Endocrine Abstracts

Background: Incidence of non-functioning pituitary macroadenoma (NFPMA) is very rare in pregnancy. We describe a case of complicated non-functioning pituitary macroadenoma presented during pregnancy. 26 year old female at 21 weeks gestation presented to emergency services with worsening headaches, nausea and vomiting for 2-3 months. This was associated with transient double vision and confusion since 2 days. She was admitted to emergency department 3 weeks ago with vomiting and was discharged following rehydration. AMTS at assessment was 7/10. Neurology review revealed papilloedema but no other focal neurological deficit. Goldman perimetry revealed enlarged blind spot and left inferotemporal field defect. Foetal assessment was normal. Urgent MRI revealed a giant (3.4cm) sellar/suprasellar mass in keeping with pituitary macroadenoma with acute obstructive hydrocephalus and optic chiasm compression. High dose dexamethasone was commenced and right frontal external ventricular drain inserted. Pituitary profile revealed a prolactin of 1657mU/l (dilutional factor applied), in keeping with stalk effect and cortisol of 329 nmol/l, IgF-1 28.4 nmol/l, TSH-1.26 mU/l, FT4-13.9 pmol/l. She was reviewed by neurosurgery, endocrinology and obstetric teams. As pituitary macroadenoma was causing compression of optic chiasm and obstructive hydrocephalus, the patient underwent selective trans-sphenoidal intracapsular partial resection was done to prevent CSF leak as the tumor was extending into third ventricle. Post-operative MRI revealed good debulking with a small posterior residual was evident. Histology and immunohistochemistry revealed Synaptophysin was strongly positive and Pit-1 positive. Prolactin, GH, TSH, ACTH, LH, FSH, CK8/Cam5_2 was negative with Ki-67 index of 3%. Post-operatively, the patient developed pan-hypopituitarism and was established on DDAVP, Hydrocortisone and Levothyroxine. Repeat ophthalmological review revealed significant improvement in the visual fields. Cognitive function improved.