Endocrine Abstracts

Introduction: Diseases of the hypothalamus/pituitary are complex and can be difficult to diagnose. Diagnostic possibilities are many and include sphenoid ridge meningiomas and aneurysms of the internal carotid artery as well as craniopharyngiomas, gliomas of the optic nerve, inflammatory and granulomatous disease.

Case report: We present two cases to illustrate the complex differential diagnosis.

The first patient presented with headache, deteriorating vision and tiredness. CT head revealed a mass in the sella and suprasellar region extending into the frontal lobe. Endocrine evaluation was within normal limits. The mass was thought to be a meningioma. She underwent bifrontal craniotomy and debulking of the tumour. Biopsy showed features of pituitary adenoma with weak FSH, HCG expression, consistent with a gonadotroph adenoma.

The second patient presented with confusion, dysphasia and hemi paresis. CT head revealed parietal haemorrhage and an incidental pituitary fossa mass. Further imaging with MRI confirmed a pituitary mass extending superiorly to the optic chiasm and into the ipsilateral cavernous sinus. Her endocrine profile was normal. She was referred to the neurosurgical centre for evaluation of a non-functioning pituitary adenoma. She underwent further imaging with CT angiogram to exclude a non pituitary mass impinging on the pituitary fossa which confirmed an unruptured cavernous carotid aneurysm.

Endocrinologists need to maintain a high index of suspicion and consider the possibility of alternative and less common diagnoses of the hypothalamus and pituitary, especially when clinical features and endocrine tests do not accord with the relatively more common presentations. Intra cranial masses may sometimes prove to be non functioning pituitary tumours.