Pituitary carcinoma is rare and diagnosis requires demonstration of cerebrospinal and/or systemic metastasis. We present case of a 64-year-old lady who presented with widespread spinal metastasis from a pituitary adenoma diagnosed 36 years ago. Our patient presented in 1971 with visual failure, headache and oligomenorrhoea. Imaging confirmed pituitary macroadenoma and she underwent transcranial hypophysectomy. Histology revealed chromophobe adenoma. Post operatively her vision and menstrual irregularities improved. She remained well until 1979 when her symptoms of visual impairment and oligomenorrhoea recurred. CT brain revealed presence of intrasellar tumour and visual fields revealed left temporal hemianopia. She underwent subtotal removal of recurrent adenoma and post-operative imaging showed tumour remnant, which was treated with radiotherapy. However, visual fields did not improve. She was discharged on hydrocortisone and thyroxine and was unfortunately lost to follow up.
In Jan 2007 she was re-referred with symptoms of headache, ataxia, and visual disturbance. On examination she had left temporal hemianopia and left optic nerve atrophy. Endocrine profile confirmed low FSH and LH with normal prolactin and IGF-1.
CT brain showed midline mass lesion with mild hydrocephalus. MRI scan showed pituitary tumour measuring 1.6×1.6×1.4 cm with multiple abnormalities bilaterally in the posterior fossa. MRI spine showed multiple abnormalities in subarachnoid space, largest being at C2/C3. Multiple nodules were seen along the spinal cord, becoming fewer with descent. Whole body CT was performed to seek a primary tumour, none was identified.
She underwent posterior fossa craniotomy for excision and biopsy of supracerebellar cervical tumour. Histology showed pituitary adenoma staining for FSH and LH thus confirming metastatic pituitary disease. A subsequent octreotide scan showed no abnormal uptake in either the primary or any of the metastatic deposits. Subsequently she has been offered radiotherapy. Our case highlights the importance of life long follow-up of patients with pituitary adenoma.