A 13-year-old male with no history of interest presented with frontal headache and nocturia in the previous months.
The examination showed normal height and weight for his age, bilateral gynecomastia of 2 cm in diameter, pubarche and 3 ml tests.
The examination was normal.
Computed tomography (CT) revealed an intrasellar (emerging from the interior of the expansive layer to the parenchymal) growth, well-defined, solid-pole, approximately 3 cm in diameter.
Magnetic resonance imaging (MRI) defined the suprasellar cystic portion of proteinaceous content (mildly hyperintense on T1 and hypointense on T2) and the solid portion intrasellar isointense.
With the radiological diagnosis of craniopharyngioma, surgical treatment was indicated (the level of prolactin had not been determined), and due to the right transcranial approach a macroscopically complete excision was performed.
Pathological anatomy diagnosed pituitary adenoma with positive immunohistochemistry for prolactin and chromogranin A.
1.
After the intervention, the patient presented a bitemporal hemianopsia with greater extension in the right visual field and panhypopituitarism, and was referred to endocrinology.
Prolactin levels after surgery were 83 ng/ml, with no residual adenoma on MRI, and treatment with cabergoline was started.
Calcemia was normal (9.5 and 8.8 mg/dl), so there is no suspicion of hyperparathyroidism or other tumors typical of multiple endocrine neoplasia (MEN 1).
