COMPLICATIONS OF NONFUNCTIONING PITUITARY MACROADENOMA REQUIRING SURGERY

Abstract

Hypopituitarism is the main complication of nonfunctioning pituitary macroadenomas. A 64-year-old patient was admitted for marked asthenia, generalized muscle contractions, acroparesthesia and lumbar pain. Clinical examination revealed grade I obesity, discrete eyelid edema, negative Chwosteckand Trousseau signs. Hormonal profile showed the presence of somathotropic pituitary insufficiency, low testosterone levels (of 1.3 ng/mL, normal: 1.68-7.58ng/mL), gonadotropin and prolactin levels within the normal range, normal values for TSH (Thyroid Stimulated Hormone) and FT4 (Free Thyroxine). On admission, low serum and urinary cortisol values were obtained, with an appropriate response after the Synacthen test. The MRI (Magnetic Resonance Investigation) examination revealed a pituitary macroadenoma of 20/21/21 mm, compressing the optic chiasm and thalamus, with bilateral 180-degree involvement of the internal carotid artery. The ophthalmological examination described a lower scotoma in the left eye, without amputation of the visual field. Thyroid and glucocorticoid hormone replacement therapy was recommended, along with neurosurgical intervention. In pituitary macroadenomas, the close proximity to the optic chiasm and carotid arteries limits the curative therapeutic potential and increases the risk of postoperative complications.

Keywords

• macroadenoma
• pituitary
• hypopituitarism