / bladder disturbances
No history of head trauma
No history of fever / neck stiffness
No history of loss of appetite / loss of weight / facial dysmorphism

Past history

No comorbidities
History of amenorrhea x 7 years

Investigations

In ER her GRBS was 368mg/dl, not a known history.She was given Inj H.Actrapid 8U subcutaneous
Ketone 0.0

CT PNS (Plain) on 05.08.2026

Impression

Invasive pituitary macroadenoma

Present study shows an ill-defined heterodense lesion involving sella and suprasellar region causing erosion of tuberculum sellae, dorsum sellae and sella turcica. Lesions also seen involving bilateral sphenoid sinuses and carotid canals. No skull base erosion.

Another hypodense (+35 HU) lesion measuring 23 x 20 mm in infrahyoid region – suggested further evaluation.

Management

Baseline investigations were carried out. Endocrinologist’s opinion was obtained and advised evaluation for a suspected prolactinoma. Ophthalmologist’s opinion was obtained for defective vision and noted bitemporal hemianopia with temporal pallor of the optic disc. The patient was diagnosed with an invasive pituitary neuroendocrine tumor (macroadenoma). Endoscopic transsphenoidal excision of the pituitary tumor was planned. Cardiologist’s opinion was obtained for cardiac status.

The patient underwent an endoscopic transsphenoidal excision of the tumor under general anesthesia (GA) on 07.08.2026. 1 unit of packed red blood cells (PRBC) was transfused. The patient was shifted to the ICU for observation and further management. A postoperative CT of the brain was done on 07.08.2026, which showed a suprasellar component (residual) with a mass effect hemorrhage.

Residual lesion with intralesional hemorrhage now measuring 4.0 x 3.1 x 3.6 cm (CC x AP x TR ) is noted in the sellar/suprasellar region.

Hence, she was planned for a second stage: a left Pterional Craniotomy and excision of the space-occupying lesion (SOL) under GA on 08.08.2026. The post-procedure course was uneventful. The patient was shifted to the ICU for further management. A postoperative CT of the brain was done on 09.08.2026, which showed the total excision of the suprasellar component and no intracranial hemorrhage.

Interval decrease in size of lesion with residual lesion with intralesional hemorrhage now measuring 2.8 x 3.6 x 1.6 cm (AP x TR x CC) is noted (previously measuring 3.1 x 3.6 x 4.0 cm (AP x TR x CC)

The patient was extubated on 09.08.2026. An endocrinologist review was obtained, and orders were followed. The patient had a fever and two episodes of vomiting; the antibiotics were escalated. She also developed Lt eye periorbital edema which subsided later. The patient was then shifted to the ward. The patient was managed with IV fluids, antibiotics, analgesics, neuroprotectants, a proton pump inhibitor (PPI), and other supportive measures. Her glucose level fluctuated she was treated with Inj Human Actrapid initially and Inj Lantus Later

On 12.08.2026 CT Brain plain was taken which showed mild interval decrease in mild pneumocephalus Mild interval decrease in diffuse cerebral edema. No significant midline shift. Residual lesion with intralesional hemorrhage now measuring 2.9 x 2.2 x 1.7 cm ( AP x TR x CC) is noted (previously measuring 2.8. x 3.6 x 1.6 cm (AP x TR x CC)

The patient improved symptomatically and was hence discharged with the following advice.

Diagnosis

Pituitary neuroendocrine tumor with apoplexy
Jules – hardy / Wilson grade 4 / Parasellar Grade/ suprasellar

Nursing Management

Monitor Neurological Status – to detect rising intracranial pressure or deterioration
Assess Visual Acuity Regular visual test, eye movements as the tumor may compress the optic chiasm
Monitor Fluid balance Strict Intake output chart was maintained to check electrolyte shifts and detect early Diabetes insipidus.
Her sodium levels had fluctuations in which corrections were given during her admission
Prevention of Strain and Pressure Patient was advised to avoid blowing nose hard, coughing
Administered stool softeners to prevent constipation

Outcomes

Patient conscious, obey commands
Pupils – Left RAPD, Left eye only perceptions of light,
Left periorbital edema
Right 3mm pupil, VA>3/60.

Discharge

Discharge with stable vitals and came back for review and now leading a normal life. She was advised to on lifelong management of certain drugs. Diabetic Diet. Fluid intake 1.5L/day. Pt was taught to measure urine output for at least a month.

Medication

Medicines	Dose	BF / AF
Tab. Thyroxine	12.5 mcg	AF
Tab. B. Complex	1 Tab	AF
Tab. Ginkosam	1	AF
Tab. Clonazepam	0.5 mg	AF
Tab.Minin (Desmopressin)	0.1 mg	AF
Syp. Cremaffin plus	30 ml	AF
Tab. Nitrofurantoin	100 mg	AF
Tab. Gemer	1 mg	BF
Tab. Sitared M	50/800 mg	AF

Conclusion

Timely diagnosis, prompt surgical intervention and vigilant post-operative nursing care are critical in mitigating vision loss and severe neurological complications. This has enabled the patient’s stable recovery and successful discharge.

Reference

NIH National Library of Medicine Website
https://my.clevlandclinic.org
Research gate
References: Kovacs K, Horvath E: Tumors of the pituitary gland; in Atlas of Tumor Pathology. Washington, Armed Forces Institute of Pathology, 1983, ser 2, pp 66–70.
Textbook of Medical Surgical Nursing Volume II: Suresh K. Sharma S. Madhavi

Pituitary neuroendocrine tumor

Pituitary neuroendocrine tumor

Yashoda K*

Nightingale Journals

Yashoda K^*