Manifestations of suprarenal insufficiency occurring with pituitary tumours.

The urgent symptoms which frequently result from compression of the optic nerves and chiasm have focused attention upon themselves so that some of the manifestations of adrenal cortical insufficiency secondary to " pituitary tumour " have received scant notice. This is not to say that they are totally unknown, but they form a submerged body of knowledge to which relatively little importance is accorded. Now that cortisone and its allied and related substances provide for the first time an effective treatment of this condition, the neurologist or neurosurgeon, who usually has the care of such patients, must be fully aware of the possible ways in which these patients' symptoms may present. The symptoms and signs of adrenal failure can closely mimic those of organic brain disease, so that a patient in crisis from adrenal failure may be mistakenly regarded as suffering from serious intracranial mischief. This may occur in primary suprarenal insufficiency, but when it happens to a patient whose suprarenal failure is secondary to an already recognized pituitary chromophobe adenoma, the temptation to ascribe the clinical picture to a massive extrasellar extension of the tumour is almost irresistible. In either case a mistake in diagnosis may cost the patient his life, for full radiological investigation or surgical exploration will likely prove disastrous when in reality the appropriate and urgent need is for adrenal cortical hormones. Moreover, in lesser degree, adrenal cortical insufficiency not only increases the risks of operation, but may cut short the patient's span of life, or may be responsible for ill-health which either prevents the patient's return to work or greatly decreases his efficiency and enjoyment of life. This paper is concerned with manifestations ascribable to adrenal cortical hypofunction in 135 cases of pituitary chromophobe adenoma (of which 124 were histologically verified) and in 31 cases of Rathke pouch cyst. The youngest patient with a pituitary adenoma was aged 18 at the time of admission to hospital for the treatment. In order to make the two groups of cases comparable, 28 cases of Rathke pouch cyst which required admission below the age of 18 have been excluded from this survey.