Endocrine Abstracts

Introduction: Even though pituitary apoplexy usually occurs in the context of a pituitary adenoma, it can also occur over other tumours, which is less common in adulthood and has faster growth and aggressiveness. It can also produce clinical, analytical and even radiological indications that are indistinguishable from a pituitary adenoma with ischemic and/or haemorrhagic events.

Case report: A 43-year-old female, with no medical history of interest except hypertension, had headaches for a period of 3 months, as well as vomiting, diplopia and left ptosis prior to admission. An image of a sellar pituitary tumour, measuring 20×23 mm with suprasellar growth (with obliteration of the parasellar tank and cavernous sinus) compressing the optic chiasm was seen by magnetic resonance imaging confirming the presence of invasive pituitary macroadenoma with subacute bleeding. Analytical data showed hyponatremia and hypopituitarism with partial data. A tumour resection by transsphenoidal approach was perfomed, suspecting pituitary apoplexy. The hystopathological finding indicated rhabdoid tumour/teratoid atypical (WHO grade IV). The evolution was satisfactory until the ninth postoperative day when the patient started with a headache, vomiting and impaired level of consciousness. A CT scan was performed and confirmed a large isointense mass of about 7.2 cm in temporal and frontal rights lobes and suprasellar region, collapsing the right lateral ventricle. The patient finally died at 27 days after surgical intervention.

Conclusion: Teratoid/atypical rhabdoid tumor is an aggressive malignant tumour of the central nervous system that usually occurs in children younger than 3 years of age and has a poor prognosis despite chemotherapy and/or radiotherapy.