Endocrine Abstracts

Mrs. P.A., a 75 year old lady, presented to Accident and Emergency with a severe persistent headache of 3 days duration. She was disorientated and drowsy. She has a history of type 2 diabetes, hypertension, hypercholesterolaemia, depression and hypothyroidism. She was a smoker of 20 a day and consumed no alcohol. Her Glasgow Coma Scale was 13/15, her examination was normal. An initial CT head showed a pituitary tumour with haemorrhage. Tests showed an FSH of 14.1 IU/L, LH 2.9 IU/L, oestradiol <20 pmol/L, prolactin 134 mU/L, TSH of 0.4 mU/L, T4 14.3 pmol/L, and 9 am cortisol of 45 nmol/L. A normal oral glucose tolerance test excluded acromegaly. Formal visual perimetry showed a right temporal upper hemi-quadrantanopia with no matching defect on the left. An MRI brain showed marked compression of the optic chiasm by a mass arising from the pituitary fossa extending into the suprasellar region. In discussion with neurosurgical colleagues, this was treated conservatively. Six weeks later a repeat MRI head showed the pituitary gland lay within the fossa with a concave superior surface with a little deviation of the stalk but no chiasmatic impingement. The visual fields were full.