Pituitary Metastasis in a Patient with Pulmonary Adenocarcinoma Presenting with a Disturbance of Consciousness

Česká verzia

Authors: Cahajlová Radka ¹; Kollerová Jana ²
Authors place of work: Oddelenie klinickej onkológie Kliniky pneumológie, ftizeológie a funkčnej diagnostiky SZU a UN Bratislava, Nemocnica Ružinov ¹; V. interná klinika LF UK a UN Bratislava, Nemocnica Ružinov ²
Published in the journal: Klin Onkol 2018; 31(5): 371-375
Category: Case Report
doi: https://doi.org/10.14735/amko2018371

Summary

Background:

Brain metastases are one of the main causes of morbidity and mortality of patients with oncological disease. In non-small cell lung carcinoma (NSCLC), the risk of CNS secondary development is 30–50%. An unusual diagnostic and therapeutic problem is the finding of suspicious pituitary lesions. Obtaining a differential diagnosis relies on evaluating the clinical course of the disease (visual disturbances, diabetes insipidus (DI), weakness etc.), and performing endocrinological examinations and imaging analyses (CT, but mainly MRI). Sometimes, however, definitive resolution of the problem requires histological assessment of the tumor. Case report: A 65-year-old patient with a newly diagnosed metastatic lung adenocarcinoma was admitted to our department for a first cycle of chemotherapy consisting of cisplatin and navelbine. However, at the beginning of hospitalization, the patient developed qualitative disturbances in consciousness and disorientation. Emergency CT of the CNS revealed a tumor of the pituitary gland, and a subsequent MRI showed intraseller and suprasellar masses making contact with the optic chiasma. An endocrinological examination revealed panhypopituitarism. Pituitary metastasis of NSCLC was confirmed by tumor histology using the trans-sphenoid approach.

Conclusion:

Lung and breast carcinomas are among the most common cancers to metastasize to the pituitary gland. The incidence of pituitary metastases is reported to be 0.4–28.1%. Clinically, they are mostly silent, but may manifest as endocrine disorders, such as DI, hypothyroidism, and hypocorticism, or as visual disturbances due to compression of the optic nerve. Management depends on the establishment of a correct diagnosis.

Key words:

hypopituitarism – magnetic resonance imaging – pituitary neoplasm – radiosurgery – targeted therapy

The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted: 26. 4. 2018

Accepted: 27. 6. 2018

Zdroje

1. Novello S, Barlesi F, Califano R et al. Metastatic nonsmall cell lung cacer: ESMO clinical practise guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (Suppl 5): v1–v27. doi: 10.1093/annonc/mdw 326.

2. Cancer Treatment Centers of America. Stage IV nonsmall cell lung cancer. [online]. Available from: https: // www.cancercenter.com/lung-cancer/stages/tab/non-small-cell-lung-cancer-stage-IV.

3. Fenske DC, Price GL, Hess ML et al. Systematic review of brain metastases in patients with non-small cell lung cancer in the United States, European Union, and Japan. Clin Lung Cancer 2017; 18 (6): 607– 614. doi: 10.1016/j.cllc.2017.04.011.

4. McGranahan T, Nagpal S. A neuro-oncologist’s perspective on management of brain metastases in patients with EGFR mutant non-small cell lung cancer. Curr Treat Options Oncol 2017; 18 (4): 22. doi: 10.1007/s11864-017-0466-0.

5. Greenspoon JN, Ellis PM, Pond G et al. Comparative survival in patients with brain metastases from non-small cell lung cancer treated before and after implementation of radiosurgery. Curr Oncol 2017; 24 (2): e146–e151. doi: 10.3747/co.24.3420.

6. Owen S, Souhami L. The management of brain metastases in non-small cell lung cancer. Front Oncol 2014; 4: 248. doi: 10.3389/fonc.2014.00248.

7. Wong A. The emerging role of targeted therapy and immunotherapy in the management of brain metastases in non-small cell lung cancer. Front Oncol 2017; 7 (5): 33. doi: 10.3389/fonc.2017.00033.

