Endocrine Abstracts

JOINT1860

Introduction: Pituitary macroadenomas, particularly nonfunctioning types, are benign tumors that can cause significant endocrine dysfunction due to their mass effects on surrounding structures, including the pituitary gland and optic chiasm. These tumors often present with symptoms related to hormonal deficiencies, visual disturbances, or neurological findings. Diagnosis typically involves a combination of hormonal assessments: ACTH, Cortisol, TSH, FT4, FSH, LH, Testosterone, Prolactin, IGF-1 and imaging, primarily MRI, while management often requires surgical resection. However, complete resection can be challenging, especially in larger tumors with suprasellar extension, where residual tissue may persist, potentially leading to tumor regrowth.

Case Report: A 62-year-old patient initially presented in 2018 with severe fatigue, weakness, weight loss, visual disturbance, headache and episodes of syncope, leading to the diagnosis of adrenal insufficiency. Further evaluation revealed secondary adrenal insufficiency, central hypothyroidism, and secondary hypogonadism, prompting suspicion of a pituitary disorder. MRI imaging identified a 2.7 cm pituitary macroadenoma with suprasellar extension and compression of the optic chiasm. In November 2018, the patient underwent transsphenoidal resection of the pituitary adenoma, which led to significant clinical improvement. Despite initial surgical resection, residual tumor tissue remained, with evidence of gradual growth. Radiation therapy was considered but could not be pursued at that time. In 2022 and 2023, the patient underwent two additional transsphenoidal resections of the residual adenoma. In October 2023, Gamma Knife radiation therapy was performed. The patient is currently well-managed, with no complaints, continues appropriate replacement therapy including levothyroxine, hydrocortisone, and testosterone. Subsequent imaging demonstrates gradual decrease of residual tumor.

Conclusion: This case highlights the challenges of managing large pituitary macroadenomas, particularly those with suprasellar extension and residual tissue post-surgery. It also underscores the importance of a multidisciplinary approach, including surgery and radiation, to address persistent tumor growth and prevent further endocrine dysfunction. Ongoing hormone replacement therapy and careful monitoring of pituitary function remain critical in managing the patient’s long-term care.