Endocrine Abstracts

The tumors that metastasis to the pituitary gland is a rare condition and generally are seen in patients in advance disease. The most common metastasis arises from breast and pulmonary cancer. We report a case of a 53 years old women with invasive ductal carcinoma diagnosed in 2017, previously treated with left radical mastectomy followed by --- cycles of chemotherapy and radiation. In 2022 her disease recurred with bone metastasis. She started again the chemotherapy. One month after the last cycle of chemotherapy she presented at our emergency department with the following symptoms poor appetite, progressive general malaise, drowsiness, blurred vision, watery diarrhea, polydipsia, polyuria, nocturia. Initial laboratory work revealed hypernatremia with sodium of 157 mEq/l (136 - 148 mEq/l), low TSH 0.04 mIU/l (0.27-4.2 mIU/l), free T3 1.3 ng/ml (2.0 - 4.4 pg/ml), low free T4 0.83 ng/dl (0.93 - 1.7 ng/dl). Low LH 1.74 mIU/ml (7.7-58.5 mIU/ml) and FSH 6.92 mIU/ml (25.8-134.8 mIU/ml). ACTH 2.49 pg/mL (7.2-63.3 pg/ml), random cortisol 203 nmol/l (68.2-327 nmol/l) and a very high level of prolactin 2395 mIU/l (102-496 mIU/l), ADH 4.3 pg/ml (2-12pg/ml), GH 0.21 ng/ml (0.126-9.88). Hypernatremia and hypopituitarism prompted further studies: magnetic resonance of the pituitary region was performed. MRI with gadolinium revealed a pituitary mass 9.9 × 7.4-mm, isointense on T1 weighted images heterogeneously involving the infundibulum diameter 4.3 mm with multiple cerebral metastasis. These findings were highly suggestive of pituitary metastasis from her metastatic breast cancer. During the hospitalization she was treated with hormone therapy and was send to the oncology department for further treatment.

Conclusion: We describe a case of invasive ductal carcinoma with pituitary metastasis (PM). Aalthough rare, PM should remain in the differential of symptomatic pituitary dysfunction so proper diagnosis and treatment can be performed. Endocrine abnormalities should be corrected. Unfortunately, the presence of PM portends a poor prognosis