Exp Clin Endocrinol Diabetes 2013; 121 - P09
DOI: 10.1055/s-0033-1336691

A 39-year-old male patient with non-functioning pituitary carcinoma with hepatic and spinal bone metastases

T Topuzoglu 1, M Schubert 1, I Gouni-Berthold 1, T Blau 2, G Brinker 3, M Faust 1, M Runge 4, K Zeitler 3, W Krone 1
  • 1University Hospital of Cologne, Center for Endocrinology, Diabetology and Preventive Medicine, Cologne, Germany
  • 2University Hospital of Cologne, Institute for Neuropathology, Cologne, Germany
  • 3University Hospital of Cologne, Department of Neurosurgery, Cologne, Germany
  • 4University Hospital of Cologne, Department for Stereotactic and Functional Neurosurgery, Cologne, Germany

Introduction: Despite of the high prevalence of pituitary adenomas pituitary carcinomas are quite rare. Commonly they are endocrine active, but some do not produce pituitary hormones.

Case report: We report about a 39-year-old male patient with a typical non-functioning pituitary adenoma (WHO I°) with optic chiasm compression who underwent subtotal transsphenoidal surgery. Complete hypopituitarism was diagnosed before surgery and the patient received hormonal replacement. After surgery the visual acuity improved but decreased again after eight months which made a second transsphenoidal surgery necessary. The pituitary adenoma was again partially dissected. Nine months after surgery left Nn. abducens and oculomotorius palsies occurred showing a progress of the pituitary adenoma with infiltration in the left sinus cavernosus in MRI. A stereotactic radiosurgery was administered (LINAC-radiosurgery, 13 Gy). After an asymptomatic year newly developed blurred vision, Diabetes insipidus, back pain and weight loss (25 kg) occured. There was new progress of the pituitary adenoma in MRI so the patient underwent two more surgical treatments for tumor mass reduction. Because of ongoing back pain further investigations were done. Suspect lesions were found in the spinal column. Furthermore there were multiple hepatic lesions found in both lobules, which were biopsated. The hepatic lesions showed similar morphological and immunohistochemical properties as the pituitary adenoma. The search for other malignancies was negative so that the diagnosis of a pituitary carcinoma was confirmed. Currently the patient undergoes fractionated radiation therapy of the pituitary carcinoma and bone metastases; afterwards a systemic chemotherapy with a combination of 5-fluorouracil (5-FU) and cyclo-hexyl-chloroethyl-nitrosourea (CCNU) will be performed.

Conclusion: This case illustrates a rare clinical case of a non-functioning pituitary carcinoma with hepatic and spinal bone metastasis.