Hurtado Andrade Maria D, Tama Elif, Atkinson John L D, Chang Alice Y
Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
Department of Neurosurgery, Mayo Clinic Rochester, MN 55905, USA.
JCEM Case Rep. 2023 Jun 1;1(3):luad054. doi: 10.1210/jcemcr/luad054. eCollection 2023 May.
A false pituitary tumor describes pituitary enlargement due to intracranial hypotension. Reported previously primarily in the neurological literature, we present this case referred to endocrinology for evaluation of a pituitary mass. A 24-year-old male was referred to endocrinology for evaluation of pituitary enlargement without a hypo-enhancing lesion on magnetic resonance imaging (MRI). The main symptom reported was headache that was worse in the standing position and in the afternoon. He had no symptoms or signs of pituitary mass-effect, or hormone excess or deficiencies. Past medical history was relevant for a history of nerve schwannoma status post resection with subsequent spinal fusion. Biochemical evaluation of pituitary hormones was normal. Upon review of his pituitary MRI, other abnormalities seen were suggestive of intracranial hypotension. Based on his history and imaging findings, he was diagnosed with intracranial hypotension causing a "false pituitary tumor" rather than pituitary enlargement or abnormality. Further evaluation revealed multiple spinal leaks that were patched. His symptoms subsided within a few days of repair. Endocrinologists should be aware of the possible misdiagnosis of a pituitary mass due to intracranial hypotension.
假性垂体瘤是指因颅内低压导致的垂体增大。此前主要在神经学文献中有报道，我们在此呈现这例因垂体肿块而转诊至内分泌科评估的病例。一名24岁男性因垂体增大被转诊至内分泌科，磁共振成像（MRI）显示无强化减弱病变。报告的主要症状是头痛，站立位和下午时加重。他没有垂体肿块效应、激素过多或缺乏的症状或体征。既往病史与神经鞘瘤切除术后行脊柱融合术有关。垂体激素的生化评估正常。复查其垂体MRI时，发现的其他异常提示颅内低压。根据他的病史和影像学表现，他被诊断为颅内低压导致的“假性垂体瘤”，而非垂体增大或异常。进一步评估发现多处脊柱漏并进行了修补。修补后几天内他的症状就缓解了。内分泌科医生应意识到颅内低压可能导致垂体肿块的误诊。
