Apoplexy in sellar metastasis; a case report and review of literature

Abstract

Apoplexy in sellar metastasis is very rare with only a few case reports in literature. A case of apoplexy in sellar metastasis from follicular thyroid carcinoma is reported and the literature is briefly reviewed. The patient presented with sudden onset headache and bi-lateral loss of vision following thyroidectomy in a case of follicular carcinoma thyroid with proven sellar metastasis. CT scan showed hyperdense blood in sellar mass suggestive of apoplexy in sellar metastasis. The patient underwent early trans-sphenoidal decompression. Apoplexy in sellar metastasis, although very rare, can be clinico-radiologically indistinguishable from pituitary apoplexy and should be especially considered in the differential diagnosis of patients with known primary neoplastic disease. In view of similar patho-physiological mechanism, sellar metastasis with apoplexy should be managed in a similar manner as pituitary apoplexy.

Pituitary apoplexy syndrome as the manifestation of intracranial tuberculoma

“…The main clinical features of pituitary apoplexy syndrome are headache, visual impairment, external ophthalmoparesis, meningismus, altered sensorium and hormone deficiencies 5. The usual causes of pituitary apoplexy are infarction and bleeds within the pituitary adenoma or, rarely, metastases 6. However, pituitary tuberculoma is an extremely unusual aetiology of pituitary apoplexy syndrome.…”

Colorectal Cancer Manifesting with Metastasis to Prolactinoma: Report of a Case Involving Symptoms Mimicking Pituitary Apoplexy

“…Although pituitary apoplexy usually occurs in patients with pre-existing pituitary macroadenoma, it has also been described in those with a normal pituitary gland, craniopharyngioma, lymphocytic hypophysitis and, in rare instances (<5%), pituitary metastasis (2, 5, 6). The major differential diagnoses of pituitary apoplexy include ruptured posterior communicating aneurysms, cavernous sinus thrombosis and hemorrhagic Rathke cleft cysts (6). Although the gradual worsening of symptoms observed in our patient is rather unusual for pituitary apoplexy, some cases of apoplexy with an atypical course (e.g., isolated third nerve palsy without headaches) have been documented (7).…”

Massive Skull Occult Metastasis of Follicular Carcinoma

“…Sellar metastasis of follicular thyroid carcinoma was reported with sudden onset of headache and bilateral loss of vision following thyroidectomy in a case of follicular carcinoma thyroid and a skull base metastasis follicular thyroid carcinoma with a cranial nerve dysfunction. 9 In 2 case reports, follicular thyroid carcinoma were reported as skull (left temporo-occipital) and dural metastasis mimicking a meningioma with a normal thyroid function tests and a choroidal metastasis of follicular thyroid adenocarcinoma. 2 In 3 different cases of skull metastasis of thyroid follicular thyroid carcinoma, thyroid hormone tests and ultrasonography of the thyroid gland were reported normal without any abnormalities.…”