Endocrine Abstracts

32 years old female referred with headache which developed post-partum with a CT head initially showed heterogeneous hyper dense 2.2 cm supra sellar lesion further confirmed with MRI pituitary, confirming a pituitary macroadenoma. In her first clinic review in March 2023, she was lactating with a normal menstrual cycle but complained of continuous headache and no double vision or visual field abnormality noted. Her 09am pituitary profile in March 2023 showed TSH: 1.34 Miu/L FT4: 12.3 pmol/l LH: 4.1 IU/L FSH: 8.0 IU/L Prolactin: 2408 mIU/L Oestradiol <92 pmol/l Cortisol N/A Growth hormone:0.08 ug/L IGF: 19.5 nmol/l. Cabergoline 0.5 mg once a week commenced considering functioning adenoma. Formal visual field noted to be normal. In August 2023, she reported increasing dizziness and irregular menses with intermittently blurred, double vision reported. Repeat prolactin was 17mIU/L and cortisol 146 at 0730. ACTH 9ng/l. Blood tests were consistent with hypophysitis than an adenoma and Pituitary MDT advised commencing Prednisolone 5 mg OD. ITT in Sept ’23 showed a normal peak cortisol 752 and Peak GH 8.35 ug/L - Nadir Glucose 2.1 and Prednisolone was stopped along with Cabergoline. Her prolactin rose again to a similar level in December 2023 and she was restarted back on Cabergoline 250 mg once weekly. Surveillance MRI Pituitary March 2024 showed no change in size of adenoma and prolactin was noted to be low on cabergoline. Due to lack of response to treatment, cabergoline was stopped. MDT in March 2024 favoured Pituitary macroadenoma and recommended ongoing surveillance with regular eye checks and MRI scans or proceeding to surgery to obtain a histological diagnosis. It’s unusual to see a non functioning pituitary macroadenoma presenting as hypophysitis post-partum and how these two clinical conditions over played making diagnosis and management slightly complicated.