Endocrine Abstracts

Introduction: Even if breast cancer is rare cause of pituitary metastases, the diagnosis of a pituitary adenoma, shortly after surgery for breast cancer, raises suspicion of a possible secondary determinations.

Material and method: This is a case report revealing the medical history and endocrine profile of a female with breast cancer and pituitary macroadenoma.

Case data: A 64-year old non-smoking female (with menopause at age of 52), who had undergone treatment for breast cancer (diagnosed at the age of 60), with left radical mastectomy pT2N0M0 L0 V0 Pn0 R0, followed by adjuvant radiation treatment and aromatase inhibitor hormonal treatment, was admitted for headache, dizziness, diplopia, and narrowed visual field. Pituitary MRI performed pointed a 40/26/36 mm-sized mass of oval shape, with intra and extra-sellar expansion. Endocrine evaluation indicated low levels of serum gonadotropins (FSH of 10.5 U/l, normal: 30–150 U/L and LH of 1.6 U/l, normal of 8.2–41 U/l), low FT4 levels (free thyroxine of 0.61 ng/dl, normal: 0.89–1.76 ng/dl), normal levels of morning plasma cortisol (of 19.8 μg/dl, normal: 5–25 μg/dl), and moderate increase of prolactin (24.4 ng/ml, normal:1.3–20 ng/mL). Thyroxine substitution therapy was initiated and followed by transsphenoidal adenomectomy. Histopathology revealed a mixed pituitary adenoma. Assessement performed three month after surgery highlighted persistent hyperprolactinemia (of 22.9 ng/ml), central hypogonadism (FSH of 10.1 U/l, LH of 2.6 U/l), normal FT4 levels (of 0.95 ng/dl), and persistent pituitary mass (of 36/21/30 mm) on MRI. The patient will be further followed-up by a multidisciplinary team regarding endocrine and oncologic profile.

Conclusions: This case emphasizes that diagnosis of pituitary macroadenoma can be difficult when occurs in the context of a pre-existing breast cancer. Intensive follow-up is necessary for specific treatment.