Endocrine Abstracts

Introduction

Nasopharyngeal carcinoma is characterized by distinct geographical distribution and is particularly prevalent in East and Southeast Asia. Environmental factors, genetic structure, and Epstein Barr virus infection are involved in the etiology of the disease. While nasal and otological symptoms are the most common (80%), intracranial extension is prevalent among 8% of cases and pituitary localization is rarely described in the literature. We report the rare case of a patient in whom the diagnosis of nasopharyngeal carcinoma was mislead by its pituitary extension.

Observation

A 50-year-old woman was referred to our department for pituitary macroadenoma. Her past medical history was unremarkable. She presented with headache, visual disorders, weakness, nausea, vomiting, and increased episodes of hypoglycemia. No polyuria was reported. Pituitary MRI showed a large mass extending from the sella turcica to the sphenoid sinus, optic chiasm, and nasopharynx. The first diagnosis was an extending pituitary macroadenoma. On physical examination, she had a body weight of 51 kg, a body mass index of 21.7 kg/m², a blood pressure of 100/60 mmHg, a regular pulse of 80 beats/mn. Biological investigations revealed corticotrope deficiency, secondary hypothyroidism, hypogonadotropic hypogonadism, and hyperprolactinemia (31 ng/ml). The patient was put on hormone replacement therapy. After corticosteroid treatment initiation, a diabetes insipidus was revealed. The second MRI showed a nasopharynx infiltration. Endoscopic biopsy confirmed the diagnosis of undifferentiated nasopharyngeal carcinoma (NPC) with intracranial extension. The patient was referred to oncology department for chemo and radiotherapy.

Conclusion

Although pituitary metastasis is a rare condition, it should be a part of the differential diagnosis of pituitary macroadenoma with hypopituitarism. The management of this case necessitates a multidisciplinary approach.