ECE2022 Eposter Presentations Pituitary and Neuroendocrinology (211 abstracts)
Vanishing Pituitary tumour in a postpartum patient - a diagnostic dilemma
Noha Meneissy 1 , 2 , Moustafa Hosni 2 , 3 , Belayet Hossain 4 , Barney Low 3 , Janessa Bell 3 , Writaja Halder 3 , Debbie Falconer 3 , Shrini Patel 3 , Muhammad Saleem 3 , Saiful Islam 3 , Musarat Hussain 3 , Jessica Howes 3 , Hassan Rehmani 3 , Gideon Mlawa 3,5 & Catherine Qin 1
1Queen’s Hospital, London, United Kingdom; 2Queen’s Hospital, Acute Medicine, London, United Kingdom; 3Barking, Havering and Redbridge University Hospital NHS Trust (BHRUT), Acute Medicine, London, United Kingdom; 4Barking, Havering and Redbridge University Hospital NHS Trust (BHRUT), Diabetes and Endocrinology, London, United Kingdom; 5Queens Hospital, Diabetes and Endocrinology/Acute Medicine, London, United Kingdom;
Introduction: Resolution of pituitary tumour without surgical intervention is rare. The mechanism of spontaneous resolution of pituitary adenoma is unclear but may be explained by either pituitary apoplexy or hypophysitis responding to steroids. Bray BP, et al(2021) reported the case of vanishing pituitary mass due pituitary apoplexy. Park SM, et al (2014) reported 22 cases of pituitary mass due hypophysititis which improved mostly with medical therapy.
Case: 29-year-old lady presented to hospital in January 2014 with vomiting, abdomen pain, headaches and profound hyponatraemia of 112. She had undectable LH<0.2), FSH(1), SST normal, Prolactin 407. IGF-1 normal. She was treated with iv fluids. She had MRI pituitary which showed homogenous enhancing pituary macroadenoma measuring (1.0 x 1.5 x 1.8 cm). She was 1 year postpartum. Second baby was born 2012 and stopped breast feeding in 10/2013 and her periods were regular She was seen initially by neurosurgeons for surgical intervention. She was started on hydrocortisone 10 mg then reduced to 5 mg twice a day then stopped in July 2014 as 9 am cortisol was normal at 300. She required no hormonal replacement therapy. Repeat MRI after10 months reported as normal appearance of pituitary gland and surgery was not required.
Discussion: Pitutary adenomas can be divided into functioning and non-functioning. The causes of non-functioning tumours include neoplastic, inflammatory and vascular. Non-functioning pituitary macroadenoma are usually managed surgically if patients are symptomatic unless contra-indicated. Spontaneous resolution of pituitary tumours is rare. The mechanism of spontantoeus resolution of pituitary adenoma is unclear but may be explained by either pituitary apoplexy or hypophysitis responding to steroids. Patient with pituitary apoplexy may present with headaches, vomiting and visual distrubances. The time of onset of spontaneous regression of pituitary adenoma following pituitary apoplexy is unclear, some cases were previously reported to be as early as 1 week. Hypophysitis as an inflammatory process which may response to steroids. It can be postulated that giving steroids facilitates regression of pituitary adenoma. Is unclear whether the patient being on steroid contributed to spontaneous regression of pituitary tumour or not.
Conclusion: Spontaneous regression of pituitary adenoma is uncommon and possible causes discussed above should be considered. Is unclear whether patients with spontaneous pituitary adenoma are at risk of recurrence and they need for long term follow up. The case raises a question of how long can non function pituitary adenoma can be monitored before when to intervening surgically in non functioning pituitary adenomas.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more