Endocrine Abstracts

Cancer metastases on pituitary gland are seen rarely. A 71-year-old male was admitted to Endocrinology Department with polydipsia, polyuria, and diplopia. Urine volume was ~5 l/day. In medical history; he had been diagnosed as having non-small cell lung carcinoma with multiple liver and bone metastases 1 year ago. He took chemotherapies with four cycles of paclitaxel, carboplatin, and zoledronic acid for bone metastases and radiation therapy (RT) was given to L4-S1 vertebras. The size of the lung mass was reduced on the follow-up computed tomography scan; thus, the patient exhibited a partial response. Owing to his complaints like as diabetes insipidus (DI), pituitary MRI was done that showed a sellar and suprasellar mass which occupied infundibulum and the pituitary gland. Older MRI was explored again by us and seen an undiagnosed smaller sellar mass. Also on T1-weighted MRI, the signal intensity was decreased, suggesting the pituitary and infundibulum metastases of current lung cancer. On physical examination; blood pressure was 100/60 mmHg and there was any abnormality. The serum osmolality was 310 mOsm/kg, whereas the urine density was 1005. Laboratory results were GH: 0.098 ng/ml, IGF1: 51.4 μg/l (64–188), TSH: 0.249 IU/ml (0.27–4.2), free T₄: 0.452 ng/dl (0.93–1.7), FSH: 0.492 IU/ml (1.5–12.4), LH: 0.1 IU/ml (1.7–8.6), total testosterone: 0.025 ng/ml (1.93–7.4), ACTH: <1 pg/ml (7.2–63.3), cortisol: 0.755 μg/dl (6.2–19.4), prolactin: 2.71 ng/ml (4.04–15.2), and Na: 143 mEq/l (135–145). Patient started to use desmopressin nasal spray 0.1 mg/ml two puffs per day, prednisolone 5 mg, levothyroxine 25 μg/day for panhypopituitarism and DI. His urine volume was normalized; the polydipsia ceased and his condition becomes clinically better. Also radiation oncology department planned RT for pituitary metastases. When symptoms of DI appear in a patient with lung cancer, pituitary metastases should be considered and evaluated properly, thus, panhypopituitarism is not skipped.