Endocrine Abstracts

The pituicytomas are extremely rare and little-studied primary tumours of the adult neurohypophysis. These are low-grade (World Health Organization [WHO] grade 1), indolent gliomas which present as a sellar mass, which is usually mistaken for a pituitary adenoma, and has no known hormonal secretory function. A 63 years old retired paediatrician was referred to the neurology clinic with the history of constant severe headache ongoing for a few weeks. It involved the whole of the head and was associated with dizziness. There were no postural symptoms and no history of vomiting or nausea or any signs of raised ICP. His past medical history included hypertension, cataract and glaucoma. An urgent MRI head, requested by Neurology, revealed a pituitary lesion which was not fully characterised. He subsequently had a pituitary MRI which showed left sided pituitary adenoma of 7×8×8 mm size with areas of previous haemorrhage. He was urgently seen in Endocrinology clinic and the blood test for anterior pituitary profile were normal. MRIs at the intervals of 6 months and then 18 months showed a slow growth in the tumour size to 15×11 mm with the compression on the right optic chiasm. Formal visual field test showed normal field of vision in the right eye and a stable defect in the left eye. This case was discussed in pituitary MDT and it was thought to be likely craniopharyngioma at that point. Trans-sphenoidal surgery was offered due to enlarging lesion and constant headache. Surgery was aimed at significant debulking and it went well without any complications. Histology report confirmed pituicytoma. Patient remained very well and his symptoms of headache resolved with an improvement in his vision and visual field. His pituitary function remained normal. Patient was interested to explore the options of radiosurgery or radiotherapy for the remnant part of the cytoma. His case was discussed in the pituitary MDT at another centre which admitted that there was paucity in experience with a rare tumour like pituicytoma and advised to continue conservative approach and to consider repeat surgery or SRS if the growth recurs. It has been a very interesting case for Endocrinology, Neurosurgery, Radiology and Oncology teams who have been involved in his care. Patient, being a doctor himself, had a very good understanding of his condition and was aware of the rare nature of the tumour. We continue to follow him up in our Endocrine clinic.