Apoplexy in sellar metastasis from papillary thyroid cancer: A case report and literature review

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Abstract

Background:

Pituitary metastasis from papillary thyroid cancer (PTC) is rare and only a few cases have been reported.

Case Description:

We report the case of a patient who presented with visual dysfunction and panhypopituitarism. Magnetic resonance imaging revealed a pituitary tumor and hydrocephalus. Transsphenoidal surgery had been indicated, but his surgery had been postponed due to COVID-19 pandemic. During that waiting period, he showed pituitary apoplexy with consciousness disturbance, resulting in acute adrenal insufficiency and diabetes insipidus. He was urgently hospitalized and underwent transsphenoidal surgery. Rapid and permanent pathological examinations have confirmed metastasis of PTC to the pituitary. The patient also underwent serial thyroidectomy. He was also suspected to have secondary hydrocephalus and underwent lumboperitoneal shunting after excluding cerebrospinal fluid metastasis. Thereafter, his cognitive dysfunction and performance status improved dramatically.

Conclusion:

To the best of our knowledge, this is the first patient with PTC who developed pituitary apoplexy secondary to metastasis.

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Most cited references 41

Record: found
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Tumors metastatic to the pituitary gland: case report and literature review.

S Korfias, John Komninos, Varvara Vlassopoulou … (2004)

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.

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Precipitating factors in pituitary apoplexy.

V Biousse, Nelson M. Oyesiku, N Newman (2001)

Pituitary apoplexy is a rare but life threatening condition caused by sudden haemorrhage or infarction of the pituitary gland. Potential precipitating factors in the occurrence of acute pituitary apoplexy in 30 consecutive patients were identified and compared with the clinical characteristics and outcome of patients with and without associated factors. Six patients had a previously known pituitary adenoma. All patients complained of severe headaches, associated with neuro-ophthalmological symptoms and signs in 83% and altered mental status in 30%. Potential risk factors were identified in nine patients (30%). When there was an associated factor, the clinical presentation was no different than in patients without such factors although altered mental status may be more frequent in patients with associated diseases. In these patients, the visual prognosis was worse and the diagnosis was more difficult to establish. Acute pituitary apoplexy is unpredictable and should be considered in any patient with abrupt neuro-ophthalmological deterioration associated with headache. Patients with pituitary apoplexy often have an associated disease that confounds recognition and treatment despite a typical presentation.

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Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis.

Wenzhuan He, Fangxiang Chen, Brian Dalm … (2015)

To report a rare case of pituitary metastasis (PM) from hepatocellular carcinoma (HCC) and help better understand the incidence of PM and its most common presenting symptoms through a pooled individual patient data analysis.

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Author and article information

Contributors

Masahiro Hirayama

Atsushi Ishida

Naoko Inoshita

Hideki Shiramizu

Haruko Yoshimoto

Masataka Kato

Satoshi Tanaka

Seigo Matsuo

Nobuhiro Miki

Masami Ono

Shozo Yamada

Journal

Journal ID (nlm-ta): Surg Neurol Int

Journal ID (iso-abbrev): Surg Neurol Int

Title: Surgical Neurology International

Publisher: Scientific Scholar (USA )

ISSN (Print): 2229-5097

ISSN (Electronic): 2152-7806

Publication date Collection: 2022

Publication date (Electronic): 17 June 2022

Volume: 13

Electronic Location Identifier: 253

Affiliations

[1 ]Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.

[2 ]Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan.

Author notes

[* ] Corresponding author: Masahiro Hirayama, Department of Neurosurgery, Moriyama Memorial Hospital, Edogawa City, Tokyo, Japan. hiramasa0701@ 123456gmail.com

Article

Publisher ID: 10.25259/SNI_131_2022

DOI: 10.25259/SNI_131_2022

PMC ID: 9282727

PubMed ID: 35855167

SO-VID: bfa9cf5d-1c4a-43b1-bb34-3383928b051d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Apoplexy in sellar metastasis from papillary thyroid cancer: A case report and literature review

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Abstract

Background:

Case Description:

Conclusion:

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Novel Coronavirus Disease COVID-19

Most cited references 41

Tumors metastatic to the pituitary gland: case report and literature review.

Precipitating factors in pituitary apoplexy.

Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis.

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