Endocrine Abstracts

Introduction: Giant pituitary adenomas represent 6-10% of all pituitary adenomas. They are mostly nonfunctional and occur commonly in male. Surgical management to preserve the vision poses significant challenges.

Case Summary: 65-year-old lady presented to the Ophthalmology with bitemporal hemianopia. On examination she had no neurological deficits and bitemporal hemianopia on confrontation and Goldmann visual field testing. Baseline investigations showed Free T4 10.6 pmol/L (11.5 – 22.7), TSH 2.79 mIU/L (0.55 – 4.78), 9am Cortisol 23 nmol/L (145 – 619), FSH was 16 IU/L, LH was less than 1 IU/L indicating secondary hypothyroidism, secondary adrenal insufficiency, and secondary hypogonadism, IGF-1 was normal. Pituitary MRI revealed a giant dumbbell shaped T2 hyperintense lesion, pituitary marco-adenoma causing expansion of sella turcica, displacing the optic chiasma superiorly and partially encasing the bilateral cavernous segment Internal carotid artery, measuring 5.3 cm in long axis. She underwent Stealth Guided Transsphenoidal extended approach endoscopic assisted pituitary adenectomy. Following which left eye vision deteriorated to light perception and patient had a further debulking of Pituitary adenoma via transcranial approach. Post-operative Pituitary MRI showed good resection of the lesion and vision improved.

Histopathology showed: 1. A plurinominal adenoma with expression of SF-1, PIT-1 and FSH.1. Meningioma CNS Grade 1.1. Appearances compatible with degenerate benign cyst. Patient remains stable and has regular follow-up in the Pituitary clinic.

Conclusion: This case illustrates a unique trio of pathologies within a giant pituitary adenoma. The pituitary adenoma occasionally co-exists with another kind of intracranial tumour. Pituitary surgery remains the cornerstone of giant pituitary tumours management in multidisciplinary centres of excellence.