Endocrine Abstracts

Introduction: Epidermoid cyst (EC) or cholesteatoma is a benign tumor, often of congenital origin. It accounts for 1% of intracranial tumors and is mainly located at the ponto-cerebellar angle and suprasellar, EC takes the aspect of a beaded tumor with nodular surface and white pearly color simulating candle wax. The treatment is surgical taking into account the substitution of endocrine pituitary deficits in this form of description.

Patient and observation: We report the case of the married patient EY, aged 38 and father of two but with no particular pathological history, particularly no cranial trauma. He showed left visual acuity decrease, left temporal headache and vomiting, with anterior pituitary deficiency symptoms of the corticotropic axis such as pallor, asthenia, fluid diarrhea, thyrotoxic such as depilation of the forearm, legs, armpits and pubic, slowing down; and gonadotropic such as libido decrease, 1 year ejaculations and morning erections. Cerebral MRI has revealed craniopharyngioma in the patient. Hormonal checkup revealed corticotropic deficit. Indeed, MRI revealed heterogeneous signal intra and supra-sellar process containing hypo and isointense tissue areas in T1, intermediate in T2, and hyperintense in Flair, with no calcifications; hyperintense multilocular zones in T1, measuring 18 * 15 * 27 mm of major axes, bridging the suprasellar cistern, elevating the optic chiasm and the anterior cerebral A1 segments and extending to the left hypothalamic region. The patient was operated using high temporal approach. Anatomopathological checkup showed a morphological aspect compatible with an epidermoid cyst. Post-operative follow up revealed the appearance of diabetes insipidus for which the patient was put under minirin; gonadotropic, thyreotropic and corticotropic deficiencies were substituted by hormonal treatment, Postoperative eye fundus was in favor of bilateral papillary palate which the patient used to have before, bilateral visual acuity improved to 10/10. Visual cham has remained altered, particularly to the right.

Conclusion: Epidermoid cyst is a benign tumor of slow but inevitable linear evolution and requires surgical treatment. The diagnosis becomes easier, especially with MRI scattering sequences’ advent. Such observation argues in favor of the congenital origin and the slow evolution of this type of tumors.