Abstract 86: Pneumo-encephalus: A rare complication following pituitary surgery

Background: Pneumo-encephalus is a rare complication of trans-nasal trans-sphenoidal pituitary surgery. Mostly it is asymptomatic, but can present with signs of raised intra-cranial tension (tension pneumo-encephalus). Tension pneumo-encephalus can lead to multiple cranial nerve palsies including vison loss, mass effect on brain parenchyma or meningitis, which can be life-threatening. Here, we present a case of Cushing's disease, who underwent adenoma resection, following which patient developed pneumo-encephalus along with cerebrospinal fluid (CSF) leak. Case Presentation: A 58-year-old female, presented to Endocrinology out-patient services for management of diabetes mellitus, with history of weight gain. On examination, patient had Cushingoid facies, centripetal obesity and thin skin. Laboratory evaluation revealed ACTH-dependent endogenous hypercortisolism, and a pituitary microadenoma was detected on magnetic resonance imaging. Patient underwent trans-nasal trans-sphenoidal adenoma excision with a documented remission; she was started on replacement dose of glucocorticoids and discharged. One week later, she presented to Emergency Medicine Department with headache, watery discharge from nose suggestive of CSF rhinorrhoea, and altered sensorium. A computed tomography of the brain was performed that revealed multiple air filled pockets inside cranium and was diagnosed as having pneumo-encephalus. CSF leak was repaired by closing the leak with an omental patch and patient was discharged after symptomatic improvement. Conclusion: Pneumo-encephalus is a rare complication which can occur in early post-operative period, following pituitary surgery. Early recognition and meticulous management of this condition is necessary, as it can be life-threatening.