Endocrine Abstracts

Case 1: A 27-year-old female presented with blurry vision and was diagnosed with a non-functioning pituitary adenoma. She underwent transsphenoidal resection in 2017 with null cell adenoma histology. She developed post-operative hypopituitarism requiring Hydrocortisone, Levothyroxine and HRT. In 2019 she had another surgery for tumour regrowth and histology revealed a sparsely granulated somatotroph adenoma. The genetic test showed AIP-related familial isolated pituitary adenoma. Her residual tumour has since remained stable, and she is well-controlled on Somatostatin analogue

Case 2: A 76-year-old female underwent two pituitary surgeries (1998, 2007) followed by radiotherapy for a non-functioning pituitary adenoma. A thyroidectomy was also performed for hyperthyroidism many years ago. During a follow up, MRI scan showed interval enlargement of residual pituitary tissue. Progressive bilateral superior temporal visual field defects led to a third surgery for resection of a supradiaphragmatic sellar mass resulting in significant visual improvement. Histology showed thyrotroph adenoma.

Case 3: A 72-year-old female had surgery for a non-functioning pituitary adenoma in 1989, followed by radiotherapy for progression. She developed hypopituitarism, that was managed with Hydrocortisone and Levothyroxine. In 2021, a new left temporal hemianopia led to MRI scan. This confirmed tumour regrowth that was followed by a repeat endoscopic resection. Histology showed sparsely granulated growth hormone adenoma with focally high Ki-67. Patient was commenced on Lanreotide and has achieved an excellent control.

Conclusion: These cases highlight the prognostic value of histopathology in predicting disease recurrence and progression. Sparsely granulated somatotroph adenomas and other Pit-1 lineage tumours are associated with more aggressive clinical behaviour.