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Non-functioning pituitary macroadenoma — SCE Endocrinology MCQ

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HardPituitaryNon-functioning pituitary macroadenomaSCE Endocrinology

A 17-year-old boy develops central AVP deficiency and secondary hypogonadism. MRI shows a 5 mm thickened pituitary stalk, and skeletal survey reveals a lytic calvarial lesion. What is the most appropriate diagnostic strategy?

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Correct answer: C — Undertake systemic evaluation for Langerhans-cell histiocytosis and seek safer lesional tissue before considering stalk biopsy

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

A is correct. Central AVP deficiency plus stalk thickening and a lytic skull lesion strongly suggests Langerhans-cell histiocytosis; germ-cell tumour and inflammatory disease remain important alternatives. UK consensus supports systematic tumour markers, imaging and surveillance, with biopsy directed to a safer extracranial or bony lesion when available. Stalk biopsy carries endocrine, visual and vascular risk. Empirical steroids can obscure histology, and symptom treatment with desmopressin must not substitute for aetiological investigation.

Reference: https://pubmed.ncbi.nlm.nih.gov/34214482/