Pseudotumor cerebri after resection of pituitary adenoma

Aims: Peudotumor cerebri is a rare complication after transsphenoidal pituitary adenomectomy in children and adolescents.

Results: We report on a 14 year old boy with extreme obesity and reduced length growth rate. Laboratory investigations revealed elevation of cortisol in 24 hour urine, no dexamethasone suppression and an increase of ACTH and cortisol in the corticotrophin assay. No other endocrinologic abnormalities were present. The findings were in accordance with Cushing's disease. Cranial MRI revealed a contrast enhancing macroadenoma of the pituary gland and transsphenoidal resection of the adenoma was performed. Postoperatively the patient developed a polyuric phase and later transient inadequate ADH secretion syndrome. Six weeks post-surgery the patient presented with headache, tinnitus and papilledema. Cerebrospinal spinal fluid (CSF) examination revealed increased CSF pressure with 54cm H2O. After lumbar puncture the clinical symptoms improved initially, but recurred 2 weeks later. Despite repeated lumbar punctures and treatment with acetazolamide the patients symptoms including papilledema remained unchanged. Four months after the initial surgery ventriculo-peritoneal shunting was performed.

Conclusion: Extreme obesity in combination with a reduced length growth rate requires endocrinologic investigations since in rare cases an adenoma of the pituary gland can be the underlying cause. Our case shows that withdrawal from corticosteroids after resection of a pituitary adenoma can lead to pseudotumor cerebri. In severe cases ventriculo-peritoneal shunting is a therapeutic option.

Pseudotumor cerebri - pituitary adenoma