Metastatic Breast Carcinoma to the Pituitary Gland that Presented as Diabetes Insipidus: A Case Report

Samaras, Ioannis

doi:10.15406/jcpcr.2017.08.00273

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Usually, they affect patients in the sixth or seventh decade of life, with no clear sex predominance [ 3 , 8 ]. Other pituitary metastases have already been reported, such as prostate tumors, renal, gastrointestinal, thyroid, and other primary sites [ 3 , 10 ]. Thyroid carcinoma metastasis to the pituitary gland is rare [ 11 ], and accounts for only 2% of PM [ 1 , 4 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Pituitary Metastasis of Thyroid Carcinoma: A Case Report

et al. 2018

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Patient: Male, 58Final Diagnosis: Pituitary metastais from thyroid carcinomaSymptoms: Visual acuity worseningMedication: —Clinical Procedure: NeurosurgerySpecialty: Endocrinology and MetabolicObjective:Rare diseaseBackground:Pituitary metastasis of thyroid carcinoma is a rare entity. Differential diagnosis with other lesions in the sellar/parasellar region, through clinical, histopathological, immunohistochemical, and imaging is challenging but essential for adequate treatment.Case Report:This case report describes a 58-year-old patient with the previous diagnosis of follicular thyroid carcinoma, with metastasis to cervical lymph nodes, bone, and lung, initially evolving to left palpebral ptosis. In the investigation, laboratory tests showed hypopituitarism, and magnetic resonance imaging of the skull showed a suprasellar formation measuring 2.2×3.5×2.5 cm, which increased in size in a few months. The patient underwent transcranial neurosurgery and subsequent immunohistochemical analysis, which confirmed pituitary metastasis of follicular thyroid carcinoma. The patient underwent chemotherapy and radiotherapy but died 26 months after the onset of symptoms.Conclusions:The differential diagnosis of pituitary metastasis from a benign lesion is difficult. Therefore, a careful analysis of the history and clinical evolution, use of complementary imaging tests, and, where possible, the histopathological and immunohistochemical analysis of the lesion for diagnostic elucidation are necessary.

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Section: Discussionmentioning

confidence: 99%

“…Metastatic tumors may involve the pituitary by hematogenous dissemination, direct invasion of metastasis from the skull base, or meningeal spread through the suprasellar cisterna [ 8 , 10 ]. As the neurohypophysis is directly exposed to the arterial circulation, PM has a predilection for it [ 7 , 8 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Pituitary Metastasis of Thyroid Carcinoma: A Case Report

et al. 2018

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Diabetes insipidus and panhypopituitarism as a first presentation of silent adenocarcinoma of lung: a case report and literature review

et al. 2019

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BackgroundPituitary metastasis is a rare condition with a poor prognosis. Very few patients with pituitary metastasis are symptomatic. It is often associated with presence of co-existing metastases to other organs. Isolated pituitary metastasis as the first presentation of primary malignancy is uncommon.Case presentationA 72-year-old woman presented with a 2-month history of polyuria, increasing thirst and unexplained weight loss. Esophagogastroduodenoscopy (EGD) was scheduled as part of the investigation. She was kept nil per os for 10 h prior to EGD, after which she developed alteration of consciousness. Further investigation revealed hypernatremia with sodium level of 161 mmol/L and low urine osmolality of 62 mOsm/kg. Her urine output was 300 mL per hour. Diabetes insipidus (DI) was diagnosed based on evidence of polyuria, hypernatremia, and low urine osmolality. Her urine output decreased and urine osmolality increased to 570 mOsm/kg in response to subcutaneous desmopressin acetate, confirming central DI. Pituitary magnetic resonance imaging showed a heterogeneous gadolinium enhancing lesion at the sellar and suprasellar regions, measuring 2.4 × 2.6 × 3.9 cm compressing both the hypothalamus bilaterally and the inferior aspect of optic chiasm as well as displacing the residual pituitary gland anteriorly. The posterior pituitary bright spot was absent. These MRI findings suggested pituitary macroadenoma. There were also multiple small gadolinium-enhancing lesions up to 0.7 cm in size with adjacent vasogenic brain edema at the subcortical and subpial regions of the left frontal and parietal areas, raising the concern of brain metastases. Pituitary hormonal evaluation was consistent with panhypopituitarism. Histopathological and immunohistochemical studies of the pituitary tissue revealed an adenocarcinoma, originating from the lung. Computed tomography of the chest and abdomen was subsequently performed, showing a 2.2-cm soft tissue mass at the proximal part of right bronchus. There was no evidence of distant metastases elsewhere. The final diagnosis was adenocarcinoma of the lung with pituitary metastasis manifesting as panhypopituitarism and central DI. Palliative care along with hormonal replacement therapy was offered to the patient. She died 4 months after diagnosis.ConclusionDiagnosis of pituitary metastasis is challenging, especially in patients with previously undiagnosed primary cancer. It should be considered in the elderly patients presenting with new-onset central DI with or without anterior pituitary dysfunction.

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Metastatic Breast Carcinoma to the Pituitary Gland that Presented as Diabetes Insipidus: A Case Report

Cited by 2 publications

References 22 publications

Pituitary Metastasis of Thyroid Carcinoma: A Case Report

Pituitary Metastasis of Thyroid Carcinoma: A Case Report

Diabetes insipidus and panhypopituitarism as a first presentation of silent adenocarcinoma of lung: a case report and literature review

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