Endocrine Abstracts

JOINT68

Introduction: Pituitary calcifications, though rare, pose diagnostic and therapeutic challenges. These lesions, frequently associated with prolactin-secreting adenomas, can present with varied clinical manifestations and often require multimodal management. This report highlights the clinical, biochemical, and imaging findings in a young female patient with a pituitary calcification, along with a review of therapeutic approaches.

Case Presentation: A 26-year-old woman, heterozygous for sickle cell disease, presented with bilateral milky galactorrhea persisting for three months. Her menstrual cycles were regular. Clinical examination confirmed provoked galactorrhea. Biochemical evaluation showed hyperprolactinemia at 38 ng/ml, confirmed on two subsequent measurements, and decreased free thyroxine (FT4) at 0.74 ng/dl, while the remaining pituitary hormonal panel was normal. MRI of the hypothalamic-pituitary region revealed a calcified anterior pituitary lesion measuring 3.7 × 3 mm, consistent with pituitary lithiasis. The patient was started on cabergoline (Dostinex) and levothyroxine replacement therapy, with plans for reevaluation after three months.

Discussion: Calcifications within the pituitary gland are rare, often linked to prolactinomas or other adenomas. They can impede tumor shrinkage despite appropriate medical management. Cabergoline remains the first-line therapy for hyperprolactinemia, effectively reducing prolactin levels and ameliorating symptoms. Imaging plays a pivotal role in distinguishing calcified adenomas from other entities such as Rathke’s cleft cysts or craniopharyngiomas. Histopathological analyses frequently reveal amyloid and calcium deposits, suggesting chronicity or degenerative processes.

Conclusion: The case underscores the importance of integrating clinical, biochemical, and imaging findings for accurate diagnosis and management of pituitary calcifications. Dopamine agonist therapy, complemented by hormonal replacement where necessary, remains the cornerstone of treatment. Longitudinal follow-up with imaging and biochemical monitoring is essential to assess therapeutic response and guide management in such rare cases.