A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis
Pituitary adenomas are the most common cause of a sellar mass. Metastases to the pituitary gland, a rare occurrence, may mimic benign pituitary adenomas. We report here a case of a 61-year-old woman with an 80-pack-year smoking history who presented with headache and diplopia. Visual field testing d...
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doaj-0d58f9e72ac747f099bbecac03480a052020-11-24T22:09:27ZengHindawi LimitedCase Reports in Medicine1687-96271687-96352012-01-01201210.1155/2012/853568853568A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the HypophysisNestoras Mathioudakis0Alfredo Quinones-Hinojosa1Roberto Salvatori2Shehzad Basaria3Division of Endocrinology & Metabolism, Johns Hopkins University School of Medicine, Suite 333, 1830 East Monument Street, Baltimore, MD 21287, USADepartment of Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Cancer Research Building II, Room 253, 1550 Orleans Street, Baltimore, MD 21231, USADivision of Endocrinology & Metabolism, Johns Hopkins University School of Medicine, Suite 333, 1830 East Monument Street, Baltimore, MD 21287, USASection of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston University School of Medicine, 2nd floor, 670 Albany Street, Boston, MA 02118, USAPituitary adenomas are the most common cause of a sellar mass. Metastases to the pituitary gland, a rare occurrence, may mimic benign pituitary adenomas. We report here a case of a 61-year-old woman with an 80-pack-year smoking history who presented with headache and diplopia. Visual field testing demonstrated bitemporal hemianopsia. Pituitary MRI revealed a 2.0 cm sellar mass impinging upon the optic chiasm. Hypopituitarism was present, with no evidence of diabetes insipidus. The patient was referred to our service for transsphenoidal resection of a presumed pituitary macroadenoma. As part of her preoperative evaluation, a chest radiograph was obtained, which showed a large hilar mass. In light of the patient’s extensive smoking history, the differential diagnosis was expanded to include metastatic lesion to the sella. Transsphenoidal resection of the tumor was performed and histopathology revealed small cell carcinoma. The patient received chemotherapy, but died 18 months later due to widespread brain metastases. Although the presence of diabetes insipidus may help to discriminate between pituitary adenomas and metastatic lesions, this is not a sensitive finding. This case illustrates the need for maintaining a high index of suspicion for pituitary metastasis in patients with known risk factors for malignancy.http://dx.doi.org/10.1155/2012/853568 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Nestoras Mathioudakis Alfredo Quinones-Hinojosa Roberto Salvatori Shehzad Basaria |
spellingShingle |
Nestoras Mathioudakis Alfredo Quinones-Hinojosa Roberto Salvatori Shehzad Basaria A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis Case Reports in Medicine |
author_facet |
Nestoras Mathioudakis Alfredo Quinones-Hinojosa Roberto Salvatori Shehzad Basaria |
author_sort |
Nestoras Mathioudakis |
title |
A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis |
title_short |
A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis |
title_full |
A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis |
title_fullStr |
A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis |
title_full_unstemmed |
A Lifelong Smoker with Hypopituitarism: Rethinking the Hypothesis of a Tumor in the Hypophysis |
title_sort |
lifelong smoker with hypopituitarism: rethinking the hypothesis of a tumor in the hypophysis |
publisher |
Hindawi Limited |
series |
Case Reports in Medicine |
issn |
1687-9627 1687-9635 |
publishDate |
2012-01-01 |
description |
Pituitary adenomas are the most common cause of a sellar mass. Metastases to the pituitary gland, a rare occurrence, may mimic benign pituitary adenomas. We report here a case of a 61-year-old woman with an 80-pack-year smoking history who presented with headache and diplopia. Visual field testing demonstrated bitemporal hemianopsia. Pituitary MRI revealed a 2.0 cm sellar mass impinging upon the optic chiasm. Hypopituitarism was present, with no evidence of diabetes insipidus. The patient was referred to our service for transsphenoidal resection of a presumed pituitary macroadenoma. As part of her preoperative evaluation, a chest radiograph was obtained, which showed a large hilar mass. In light of the patient’s extensive smoking history, the differential diagnosis was expanded to include metastatic lesion to the sella. Transsphenoidal resection of the tumor was performed and histopathology revealed small cell carcinoma. The patient received chemotherapy, but died 18 months later due to widespread brain metastases. Although the presence of diabetes insipidus may help to discriminate between pituitary adenomas and metastatic lesions, this is not a sensitive finding. This case illustrates the need for maintaining a high index of suspicion for pituitary metastasis in patients with known risk factors for malignancy. |
url |
http://dx.doi.org/10.1155/2012/853568 |
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