MANIFESTASI DISFUNGSI BEBERAPA HORMON DARI SEORANG PENDERITA DENGAN RIWAYAT ADENOMA HIPOFISIS

Abstract

The sellar region is a site of various types of tumors. Pituitary adenomas are common neoplasms of the anterior pituitary
gland. They arise from epithelial pituitary cells and account for 10-15% of all intracranial tumor. The remaining one-third of
pituitary adenomas is endocrinologically silent, known as nonfunctioning pituitary adenomas, and cause symptoms or signs due
to tumor growth. Incidence of pituitary adenomas is difficult to know with certainty because they are often asymptomatic;
autopsy estimates range from 2.7 to 27%. There is not a predominance in either men or women. An increasing proportion of
pituitary adenomas are recognized in the elderly, raising the question of their optimal diagnosis and management. However, the
advent of the sophistical imaging systems for the brain such as the CT and MRI scans have greatly contributed to the early
detection of these tumors. This is our reported case the occurrence of many endocrinology disorders with a pituitary adenoma. A
79 year old male with a known pituitary macroadenoma, who presented with a chief complaint shortness of breath and took a
double dose of costison a view days ago. The related symptom also decreased libido and progressive impotence, mild cold
intolerance and decreased appetite. Physical exam was notable for a BP of 180/115, pulse of 120 (with significant orthostatic
changes), pallor, bilateral gynecomastia He also complained of generalized fatigue and weakness. He had history at 1988 with
CVA and got euthyrox for the hypotiroidsm. In 1998 was hospitalized on Danderyds Hospital with diagnosed adenoma pituitary
from the CT-Scan, and got trombyl 180 mg 2 x 1 tablet, triatec 4 x 5 mg, omeprazole 4 x 20 mg, duroferon 4 x 100 mg, and also
nibido 4 ml every 4 month. On 2005 he developed a severe and sudden headache, disorientation, weakness and fever. The
laboratory result were testosteron 15 mmol/L (10-30 mmol/L), prolaktin 17 µg/L (normal 3-13 µg/L), tyrotrhopin TSH (thyroid
stimulating hormone) 0,15 mE/L (normal 0.4-3.5 mE/L), S-IGF-I 57 µ/L (normal 85-220 µ/L) TSH 0,075 mE/L (normal 0.4-3.3
mE/L), FT4 9 pmol/L (normal 8-16 pmol/L), kortisol 98 nmol/L (normal, 08.00 am; 200-700 nmol/L, 10.00 pm; 50-200 nmol/L),
the echocardiografi was EF(ejection fraction) 35-40%, angiografi with striktur on proximal LAD. For the second CT-scan was
founded the increasing size of the adenoma pituitary 3 x 4 centimeter. Because of the presence and the past history also supporting
with another laboratory and rontgen examination. The diagnosis of a clinically nonfunctioning pituitary adenoma with hypogonadism
tipe was made, but now with conditions acute heart failure, pleural effusion and bronchopneumonia. Nonfunctional pituitary
adenomas, also called null-cell adenomas, are the most common macroadenomas (> 1 cm). Nonfunctional adenomas usually
present with local mass effects (e.g., optic chiasm compression), neurologic symptoms (cranial nerve III, IV and VI palsies) and
pituitary hormone deficiencies (e.g., hypogonadism). Headache, nausea, vomiting, ophthalmoplegia and reduced level of
consciousness, can occur in patients with large pituitary adenomas who suddenly deteriorate clinically. Pituitary apoplexy, a lifethreatening
sudden hemorrhage or infarction of a pituitary adenoma characterized by severe. The majority of patients with pituitary adenomas present with signs and symptoms reflecting excess hormone production. This case illustrates one of the many type from
pituitary adenoma and also the another conditions that can addition severity of the disease. The professional clinical examination
should be done for decreasing the mortality