Endocrine Abstracts (2017) 49 EP1059 | DOI: 10.1530/endoabs.49.EP1059

What should central diabetes insipidus and panhypopituitarism point out in a patient with lung adenocarcinoma in remission?

Sule Canlar, Caglar Keskin, Asena Gokcay Canpolat, Sevim Gullu & Demet Corapcioglu

Ankara University Faculty of Medicine, Ankara, Turkey.

Objectives: Pituitary gland is an uncommon site for metastasis of malignant tumors. Breast and lung are the most common cancer sites. Most pituitary metastases are asymptomatic, with only 7% symptomatic and central diabetes insipidus is the most common symptom.

Case presentation: A 54 year-old woman presented with nause, emesis and diplopia to emergency department. Her relatives stated that she had poliuria, nocturia, polidipsia for three months. Her history revealed that she had been operated because of lung adenocarcinoma and postoperatively had underwent adjuvant chemotherapy. She was at follow-up in remission. Laboratory tests denoted hypernatremia and MRI scan images demonstrated that hypointense contrasted hypophysis and infundibular enhacement. She possesed central diabetes insipidus and desmopressin treatment administered primarily. On observation, central hypothyroidism and secondary adrenocortical defficiency developed. Medical oncology department assesed the patient, no metastatic lesion was detected in thoracoabdominal CT additionally PET scan, so that they didn’t consider pituitary metastasis. We didn’t reveal any autoimmune, infectious and inflammatory diseases that can cause hypophyseal involvement. Transnasal-transsphenoidal hypophysis biopsy was occured, but histopathological sampling was insufficient. The patient refused second biopsy, so she was discharged with replacement therapy in clinical stable state. But two weeks later, the patient applied with emesis-vomitting and diplopia and MRI scans showed progression. Also she had seizures, periferal facial paralysis and drop foot. The progression of lesions necessitated exact diagnosis and transcranial biopsy was carried out by the same neurosurgeon. After biopsy, her clinical course worsened and she lost her life. Meanwhile, histopathological examination resulted as metastasis of lung adenocarcinoma to hypophysis.

Conclusions: A past history of cancer should be kept in mind in a patient presenting with sellar mass even if the cancer is in remission. Especially, presence of diabetes insipidus and MRI scan findings are clues for metastatic disease.

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