A rare case of Olfactory Groove meningioma with Panhypopituitarism
James Burgess, Rakshit Kumar
North Middlesex University Hospital
We present the case of a 77 year old male, admitted with severe confusion and underwent subtotal resection of a large olfactory groove meningioma with sella turcica involvement.
Drowsiness and confusion prevented rehabilitation 2 months post operatively. MRI brain revealed continued invasion of the meningioma into the sella turcica but surgical treatment was deferred by the neurosurgical MDT. In view of low blood pressure, hypothermia and bradycardia, an endocrinology opinion was taken.
Hormone profile and short synacthen test suggested Panhypopituitarism and the patient was treated with steroids, thyroxine and testosterone replacement. There was remarkable improvement in mental and physical performance within 2 weeks and the patient was able to walk whereas previously he was bed bound.
This is first reported case of Olfactory groove meningioma with panhypopitutiarism and documents a potentially treatable serious complication. It highlights the need to consider and screen for panhypopituitarism in patients with large olfactory groove meningiomas, particularly with sella turcica involvement.
The aetiology of panhypopituitarism in this case is most likely attributable to direct compression or invasion of pituitary gland. Further case reports are necessary to develop our understanding of panhypopituitarism and its association with olfactory groove meningioma.
Conclusion: Pituitary function needs to be assessed in patients with large olfactory groove meningiomas