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

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.

Pituitary Metastases From Differentiated Thyroid Cancers: A Systematic Review

“…Sixteen studies [ 5 , 9 , 10 , 18 - 20 , 22 - 25 , 29 , 30 , 33 - 36 ] reported other deficient hormones: luteinizing hormone (LH) was the most frequently deficient hormone in 50% (n = 8) of cases while growth hormone deficiency was the least common, occurring in 12.5% (n = 2) of the patients. Serum prolactin was elevated in 63.2% (n = 12) of cases [ 5 , 9 , 10 , 18 , 20 , 21 , 23 , 27 , 30 , 31 , 33 , 34 ].…”

Neuro-ophthalmological findings of pituitary metastasis: Case series from a single center and review of the literature

“…The cases without detailed neuro-ophthalmological examinations. Forty-four cases from 38 papers reported the presenting neuro-ophthalmological symptoms, such as visual field defects, vision loss, diplopia, and ophthalmoplegia, were selected [ 1 , 2 , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] ]. The patient information, including age, sex, the time elapsed from primary cancer to the diagnosis of PM, sites of metastasis, treatment, and survival time after diagnosis of PM, were collected ( Supplementary material ).…”