Introduction: Patients with large non-functioning pituitary macroadenomas often have symptoms due to varying degree of hypopituitarism and/or mass effect on visual structures, while presentation with hydrocephalus is extremely uncommon.
Case report: We describe an 82-year-old man who was referred to the Neurology department of our hospital because of rapidly progressive memory loss. The patient was in good health until ten weeks earlier, when he insidiously began to develop memory impairment, headaches and progressive asthenia. Ophtalmic examination revealed bitemporal hemianopia and bilateral papilloedema. The contrast enhanced CT scan of head revealed a well-defined enhancing mass in the sella and suprasellar region extending into the lumen of the 3rd ventricle producing obstructive hydrocephalus. Magnetic resonance imaging (MRI) confirmed the sellar mass with supra and parasellar extension compatible with pituitary macroadenoma (6×2.6×2.6 cm) associated with active hydrocephalus. Endocrinologic evaluation confirmed panhypopituitarism, therefore, hormone replacement therapy was immediately instituted. At the same time, surgical resection was planned but the patient and his family refused both surgical excision and external drainage.
Conclusions: Obstructive hydrocephalus as a late complication of adenomas or after pituitary surgery has been described, but the initial clinical manifestation of a pituitary adenoma with symptomatic hydrocephalus is rare.