Endocrine Abstracts

Introduction: The clinical presentation of a secretory pituitary macroadenoma usually consists of a tumor syndrome accompanied by visual disturbances with signs of pituitary insufficiency and/or hormonal hypersecretion. Herein we describe an unusual presentation of a mixed secretory adenoma.

Observation: A 69-year-old was referred to our department for the management of a pituitary macroadenoma revealed by a symptomatology mimicking the Hakim Adams triad with gait disorders, sphincter disorders and a dementia syndrome, as well as a right monocular blindness. His past medical history included type 2 diabetes mellitus and hypertension. Physical examination noted a dysmorphic syndrome suggestive of acromegaly. Hormonal investigations revealed a hyperprolactinemia at 4755 ng/ml, a baseline GH of 7.8 ng/ml (>1) with elevated IGF1 levels. Baseline cortisol was at 8.9 μg/dl (nr:5-18) with an ACTH at 36.16 pg/ml (nr:7.22-63.3). TSH and FT4 were at 0.143 mIU/l (nr:0.1- 4.5) and 0.67 ng/dl (0.7-1.5) respectively. FSH and LH were at 2.94 IU/l (nr:1-12) and 1.34 IU/l (nr:2-12) respectively. Brain MRI showed a 5 cm pituitary macroadenoma with supra sellar extension pushing back the optic chiasm and leading to lateral ventricles dilatation upstream and an invasion of the right cavernous sinus. Ophthalmological examination showed pallor and bilateral papillary atrophy. Visual acuity was very low. Visual field showed right monocular blindness and was agonic on the left. The patient was put under Cabergoline at the dose of 1.5 mg per week. The evolution after one week was spectacular with disappearance of the walking, sphincter, and memory disorders with visual improvement, being reduced to a right lateral homonymous hemianopia.

Conclsion: Symptoms mimicking Adams Hakim’s triad are exceptionally in relation with a pituitary adenoma. In case of prolactinoma, medical treatment with dopaminergic agonists may be associated with resolution of those neurological symptoms.