Hypopituitarism following surgical resection and cranial radiotherapy for craniopharyngioma. A case report

Abstract

A 33- year old Malay lady was admitted in August 1988 with a 5-year history of headache and hypopigmentation. She had primary amenorrhoea. Six months prior to admission she developed left hemiparesis and blurring of vision. On examination, hirsutism and underdevelopment of secondary sexual characteristics were noted. Eye examination showed bitemporal hemianopia and bilateral optic atrophy. CT- scan showed suprasellar calcification with enlarged sella turcica, compression of the third ventricle. A diagnosis of craniopharyngioma with hydrocephalus was made but she refused surgery and defaulted follow-up. In September 1991, she was again admitted with worsening of vision though her left hemiparesis had resolved completely. Craniotomy was performed. The optic chiasma was found to be prefixed and stretched but no visible tumour tissue was seen. Cystic craniopharyngioma was identified protruding through the dilated right foramen of Monro and was removed. Postoperative course was uneventful following that, she underwent 25 courses of radiotherapy. Her visual defects, however, did not improved. Subsequent endocrine investigations revealed hypopituitarism and she was started on hormone replacement therapy.