Description

Overview:

(This case study was added to OER Commons as one of a batch of over 700. It has relevant information which may include medical imagery, lab results, and history where relevant. A link to the final diagnosis can be found at the end of the case study for review. The first paragraph of the case study -- typically, but not always the clinical presentation -- is provided below.)

A 13-year-old girl presented with polyuria, headache, drowsiness, and worsening vision. She reported that polyuria initially occurred 5 years before the consultation, headache and drowsiness developed 3 months earlier, and vision in both eyes had deteriorated dramatically over the previous 1 month. She was subsequently referred to our clinic for further evaluation and treatment. Coronal contrast magnetic resonance imaging (MRI) of the pituitary in our hospital revealed a giant sellar and suprasellar mass with "hourglass sign", measuring 25 × 42.2 × 23.7 mm. The mass had no cystic areas and was heterogeneously enhanced by gadolinium, suggesting a pituitary adenoma (Figure 1a). She denied nausea, vomiting, lactation, acromegaly, and central obesity. Her first menstrual cycle had not yet occurred, and her growth and development were normal. Neurological examination revealed bilateral pupillary dilation of OD 8 mm and OS 6 mm, with pupillary light reflex depressed in both eyes. Baseline pituitary function evaluation revealed primary hypothyroidism (thyroid-stimulating hormone: 7.17 μIU/ml, free-T4: 0.454 ng/dl), hypocortisolism (cortisol < 0.50 μg/dl), decreased somatotropin (growth hormone: 0.1 ng/ml, insulin-like growth factor: 133ng/ml), decreased estradiol with low gonadotropins (estradiol: 13.32 pg/ml, follicle-stimulating hormone: 0.20 IU/L, luteinizing hormone: < 0.2 IU/L). However, her prolactin, β-human chorionic gonadotropin, and α-fetoprotein levels were normal. Based on these findings, panhypopituitarism secondary to a nonfunctioning pituitary macroadenoma was highly suspected and presumptively treated. The patient underwent right frontal craniotomy using a coronal incision for tumor resection and optic chiasm decompression. Visual acuity recovered soon after surgery.

Subject:

Health, Medicine and Nursing, Education, Life Science

Level:

College / Upper Division, Graduate / Professional, Career / Technical

Material Type:

Case Study, Diagram/Illustration

Author:

Renzhi Wang, Xinjie Bao, Zhiwei Shen

Provider:

University of Pittsburgh School of Medicine

Provider Set:

Department of Pathology

Date Added:

08/01/2022