Endocrine Abstracts

Case report: A 40-year-old lady was diagnosed with acromegaly in 1993 after presentation with clinical symptoms. Imaging showed a 1 cm pituitary lesion and she underwent transphenoidal hypophysectomy in 1993. Post-operatively she was rendered hypopituitary, but still had biochemical evidence of active acromegaly. She proceeded to external beam radiotherapy and was started on bromocriptine medical therapy.

On routine review in 2006, her acromegaly was biochemically quiescent, but a surveillance pituitary MRI revealed an asymptomatic incidental 1.5 cm right parafalcine tumour (Fig. 1). This had features consistent with a meningioma and was treated conservatively.

Figure 1 Gadolinium enhanced MRI Brain 1.5 cm right petrous right parafalcine tumour cavernous posteriorly to abut the anterior surface of the pons/mid-brain.

Figure 2 Meningioma arising from the apex adjacent to the sinus.

In 2007, she complained of right facial neuropathic pain. On clinical examination she had reduced sensation of the ophthalmic and maxillary division of 5th cranial nerve with loss of corneal reflex & loss of right tongue sensation. Repeat MRI imaging showed a new lesion arising lateral to the cavernous sinus from the dural tail of the petrous bone (Fig. 2). She underwent an orbito-zygomatic craniotomy and excision of this lesion. Histology confirmed an atypical meningothelial meningioma with brisk mitotic activity with 80% of cells expressing progesterone receptor.

Clinical learning point: Hypopituitarism secondary to radiotherapy is common and well described. It is likely that this patient had radiotherapy-related meningiomas since they occurred within the field of the radiotherapy beam and at an appropriate time interval.

As of yet, there are no conclusive prospective studies with long term follow up and adequate patient numbers to fully assess the excess risk of non-pituitary cerebral malignancies secondary to radiotherapy.

This potential late occurrence should be considered for patients who have had radiotherapy for pituitary disease.