Endocrine Abstracts

Metastatic involvement of the pituitary gland is a rare phenomenon with various clinical and radiological manifestations, but it is clinically important and requires appropriate and early diagnosis. The posterior lobe of the pituitary gland is more often involved, so we expect that AVP deficiency would be the most common clinical manifestation of pituitary metastasis. Presentation without involvement of the posterior lobe, without AVP deficiency and with anterior lobe hypofunction is rather an unexpected course. Pituitary biopsy especially when pituitary metastasis is the first detected manifestation of cancer, is an important method for diagnosing metastatic lesions. A 66-year-old female patient with no History of chronic diseases was admitted to the Department of Neurology in March 2023 due to increasing headaches for two months and double vision since the day of admission to the hospital. CT scan and head MR were performed, and a lesion measuring 27×19×25 mm was described in the sella turcica region and part of the posterior sphenoid sinuses; the pituitary infundibulum remained unchanged, moved upwards and forwards. The examination suggested a metastatic involvement of the pituitary gland or a pituitary macroadenoma. Laboratory tests revealed hypofunction of the anterior pituitary lobe in the thyrotropic and corticotropic axes (L-thyroxine substitution and steroid therapy were implemented). In March 2023 the patient was consulted by neurosurgeons to assess the possibility of surgical intervention – however, regarding the risk of metastasis and incomplete resection, they suggested further diagnosis and did not perform adenomectomy. In May 2023, a lesion biopsy using a transsphenoidal approach was performed at the Department of Otolaryngology. Additionally chest CT revealed a tumour in section 3 of the right lung; a biopsy of the lung lesion was performed. The results of the biopsies showed the presence of mucinous adenocarcinoma with primary location in the lung. In June 2023, the patient began palliative radiotherapy in the sphenoid sinus area and passed away in the same month. The described case demonstrates that the clinical and radiological picture of pituitary metastases may be varied and the differential diagnosis is difficult. AVP deficiency is not always a clinical symptom that distinguishes pituitary metastases from PitNET. Our case also highlights the role of pituitary biopsy which should be more common in justified indications, and in this case, performed earlier, could have contributed to earlier implementation of the treatment. This case sustains that a multidisciplinary approach to patients with pituitary lesions is crucial.