ATYPICAL NEUROLOGICAL AND METABOLIC PRESENTATIONS OF PITUITARY ADENOMAS: A CASE SERIES

Abstract

Pituitary adenomas are common intracranial tumors with highly variable clinical presentations depending on tumor size, hormonal activity, and duration of disease. Although classical endocrine manifestations are well recognized, atypical neurological and metabolic presentations may lead to delayed diagnosis. We report a case series of three female patients with pituitary adenomas who presented with uncommon clinical features.

The first case involved a 17-year-old adolescent who presented with a first episode of generalized tonic–clonic seizure associated with headache and vomiting. Neuroimaging and hormonal evaluation revealed a prolactin-secreting pituitary macroadenoma. The second case was a 39-year-old woman referred with persistent vomiting, severe hyponatremia, anemia, and cerebellar ataxia. Detailed evaluation revealed panhypopituitarism secondary to a non-functioning pituitary microadenoma, with complete neurological recovery following hormone replacement therapy. The third case was a 47-year-old woman with long-standing diabetes mellitus who presented with diabetic keto acidosis in whom acromegalic features were noted on examination, leading to the diagnosis of a growth hormone-secreting pituitary macroadenoma.

This case series highlights the protean manifestations of pituitary adenomas, including seizures and reversible cerebellar ataxia, which are rarely the initial presenting features. Early recognition of subtle clinical clues and prompt endocrine evaluation are crucial for timely diagnosis and improved outcomes. Clinicians should maintain a high index of suspicion for pituitary pathology in patients with unexplained neurological symptoms, electrolyte abnormalities, or progressive somatic changes.