Endocrine Abstracts

45/M presented to hospital with h/o assault on head (hit by meat cleaver). Background history of drug abuse and previous drug induced psychosis. Trauma CT head revealed mass in the enlarged pituitary fossa. MRI head revealed 5 x 4 cm mass in the sella turcica encasing the internal carotid vessels but sparing optic chiasma. Visual field examination was normal and no other clinical symptoms were present. Serum prolactin was 67922. Tumor was not for resection so medical treatment advised, started on cabergoline and serum prolactin levels declined. Later, on treatment, he presented with depression and compulsive shop lifting behaviour. So his medical treatment had to be stopped as per MDT and neurosurgical opinion was sought. Because of the extent of involvement of the key brain vessels, surgery was risky. Repeat MRI head was advised but patient didn’t turn up and didn’t pick up phone. Incidentally he had X-Ray skull available from 13 years ago, done to r/o skull fracture post head assault at that time, which was reported normal by radiologist at that time. But the Radiologist who reported MRI head this time was able to view the X-Ray skull 13 years ago, and reported that there was bony re-modelling present in the X-Ray in area of sella turcica, indicating the long-standing nature of this prolactinoma. This case was interesting as the patient had no clinical symptoms despite large size of the pituitary mass and he had developed the well known but rare side effect of dopamine agonist therapy (compulsive behaviour), which improved upon stopping the therapy.