Endocrine Abstracts

A 36 year old lady presented with a 6 month history of amenorrhoea & increasing fatigue. There was no background of headaches or visual disturbance. She denied thyroid related symptoms. Examination revealed her to be both pale and fatigued however there were no other significant findings. Investigations revealed: random cortisol 56 nmol/l; prolactin 1698mU/l (0-480); LH 0.3U/l; FSH 2.9U/l; fT4 <5pmol/l (10-24); TSH 21.92mU/l (0.4-4.0); IGF1 12.5nmol/l (10-24) An insulin stimulation test revealed growth hormone & cortisol insufficiency
The diagnosis was of secondary amenorrhoea, hypoadrenalism and growth hormone insufficiency with hypothyroidism. She was commenced on appropriate replacement therapy.
MRI revealed an ovoid mass extending upwards from the sella turcica with very high signal return on T1 weighted scan. The neuroradiology impression was of pituitary adenoma with haemorrhagic cyst formation. Visual fields were normal.
Surgical intervention was deemed inappropriate and a plan was made for repeat scan and visual field assessments at regular intervals. Subsequent repeat MRIs revealed an overall reduction in the size in of the mass with changes in keeping with a haemorrhagic cyst.
Subsequent cortisol profile on replacement therapy revealed a high nadir suggesting good endogenous production with very high peaks and hydrocortisone therapy was successfully tailed off and stopped.
This case demonstrates an example of a haemorrhagic cyst within a pituitary adenoma with subsequent reduction in lesion size and resolution of adrenal insufficiency providing a reminder that pituitary haemorrhage may not always present with headaches and visual disturbances and that the associated endocrine deficiencies may be transient.