Endocrine Abstracts

Introduction: Pneumocephalus is defined as the presence of air within the cranial cavity. It is usually associated with neurosurgical procedures but can also be caused by craniofacial trauma, infections and tumours of the skull base and rarely can occur spontaneously. Neoplasms involving the pituitary fossa are unusual causes of spontaneous pneumocephalus.

Case report: A 39-year-old man presented in the emergency department with significant visual loss, headache and rhinorrhoea. He had no previous history of head trauma or medical illnesses. He complained for increasing fatigue, headache and progressive loss of libido for the last 20 years. On physical examination his height was normal but he had low blood pressure and orthostasis. Optical field examination revealed preservation of central vision only. Initial laboratory examinations showed anaemia. All measured pituitary hormones were low except prolactin. The patient was diagnosed with panhypopituitarism. In the emergency department the patient brought with him a skull radiograph lateral view which showed air in the intracranial cavity. He underwent a brain MRI. A midline large space-occupying inhomogeneous mass was seen, extending and filling the suprasellar cistern, pituitary fossa and sphenoid sinus. It was characterised by cystic lesions separated by thin diaphragms and filling by fluid of increased signal intensity on T2 due to increased protein concentration. Haemorrhagic elements were demonstrated inside the solid contents at the left part of the mass. The aforementioned characteristics were indicative of a giant craniopharyngioma. The patient underwent neurosurgical debulking of the tumour and evacuation of the air collection. He was placed in replacement therapy with marked improvement Histological examination confirmed the diagnosis of craniopharyngioma.

Conclusion: Although extremely rare, spontaneous pneumocephalus should be considered as a possible diagnosis in patients with large pituitary lesions, rhinorrhoea and non-specific neurological manifestations. Early treatment of this potentially life-threatening disorder improves surveillance of these patients.