Category: Pituitary Disorders/Neuroendocrinology

Monitor: 12

12 - Panhypopituitarism Secondary to Pituicytoma: Rare Low-grade Glioma of the Neurohypophysis

Saturday, Apr 27
11:00 AM – 11:30 AM

Objective :

Pituicytoma is a rare, low-grade glial neoplasm that originates from neurohypophysis. This tumor can be easily confused with a pituitary adenoma and mimic other neoplasms of the sellar and parasellar regions. We found a challenging case of Pituicytoma in a 49-years-old female with a clinical presentation of Panhypopituitarism.


Methods : n/a


Results : n/a


Discussion : A 49 years-old Hispanic Female presented with headache, dizziness and intractable vomiting. Patient reported one year of multiples visits to primary care physician with persistent symptoms of poor appetite, nausea, vomiting, headache, general weakness and dizziness with progressive worsening over the past few weeks. She stated a recent weight loss of 15 lbs and irregular menstrual cycle. She denied galactorrhea and vision problems. Past medical history included hypertension and chronic systolic heart failure.  On Examination, the patient was well-oriented, with stable vital signs except for mild hypotension, normal visual acuity, diffuse abdominal tenderness without any rebound or guarding. Initial laboratory results revealed sodium 133 mEq/L, potassium 4.6 mEq/L and CBC was unremarkable. Management with intravenous Hydrocortisone, antiemetic, and IV fluids were initiated on admission. Nausea, vomiting and poor oral intake improved significantly after first doses of steroids. A series of test showed persistent hyponatremia and low glucose.  On 2nd day of hospitalization, sodium dropped to 130 mEq/L, glucose 68 mmol/L and serum osmolarity of 276 mosm/kg. Endocrine studies revealed T4 0.6 ng/dl, T3 1.78 ng/dl, FSH 3.1 mlu/ml, LH <0.1 IU/L, GH <0.1ng/mL, Prolactin of 79 ng/dl. ACTH < 5 pg/ml, Cortisol 3.6 ug/dl, and Cosyntropin test was positive confirming secondary adrenal insufficiency. Patient received IV Hydrocortisone and Levothyroxine replacement. A brain MRI showed sellar/suprasellar mass of 1.8 x 1.8 x 2 cm. The tumor was resected via a partial trans-sphenoidal surgical approach and histopathological report confirmed pituicytoma. Patient responded well to both surgical and medical treatment.


Conclusion :

Pituicytoma is an extremely rare low-grade glial tumor derived from the parenchymal cells of the posterior lobe of the pituitary gland (pituicytes). The most common presenting symptoms were visual disturbance followed by a headache. This case illustrates a diagnosis of Hypopituitarism can be missed due to vague symptoms on presentation. Hyponatremia, hypotension, low glucose level and intractable vomiting with poor response to medical treatment, suggests a possible endocrine dysfunction. Recognition of this Pituicytoma represents a clinical challenge due to the paucity of pathognomonic features.

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Kyaw Zin Win

Internal medicine resident (PGY 2)
Wyckoff Heights Medicine Center
Brooklyn, New York

I am PGY 2 working in Internal medicine program at Wyckoff Heights Medical Center. I am passionate about Endocrinology and my goal is joining to Endocrinology fellowship after residency. My special interests are in Diabetes management, Hypothyroid, and Pituitary Diseases.

Susana Urgiles

Resident
Internal Medicine
Ozone Park, New York

Multiple important endocrine disease are overlooked, I think is important for our formation as internist and future endocrinologist accumulate enough knowledge in benefit of our patients