Endocrine Abstracts

79 year old gentleman was reviewed as new patient in the Endocrine clinic. He was diagnosed with Pituitary Apoplexy of a Non-functioning Adenoma in 1998. He was under surveillance and the tumour remained relatively stable with no complications until 2008.

Surgical history: There was a gradual increase in the size of the adenoma over 5 years. He underwent Transphenoidal adenectomy in Feb 2014 as the tumour was draped over the optic chiasm. Intra-operatively, the tumour consisted of tough fibrous tissue. He had a large remnant tumour post-surgery. He re-presented in March 2016 with sudden onset headache and was diagnosed with Pituitary apoplexy and necrosis. He underwent further surgery and had similar intra-operative finding of tough fibrous tumour which was technically difficult to resect. Post-surgery MRI showed marked reduction in size of the adenoma but had remnant suprasellar tumour elevating optic chiasm.

Changes in hormone profile: The 9am Cortisol levels remained in the normal range and the Short Synacthen tests repeated over the years always showed good response. He was started on Levothyroxine in 2013 but was stopped as he did not tolerate it. He had a transient episode of thyroiditis in 2014–2015 with positive TSH receptor antibodies. He was diagnosed with Hypogonadotrophic Hypogonadism in 2010 and he is on testosterone replacement. The IGF1 has remained low since 2013 but not currently on replacement. This is an interesting case of the long term complications of Non-functioning Pituitary Adenoma including pituitary apoplexy. There is a slow progression to panhypopituitarism but the ACTH and cortisol production are still preserved. This case also demonstrates the challenges in managing thyroid dysfunction in patients with pituitary disease in the community and secondary care.