Περίληψη:
Tumors metastatic to the pituitary gland are an unusual complication of
systemic cancer typically seen in elderly patients with diffuse
malignant disease. Breast and lung are the commonest sites of the
primary tumor, whereas diabetes insipidus is the most frequent symptom
at presentation. Their rarity and usually indolent course, as well as
the lack of specific clinical and radiological features, impede their
differentiation from other more common sellar area lesions, particularly
when history of malignancy is absent. Management of these patients may
also be very difficult because the prognosis depends on the course of
the primary neoplasm. A 68-yr-old man, with no history of malignancy,
presented with recent onset of hypopituitarism, mild diabetes insipidus,
headaches, left oculomotor nerve palsy, and progressive bilateral
deterioration of visual acuity and visual fields. Magnetic resonance
imaging revealed a large sellar mass compressing the optic chiasm and
invading the left cavernous sinus, whereas a prolactin elevation at
438.6 ng/ml (19.73 nmol/liter) was noted. Decompression of the sellar
region was attempted, and pathology disclosed a metastatic
hepatocellular carcinoma. On postoperative investigation, primary liver
tumor was identified and confirmed by biopsy. The patient improved
transiently but died 3 months after diagnosis because of deterioration
of the liver disease. The relevant literature is reviewed in light of
this unusual case, illustrating the problems in the diagnosis and
management of patients with metastasis to the pituitary.
Συγγραφείς:
Komninos, J
Vlassopoulou, V
Protopapa, D
Korfias, S and
Kontogeorgos, G
Sakas, DE
Thalassinos, NC
