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CONCLUSION: The biochemical and radiological findings combined with the patient’s longstanding history of sinusitis point to a granulomatous/vasculitic cause for his pituitary mass. PET-CT has provided a target for extraneural biopsy, which is less risky and may be of higher diagnostic yield than neural biopsy. On confirmation of the underlying diagnosis we aim to initiate medical treatment of the underlying cause which might enable reduction/resolution of his pituitary mass without the risks of surgery. CASE: A 56-year-old male with a background of sickle cell trait and hypertension presented with syncope, lethargy and nausea. He also reported an 18-month history of headaches and recurrent episodes of sinusitis. On examination he had acromegalic features as well as proximal myopathy with normal visual fields, this prompted pituitary function tests to be performed which showed panhypopituitarism (Figure 1). Routine blood tests also revealed AKI (figure 2), which was further investigated with a vasculitic screen and a renal USS. His renal USS proved unremarkable however his vasculitis screen showed elevated anti-MPO and Anti-PR3 antibodies and a raised ESR (figure 2). His urinary protein: creatinine ratio was normal with no casts or red blood cells seen.

An unusual case of pituitary pathology and the utility of whole body 18F-FDG PET-CT imaging in identifying extraneural biopsy targets