A 13-year-old boy with no past history of interest consulted for frontal headache and nocturia in the previous months. On examination he presented normal height and weight for his age, bilateral gynaecomastia of 2 cm in diameter, pubarche and testicles of 3 ml. Ophthalmological examination was normal.
Computed tomography (CT) revealed an intrasellar expansive process (emerging from within the sella turcica) with a well-defined suprasellar growth, about 3 cm in maximum diameter, isodense with respect to the parenchyma, cystic in appearance with a solid pole and peripheral ring that were hyperintense after contrast injection. Magnetic resonance imaging (MRI) defined the suprasellar cystic portion with proteinaceous content (slightly hyperintense in T1 and hypointense in T2) and the intrasellar solid portion isointense to the grey matter in both sequences and intensely enhanced after gadolinium. With the radiological diagnosis of craniopharyngioma, surgical treatment was indicated (the prolactin level had not been determined), and a macroscopically complete excision was performed via the right transciliary approach. Pathological anatomy diagnosed a pituitary adenoma with positive immunohistochemistry for prolactin and chromogranin A.

After surgery, the patient presented bitemporal haemianopsia with increased extension in the right visual field and panhypopituitarism, and was referred to endocrinology. Postoperative prolactin levels were 83 ng/ml, with no adenoma remnants on MRI, and treatment with cabergoline was started. Calcaemia was normal (9.5 and 8.8 mg/dl), so there is no suspicion of hyperparathyroidism or other tumours typical of multiple endocrine neoplasia (MEN 1).