Endocrine Abstracts

A 41-year-old woman was referred with 9 months history of secondary amenorrhoea and galactorrhoea. She was otherwise well and not taking any medications. Biochemical evaluation showed prolactin 2000 mU/l but otherwise unremarkable. Pituitary MRI revealed a 30 mm pituitary lesion with right cavernous sinus invasion, presumed to be a craniopharyngioma due to the presence of calcification. Surgical intervention was recommended, but the patient declined. She was commenced on cabergoline with normalisation of prolactin and restoration of menses. Serial pituitary MRI showed stable disease until 3 years later where there was an increase in size and filling of the sphenoid sinus. She developed right 6th cranial nerve palsy. A stronger recommendation for surgery was made, but also declined. A year later, MRI showed a further increase in size of the pituitary lesion. Right 6th and left 4th nerve palsies were noted. Following further discussion she underwent endoscopic transsphenoidal surgery to debulk the lesion with complete resection of the suprasellar component but with residual tissue within the pituitary fossa and right cavernous sinus. Postoperatively, pituitary function remained normal. Histology revealed WHO grade-2 chondrosarcoma. She was referred for proton beam therapy in Florida, USA, and tolerated the treatment well. Pituitary MRI 3 months later showed reduction of the pituitary fossa and cavernous sinus tumour residues. Her pituitary functions remain intact.

Pituitary chondrosarcomas are rare tumours of cartilage-forming cells arising from the sella, usually presenting as a non-functioning mass. The best predictor of good long-term outcome is the extent of resection of the initial tumour. However, the anatomical location may render complete resection extremely difficult and hazardous to achieve. Our case demonstrates that these tumours are slow growing. It illustrates the importance of histological diagnosis for proton therapy to be offered which is recommended for any residual as it allows safer delivery of higher radiation doses.