Pituitary macroadenoma with secondary adrenal insufficiency in a 29 year-old black African lady

Abstract

Introduction : pituitary adenomas are usually benign tumors. The most common symptoms on presentation are those related to endocrine dysfunction such as irregular menses and those pertaining to mass effects such as headaches, blurring of vision to complete loss of vision. We present the case of a 29 year-old lady with a pituitary macroadenoma with secondary adrenal insufficiency who presented with chronic headaches, blurred vision, galactorrhea and amenorrhea for 3 years. The objective was to present this case in view of the complex relationship between macroadenomas and their inhibiting action on the other cells of the pituitary gland. Methods : this was a case review and report after clinical consultation at the National Obesity Center of the Yaounde Central Hospital. Results : a 29 year old married lady who looks anxious and tired. She has no family history of amenorrhea or other endocrine pathology. On examination, she looks anxious and tired. Blood pressure of 110/70 mmHg, pulse rate of 80 bpm, respiratory rate of 20 cpm, weight of 107 kg and temperature of 36°C. The rest of physical examination was uneventful. Hormone profile showed: prolactine 9048 ng/mL, cortisol 3.21 ug/L, ACTH 15.22 pg/mL, FSH 3.17 IU/L, LH 4.94 IU/L, tyroxine 59.10 ng/mL. Abdominal ultrasound showed a non-gravid uterus with a regular contour measuring 53.3 x 39 mm with hypotrophic ovaries. Brain CT scan revealed an infiltrative mass of the pituitary lobe, in favor of a pituitary macroadenoma measuring 21 x 17 x 17 mm. She was treated with cabergoline, hydrocortisone and analgesics pending transphenoidal surgery. Conclusion : this case sparks an interesting discussion on the varied clinical presentation of pituitary tumors. It also highlights the importance of the use of a high clinical index of suspicion and radiological findings in diagnosis.