[A case of an aged patient suspected of craniopharyngioma with a chief symptom of eunuchoidism accompanied with panhypopituitarism].
A 78-year-old man with developmental disturbance of the genital organs and eunuchoidism was reported. He also had a high pitched voice, thickness of the lower lip and kyphosis of the thorax. He seemed to be fretful, but his intelligence was normal. Neurological tests revealed bilateral hemianopsia and decreased tendon reflexes. A plain skull radiograph clearly showed an egg shaped calcified mass extending upward from the sella turcica which resembled a ballooning shape. Brain CTs showed a high density round mass which expanded the sella turcica and raised the floor of the third ventricle. The inner part of the tumor showed irregular high density. T1-weighted MR imaging revealed an iso signal intensity, and T2 showed low signal intensity in the mass. These findings strongly supported the diagnosis of calcificated craniopharyngioma. Endocrinological study showed panhypopituitarism caused by the tumor compressing the pituitary gland and the hypothalamus. The main reasons why there were no apparent symptoms of hypopituitarism were because the receptors were up-regulated and secondarily because the thyroid and the adrenal cortical functions decreased while struggling to maintain balance with each other. There was also a possibility that these symptoms might have been masked by normal aging. Benign monoclonal hypergammopathy was also indicated, although we could not find a clear correlation between this finding and others.
Nokura
K
K
Department of Internal Medicine, Nagoya City Kosei-in Hospital.
Inagaki
T
T
Naitou
K
K
Niimi
T
T
Yamamoto
T
T
Mitake
S
S
Ojika
K
K
Yamamoto
M
M
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D003397:Craniopharyngioma / Q000097:blood / Q000150:complications*; D005058:Eunuchism / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology*; D008297:Male; D010911:Pituitary Neoplasms / Q000097:blood / Q000150:complications*
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone