Case 37-2008 -- A 17-Year-Old Boy with a Pituitary Tumor and Skull Abnormalities

doi:10.1056/NEJMcpc0806983

Volume 359:2367-2377		November 27, 2008		Number 22

Case 37-2008 — A 17-Year-Old Boy with a Pituitary Tumor and Skull Abnormalities

Edward R. Smith, M.D., Jay Loeffler, M.D., Madhusmita Misra, M.D., Stuart R. Pomerantz, M.D., Anat Stemmer-Rachamimov, M.D., and Miriam D. Post, M.D.

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Presentation of Case

A 17-year-old boy was seen at this hospital because of a pituitarytumor and radiologic evidence of bony abnormalities in the skull.The patient was well until approximately 12 years of age, whenheadaches developed. The pain ranged from dull to stabbing (upto 8 on a scale of 1 to 10, with 10 indicating the most severepain), was located primarily in the left frontal region (medialand posterior to his left eye), and occurred one to two timesper month, with no precipitating factors. Nausea, without vomiting,occurred occasionally in the morning. His peripheral visionand visual acuity . . . [Full Text of this Article]

Differential Diagnosis

Findings Suggestive of an Intracranial Process

Localization of the Lesion

Sellar Lesions

Lesions of the Skull Base

Diagnostic and Therapeutic Approach

Dr. Edward R. Smith's Diagnosis

Pathological Discussion

Anatomical Diagnoses

Source Information

From the Department of Neurosurgery, Children's Hospital of Boston (E.R.S.); the Departments of Radiation Oncology (J.L.), Pediatrics (M.M.), Radiology (S.R.P.), and Pathology (A.S-R., M.D.P.), Massachusetts General Hospital; and the Departments of Surgery (E.R.S.), Radiation Oncology (J.L.), Pediatrics (M.M.), Radiology (S.R.P.), and Pathology (A.S.-R., M.D.P.), Harvard Medical School.