Endocrine Abstracts

We report two cases with initial presentation of sudden onset ophthalmoplegia in i) a patient recently diagnosed with breast carcinoma and ii) a patient subsequently diagnosed with carcinoma lung. The first patient (68 years) was referred to the tertiary endocrine unit with a 2 weeks history of visual loss associated with 3rd cranial nerve palsy in her right eye and with a temporal hemianopia in her left eye. MRI showed an enhancing sellar and suprasellar mass. Initial biochemistry was consistent with anterior hypopituitarism. She underwent trans-sphenoidal debulking surgery. Histology confirmed a metastatic lesion consistent with a breast primary.

The second patient (49 years) presented with a one day history of left sided ptosis and retroorbital pain and symptoms of anorexia, weight loss and lethargy over a period of 1 month. He was a heavy smoker with no past medical history. Examination revealed left sided ptosis with complete ophthalmoplegia. Biochemistry was consistent with anterior hypopituitarism. MRI scan revealed an enhancing sellar and suprasellar mass. Chest X-ray showed an opacity in the left upper lobe which was confirmed by CT. He was treated with steroid and thyroxine replacement with subsequent development of polyuria and polydipsia consistent with diabetes insipidus. He underwent tras-sphenoidal debulking surgery with histology consistent with metastasis from a lung primary.

Tumours metastatic to the pituitary gland are an unusual complication of systemic malignancy. Breast and lung are the common sites of primary tumour. The most common presentation is usually diabetes insipidus which was observed in the second patient but only after steroid replacement. Sudden onset of symptoms such as headaches, ophthalmoplegia and diabetes insipidus in a patient above 45 years of age should always raise the suspicion of metastasis to the pituitary regardless of a history of malignancy.