Garcin Syndrome in Pituitary Adenoma

Abstract

Objective: To report pituitary adenoma with Garcin syndrome. Study Design: Case presentation. Patient and Methods: A 47-year-old female with schizophrenia and visual deficit with unknown onset before admission. An initial evaluation showed right-sided amaurosis, complete ophthalmoplegia, right face numbness, decreased gag reflex, right-sided trapezius weakness, and right tongue deviation. Also, left side light perception only and hypocortisolism was seen. Her brain CT scan, and MRI showed an invasive 3×5×4cm heterogeneous sellar, parasellar, suprasellar, anterior fossa, nasopharynx, and clival minimally enhancing lesion with prepontine extension, no signs of hemorrhage, and no hydrocephalus. MRA brain with 50% narrowing of right cavernous carotid was due to lesion compression. She underwent endonasal biopsy/decompression per ENT, and final pathology report was pituitary adenoma. Results: After initial decompression, underwent to endonasal, microsurgical, and endoscopic pituitary adenoma resection (transsphenoidal, transclival, transplanum) with electrophysiology monitoring, and lumbar drain placement. She experienced transient diabetes insipidus, and on early postoperative follow-up referred left eye perception for movement, otherwise continued with baseline dysfunction. Conclusion: Garcin syndrome is very rare, and reported mainly for malignancies, and to our knowledge this is the first case reported on pituitary adenoma. The psychiatric condition of this patient unfortunately allowed this progression.