MON-426 Non Functioning Pituitary Adenoma And Schizophrenia: An Incidental Association?

Background: Non-functioning pituitary adenomas (NFPA) characterized by the absence of clinical and biochemical evidence of pituitary hormonal overproduction are often diagnosed when they grow large in size compressing the optic chiasm causing bitemporal hemianopia or compressing the normal pituitary gland causing hormonal deficiencies (hypopituitary). Although there is a link between Schizophrenia and prolactinoma, it’s unknown whether there is association between Schizophrenia and NFPA. Case: A 52 year old Caucasian man presented with two weeks history of visual loss in the left eye on background of poor vision. Patient’s past medical history was significant for schizophrenia diagnosed in 1999 that required multiple hospitalisations, hydrocephalus with previous shunt at age of 9 years, learning disabilities, asthma, sleep apnoea and hypothyroidism. Examination showed Bilateral pale optic discs with Visual acuity of 6/36-1 with glasses and 6/36 with pinhole. Endocrinology service was consulted and Patient noted to have a history of infertility, reduced libido, erectile dysfunction, shaves very infrequently, chronic tiredness and fatigue. On examination body mass index was 45.3kg/m(2) with central obesity and loss of secondary sexual characteristics and gynaecomastia were noted. endocrine laboratory investigations showed hypopituitarism picture with FSH 1.1 Iu/L (1.4-10.8),LH <0.5 Iu/L (1.4-6.5),Testosterone <0.1 nmol/L( 7.1-31.1) ,FT4 9.3 Pmol/L(9-20)(on levothyroxine 50mcg od) ,TSH 2.81 mIu/L(0.35-4.94), Cortisol <22 nmol/l.,ACTH 3 ng/L (7-63),Prolactin 309 mIu/L (37-407) ,GH <0.10 ug/l and IGF-1 24 ug/l(56-202).MRI pituitary with gadolinium revealed 4.9*3.2*3.2 cm solid cystic mass extending from pituitary fossa superiorly into the suprasellar cistern with Mass effect on optic chiasm and undersurface of the frontal lobe bilaterally. Patient was started immediately on hydrocortisone and was transferred urgently for neurosurgical intervention. He successfully had tansphenoidal resection of the macro adenoma with good improvement in the visual field afterward. Histology showed large fibrous walled cyst in which pituitary adenoma was present at the margin. lesional cells stained positive for chromogranin and LH. Patient was commenced; in addition to steroid replacement; on testosterone replacement and he is currently pending DEXA (dual energy X-ray absorptiometry) scan to asses for osteoporosis and will be reviewed in the endocrine outpatient for the assessment of other hormonal replacements. Conclusion: we illustrated a challenging case of delayed NFPA diagnosis in vulnerable patient and longer term follow up will establish if there is improvement in his schizophrenia.