8. Fassett DR, Couldwell WT. Metastases to the pituitary gland. Neurosurg Focus 2004; 16 (4): E8.

9. Habu M, Tokimura H, Hirano H et al. Pituitary metastases: current practice in Japan. J Neurosurg 2015; 123 (4): 998–1007. doi: 10.3171/2014.12.JNS14870.

10. Rajput R, Bhansali A, Dutta P et al. Pituitary metastases masquerading as non-funcioning pituitary adenoma in a woman with adenocarcinoma lung. Pituitary 2006; 9 (2): 155–157. doi: 10.1007/s11102-006-8326-0.

11. Yaylalı GF, Topsakal S, Değirmencioğlu S et. al. Pituitary metasasese of lung cancer presenting with hypopitua-trism. Abstract 49. In: Endocrine Abstracts. 19th European Congress of Endocrinology. European Society of Endocrinology, Lisbon, 2017.

12. Goulart CR, Upadhyay S, Beer-Furlan A et al. Newly diagnosed sellar tumors in patients with cancer: a diagnostic challenge and management dilemma. World neurosurg 2017; 106: 254-265. doi: 10.1016/j.wneu.2017.06.139.

13. Marsh JC, Garg S, Wendt JA et al. Intracranial metastases disease rarely involves the pituitary: retrospective analysis of 935 metastases in 155 patients and review of the literature. Pituitary 2010; 13 (3): 260–265. doi: 10.1007/s11102-010-0229-4.

14. Guijarro de Armas MG, Torán Ranero CE, Pavón de Paz I et al. Panhypopituitarism and lung neoplasm: A case study. Endocrinol Nutr 2013; 60 (10): e35–e36. doi: 10.1016/j.endonu.2013.02.006.

15. Iwai Y, Yamanaka K, Honda Y et al. Radiosurgery for pituitary metastases. Neurol Med Chir (Tokyo) 2004; 44 (3): 112–116.

16. Komninos J, Vlassopoulou V, Protopapa D et al. Tumors metastatic to the pituitay gland: case report and literature review. J Clin Endocrinol Metab 2004; 89 (2): 574–580. doi: 10.1210/jc.2003-030395.

17. Hsiao CH, Wang CH, CHung MT et al. Diabetes insipidus due to pituitary metastases in a woman with lung adenocarcinoma: a case report. Cent Eur J Med 2011; 6 (4): 475–479.

18. Schubiger O, Haller D. Metastases to the pituitary-hypothalamic axis. An MR study of 7 symptomatic patients. Neuroradiology 1992; 34 (2): 131–134.

19. Harzallah L, Migaw H, Harzallah F et al. Diabetes insipidus and panhypopituitarism revealing pituitary metastasese of small cell lung canrcinoma: a case report. Ann Endocrinol (Paris) 2005; 66 (2 Pt 1): 117–120.

20. Shaw AT, Ou SH, Bang YJ et al. Crizotinib in ROS1– re-arranged non-small cell lung cancer. N Engl J Med 2014; 371 (21): 1963–1971. doi: 10.1056/NEJMoa1406766.

21. Solomon BJ, Cappuzo F, Felip E et al. Intracranial efficacy od crizotinib verusus chemotherapy in patients with advanced ALK-positive non-small cell lung cancer: results from PROFILE 1014. J Clin Oncol 2016; 34 (24): 2858–2865. doi: 10.1200/JCO.2015.63.5888.

22. Lukas RV, Hasan Y, Nicholas MK et al. ROS1 rearranged non-small cell lung cancer brain metastases respond to low dose radiotherapy. J Clin Neurosci 2015; 22 (12): 1978–1979. doi: 10.1016/j.jocn.2015.04.009.

23. Kinoshita Y, Koga Y, Sakamoto A et al. Long-lasting response to crizotinib in brain metastases due to EML4-ALK-rearranged non-small cell lung cancer. BMJ Case Rep 2013; 2013 (10): bcr-2013-200867. doi: 10.1136/bcr-2013-200867.