Abstract #1400950: Chiari I Malformation with Concomitant Nonfunctioning Pituitary and Adrenal Tumors

Chiari I malformation (CM1) is a rare finding with an incidence ranging from 3.3 to 8.2 per 100000. CM1 has been described growth hormone secreting pituitary adenomas, and EPAS1 gain-of-function mutation syndrome multiple paragangliomas/pheochromocytomas, somatostatinoma, polycythemia. There only one case report in the literature describing nonfunctional adenoma CM1. We describe first reported of patient concomitant adrenal incidentalomas. A 45-year-old female history diet-controlled diabetes HTN presented two-week bilateral upper extremity weakness paresthesia, along gait instability. She had reduced motor power extremities on physical exam. MRI cervical spine demonstrated cervicothoracic syrinx, cerebellar tonsillar ectopia consistent brain showed diffuse enlargement gland measuring 16 x 14 13 mm bulging into suprasellar cistern minimally abutting inferior aspect optic chiasm. lumbar revealed left nodule 1.5 2.0 cm. Endocrine hormonal evaluation normal prolactin, follicle stimulating luteinizing hormone, estradiol, free T3, T4, IGF-I levels. Aldosterone level was high supine position plasma renin activity initially levels repeat testing. Plasma metanephrine, normetanephrine, testosterone were also normal. Patient started dexamethasone anticipation surgery. underwent suboccipital craniectomy, C1 laminectomy, coagulation tonsils expansile duraplasty for did well postoperatively tapered off. Postoperative follow up after off steroids three weeks all hormones, including suppression test. While finding, adenomas are relatively common. In cases occurrence adenoma, over-secretion proposed as mechanism precipitate symptoms by causing hypertrophy connective ligamentous tissue skull base cranio-cervical canal. Our IGF-1 raising question whether there some other underlying mechanism, possibly genetic predisposition, that contributed tumors. Whether these tumors become functional future remains be seen.