Symptomatic pituitary metastasis is an uncommon presentation of primary carcinoma. We report a case of a 65 years old lady who presented with a six week history of headache and diplopia and a five day history of diarrhoea and vomiting. She also suffered from osteoporosis. She had undergone a hysterectomy for a fibroid. Examination revealed diplopia in all directions of gaze, no papilloedema and an unremarkable systemic examination. Brain MRI showed a contrast enhancing pituitary mass with suprasellar extension, indenting the chiasma. Perimetry revealed bitemporal hemianopia. Her sodium was 142 millimols per litre, potassium 3.9 millimols per litre, urea 1.2 millimols per litre, creatinine 63 millimol per litre, calcium 2.45 millimol per litre, ALP 205 units per litre. TSH 0.11 milliunits litre and FT4 9.6 picomols per litre. 9.00 am serum cortisol 79 nanomols per litre, FSH 1.8 units per litre and LH 0.2 units per litre. Short Synacthen: 0' 74 nanomol per litre, 30' 313 nanomols per litre, 60' 454nanomols per litre. Growth hormone 8.5 milliunits per litre, IGF-1 10.1 nanomols per litre. Prolactin levels 2316 milliunits per litre. Tumour markers CEA 56 microgramms per litre (0-5), OV 21 units per millilitre (0-23), BR 17 units per millilitre (0-28), total HCG <2 international units per litre, AFP 6 K units per litre (0-7). She recieved HRT, glucocorticoids, thyroxine and cabergoline and was transferred to a tertiary hospital. She underwent a trans-sphenoidal hypophysectomy. Histology revealed a poorly differentiated metastatic carcinoma. CT of chest and abdomen revealed hepatic metastasis. She subsequently received palliative care.
The incidence of metastatic spread to the pituitary has been reported to occur in 3% to 5% of patients with carcinoma, rising to 27% when post mortem studies are included. Headache, cranial nerve compression causing double vision and hypopituitarism can occur. Trans-sphenoidal surgery can provide symptomatic relief.
03 - 05 Nov 2003
Society for Endocrinology