Endocrine Abstracts

A 76 year old man known to have coronary heart disease, hypertension and chronic kidney disease due to hypertensive nephropathy admitted to the nephrology clinic with fatigue, nausea and dizziness. His creatinine level was detected to be increased (from 1.5 to 2.5 mg/dl) and was he was hospitalized. The cranial magnetic resonance imaging (MRI) performed after neurology consultation for dizziness showed a pituitary mass. When asked, the patient described bitemporal hemianopsia for 2 months and double vision for the last 3 days. During eye examination bitemporal hemianopsia and VI. nerve palsy were detected. Pituitary MRI showed a 18.2 × 18.6 × 17 mm, bilobular, heterogenous mass with cystic and necrotic areas invading and expansing sella turcica. The lesion also compressed optic chiasma and stretched out pituitary stalk. ıt was interpreted as a macroadenoma but a metastasis could not be excluded. Pituitary hormones revealed panhypopituitarism; cortisol 1.92 mg/dl, ACTH<5 pg/ml, TSH 0.207 uIU/ml, triiyodothyronin 3.46 pmol/l (3.5–6.5), thyroxin 9.31 pmol/l (11.5–22.7), IGF-1 48.8 ng/ml (35–216), LH 0.389 mIU/ml (3.1–34.6), total testosteron< 7.00 ng/dl (86.4–788), PRL 43 ng/dl. The patient was started L-thyroxin subsequently methyl-prednisolon. The patient underwent pituitary biopsy; the tumor, within a desmoplastic stroma, was composed of malignant epithelial cells forming large glandular structures with intraluminal mucin. The neoplastic cells were positive for Cytokeratin 7 and TTF1, was negative for Cytokeratin 20, CDX2, Thyroglobulin, Synaptophysin, Chromogranin and CD56. The tumor was consistent with an adenocarcinoma metastasis. Positron emission tomography-fluorodeoxycortisol (PET-FDG) was performed to reveal the possible primary source of the tumor. PET-FDG showed bone metastases at the dorsal, lumbar vertebrae, left scapula, right acetabulum and left hip (SUVmax: 8.6) and a thyroid nodule at right lobe with normal FDG uptake. Cyber-knife neurosurgery was made to the pituitary lesion of the patient. The pituitary gland is an unusual location for any metastatic spread. Metastases to the pituitary gland represent 0.4% of all intracranial metastatic tumors. Symptoms and signs of pituitary metastases include diabetes insipitus, visual damage, ophtalmoplegia, headache, fatigue, weight loss, nausea and cognitive deterioriation. Anterior pituitary deficiency is common and hyperprolactinemia can be seen.