Endocrine Abstracts

Back ground: Pituitary adenomas are the most common cause of a mass in the sella, accounting for up to 10–15% of intracranial neoplasm’s¹. However, when dealing with abnormal intrasellar masses, a number of different etiologies are possible: germ cell tumour, metastatic tumours, granulomatous, and inflammatory processes². We report an unusual case of primary pituitary lymphoma diagnosed on biopsy presenting as panhypopituitarism and Diabetes Insipiduis (DI).

Case report: A 59 years old gentleman presented with sudden onset of diplopia, postural dizziness. He was complaining of tiredness with loss of libido and sexual drive for few months. Physical examination revealed orthostatic hypotension, hypogonadism. He had hypernatremia and symptoms of DI. Endocrine assessment revealed panhypopituitarism and raised inflammatory markers (CRP and ESR) and slight normocytic normochromic anaemia. Magnetic resonance imaging (MRI) Head showed pituitary mass with suprasellar extension. Because he had raised inflammatory markers he was referred to neurosurgeons for biopsy of this mass which revealed high grade B cell lymphoma.

Management: He was commenced on desmopressin, hydrocortisone, and levothyroxine replacements. Lymphoma was treated with Methotrexate and radical radiotherapy to pituitary lesion. He remained well following this treatment.

Conclusion: This case highlights the importance of consideration of biopsy in certain pituitary mass with raised inflammatory markers. Benefits are twofold, first it allow tissue diagnosis and second it guide towards specific treatment.

References

1. Gsponer J et al. 1999 Diagnosis of pituitary tumours and other abnormal intrasellar masses. Retrospective analysis of 353 patients. Medicine 78 236.

2. Freda PU, 1999 Differential diagnosis of sellar masses. Endocrinol Metab Clin North Am 28 81.