Endocrine Abstracts

42 year old female presented to ENT clinic in Nov 2020 with otitis externa and underwent CT mastoid which showed an incidental finding of right sellar / parsellar mass, confirmed later by Pituitary MRI in Nov 2020. Referred with an invasive pituitary parasellar adenoma with a size of 2.4 cm, sellar lesion which extends infrasellarly and into the cavernous sinus. Raised GH level which failed to suppress on OGTT with a low normal IGF-1 level. She had mild symptoms associated with acromegaly (sweating and possible change to show size) with nil significant phenotypic features of acromegaly. She had a raised prolactin and had an episode of galactorrhoea one to two year prior to this which was not persistent and was disregarded in past. Background of severe anorexia under the Psychiatric unit, secondary amenorrhea on oestrogen replacement therapy along with severe Osteoporosis and was on Densoumab injections. Pituitary MDT 16 Feb 2021, diagnosed with Somatotroph Adenoma and growth Hormone resistance due to anorexia nervosa with evidence of disease progression on repeat Pituitary scan. Octreotide test showed good response with raised IGF binding proteins 163 (10 × upper limit). Underwent Trans sphenoidal surgery on 12th July 2021 with a good post operative recovery. Post operative bloods revealed a IGF level: 4.7, GH >200, Prolactin: 1239, octreotide test dose and was discharged on Hydrocortisone. Post operative MDT October 2021: Underwent the ITT test post operative, which achieved minimal cortisol response to hypoglycaemia but adequate baseline cortisol levels. Growth hormone values suggest persistent disease with failure to suppress on OGTT. Comparison of Post operative imaging: showed good decompression but suspicious residual on the right side as well as in the cavernous sinus. Histology: adenoma seen with obvious bone invasion. Decreased immunostaining thought to be related to surgical damage of tissue. Pit1 positivity & GH positivity\. Densely granulated GH producing somatotroph adenoma. Ki67 1% Repeat Pituitary MDT review in Nov 2021: Post operative MRI scan showed residual tissue in the aspect of the right para sellar region with normal IGF levels and persistent raised GH levels with an outcome advised no indication for further surgical intervention and to continue with surveillance programme and continue Hydrocortisone Repeat clinic review in February 2022 showed low IGF-1 at 5.6 nmol/l. Prolactin was mildly elevated at 558 mU/l, Cortisol was reassuring at 461 nmol/l. Marked as treated acromegaly with marked elevation of growth hormone but without an IGF 1 response with continued surveillance.