Endocrine Abstracts

Case report;

A 42-year-old male presented with headache, coarserning of facial features, enlargement of body parts of 2 years duration. There was no visual disturbance. His height was 168cms, wt 71kg and BMI of 25Kg/ per met square.He was normotensive .Biochemical and hormonal profile revealed he was euglycemic, euthyroid, serum cortisol(am)280nmo/lit(normal 450-700nmo/lit) non suprresible GH values of 46 ng/ml with 75gms of oral glucose (normal< 1 ng /ml), prolactin 19.7 ng/ml (n 3-20 ) LH 2.1, FSH 1.25 mIu/ml, testosterone 5.9nmo/lit. MRI of the hypothalmo pituitary area revealed a 4.8x 4.6x4.2 cm sellarmass with suprasellar extention and unilateral hydrocephalus but there was a clear cut line of clevage between the tumor and frontal lobe . Patient was subjected to transs-phenoidal tumor removal, which was partial. Histopathology of the tumor revealed a pituitary adenoma intermingled with numerous focii of apparently neural tumor comprising of large neuron like cells and abundant neuropil. The neuron like cells and neuropil showed strong positivity for neuron specific enolase (NSE), synaptophysin and glial cell fibrillary acidic protein(GFAP)was faintly positive.The adenomatous component was positive for GH, negative for ACTH and PRL, LH, FSH on immunohistochemistry . On follow up patient had partial improvement in his symptoms and MRI repeated at third month revealed a reduction in tumor-size. He was euhormonal without any replacement except growth harmone to oral glucose was still nonsupressble. He underwent redo-surgery and there was near total removal of tumor. Repeat histopathology revealed the same findings as before. At one year of follow up patient was doing well. During second surgery immunostaing with cytokenotin was performed which was found to be positive.

Neuronal choristoma in the region of sella turcica is a rare entity and their histogenesis is enigmatic. Our finding supports the metaplastic hypothesis of histogensis.

Key words : ACROMEGALY, CHORISTOMA, PITUITARY, SOMATOTROPINOMA.