This case series explores the genetic and clinical consequences of consanguineous marriage in Bahrain. Two pediatric patients born to first-cousin parents were identified and evaluated at tertiary hospitals. Each underwent detailed clinical assessment, imaging, and genetic testing. The first case involved Müllerian duct agenesis, adrenal insufficiency, and primary ovarian failure without a pathogenic variant. The second case featured growth failure and hypopituitarism linked to a heterozygous nonsense mutation in the Sonic Hedgehog (SHH) gene (7q36.3). These findings highlight the broad phenotypic spectrum of genetic disorders arising from consanguinity and highlight the need for genetic counseling, early screening, and public awareness initiatives in populations with high rates of consanguineous unions.

Pituitary neuroendocrine tumors (PitNETs) are commonly managed with endoscopic endonasal transsphenoidal surgery (EETS), but early postoperative hypopituitarism remains a clinically important complication. This retrospective cohort study analyzed early postoperative risk factors for hypopituitarism in 124 patients with PitNETs who underwent EETS at a single center between January 2022 and December 2024. Endocrine status was assessed preoperatively, during the immediate postoperative period before discharge (postoperative days 3-7), and at scheduled outpatient reassessments at 1 and 3 months after surgery; the mean interval from surgery to endpoint endocrine assessment was 3.2 ± 0.6 months. Patients were categorized into a hypopituitarism group (n = 38) and a non-hypopituitarism group (n = 86) based on postoperative endocrine evaluation across the hypothalamic-pituitary-adrenal, thyroid, gonadal, and growth hormone axes. Demographic, radiologic, perioperative, and endocrine data were collected, and univariate and multivariate logistic regression analyses were performed. Patients who developed hypopituitarism were older and had larger tumors, higher Knosp grades, more frequent suprasellar extension, longer operation times, greater intraoperative blood loss, more intraoperative cerebrospinal fluid leakage, and lower rates of gross total resection. In the multivariate model, maximum tumor diameter (adjusted odds ratio [aOR] per 10-mm increase = 2.02, 95% confidence interval [CI]: 1.09-3.74) and Knosp grade 3-4 (aOR = 2.37, 95% CI: 1.03-5.46) were identified as independent risk factors for early postoperative hypopituitarism, whereas gross total resection was independently associated with a reduced risk (aOR = 0.39, 95% CI: 0.16-0.96). These findings indicate that tumor anatomy and extent of resection are key determinants of early endocrine outcomes after EETS and should be incorporated into preoperative risk stratification and postoperative endocrine surveillance; however, they should not be extrapolated to long-term pituitary functional recovery or deterioration without further follow-up.

Lymphocytic hypophysitis (LYH), attributed to autoimmune mechanisms, typically causes multiple anterior pituitary hormone deficiencies, with corticotroph dysfunction occurring earliest; predominant thyrotroph dysfunction is uncommon. A 65-year-old woman presented with headache, fever, and diplopia. Laboratory tests revealed marked systemic inflammation and cerebrospinal fluid (CSF) pleocytosis. Pituitary magnetic resonance imaging (MRI) demonstrated diffuse enlargement and homogeneous contrast enhancement of the pituitary gland and stalk. Endocrinological evaluation showed paradoxically decreased thyroid-stimulating hormone (TSH) despite low thyroid hormone levels, contrasting with elevated adrenocorticotropic hormone (ACTH) levels. Endocrinological stimulation tests revealed a markedly blunted TSH response, with preserved gonadotropin and growth hormone responses, indicating predominant thyrotroph dysfunction despite preserved corticotroph function. Glucocorticoid therapy resulted in prompt improvement of clinical, laboratory, and MRI findings, with complete recovery of anterior pituitary functions. A presumptive diagnosis of LYH with reversible predominant thyrotroph dysfunction and meningitis secondary to direct extension of pituitary inflammation was established. This case demonstrates that LYH can present with atypical anterior pituitary hormone dysfunction, may be complicated by aseptic meningitis, and requires prompt glucocorticoid therapy for favorable outcomes.

Opioid-induced adrenal insufficiency (OIAI) is a known, but often overlooked complication associated with chronic opioid use. It is important to recognize OIAI as, if untreated, can lead to increased morbidity and mortality.

Peptide receptor radionuclide therapy (PRRT) is an emerging and promising targeted treatment for aggressive pituitary neuroendocrine tumours (PitNETs) and pituitary carcinomas refractory to conventional therapies. Its use is supported by the frequent expression of somatostatin receptors (SSTR), predominantly SSTR2, in pituitary tumour cells, enabling selective delivery of β-emitting radionuclides such as 177Lu-DOTATATE and 90Y-DOTATOC, resulting in targeted antitumour and antisecretory effect. This narrative review summarizes current scanty evidence on PRRT efficacy and safety in aggressive pituitary tumours. Successful outcomes were reported in some cases, in terms of tumour growth and/or hormonal reduction, or relief of mass-effect-related symptoms. PRRT related adverse events are mostly mild and transient, predominantly hematologic, with clinically significant renal toxicity uncommon when amino-acid nephroprotection is used. Preserved pituitary function and no clinically significant PRRT-induced hypopituitarism have been reported. Overall, PRRT represents a biologically rational and potentially effective option for selected patients with SSTR-positive aggressive PitNETs after failure of previous therapies.

Pituitary stalk interruption syndrome is a rare, congenital endocrine disorder of hypopituitarism. It has highly variable clinical presentation depending on the extent and type of hormonal deficiency and age at presentation, with growth hormone deficiency being the most common manifestation. Growth hormone plays an important role in maintaining normal blood glucose levels during stress or fasting, by stimulating hepatic gluconeogenesis and lipolysis. Therefore, hypoglycemia should alert us to a possibility of growth hormone deficiency necessitating imaging and facilitating early diagnosis of pituitary stalk interruption syndrome.

Craniopharyngioma is histologically benign yet locally aggressive, with frequent recurrence. Long-term multicenter outcomes after stereotactic radiosurgery (SRS) remain incompletely defined.