Background: Craniopharyngiomas may lead to pituitary insufficiency and neurological symptoms. However the rate of the tumor growth and the time of developing hypopituitarism are difficult to predict.
Case report: A 68-year-old male of short stature (height 148 cm) was admitted to the area hospital due to loss of consciousness. The acute coronary syndrome and stroke had been excluded but laboratory tests showed hyponatremia of 106 mmol/l. Hormone measurements were as follows: ACTH, 6 pg/ml; cortisol, 1.6 μg/dl; TSH, 0.818 μIU/ml; fT4, 7.7 pmol/l; fT3, <1.0 pg/ml; LH, <0.1 IU; FSH, 0.282 IU/l, DHEA-S, <150 ng/ml; testosterone, <0.2 ng/ml; PRL, 0.78 μg/l; GH, <0.1 μg/l; and IGF1:<25 μg/l. The physical examination revealed the absence of testes in the scrotum and lack of pubic hair. MRI demonstrated a pituitary tumor consistent with craniopharyngioma measuring 31×34×35 mm, enveloping cavernous sinuses and internal carotid arteries. Densitometry showed L1L4 T-score: −4.8. A CT scan revealed the presence of undescended testes measuring 15 mm in the inguinal canals. Owing to pituitary insufficiency a replacement therapy with hydrocortisone and L-thyroxin was initiated, leading to improvement in general condition as well as normalization of sodium level. Additionally, the intravenous bisphosphonate and vitamin D was started. The patient remains in stable state and refuses the possibility of surgical treatment.
Conclusions: The case described demonstrates a natural history of craniopharyngioma, developing since birth or even fetal life, with gradual deterioration of pituitary function first manifested by gonado- and somatotropic dysfunction, and several decades later followed by thyreo- and corticotropic deficiency. Moreover, in management of hyponatremia a possibility of secondary adrenal insufficiency and hypothyroidism due to a pituitary tumor should be considered. In such cases, initiation of hydrocortisone and thyroxin treatment can be life-saving.