Abstract

The Investigation to be reported here was prompted by an unusual case of pituitary neoplasm. A married woman of 52 was first seen as an outpatient complaining of loss of memory and sleepiness. A few days later she was admitted to the hospital in coma. Clinical examination showed her to be demented and disoriented. Careful testing disclosed no visual field defect. There were no endocrine disturbances and the urinary ketosteroids were normal. A clinical diagnosis of frontal lobe tumour was made. A roentgenogram of the skull showed the pituitary fossa to be enlarged and eroded from within. At encephalography very little air entered the ventricular system, and the third ventricle was not filled. The air did, however, outline a tumour arising from the pituitary fossa (Fig. 1) and a radiological diagnosis of pituitary tumour with suprasellar extension was made. Some widening of the cortical subarachnoid channels was noted anteriorly. The patient's condition continued to deteriorate and ventriculography was performed in order to demonstrate the third ventricle. In anteroposterior views a filling defect, very like that of a colloid cyst of the third ventricle, was seen deforming the inferomedial borders of the lateral ventricles, but in the lateral view the third ventricle was seen to be displaced backward (Fig. 2). The lesion could not, therefore, be a colloid cyst, and the findings supported the original diagnosis. The patient was transferred to a neurosurgical centre, where a diagnosis of glioma of the third ventricle was made and a craniotomy performed. At autopsy a huge pituitary adenoma was found. The absence of field defects was explained by the presence of a prefixed optic chiasm. The optic nerves were short, and the tumour had grown upward and backward, like a mushroom, sparing the optic tracts. Since the absence of endocrine changes in this case remained unexplained, it was decided to investigate the endocrine aspects of pituitary and parapituitary tumours and their relationship to radiological changes. Accordingly, a number of cases of chromophobe adenoma, craniopharyngioma, suprasellar meningioma, and raised intracranical pressure with an enlarged third ventricle were selected at random. The assessment of endocrine changes has been made on clinical grounds only, as none of the patients had had an adequate endocrine survey. Chromophobe Adenomas Fifty cases of chromophobe adenoma were studied. The eldest patient was fifty-nine and the youngest fifteen years of age; the majority were between the ages of thirty and sixty. Thirty-two were male and 18 were female (Table I). The tracings of the pituitary fossa and ventricular system were included in a chart (Fig. 3), those showing endocrine changes being edged with a thick black line. A characteristic pattern of radiological changes was found in the majority of cases. The pituitary fossa is nearly always enlarged. The dorsum sellae is thinned and frequently destroyed inferiorly.

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