Pediatric Pituitary Neuroendocrine Tumor With Extensive Necrosis: A Case Report

We describe an unusual presentation of a pediatric pituitary neuroendocrine tumor (PitNET).A 17-year-old previously healthy male presented to the emergency department with altered mental status, lethargy, nausea, vomiting, fever, and tachycardia.Head imaging incidentally demonstrated a large expansile sellar/suprasellar cystic and solid mass displacing the optic chiasm, invading bilaterally into the cavernous sinuses, and encasing the internal carotid arteries.He developed decreased vision of the left eye on hospital day two and underwent urgent endoscopic endonasal transsphenoidal resection of the mass.Pathology demonstrated a PitNET with extensive necrosis, lactotroph differentiation, and changes suggestive of superimposed tumoral infection.His postoperative course was complicated by panhypopituitarism, chronic diabetes insipidus, and a cerebrospinal fluid leak managed with lumbar drainage.His presenting symptoms resolved completely, with no tumor recurrence at two-month follow-up.The initial clinical manifestation in this case was suggestive of adrenal crisis secondary to pituitary hypofunction and secondary adrenal insufficiency, attributed to significant tumor compression and pituitary necrosis, and surgical decompression was performed for new visual loss.