Endocrine Abstracts

Introduction: Non-functioning pituitary adenomas, usually macroadenomas, represent around 30% of pituitary tumors. Patients often present with signs of mass effect and symptoms of pituitary insufficiency. We report a complicated case of a cystic pituitary ‘macroadenoma’ presenting with recurrent mucocoeles likely due to underlying sinusitis.

Case report: A 42-year-old Caucasian female presented with chronic headaches and unilateral temporal visual field defect. She also reported secondary amenorrhoea, intermittent galactorrhoea, polydipsia with polyuria. Investigations confirmed a cystic pituitary macroadenoma with chaismal compression associated with hyperprolactenaemia (adjusted PRL 1245, normal range <400). Rest of the baseline pituitary profile was normal. Histology following transsphenoidal surgery was suggestive of a necrotic tumour of unknown aetiology. Postoperative MRI scan showed a thickened stalk with crescentric residual tissue. She later developed sphenoid sinusitis requiring ENT intervention. Postoperatively, she presented with two further episodes of severe headaches with recurrent pituitary mucocoeles warranting further neurosurgery. On at least one occasion sterile purulent fluid was aspirated. Given the suspicion of sphenoid sinusitis causing recurrent mucocoeles, she received a prolonged course of intravenous antibiotics. She recently underwent radical excision of the inflamed sinusoidal mucosa with obliteration of the sinus with a fat graft. Since her last presentation with a pituitary mucocoele, she has had no further recurrence over past 22 months.

Conclusion: Recurrent pituitary cysts are usually craniopharyngiomas or remnants of Rathke’s cleft. Infected pituitary cysts or abscesses are rare, characterized by systemic signs of toxaemia, mass effects due to enlarging pituitary and/or associated endocrine dysfunctions. Diabetes insipidus on presentation, has also been reported in the literature.The infection usually extends from paranasal sinuses, whereas involvement of the pituitary gland in systemic sepsis is quite rare because of effective blood brain barrier.

Hence we highlight the role of both medical and surgical intervention in the management of a rare and complicated case of a pituitary adenoma.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.