Category: Pituitary Disorders/Neuroendocrinology

Monitor: 8

8 - ONCE IN A LIFE TIME; A TALE OF MANY TUMORS AND ONE ENDOCRINE SITE; THE FASCINATING STORY OF PITUITARY METASTASES: A CASE SERIES

Thursday, Apr 25
11:30 AM – 12:00 PM

Objective :

Metastases to the pituitary gland are extremely rare. Common tumours that metastasize are breast and gastrointestinal tumours. We present a case series of 5 cases.


Methods : N/A


Results :

Five cases presented with DI, a lady 45 years of age who was diagnosed with breast carcinoma and on MRI & PET scan was found to have multiple secondary deposits in bones, liver and pituitary. She later developed frank symptoms of DI and was confirmed to have panhypopituitarism. The second case was 77 years old male who presented with DI and on MRI scan was found to have thickening of the pituitary stalk, and on testing no other pituitary hormones were deficient but he had confirmed posterior pituitary deficiency. CT scan of viscera showed a lung mass which was confirmed on biopsy to be a bronchogenic adenocarcinoma. The third case was a 52 year old who presented with symptoms of DI and on investigation was found to have panhypopitutraism and imaging revealed a lung mass, (on biopsy confirmed to be small lung cancer), with secondaries to the pituitary and both adrenals. The fourth case was  a 50 years old man  who presented with weight loss & lymphadenopathy. He had very low morning cortisol & developed DI after starting steroid replacement. MRI head showed multiple ring enhancing lesions including a lesion in relation to the pituitary stalk measuring 8mm. Further investigations confirmed metastatic small lung carcinoma. The last case was a 42 year old female who had metastatic breast carcinoma and presented with panhypopituitarism.


Discussion :

Pituitary metastases are relatively rare clinical condition. They occur in 1 - 3.6% of patients with advanced cancer at autopsy. It appear to occur more frequently with certain types of tumours, namely, breast and lung cancers which account for 50% and 20% of cases respectively, followed by prostate, renal, GI, haematological and thyroid malignancies. Occasionally, no primary tumour can be identified.  In some patients, symptoms due to pituitary metastases may be the first presenting feature of cancer in a patient is not known previously to have malignancy.The majority of pituitary metastases remain undiagnosed and found incidentally. However, an early detection and appropriate treatment may improve the quality of life and even the prognosis.


Conclusion :

Our case series confirmed earlier reports that DI is the commonest presentation of metastases to the pituitary gland, four of our five cases presented with such syndrome. Recent reports showed metastases may come from a diverse source, including renal cell, follicular thyroid and hepatocellular cancers, but lung and breast cancer were the leading ones.

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Muna S. Mohamed

Specialty Doctor in Diabetes & Endocrinology
NHS Dumfries & Galloway
Dumfries, Scotland, United Kingdom

Muna Mohamed is a specialty doctor in Diabetes & Endocrinology working in Scotland's newest state-of-the-art hospital. Muna Mohamed is a graduate of Faculty of Medicine , university of Gezira in Sudan. Muna Mohamed is a member of the Royal College of Physicians of Edinburgh & holds PGdip in Diabetes from University of Leicester. Muna Mohamed have special interest in Technology in Diabetes & adrenal disease & works in multidisciplinary endocrine antenatal clinic & Diabetes renal clinic among general medicine & specialty commitments . Muna is a clinical & educational supervisor for junior doctors & University of Glasgow medical students. Muna is a co-investigator in national Diabetes trials

Zeinab Dabbous

Consultant Endocrine
Hamad Medical Corporation
Doha, Qatar

Dr. Zeinab Dabbous is a Consultant Endocrine/Diabetes in Hamad Medical Corporation.
She completed her MBChB from Beirut Arab University in Lebanon in 2005. She then moved to Qatar where she did her residency in Internal Medicine in Hamad Medical Corporation and was certified by the Arab board of Internal Medicine in 2012.
Dr. Zeinab Joined the Department of Endocrine at Hamad Medical Corporation as a Clinical Fellow and obtained MRCP Endocrine certification 2016.
Dr. Zeinab is involved in several research projects in the field of Diabetes and Endocrine disorders.
Dr. Zeinab has been awarded with a ‘Stars of Excellence-Hamad Hospital Award-Rising Star’ for the Diabetes and Endocrine Urgent clinic.

Silas Benjamin

Consultant Physician
Hamad Medical Corporation

I am working as a Consultant Physician at Hamad Medical Corporation since 2014. I have completed my CCST in Diabetes and Endocrinology from Royal College of Physicians UK and has Dual accreditation in both Internal Medicine and Endocrinology from UK . My area of interest are in patient centred Diabetes Education and thyroid disorders. I am also involved in teaching and training of junior residents and medical graduates.

Fiona Green

Consultant Physician
Dumfries Royal Infirmary

I am a consultant physician I have an interest in diabetes and endocrinologyI

Salman Hassoun

Consultant
NHS Dumfries and Galloway

I graduated from the faculty of human medicine, Damascus university, in 1987 then got my specialisation in general internal medicine in 1997 and then finished my training in endocrinology in 1999. I worked at Tishreen hospital in Damascus in the endocrinology department at a consultant level until I moved to the UK in 2008. I worked at middle grade level for few months and then at consultant physician. I currently work as a consultant in the endocrinology department at Dumfries and Galloway royal infirmary in Scotland.

Tarik Elhadd

Senior Consultant
Hamad Medical Corporation

Dr. Tarik A. A. El Hadd qualified from the Faculty of Medicine, Khartoum University, Sudan and then pursued higher medical training in the UK. Upon completing junior posts in East Anglia, West Yorkshire and Staffordshire, he obtained his MRCP in 1992 and then moved to the Royal Infirmary of Edinburgh for specialist training in endocrinology and diabetes. Dr. El Hadd then moved to the North East of England at Tees-side and the Royal Victoria Infirmary in Newcastle-upon-Tyne. In 1995 he obtained an MRC research fellowship at Dundee University, Scotland, followed by an MD with a theme of endothelial dysfunction in diabetes. Dr. El Hadd completed specialist training in General Internal Medicine, Diabetes and Endocrinology with CCST at the Professorial Department of Endocrinology at North Staffordshire Hospital, Stoke-on-Trent, England. In 2000, he was appointed to the first Consultant post in the UK at Dudley Group of Hospitals in West Midlands, England. Between 2003 to 2006 he held the post of Consultant Endocrinologist at King Faisal Specialist Hospital and Research Centre in Jeddah, Saudi Arabia, followed by the post of Consultant Physician and Endocrinologist at Ayr Hospital, Scotland. In 2009 he was appointed to a personal chair at the University of Medical Sciences and Technology in Khartoum, Sudan. He subsequently held several consultant posts in the UK, before moving to Hamad Medical Corporation in October 2014.

Dr. El Hadd served as a peer reviewer for several journals, including the Diabetic Medicine, Annals of Saudi Medicine, Endocrine Practice and Clinica Acta Medica. He currently serves as Associate Editor of the Sudan Medical Journal. Dr. El Hadd has been invited to speak at several professional endocrine and diabetes meetings. He has authored and co-authored more than 50 articles in peer reviewed journals and several book chapters. Dr. El Hadd is a Fellow of the Royal Colleges of Physicians of London and Edinburgh, a Fellow of the American College of Endocrinology and a member of several European and American professional associations.