Pituitary neuroadenoma as an ‘Incidentaloma’ in a case of road traffic accident

Abstract

: Pituitary adenomas are the most common tumors found in the Sella region. Functional pituitary adenomas exhibit a wide range of endocrine manifestations due to either hypo- or hyperfunction of the pituitary gland, as well as mass effect. They can have a slow but severe impact on vision due to compression of the optic nerves, optic chiasm and cavernous sinus.: A 42-year-old male, a security guard at a local dabha, was struck by a van while crossing the road. He sustained a head injury and unfortunately passed away during treatment at our tertiary case institute. At autopsy, upon examination of the skull, a mass measuring 5x5x3cm was discovered in the suprasellar area of base of skull. This mass was sent for histopathological examination, which confirmed it to be a "Pituitary neuroendocrine tumor possibly gonadotropic in nature." However, the cause of death in this case was opined as ‘Head injury’.: Forensic pathologists rarely encounter intracranial neoplasms that present as sudden and unexpected deaths. The incidence of undiagnosed fatal brain tumors detected at autopsy has been reported to range between 0.02% and 0.4%. Several studies have investigated the relationship between hormonally active pituitary adenomas and both mental health disorders and quality of life. One study by Johnson et al. found that patients with nonfunctional adenomas reported impairments in physical and emotional well-being compared to the normal population. Headache and visual symptoms are most commonly associated with pituitary adenomas.In the present case, although it was an incidental finding and not contributing to the cause of death, we cannot underestimate the effect of the tumor on the visual acuity of the decedent. Nonetheless, visual impairment due to the tumor could also have partially led to the road traffic accident.