Endocrine Abstracts (2007) 13 P68

Recurrent cystic pituitary lesion - A case report

K Sukesh Chandran, Andrew Advani & Richard Quinton

Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.

41 year old male presented in 1992 with 2 years history of blurring of vision, headaches, dizzy spells. Had Right supratemporal visual field defect, pituitary MRI which showed cystic pituitary lesion. Had TSS in May 1992 and histology showed Rathkes pouch cyst. Post operatively developed DI and started on DDAVP.SST,TRH and GnRH tests were normal. Persisted retro orbital head aches, developed nasal and temporal field loss. MRI in Sept 1992 showed large intrasellar recurrence of Rathkes pouch cyst. Repeated TSS Nov.1992.Post operatively SST 0 min 107, 60 min 485,Serum Osmalality 290, urine Osmalality 849 on DDAVP.Started Hydrocortisone. Headaches and tiredness persisted. In 1994 became panhypo pituitary.FT4 8.8,Testosterone 7.9, LH 2.1,FSH 4.2,Cortisol 487(on Hydrocortisone)and started on Thyroxin, Restandol and GH replacement inaddition to Hydrocortisone and DDAVP.MRI in 1995 showed recurrence of pituitary lesion and decided not for further surgery. He developed suicidal thoughts had psychiatry review. MRI 1996 showed small residual localised cyst causing no pressure and decided not for surgery. In 1998 headaches became intolerable and started self mutilating. He had fronto-temporal craniotomy and radical marsupialisation of cystic lesion. Head aches persisted and decided to consider insertion of drainage device if cyst recurs. Post –operative MRI showed small cyst with no compression. Repeat MRI 2002 showed no significant change from previous scan and decided not for any radiotherapy. In 2005 he stopped all medications and further endocrine investigations were as follows:SST 0 min 357,30 min 1047,60 min 945,TSH 5.2,FT4 12,FT3 5.3, ATPO 51,LH 2.2,FSH 2.4,SHBG 15,Free Testosterone 261,Random cortisol 387,Urine Osmalality 605,Serum Osmalality 296(Off DDAVP),Routine Biochemistry Normal.He was eupituitary off all medications and decided to watch his pituitary functions.

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