Case Discussion

Re : delhi-pituitary microadenoma   Posted By Dr Garima Khurana    Date : 19-Aug-08   12:28 PM     Reply

Dear Dr. Sir, this is to your reply on Indmedica .com to my case (Dr.Garima Khurana, 35yrs) with Pituitary Micro adenoma (2mm). I am hereby giving the details of my case. I presented with Galactorrea -4 mths (accidental finding) and blurring of vision only when looking into microscope (sir, I am a pathologist) which lasted for 3-4 hrs with severe headache and nausea 2&1/2 mths on off. I got my vision checked which showed Myopia (+1.25, both eyes). As I am using my glasses only while working there is only little bit of blurring? I also have Past History of Migraine (1991) no symptoms since many yrs, H/o PIH /Borderline Gestational Diabetes with normal vaginal delivery 3 yrs back. Normal menstrual history. My Father is diabetic /hypertensive. Physical Examination shows acanthosis nigrans, hirsutism. Investigations done are:

1. USG Breast: showed B/L Prominent Lactiferous Ducts.

2. USG Ovaries: showed polycystic ovaries (not enlarged).

3. Hormones Studies: on 18/06/08

Test Results n.range

T3 1.0 ng/ml 0.9 -2.6

T4 6.4mcg/dl 5.5 -13.5

TSH 1.3 uIU/ml 0.3 -6.5

LH 3.8 ml-U/L 0.5 -15.0 FSH 4.7 ml-U/L 0.2 -10.0

Prolactin 11.5 ng/ml <25.0 12.6 (14/07/08) pooled sample Testosterone 0.4 n-mcg/ml 0.07 -0.65

Cortisol(8 am) 10.7 mcg/dl 3.0 -25.0

Insulin (Fasting ) 1.0 mcu/ml 2.1- 30.0

4. MRI Sella: reveals Microadenoma Pituitary. FINDINGS: " Focal, well defined, abnormal area of altered signal intensity at the coronal level of the pituitary stalk appears homogeneously hypo intense on T2WI images.

" On Post Contrast sequences: o The lesion show homogeneous enhancement. o The true size of the lesion is 2(AP) x 2.2(CC) x 2(TR) mm.

" There is no associated contour bulge and the infundibulum appears in the midline.

" The diaphragm sella is normally visualized.

" The Hypothalamus and brainstem appears normal.

" Cavernous sinus and the carotid siphon are normal in appearance and enhancement pattern.

" The clivus displays normal MR morphology and signal intensity.

" The visualized neuroparenchyma in the FOV appears essentially normal.

" Dynamic mean curve analysis:

" The dynamic mean curve shows slow uptake of contrast by the lesion.

EYE Examination: Normal central fundi both eyes. Normal fields on kinetic perimetry Diagnosis: Pituitary Microadenoma with PCOD

Treatment: Started on 14/07/08

1. Tab Cabergolin 0.5 mg twice weekly 2. Tab Metformin SR 500mg BD

After starting treatment I am feeling better as Galactorrea has reduced, nausea /headache/blurring of vision /arthralgia all improved. I am not able to attach my MRI scan file ,as it is to big to attach. On 12/08/08, I have given blood samples for S.Prolactin (in dilution), Free T3/T4, TSH, waiting for results. Kindly give your valuable advice. Sir, I am taking treatment from AH(R&R) as my husband is Doctor in Army.

Thanks, Dr.Garima Khurana

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