Endocrine Abstracts

A 16 years old boy referred to neurosurgery due to sellar and suprasellar mass. He had a history of retro orbital headache in the last three years. he noticed increase in his height, enlargement of hands and feet. He had one year history of progressive decrease in vision mainly in the left. He did not enter puberty.

Physical examinations

BMI 36 kg/m² (more than 95 percentile), Tall height 190 (more than 97 percentile), Weight 130 kg (more than 97 percentile).

He had coarse features, with large hand and feet, oily skin. His visual field examination revealed left temporal hemianopia. He is still Pre pubertal.

Laboratory

GH 40 ng/ml, IGF1 1220 ng/ml (107–584).

FT4 10.0 pmol/l, TSH 0.458 miu/ml.

Cortisol 100 nmol/l, Post ACTH stimulation: Cortisol 300 nmol/l.

Testosterone index 7 (33–106), LH < 0.1 IU/l, FSH <0.1 IU/l.

Prolactin 888032 miu/l (86–324).

Diagnosis of Pituitary macroadenoma (co-secreting GH and Prolactin) was made.

Patients was treated initially with cabergoline 0.5 mg po once week with dose escalation. Follow up 2 weeks Octreotide 30 mg IM/4W.

His headache improve, as well Visual field improve.

Follow up Prolactin was 30300 miu/l, After three months follow up, he showed marked Improvement in his visual field, and no more headache disappear. The Prolactine level was 6000 miu/l and IGF1 800 ng/ml (107–584). MRI showed Minimal regression of the mass

After 6 months follow up.

The Visual field was normal, Prolactin 3000 miu/l, IGF1 650 ng/ml (107–584).

He is still on Cabergoline 1.5 mg twice per weeks and Octreotide 40 mg/4 weeks.

Conclusion: Young patient present with sellar and suprasellar mass. The diagnosis was Pituitary macroadenoma (co-secreting GH and Prolactin) was made.