Endocrine Abstracts

Introduction: Although meningiomas often occurs in parasellar regions such as the tuberculum sellae, olfactory groove, and sphenoid wing, pure intrasellar meningiomas are extremely rare. Patients usually present with gradual visual deterioration secondary to compression of the optic apparatus. Obtaining a correct preoperative diagnosis will likely require a thorough clinical assessment including neuroimaging and endocrine studies.

Case report: A 56 year-old woman with a 6 month history of anosmia was referred to the Neurology Department. A pituitary mass was found and she was referred to the Endocrine Department. A magnetic resonance imaging (MRI) scan revealed a 15×16×19 mm enhanced homogeneous intrasellar mass with suprasellar extension. The optic chiasm was slightly displaced, as well as the anterior cerebral artery, and the pituitary stalk was not visualized. Formal visual field testing was normal, and laboratory data revealed intact pituitary axes. Total resection of the mass was attempted via the transsphenoidal route, and the surgery was complicated with meningitis, which resolved after a 3 week course of antibiotics. The histological report showed a grade I meningotelial meningioma. The patient developed hypopituitarism as evidenced by low levels of ACTH, Cortisol, FSH, LH, estradiol, TSH and FT4. Surgery was further complicated by diabetes insipidus and bilateral temporal hemianopsia. Intrasellar meningiomas are extremely rare, they may be easily confused with pituitary adenomas. They frequently cause visual dysfunction and rarely cause anosmia as the first manifestation. Some evidence suggests that the correct preoperative identification of an intrasellar meningioma is of value in order to appropriately decide the best surgical approach.

Conclusion: To our knowledge, this is the first case of an intrasellar meningioma causing anosmia. The presence of anosmia might aid in the correct diagnosis of an intrasellar meningioma mimicking pituitary adenoma.