Endocrine Abstracts

Introduction

Multiple myeloma is a haematological malignancy arising from plasma cells. It accounts for 10% of all haematological malignancies. Myeloma usually occurs in people over the age of 65, however, we have noted an increase occurrence of people with a younger age.

Case Report

A 68 year old male, with background of hypertension and right total hip replacement, was referred to the outpatient haematology; as his blood results revealed IgGK monoclonal bands(18 g/l) following a GP appointment. Further testing also confirmed Bence-jones protein in the urine sample. A skeletal survey was requested, which showed some soft lucencies in the skull. Subsequently, a CT head was organised, however this did not show any skull lucencies. Despite the absence of skull lucencies on the CT head, lytic lesions in C1 vertebral body were present as well as an incidental finding of macroadenoma pituitary adenoma compressing the optic chiasm. This was confirmed with an MRI scan. Further discussions were made with neurosurgeons, who also noted the incidental pituitary adenoma. In spite of this, the neurosurgeons were strongly convinced that this was likely a pituitary plasmacytoma given the patients latest diagnosis of multiple myeloma. Therefore, neurosurgeons suggested to start the patient on treatment for multiple myeloma. The patient responded very well to the chemotherapy however, he later developed some blurring of his vision which prompted an optician review. This confirmed bitemporal visual field defects with no reduction in pituitary tumour size on MRI. As a result, the patient underwent transsphenoidal surgery with improvement in visual field.

Discussion

A common diagnostic criteria for multiple myeloma include: ≥10% clonal plasma cells on bone marrow examination or presence plasmacytoma following biopsy, hypercalcemia, renal failure, anaemia, and lytic bone lesions. Pituitary adenomas are often misdiagnosed. Sella and Parasellar plasmacytomas are rare tumours, that can progress to multiple myeloma or even be present in the midst of a diagnosis of multiple myeloma. The clinical presentation of patients with sellar or intrasellar plasmacytoma are headaches due to the mass effect or visual disturbances. Due to the mimicry nature and similarity in clinical presentations accurate diagnosis is essential for successful management.

Conclusion

This case delayed definitive treatment of non-functioning pituitary adenoma for almost 2 years. This highlights the importance of having the correct diagnosis, to avoid delayed treatment.