Spontaneous Regression Of Anterior Pituitary Deficits In A Woman Harboring A Persistent Hypothalamic Mass
Amico, J. A., Miaskiewicz, S. L., Harris, R. N., & Hirsch, W. L. (1990). spontaneous regression of anterior pituitary deficits in a woman harboring a persistent hypothalamic mass. Journal of endocrinological investigation, 13(6), 521–525. https://doi.org/10.1007/BF03348616
View Original Source →Abstract
Sellar or parasellar lesions can cause anterior pituitary dysfunction either by direct damage to the anterior pituitary gland or by compression of the pituitary stalk and mediobasal hypothalamus which contain the hypophysiotropic hormones. Without treatment, the pituitary deficits in such cases are not likely to improve. We describe a case in which deficits in anterior pituitary hormones spontaneously remitted in a woman who had a persistent hypothalamic lesion that was not amenable to surgery or radiotherapy. The factors that may predict spontaneous recovery of anterior pituitary function in such cases are discussed.
Case Details
Disease Location
Sellar mass, most likely hypothalamic hamartoma
Personal Characteristics
26-year-old female, 10 years history of headaches
Clinical Characteristics
1984: 26-year-old female hospitalized with headache, 30 pound weight gain, and amenorrhea and galactorrhea for 8 and 3 months, respectively. Positive p/e findings: galaetorrhea expressible from both breasts. Labs, cxr normal. Hormonal tests showed ant-pituitary hormone deficiency. CT scan: a 1 cm suprasellar mass was found; amipaque cisternogram showed that the mass had a broad-based attachment to the hypothalamus. Csf studies normal. Treated with hormones replacement - e+p, levothyroxine and steroids.
Remission Characteristics
In february 1985, resolution of galactorrhea and decreased frequency of headaches. One month later she stopped estrogen-progesterone treatment and within two months had spontaneous menses, resolution of headaches, decrease in weight to 68 kg and an improved sense of well-being. On a repeat CT scan in may 1985, the hypothalamic lesion was unchanged in size. Hormonal testing was normal and thyroxine and steroids were stopped. She remained asymptomatic and was reevaluated in september 1986. Anterior pituitary dynamics were normal except for gh. MRI done in january and september 1986 and august 1988 confirmed the persistence of the well-defined broad-based pedunculated mass arising from the hypothalamus and protruding into the suprasellar cistern. Imaging showed no change in the mass since 1984. Static testing of anterior pituitary function in 1987, 1988, and 1989 was normal. The patient remained asymptomatic.
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible shrinkage in size (impercepatientible via imaging) due to rupture of a cyst/ hemorrhage.
Clinical Treatment
Hormonal replacement with estrogen, progesterone, thyearsoxine, steroids