Endocrine Abstracts

Introduction: Pituitary tumours one of the most commonly occurring intracranial neoplasms accounting for up to the 15 % of all intracranial neoplasms. Pituitary tumours are often associated with overproduction of hormones or, when they are large, they cause mass effect on surrounding neural structures which are adjacent to their typical location in the Sella turcica. Due to their multifaceted effects pituitary tumours may cause cognitive impairment due hormonal deficiency or mass effect on key cognitive areas of the brain. There is limited research on the impact of slow growing tumours and their impact on cognitive function.

Cases 1: A 26-year-old lady was admitted with general lethargy and leg swelling in her legs and being generally unwell. She had a history of epilepsy, long-standing amenorrhea and autism. Her hormone profile showed low cortisol level and hypopituitarism. she commenced hormonal replacement which improved her symptoms. MRI pituitary revealed a cystic pituitary mass with suprasellar extension (2.9x1.4 cm)

9/12/2022 SHORT SYNACTHEN TEST

ACTH-8

Cortisol-23

Cortisol 116

Cortisol-164

Case 2: A 20-year-old presented with right-sided visual dysfunction and headaches, diplopia and blurred vision in the right eye. There was no other focal neurology. He had history of Autism/learning disabilities diagnosed at age of 16 years. On examination, there was a partial right-sided third nerve palsy, with a fixed dilated right pupil. The right sixth nerve and fifth nerve showed no deficit. The fundi appeared within normal limits. MRI pituitary showed a large right-sided seller/cavernous sinus tumor partly cystic. The Sella was slightly enlarged at 12mm AP diameter. Normal biochemical hormonal profile. Admitted for Endoscopic Transsphenoidal Debulking of pituitary mass subsequently developed diabetes insipidus. He is on Desmopressin replacement and has achieved good fluid balance. Post-operative MRI was normal.

Discussion/Conclusion: Pituitary adenomas are slow-growing tumours that are classified basis of whether they secrete hormone or not. The benign nature of these tumours often means that they may be overlooked and remain untreated, with patients developing serious comorbidities that reduce their quality of life. Several studies have indicated that the physical compression from tumour might play a role in cognitive impairment as evidenced by the slow improvement observed post-surgical resection of tumour. We recommend doing MRI of the brain for patient with latent adolescent learning disabilities or difficulties