What lurks in the sellar?

摘要

In June, 2008, a 44-year-old immunocompetent man presented to us with sinusitis associated with headache, transient diplopia, and dizziness. He had a 7-year history of chronic sinusitis occasionally treated with pseudoephedrine and antibiotics. CT of the sinuses showed opacification of the paranasal sinuses which were filled with high density material, erosion of the sphenoid bone, and propagation of the pathological process to the sellar region, with a large sellar mass (figure A). MRI confirmed a giant hypointense lesion in the sellar region. The pituitary gland was displaced upwards. Physical examination was unremarkable, except for obesity (BMI 38 kg/m~2). Computerised visual-field examination, and visual acuity and motility were normal. The insulin hypoglycaemia test showed a peak growth hormone (GH) of 3.4 ug/L, borderline for severe GH deficiency (<3.0 mug/L); cortisol response was normal. Prolactin concentration was high (1150 mU/L; mean of three values). Macroprolactin was negative. Testosterone, FT4, and TSH concentrations were normal, and antibodies to thyroid peroxidase and thyroglobulin were present, compatible with a diagnosis of euthyroid chronic thyroiditis.