An unexpected case of frontal headache: Silent corticotroph pituitary neuroendocrine tumor presenting as a sphenoid sinus mass
Bibliographic record
Abstract
We report the case of a 43-year-old male who presented with a 2-year history of frequent frontal headaches, initially attributed to sinus disease. Magnetic resonance imaging revealed a 30 mm mass in the right sphenoid sinus with extension into the cavernous sinus, encasing the internal carotid artery, and invading the sella turcica. Differential diagnosis based on imaging included sphenoid meningioma, low-grade carcinoma, or lymphoma. An endoscopic sphenoid sinus biopsy identified the lesion as a silent corticotroph pituitary neuroendocrine tumor/adenoma (SCA), confirmed by positive immunostaining for ACTH and T-PIT. The patient underwent a successful transsphenoidal resection, followed by a transient postoperative central adrenal insufficiency and diabetes insipidus, which resolved within eight months. Eighteen months postoperatively, the patient retains normal pituitary function with minimal residual tumor. This case illustrates the diagnostic challenge posed by SCAs when presenting as sphenoid sinus masses and highlights the importance of considering SCAs in similar cases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".