Endocrine Abstracts

Meningioma is a common, usually benign, tumor of the brain and the spinal cord that originates from any dura surface. Such lesion accounts for 10 to 15% of nonadenomatous sellar masses. Purely intrasellar meningiomas are relatively rare and can mimic a nonfunctioning adenoma. A 33-year-old man with a history of 1.5 year fatigue, anemia and erectile dysfunction referred to our department. The laboratory data revealed low levels of ACTH, Cortisol, FSH, LH and Testosterone, while TSH, FT₄, IGF-1, PRL, K⁺ and Na⁺ levels were normal. Pituitary MRI demonstrated the presence of an intrasellar mass measuring 2.4×2.4×1.7 cm in diameter. The suprasellar extension was causing displacement of the optic nerves and the chiasm. There were foci of low signal intensity consistent with areas of calcification or hemorrhage. Formal visual field testing resulted normal. The patient received replacement therapy with hydrocortisone and testosterone and referred to a Neurosurgeon. Few days before surgery the patient complained of polyuria and polydipsia and desmopressin was prescribed. The mass couldn’t be totally resected through transsphenoidal approach due to its hard fibrous tissue. The histological report showed Grade I psammomatous meningioma. The postoperative MRI revealed residual tumor measuring 1.8×1.8×1.6 cm in diameter. A debulking surgery followed and the postoperative blood tests demonstrated panhypopitutarism with low levels of ACTH, Cortisol, FSH, LH, Testosterone, TSH, FT₄, PRL and IGF-1. Thyroxine replacement therapy was added. Meningiomas of the pituitary fossa represent approximately 5 to 10% of intracranial meningiomas. They commonly cause visual dysfunction and infrequently hormonal insufficiency. In our case the patient presented with hypopituitarism caused by the meningioma, but no visual disturbances. To our knowledge this is the first case that an intrasellar psammomatous meningioma causes pituitary insufficiency of both the anterior and posterior lobe with normal visual fields.