MON-LB056 A Case of Transient Global Amnesia and Pituitary Tumor

Abstract

Introduction Transient Global Amnesia (TGA) is benign clinical syndrome of reversible anterograde amnesia that occurs in middle-aged and older individuals. Only few cases on literature have reported co-occurrence of TGA and pituitary lesion. Case Presentation 72 year old man with history of hypertension, hyperlipidemia, coronary artery disease presented with a transient amnestic state where he appeared confused unable to recall the time, asking multiple times and forgetting things they had discussed repeatedly. The anterograde amnestic episode lasted approximately 5 hours and there was no motor weakness, aphasia, conscious disturbance or any other focal neurological deficit. Patient returned fully to his baseline. Prior to this event he was in good health, no excess headache, no vision issues, no increase in size of hands or feet, and no history of head trauma. CT head noted note a mass in the left sella extending into the cavernous sinus. CT perfusion of head and neck demonstrated no significant stenosis. MRI brain characterized a hypointense T1-weighted sequence with homogeneous contrast enhancement eroding the dorsum sella measuring 1.5 x 1.4 x 1.4 cm. The pituitary gland is not well separated from this mass and the basilar and internal carotid arteries were patent. Labs show prolactin to be >1000,testosterone and LH was low but FSH, Free T4, TSH, ACTH, am cortisol, IGF-1 were normal range. Labs showed normal electrolytes and normal glucose level. Discussion TGA is an isolated, sudden and self-limited disturbance of anterograde amnesia lasting less than 24horus and unaccompanied by other focal neurological deficits or seizure. The etiology of TGA is not completely clear with hypotheses including migrainous or epileptic phenomenon, vascular with transient interruption of vascular perfusion of memory related structure versus psychogenic disorder theory. In our case the CT and MR imaging studies disclosed a case of pituitary mass. The markedly high serum prolactin level and imaging finding are suggestive of prolactin-producing adenoma, although histological confirmation was not obtained. Literature review has showed a case of TGA presenting with hemorrhagic pituitary adenoma or pituitary apoplexy, postulating that the compression from bleeding adenoma affecting the memory eloquent pathways of hyppocampus.On our index case there is no exact anatomical relationship with memory related structure. It is not clear if TGA and pituitary adenoma finding on our patient is due to a chance of concurrence or it has etiological association. Although TGA is considered as a benign and functional disorder, neuroimaging need to be obtained to exclude organic causes of amnesic events. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.