Exploring the Symptoms and Treatment of a Pituitary Macroadenoma: A Case Report

TL;DR

This case report describes a 78-year-old man with a pituitary macroadenoma presenting with altered consciousness, headache, and throat pain, highlighting the need for early diagnosis and individualized treatment.

Contribution

The paper presents a rare clinical case of PMA with atypical symptoms and comorbidities, emphasizing the importance of differential diagnosis in complex patient presentations.

Findings

MRI revealed a 1.5 × 2.2 × 2.3 cm pituitary macroadenoma extending into the sphenoid sinus and near the optic chiasm.

The patient exhibited decreased sodium and ACTH levels but no signs of hypogonadism, acromegaly, or hyperprolactinemia.

Surgical intervention was not performed due to tumor size and patient condition; pharmacological treatment and monitoring were used instead.

Abstract

Pituitary macroadenoma (PMA) are significant intracranial tumors that can cause local mass effects and systemic endocrine disruptions. This case report illustrates an unusual case of PMA in a patient presenting with an altered level of consciousness subsequently coupled with headache and throat pain. A 78-year-old man reported to the emergency room with a history of an altered level of consciousness followed by headache and throat pain for two days. He had a past medical history of diabetes mellitus (DM), hypertension (HTN), severe hypothyroidism, ischemic heart disease, cholelithiasis, and right vesicoureteric junction calculus. The physical examination yielded minimal findings, with no indications of hypogonadism, acromegaly, or hyperprolactinemia. Magnetic resonance imaging (MRI) identified a PMA measuring 1.5 × 2.2 × 2.3 cm extending from the sella turcica with suprasellar expansion next to the optic chiasm and into the sphenoid sinus. Laboratory tests showed decreased sodium and adrenocortical hormone (ACTH) levels. Due to the size of the tumor and the patient's condition, surgical intervention was not undertaken. The patient was managed with continued pharmacological treatment, including vaptan, follow-up imaging, and endocrinological monitoring. This case emphasizes the importance of considering macroadenomas in differential diagnosis when encountering unusual patient presentations with a complex medical history. Therefore, early diagnosis and individualized management are crucial for achieving optimal outcomes.

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