Endocrine Abstracts

Metastasis to the pituitary gland is a rare occurrence. Here we discuss our experience managing a patient with pituitary neuroendocrine metastasis who first presented with ocular symptoms. A 65-year-old lady presented in July 2015 with progressive diplopia. An MRI scan revealed a pituitary mass lesion with aggressive features and two abnormal enhancing nodules within the brain white matter, raising suspicion of metastatic disease. Radiotherapy was commenced on the basis that the lesion was equally infiltrative as compressive. External beam therapy of the pituitary lesion was initially successful at maintaining visual acuity (VA) (right VA 6/9, left VA 6/36) and stabilising Goldman visual field (VF) loss; however, the cranial nerve 3 palsy persisted. Six months after the initial presentation, the patient reported worsening vision, which was reflected in a decline in visual acuity (right VA 6/9, left VA 3/60) and further visual field loss. There was no evidence of pituitary lesion progression, and vision stabilised on follow-up six months later (right VA 6/7.5, left VA 2/60). Identifying and treating the primary lesion proved to be a challenge. CT-TAP revealed a likely right middle lobe primary, with local collapse and multiple hepatic foci. FDG-PET and octreotide scan were negative, and the tumour was not visible on bronchoscopy. However, liver biopsy revealed metastatic atypical bronchial carcinoid. The patient was started on interferon alpha 2a. The patient was able to tolerate this for only four months before stopping, by which time she had developed proximal muscle weakness. MRI revealed spinal drop metastases, and patient was placed on the palliative pathway. 19 months after diagnosis, the patient passed away. In summary, bronchial carcinoids can metastasise to the central nervous system and herald a poor prognosis.