PMON223 Sellar Meningioma in Association with Fertility Treatment, A Case Report
Authors: Alnahas Zeinab , Horani Mohamad H 
Published: November 2022

Abstract

Introduction
Sex hormones play a crucial role in the development and growth of meningioma. Progesterone receptor is expressed in more than 70% of meningioma, practically in benign (WHO grade1) meningioma. It was observed that meningiomas increase in size and become more symptomatic during pregnancy. Similarly, the use of hormonal therapy, including gonadotropin-releasing hormone (GnRH) agonist, can be associated with an increased risk for meningioma. Moreover, the use of GnRH agonist can be associated with a risk of pituitary adenoma growth, which is difficult to distinguish from sellar meningioma by routine MRI scan. This case report shows a rare association of fertility hormonal treatment with sellar meningioma and the possible differential diagnosis.

Case Presentation
A 45-year-old obese woman with a past medical history of hypertension, prediabetes, hypothyroidism, and mild hyperprolactinemia presented to us with a 2-week history of persistent and worsening periorbital headache, associated with nausea, vomiting, and left retro-orbital pain with eye movement. She had undergone fertility treatment, intrauterine insemination (IUI), and hormonal therapy, including GnRH agonist, bromocriptine, and levothyroxine. She had a recent IUI 1 week prior to her presentation. She denied weakness, facial paresthesia, blurry/double vision, recent excessive weight gain/loss, or the use of any anticoagulation or antiplatelet medications. Her MRI brain scan without contrast revealed a 2.3×1.5×1.2 cm heterogeneous soft tissue mass involving the sella and left cavernous sinus with a slight impingement of the optic chiasm and left optic nerve. These findings were consistent with meningioma or pituitary macroadenoma. The patient denied any increase in her ring or shoe size, menstrual disturbances, loss of peripheral vision, orthostatic dizziness, or skin pigmentation.Her laboratory workup showed a serum prolactin of 33.3 ng/mL (reference value &lt;25ng/mL), TSH of 2.11 mIU/L (reference value 0.5-5.0 mIU/L), free T4 of 1.3 ng/dL (reference value 0.7-1.9 ng/dL), IGF-1 of 250 ng/mL (reference value 90-360 ng/mL for people ages 40-54), morning ACTH of 6 pmol/L (reference value 10-60 pmol/L), and morning cortisol of &lt;0.2 mcg/dL (reference value 5-25mcg/dL). In addition, she had a subnormal response for the cosyntropin stimulation test, which confirmed the diagnosis of secondary adrenal insufficiency. The patient was treated with replacement glucocorticoid therapy. She underwent an endonasal endoscopic transsphenoidal resection of the tumor, and its histopathological examination revealed meningioma with fibrosis and sclerosis, WHO grade 1.ConclusionGnRH agonist can stimulate the growth of meningioma and pituitary adenoma in women undergoing fertility treatment. Our case shows a rare association of GnRH use with sellar meningioma and how we should consider meningeal and pituitary tumors in the differential diagnosis of any sellar mass in women undergoing fertility treatment.
Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.