NON-FUNCTIONING PITUITARY MACROADENOMA WITH PANHYPOPITUITARISM: CLINICAL CASE PRESENTATION

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0845

Abstract

Objective: To describe the presentation, diagnostic-therapeutic approach, and management considerations of a non-functioning pituitary macroadenoma (NFPA) associated with panhypopituitarism. Clinical case: 62-year-old male with headache 7/10, dizziness, diplopia, and bitemporal hemianopsia; weight loss of 15 kg in 18 months. Diagnostic evaluation: Laboratory tests showed euvolemic hypotonic hyponatremia (osmolality 241.69 mOsm/kg), eGFR 109 mL/min/1.73 m²; hyperprolactinemia, hypogonadotropic hypogonadism, and secondary adrenal insufficiency. Sellar MRI: solid lesion measuring 3.4 × 2.5 × 1.18 cm with suprasellar extension, brainstem displacement, and chiasmatic compression. Intervention: Sequential correction prioritizing glucocorticoids before levothyroxine; androgen therapy (testosterone undecanoate) and weekly cabergoline as adjuvant; management of hyponatremia and symptomatic measures. Scheduling of neurosurgical (transsphenoidal) and ophthalmological (campimetry) evaluation. Results: Discharge with replacement therapy and multidisciplinary monitoring plan (clinical-hormonal controls, campimetry, and follow-up MRI). At the time of discharge, surgical decompression had not been performed. Conclusions: The case illustrates the classic phenotype of NFPA macroadenoma with panhypopituitarism and chiasmatic involvement. Euvolemic hyponatremia should prompt the search for adrenal insufficiency and central hypothyroidism. Optimal management integrates safe hormonal correction (glucocorticoids prior to levothyroxine), early neuro-ophthalmological evaluation, and surgical treatment when visual impairment is present, reserving adjuvant therapies according to evolution.

Keywords: Pituitary macroadenoma; Non-functioning pituitary adenoma; Panhypopituitarism; Euvolemic hyponatremia; Stalk effect; Transsphenoidal surgery.