Pituitary tumors and pyramidal syndrome

Giant pituitary tumors (≥ 4 cm in diameter) are more frequent in men. Their main manifestations are headaches with sexual and visual troubles. But, sometimes they can have severe neurological complications, such as psychiatric troubles, hydrocephalus, memory troubles, meningitis, and epilepsy. To our best knowledge, pyramidal and cerebellar syndromes are exceptional. Our aim was to describe two men with giant PT associated to pyramidal syndrome with or without the cerebellar one. Case 1 A 38 years old man was sent for a large prolactinoma infiltrating the cerebellum [Prolactin = 376 ng/ml, tumor size: 61 mm (height), 50 (transverse diameter) and 81 (antero posterior diameter)] with gonadal deficit and uncommon neurological signs, such as right central facial paralysis, pyramidal syndrome in lower and upper limbs, dysarthria and static and kinetic cerebellar syndrome. Neurological symptoms and signs, which began one year ago, disappeared miraculously two weeks after starting bromocriptine and reduction in the tumor size. He is now speaking, walking and working normally. Case 2 A man aged 63, suffering from right hemi paresis for two years and recent vomiting was sent to our department for a non functioning PT (42 × 35 × 60) with hydrocephaly. On clinical examination apart from pituitary insufficiency, he had left facial paralysis and pyramidal syndrome. Cerebral MRI showed a multidirectional tumor with hydrocephalus and invasion of cerebral trunk. Conclusion Both PT has an important invasion of the brainstem, which explains pyramidal, and cerebellar syndromes. Those tumors need to be recognized as they are life threatening.