Endocrine Abstracts

Case history: 37F presented with 4 years history of amenorrhea. In addition, she had fatigue, low mood and joint pains. She also had history of polyuria and nocturia.

Investigations: Her investigations revealed FSH 2.4 IU/l, LH 1.1 IU/l, Oestradiol < 92 pmol/l, T4 <5 pmol/l, TSH 1.5 mIU/l, IGF-1 13.3 nmol/l (8.5- 30.07), Cortisol 65 nmol/l, Prolactin 68 mIU/l. She was started on Hydrocortisone and levothyroxine. Pituitary MRI revealed a 15 mm lesion not impinging on the chiasm. Heterogeneous enhancement was in keeping with an inflammatory process. Osmolarities were consistent with a diagnosis of DI.

Results and treatment: Interval imaging at 4 months did not show change in size. However, to obtain a histological diagnosis she underwent a TSS. Histology revealed pus like material and chronic inflammatory infiltrate. Extended microbiology screen including TB was negative. She was started on PO Co-amoxiclav for 4- 6 weeks with aim to repeat MRI afterwards. Interval scan at 2 months post TSS showed peripherally enhancing lobulated lesion, which appeared larger than (1st) post-operative imaging, with slight chiasm contact and minimal displacement. She was offered a second TSS and this time the plan is for her to remain on IV antibiotics for 6 weeks.

Conclusion and points for discussion: Pituitary abscess is a rare finding. The clinical presentation and radiological appearance is similar to many other pituitary lesions. On review of literature, patient can present with fever and non-specific signs and symptoms in addition to pituitary dysfunction. The mainstay of diagnosis remains on histopathology. Most of these lesions resolve after IV antibiotics.