Missing Periods – the Case of a Pituitary Carcinoma
S G Wijetilleka, S Qureshi, R Kaushal
We would like to present the rare case of pituitary carcinoma. We reviewed a 21 year old female with normal development and BMI and 18 months of secondary amenorrhoea after stopping the oral contraceptive pill. She experienced occasional headaches but had no other symptoms and signs of pituitary disease.
Post-clinic bloods revealed 9am morning cortisol – 123, oestradiol 103, FSH 1.3, LH 0.4, TSH 2.17, T4 - 5.8. IgF-1 and Prolactin in the normal range. Her HCG was negative, her vitamin D – 25.6 and her FBC and U&E were normal.
We advised replacement with Hydrocortisone 10mg at 8am, 5mg at noon, 5mg at 1800 and Levothyroxine 50mcg od. Microgynon 30 if periods do not return after commencing levothyroxine. We also advised Vitamin D replacement (cholecalciferol).
Pituitary mass seen on MRI Sept 2015 - 2.8 cm likely pituitary macroadenoma with compression of the optic chiasm superiorly. Images reviewed in pituitary MDT at St George’s Hospital. Patient’s mass akin to a craniopharyngioma upon review of radiology. Patient seen at St George’s on 28/10/15; she elected for transphenoidal surgery which took place in January 2016. The histology showed a pituitary carcinoma and our patient went on to have pituitary radiotherapy.
At West Middlesex Hospital, we ordered a pre-operative ECHO (family history of HOCM) and monitored the patient for signs of diabetes insipidus. Her U&E at present is within the normal range, with a serum osmolality of 290 and a urine osmolality of 76. She is currently euvolaemic and on hormone replacements.