Poster Abstract Abstract

(Adults - Pituitary/Neuroendocrinology), #220530271138

Acromegaly With Spontaneous Ventriculostomy-A Rare Phenomenon

Dorothy Maria Anthony Bernard, University of Malaya Medical Centre; Lim Sue Wen, University of Malaya Medical Centre; Nicholas Hee Ken Yoong, University of Malaya Medical Centre; Lim Quan Hziung, University of Malaya Medical Centre; Deviga Lachumanan, University of Malaya Medical Centre; Sharmila Sunita Paramasivam, University of Malaya Medical Centre; Lim Lee Ling, University of Malaya Medical Centre; R. Jeyakantha Ratnasingam, University of Malaya Medical Centre; Raja Rizal Azman bin Raja Aman, University of Malaya Medical Centre; Shireene Ratna D. B. Vethakkan, University of Malaya Medical Centre

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Introduction

Spontaneous ventriculostomy is an unique condition that occurs in patients with chronic obstructive hydrocephalus wherein spontaneous ventricular rupture results in communication between the ventricular system and subarachnoid space. We present a case of acromegaly who presented with spontaneous ventriculostomy on MRI pituitary with no prior history of neurosurgical intervention.

Methods

A 66-year-old gentleman with chronic hypertension presented with long standing bilateral peripheral vision loss, worsening over the right eye for 3 months, obstructive sleep apnea symptoms and no symptoms of pituitary apoplexy. Clinically, he had classical features of acromegaly and ophthalmological assessment confirmed bitemporal hemianopia with no optic atrophy.

Results

Pre-operative investigations confirmed elevated IGF-1:240 ng/ml (40.2-225), random growth hormone(GH): 3.7 ng/ml (<3) and prolactin(PRL): 805 mIU/L (45-375). Thyroid and cortisol levels were normal. Pre-operative MRI pituitary revealed a heterogenous sellar mass with CSF fistulous connection between floor of third ventricle and sella turcica. He underwent endoscopic chiasmopexy which revealed dense arachnoid adhesions in sellar region with CSF gush on manipulation. No tumour was removed as a discrete adenoma could not be identified. Post-operatively, IGF-1 normalised to 184 ng/ml (40.2-225), but GH and PRL remained elevated at 4.9 ng/ml and 474 mIU/L respectively. Failure of growth hormone suppression following 75g OGTT at 2.8 ng/ml denotes persistent active acromegaly. As he had mild acromegaly with prolactin co-secretion and was unable to afford Somatostatin Receptor Ligand therapy, he was commenced on Cabergoline 0.25mg twice a week.

Conclusion

Preceding cases reported of spontaneous ventriculostomy secondary to obstructive hydrocephalus was caused by neoplastic disease or benign aqueduct stenosis. We report a case of acromegaly with prolactin co-secretion who presented with a rare finding on MRI pituitary of spontaneous ventriculostomy.

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