International Journal of Clinical Science and Medical Research

Giant pituitary adenomas represent a major clinical challenge due to their invasive nature and the serious complications caused by their mass effect on adjacent structures. This report describes the case of a 35-year-old patient presenting with a massive 60x34 mm tumor, revealed by intracranial hypertension and bilateral blindness, whose histopathology confirmed a Pit-1 lineage plurihormonal PitNET. Despite emergency surgical resection aimed at decompressing the optic pathways and restoring cerebrospinal fluid circulation, resection remained subtotal due to adhesion to critical structures such as the cavernous sinus. Postoperative management required a complex multimodal strategy, combining hormone replacement therapy with targeted medical therapies using dopamine agonists and somatostatin analogues, in the face of a persistent invasive tumor remnant. This case illustrates the therapeutic complexities and fragile prognosis inherent to these neoplasms, highlighting the imperative of multidisciplinary management and rigorous molecular characterization to optimize follow-up and treatment strategies in these high-risk patients.

Giant PitNETs, Knosp Grade 4, Cavernous sinus invasion, Somatostatin analogues, Dopamine agonists, Multidisciplinary management, Optic chiasm compression

1. Whyte, E. e. (s.d.). Update on Current Evidence for the Diagnosis and Management of Nonfunctioning Pituitary Neuroendocrine Tumors. Endocrinology and Metabolism. (Source détaillant les conséquences cliniques liées à l'effet de masse et à la gestion p.
2. 2-Azkoul, A. &. (s.d.). When size matters: the impact of a giant non functioning pituitary adenoma. Endocrine Abstracts. (Source spécifique sur les tumeurs géantes et les défis cliniques associés).
3. 3-Persani, L. (. (s.d.). Thyrotropin-Secreting Pituitary Adenomas. Endotext. (Source traitant des profils hormonaux complexes et des adénomes sécrétant de la TSH).
4. 4-Asa, S. L. (s.d.). Overview of the 2022 WHO Classification of Pituitary Tumors. Endocrine Pathology, 33(1), 6–26..