| Abstrakt: |
Introduction and aim. Adenomas are the most commonly diagnosed types of pituitary tumors. Due to the infiltration of surrounding tissues, they are divided into invasive and non-invasive adenomas. Symptoms may be due to pathological endocrine function, which depends on the type of hormone secreted, or the "mass effect" of the tumor, such as visual field defect or hypopituitarism. Diagnosis is made using functional tests and Magnetic Resonance (MR) imaging. The treatment of choice is surgery. Description of the case. A 69-year-old man with a history of hypertension and prostatic hypertrophy was admitted to the hospital because of an increasing fatigue for 2 days. Physical examination revealed fever, lethargy and impaired verbal contact. Laboratory tests performed on admission showed elevated TSH levels, and hyponatremia. Urinalysis revealed high level of leukocytes and bacterias, what confirmed an urinary tract infection. Next step, determination of the concentrations of other hormones in venous blood showed decreased levels of ACTH, FSH and LH, FT3 and FT4, cortisol and testosterone. Based on the results, a diagnosis of hypopituitarism was made, and a MRI confirmed 38x30x43 mm pituitary macroadenoma as the cause of the disorder. Substitution treatment was started, after which the patient's condition improved. After receiving medical recommendations the patient was discharged home. He remains in contact with neurosurgeon to set date for surgery. Conclusion. The presented case of the patient shows an atypical clinical picture of a pituitary macroadenoma. Initially, laboratory test results finding primary hypothyroidism with secondary TSH elevation suggested that pituitary secretory activity of other axes was preserved. However, concomitant hyponatremia and urinary tract infection prompted the physician to deepen the diagnosis. Further tests revealed a number of pathologies in the concentrations of peripherally secreted hormones. On this basis, an atypical pituitary adenoma was found. Hypopituitarism, which was the result, induced secondary insufficiency of peripheral endocrine organs and primary hypothyroidism. [ABSTRACT FROM AUTHOR] |
