Endocrine Abstracts

Introduction: Pituitary carcinomas are extremely rare neoplasms and molecular events leading to malignant pituitary transformation are largely unknown.

Case report: 36-year-old man turned to the clinic for visual and oculomotor disorders. A large endo-supra-latero(S)sellar tumor was found on MRI. There was also an increase in the level of ACTH in the blood (60,80 pmol/l (normal values 5–49)). The level of free cortisol in 24-hour urine was normal. Endoscopic transsphenoidal tumor removal was performed. Histological conclusion was pituitary adenoma (Ki67 10–15%). Immunohistochemical study revealed the expression of ACTH by a tumor. A month after the operation, MRI control was performed. A tumor recurrence was detected. PET-CT revealed metastases in the spine, liver and tubular bones. In the metastasis of the brachial bone, the expression of ACTH was also found. The patient was carried out the combined treatment including 18 courses of palliative chemotherapy (docetaxel, carboplatin, irinotecan, cisplatin, temodal), 3 courses of stereotactic irradiation for primary tumor and therapy with cabergoline and somatostatin analogues. The patient lived 2 years and 9 months after detection of the tumor was made.

Conclusions: There was a decrease in size of the primary tumor after radiotherapy, and chemotherapy resulted in a decrease in the metabolic activity of metastases which increased the life expectancy of the patient.