Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report

Abstract

BackgroundMetastasis to the pituitary gland is extremely rare and is often detected incidentally by symptoms associated with endocrine dysfunction. Breast and lung cancer are the most common primary metastasizing to pituitary gland. Metastasis from hepatocellular carcinoma to the pituitary gland is extremely rare, with only 10 cases having been previously reported. We present here the first case of pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism diagnosed by magnetic resonance imaging.Case presentationWe report the case of an 80-year-old Japanese woman who presented with the sudden onset of hypotension and bradycardia after having previously been diagnosed with hepatocellular carcinoma. Based on low levels of pituitary hormones, she was diagnosed with panhypopituitarism caused by metastasis of the hepatocellular carcinoma to the pituitary gland. Magnetic resonance imaging with arterial spin-labeling was effective in the differential diagnosis of the intrasellar tumor. The patient died despite hormone replacement therapy because of hypovolemic shock.ConclusionMetastasis to the pituitary gland causes various non-specific symptoms, so it is difficult to diagnose. The present case emphasizes the importance of diagnostic imaging in identifying these metastases. Clinicians should consider the possibility of pituitary metastasis in patients with malignant tumors who demonstrate hypopituitarism.

Nomogram for Predicting the Prognosis of Patients with Hepatocellular Carcinoma Presenting with Pulmonary Metastasis

“…The most frequent site of extrahepatic metastasis in patients with HCC is the lung. Due to its lower incidence, previously published investigations [9][10][11][12] were primarily derived from case reports and single-institution experience, with relatively small sample sizes. Therefore, the largest population-based investigation conducted to date was performed to analyze the clinical characteristics, risk factors and prognostic factors and subsequently construct a novel and accurate nomogram for predicting the prognosis of patients with HCC presenting with pulmonary metastasis.…”

Metastasis of lung adenocarcinoma to the pituitary gland

“…The differential diagnosis of intrasellar tumor includes meningioma, craniopharyngioma, aneurysm, hypophyseal adenoma, and Rathke's cleft cyst [13] . Primary carcinomas known to metastasize to the pituitary are from the kidney, prostate, and colon with an incidence of 3%-5% [6] .…”

A rare case of pituitary metastasis from hepatocellular carcinoma: case report and literature review

“…Surgery largely alleviates symptoms in the cases reviewed, including headaches, visual defects, ophthalmoplegia, and so on. But there is not always space for surgical treatment because metastatic lesions tend to be invasive, diffuse, and highly vascularized as mentioned before ( 30 , 31 ), or the general condition of the patient does not tolerate surgery ( 32 ).…”