SFEBES2022 Poster Presentations Neuroendocrinology and Pituitary (72 abstracts)
A rare case of multicentric glioblastoma causing panhypopituitarism: A case report
Shahriar Shafiq 1 , Yi Tao Sim 2 , Sheena Thayyil 1 , Shailesh Gohil 1,2 , Ragini Bhake 1 , Narendra L Reddy 1,2 , Ian Scott 3 , Iain Robertson 3 & Miles Levy 1,2
1Leicester Royal Infirmary, Leicester, United Kingdom; 2University of Leicester, Leicester, United Kingdom; 3Queen’s Medical Centre, Nottingham, United Kingdom
Introduction: Glioblastoma, an aggressive intracranial tumour usually is a solitary lesion and not commonly located in the sella turcica. Panhypopituitarism due to multicentric glioblastoma can present with a challenging clinical picture masking or delaying the underlying diagnosis.
Case presentation: 58 year old female presented with marked behavioural change, reduced appetite, nausea, polyuria & increased thirst over 4-6 weeks precipitating into an acute admission with dehydration, hypernatraemia and acute kidney injury. On a face to face review in the joint pituitary clinic, she appeared entirely disinterested in her own consultation in the presence of her husband, sister-in-law via telephone and a large multidisciplinary team, prompting the impression of her displaying signs of a frontal lobe syndrome. Full anterior pituitary biochemistry was suggestive of panhypopituitarism affecting the anterior and posterior pituitary, for which appropriate hormone replacement was administered in addition to supportive measures. MRI pituitary revealed two lesions, one in the suprasellar region and another in the left anterior cingulate gyrus. Craniotomy and biopsy at the regional neurosurgical centre confirmed multicentric WHO grade 4 glioblastoma. She had rapid disease progression precluding further treatment with the adoption of a palliative approach.
Conclusion: Multifocal glioblastoma is a rare diagnosis to encounter in the pituitary clinic. Involvement of the pituitary by a suprasellar lesion may be misleading and delay the overall diagnosis which needs prompt diagnosis and management if survival is to be improved. Good clinical history and collaborative working between endocrinology, neuroradiology, neurosurgery and acute medicine is what facilitated timely diagnosis for this patient and her very anxious family. Recognising and managing panhypopituitarism in the acute phase was important in improving physical health, although cognitive impairment was progressive until the time of her demise.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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