Endocrine Abstracts

A 32-year-old female presented with a 6-week history of worsening headaches associated with bitemporal visual field defects. An urgent MR scan demonstrated a sizeable pituitary lesion with chiasmal compression and suprasellar extension. Endocrine tests revealed hyperprolactinaemia (2550 mU/l) with hypocortisolaemia (<37 nmol/l). Cabergoline and hydrocortisone replacement were initiated. Unfortunately, 24 h later her visual fields deteriorated further and the patient underwent a subtotal transsphenoidal, followed by transcranial resection of the tumour. Post-operatively, the visual fields improved slightly. The histology was in keeping with carcinoma – either of metastatic origin or primary pituitary cancer. A CT chest, abdomen and pelvis did not suggest a possible primary.

Three weeks post-operatively, the patient re-presented with worsening headaches and a deterioration in visual fields. Tumour recurrence was confirmed on CT and the patient proceeded to have urgent radiotherapy. Unfortunately, 2 days after completing the course of radiotherapy (3 months post-surgery), she was readmitted to hospital with progressive headache, nausea and deterioration of vision in the left eye. An MRI demonstrated widespread meningeal thickening with evidence of multiple durally-based metastases. Upon review by the oncology team it was advised that the patient have a lumbar puncture for CSF cytology and a repeat CT chest, abdomen and pelvis to aid future management decision. Sadly however, this patient passed away days after this review.

This case not only highlights the difficulty in diagnosis but also the therapeutic challenge in managing what has been in this case a rapidly fatal disease.