Endocrine Abstracts

Introduction: Pituitary adenomas are not uncommon presentations in our clinical practice but the challenge with management becomes more daunting as the size of the tumour gets bigger as seen in this woman we present herein with a macroadenoma. The combination of factors militating against accessing the best of health care available is unconnected with the usual problems affecting health care delivery in Sub-Saharan Africa, including out-of-pocket payments for health services and unavailability of prescribed drugs.

Case presentation: A 38-year-old lady presented to the endocrine clinic of our hospital 2 years ago with a 4-year history of irregular menses and 1-year history of both right sided headaches and blurring of vision. There is associated galactorrhea, weight gain and loss of libido. The CNS examination is remarkable for a right homonymous hemianopia. Examination of the cardiovascular, chest, abdomen and thyroid glands are not remarkable. She was referred from a neurosurgeon on account of pituitary macroadenoma after cranial CT confirmation because she declined surgery, however, was already commenced on 0.5 mg weekly of carbagoline. At presentation she has a normalized serum prolactin level (16 ng/ml) as compared to a baseline of 96 ng/ml. The free T3, free T4, TSH, LH, FSH were within reference range. A repeat cranial CT was ordered which revealed a further increase in the size of the mass to 35.9*28.3*25.5 mm compared to the initial CT. Carbagoline was increased further to 1 mg weekly and noticeable changes in symptoms include: return of menses, less frequency of headaches and improved vision on the right eye. However, another cranial CT to recheck the tumor size could not be done due to lack of funds.

Conclusion: She has been on and off carbagoline in the past year because of lack of funds though appears clinically stable.