CASE STUDIES IN PITUITARY ADENOMA RADIOTHERAPY ASPECTS

1. CASE STUDIES IN PITUITARY ADENOMA
RADIOTHERAPY ASPECTS
KANHU CHARAN PATRO

2. NAME-PSR
NON FUNCTIONING PITUITARY
MACROADENOMA
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3. Presented with
• 40 YEAR MALE
• Head ache
• Blurring vision
• ?Acromegaly
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5. HROMONAL LEVELS
HORMONAL LEVEL Value NORMAL RANGE
1. GROWTH
HORMONE
0.139ng/ml Up to 3 male
1. PROLACTIN 14.5ng/ml Up to 17 male
1. TSH 2.9IU/ML 0.7-6.4
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6. 4/5/2019 6
RIGHT EYE FINGER COUNT
LEFT EYE NORMAL VISION

7. RIGHT EYE VISUAL FIELD
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8. LEFT EYE VISUAL FIELD
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9. MRI CONTRAST
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10. MRI BRAIN CONTRAST
• Sellar and suprasellar mass
• 40 x28x27 mm mass
• ISO on T1
• Hyper onT2
• Homogenous enhancement
• Sellar floor intact
• Both Cavernous sinus normal
• S/O PITUITARY MACROADENOMA
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11. SAGITTAL
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12. CORONAL VIEW
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13. T2
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14. T2 FLAIR
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15. SURGERY
• TRANS NASAL TRANS SPHENOID ENDOSCOPIC
EXCISION
• PARTIAL EXCISION
• PACKING MATERIAL –ABDOMINAL FAT
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16. HISTOPATHOLOGY REPORT
• pT-1.5x1.4cm
• s/o – PITUITARY ADENOMA
• No mitosis
• No atypical picture
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20. INDICATION OF RADIOTHERAPY
• Gross residual
• Decrease vision
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21. POST OP CT SCAN
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22. T2
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23. T2-PACKING MATERIAL
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24. RT. CAVERNOUS SINUS INVOLVEMNET
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25. OPTIC CHIASMA
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26. GTV
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27. CTV -5mm UNEDITED
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28. CTV EDITED-YELLOW
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29. PTV-5mm
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30. DOSE
45Gy/25#
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31. BUTTERFLY ARC
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32. FULL ARC
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33. HELMET ARC
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34. ALEXANDER ARC
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35. PLAN COMPARISON
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36. ANTERIOR CHAMBER DOSE
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37. PTV COVERAGE
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38. CASE-2
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39. NAME-GK
NON FUNCTIONING PITUITARY
MACROADENOMA
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40. PRESENTATION
• 26 YEAR
• MALE
• HEADCAHE
• DECREASE VISION ON LEFT EYE ONLY
PERCEPTION TO LIGHT
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41. HORMONAL LVEL
• NORMAL LEVEL
• BIOCHEMISTRY NORMAL
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42. HROMONAL LEVELS
HORMONAL LEVEL VALUE NORMAL RANGE
1. GROWTH
HORMONE
0.1ng Up to 3 male
1. PROLACTIN 25.96 Up to 17 male
1. TSH 1.48yg 0.7-6.4
1. ACTH 19.37pg
1. CORTISOL 7.51 10-20
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43. OPHTHALMIC EXAMINATION
• LEFT EYE
• LIGHT PERCEPTION
• LEFT OPTIC ATROPHY
• RIGHT EYE
• ACUITY -6/9
• PLAE DISC
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44. CT BRAIN CONTRAST
• SELLAR AND PARASELLAR MASS
• BASIFRONTAL EXTENSION
• LEFT TEMPORAL EXTENSION
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45. MRI BRAIN CONTRAST
• SELLAR AND PARASELLAR MASS
• BASIFRONTAL EXTENSION
• LEFT TEMPORAL EXTENSION
• T1-ISO
• T2-HYPER
• CONTRAST-ENHANCING MASSS
• ABUTTING ICA,MCA,ACA
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46. SURGERY
• BIFRONTAL CRANIOTOMY
• INTERHEMISPHERIC APPROACH
• NEAR TOTAL DECOMPRESSION
• PART OF TUMOR ATTACHED TO CHIASM LEFT
BEHIND
• TUMOR WAS GREYISH, VASCULAR,SUCKABLE
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47. HISTOPATHOLOGY
PITUITARY ADENOMA WITH HEMORRHAGE
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48. SURGEON KEPT UNDER FOLLOW UP
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49. AFTER 6 MONTH
• AGAIN DECREASE VISION AFTER
IMPROVEMENT
• ELECTROLYTE IMBALANCE
• TEMPORAL HEMIANOPIC DEFECT
• LEFT EYE20/20
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54. AFTER 6 MONTH-2ND SURGERY
• TRANS NASAL AND TRANS SPHENOID
EXCISION
• DEVELOPED HYPER NATREMIA
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60. PRE RT IMAGES
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63. GTV
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64. CTV EDITED
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65. PTV
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66. PTV
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67. PTV
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68. PTV
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69. DVH
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