Endocrine Abstracts

Introduction: Metastases in the pituitary gland are an uncommon presentation of carcinomas, lung and breast being the most common sites of the primary tumor. The most frequent clinical manifestations are diabetes insipidus, visual disturbances, cranial nerve paralysis and hypopituitarism.

Case report: We report the case of a 64 years old man, smoker, with no chronic illness, with one year history of headache, and more recent asthenia, weight loss, poliuria, polidipsia, loss of appetite. The MRI exam revealed a 20/14/12 mm sellar tumoral mass that interest the pituitary stalk. The endocrinological assessment confirmed diabetes insipidus, hypopituitarism and hiperprolactinemia (TSH =0.5 uUI/ml, n.v=0.4–4, FT4=0.6 ng/dl, n.v=0.89–1.76; FSH =0.32 U/l, n.v=0.7–11.5, LH =0.1 U/l, n.v. =0.8–7.6; testosterone <0.1 ng/ml, n.v=1.3–8.53; cortisol =4.46 mcg/dl, n.v=5–25; PRL =76.1 ng/ml, n.v=2.5–17). He started treatment with Prednison 5 mg/day, Desmopresin 120 mcg/ twice daily, then Euthyrox 50 mcg/day and then he underwent surgery. The histological exam revealed a metastatic lesion of a poorly differentiated lung adenocarcinoma. The chest CT scan confirmed multiple pulmonary lesions and mediastinal lymph node metastasis. No secondary lesions on abdominal CT scan. The postoperatory hormonal assessment reconfirmed hypopituitarism, hyperprolactinemia and diabetes insipidus (STH =2.09 ng/ml, n.v=0–7; TSH =0.5 uUI/ml, n.v=0.4–4, FT4=0.98 ng/dl, n.v=0.89–1.76; FSH =0.28 U/l, n.v=0.7–11.5, LH =0.1 U/l, n.v. =0.8–7.6; testosterone <0.1 ng/ml, n.v=1.3–8.53; cortisol =1.47 mcg/dl, n.v=4–25; PRL =47.9 ng/ml, n.v=2.5–17). He continued the same substitution therapy and he also underwent cranial radiotherapy.

Conclusion: Diabetus insipidus and pituitary insufficiency may be the first and only manifestation of malignancy. The detection and appropriate treatment of hormonal insufficiency are important to improve the quality of life.