Endocrine Abstracts

A 73 year old male presented to his optician with reduced vision in his right eye. He was found to have a right sided visual field defect and referred to Opthalmology. An MRI scan was arranged which showed a 29 x 22 x 17mm pituitary fossa mass, elevating and flattening the optic chiasm. He was therefore referred urgently to Endocrinology. He denied any symptoms other than some lethargy, a mild headache and erectile dysfunction. His anterior pituitary function tests are displayed below: His past medical history included hypertension, previous colorectal cancer and a microprolactinoma diagnosed 13 years prior. At that time, he had presented with erectile dysfunction and hyperprolactinaemia (664-832mU/l), with low testosterone (5.7-6.6nmol/l, FSH 5u/l, LH 1u/l). Other anterior pituitary function unremarkable at the time. An MRI pituitary at that point had shown a 5mm diameter pituitary microadenoma. He was commenced on Quinagolide with subsequent improvement in his prolactin (124 mU/l) and a rise in his testosterone to 10nmol/l, but no clear improvement in erectile dysfunction. 4 months later, he was diagnosed with colorectal cancer and was subsequently lost to endocrine clinic follow up. Following his representation recently, he was commenced on Cabergoline 500 micrograms once weekly along with Levothyroxine 75 micrograms once daily. 3 months later, he reported improvement in his vision, confirmed by repeat visual field testing. A repeat MRI pituitary showed a reduction in the size of the pituitary lesion to 25 x 17 x 15mm, with reduction in mass effect on the optic chiasm. His bloods showed a reduction in prolactin, to 3054mU/l. His cabergoline was uptitrated to 750 micrograms per week. The patient’s main concern was erectile dysfunction and a trial of topical testosterone was commenced. 3 months later, there was some improvement in sexual symptoms, as well as energy levels. He continues on Cabergoline, Levothyroxine and topical testosterone, with a plan for a repeat MRI in 12 months’ time, and ongoing endocrine follow up.