Endocrine Abstracts

50 M presented to our hospital with plantar foot pain and clawing of the toes in his right foot for a period of 12 months and a 4 month history of headaches. He was initially managed with physiotherapy and neurology undertook MRI scans. MRI: The pituitary gland is enlarged due to a right-sided hypoenhancing lesion measuring 9.5 × 9 × 6.5 mm. No further pituitary lesion is identified. The pituitary infundibulum is at the midline. The optic chiasm is not displaced. On assessment in the endocrine clinic patient reported multiple skin tags and inability to wear his rings anymore. Patient also reported ongoing Lab work up showed: IGF1 98 nmol/l (8.5-31 nmol/l), OGTT showed inadequate suppression of GH:

Rest of Pituitary function were within normal limits. Patient was commenced on Lanreotide therapy whilst waiting for definitive management of the adenoma causing GH excess. TSS with good resolution of GH excess. Post op no loss of Pituitary function with post op Cortisol 381 and rest of pituitary function within normal limits. IGF1 in the immediate post Op FU: 37.7 (8.5-31 nmol/l). A further appointment showed a rise in IGF1:

21/09/23 09:06 IGF1: 43.0 (H)

27/11/23 09:30 IGF1: 51.1 (H)

Patient underwent a GH day curve: GH day curve:

Further MRI showed: There still remains a 6 mm hypo-enhancing lesion in in the right side of the pituitary fossa. This also returns a similar signal on the T2-weighted sequences to the tumour on the preoperative scan and and may represent a small residuum Postsurgical changes also possible. Patient was referred for pituitary radiotherapy after discussion in the local MDT as there is residual disease. Patient currently awaits radiotherapy.