Small Cell Lung Cancer with Pituitary Metastasis Presenting as Secondary Adrenal Insufficiency: A Case Report and Literature Review

Abstract

Patient: Male, 62 Final Diagnosis: Pituitary metastasis of small cell lung cancer Symptoms: Blurred vision • weakness Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: Pituitary gland metastasis is rarely the initial presentation of metastatic cancer. Most cases of pituitary gland metastasis are asymptomatic with diabetes insipidus being the most common symptomatic presentation. It can rarely present with symptoms of hormone underproduction such as secondary adrenal insufficiency. Although pituitary gland metastasis is rare, it is underestimated, as it is commonly misdiagnosed with pituitary gland adenoma due to the lack of clear radiological criteria differentiating between both. Case Report: We present a case of a 62-year-old male who presented with weakness, blurry vision, and persistent hypoglycemia despite intravenous dextrose infusion and having discontinued taking his diabetes medications. Chest x-ray showed a left hilar mass, while computed tomography scan demonstrated a left superior hilar mass and hilar lymphadenopathy with bilateral adrenal nodules and a T6 vertebral lesion suspicious for metastasis. Further workup showed secondary adrenal insufficiency with a low adrenocorticotropic hormone (ACTH) level. Vertebral biopsy was performed and confirmed the diagnosis of small cell carcinoma of the lung. This was followed by a brain magnetic resonance imaging (MRI), which showed multiple metastatic lesions with an enhancing mass involving the right clivus, sella, and suprasellar cistern with mass effect on the optic chiasm and involvement of the cavernous sinus supporting the diagnosis of pituitary gland metastasis of small cell lung cancer. The patient received brain radiation, and repeated MRI showed regression of the previous MRI findings. Conclusions: Secondary adrenal insufficiency is an unusual presentation of pituitary gland metastasis. Physicians should take into consideration both radiological findings and presentation to differentiate between pituitary gland metastasis and pituitary adenoma.

Hyperprolactinemia due to pituitary metastasis: A case report

“…At present, there are no uniform standards advocating postoperative radiotherapy and chemotherapy. However, an exceptional case was reported by Atallah-Yunes et al [ 12 ], in which radiotherapy resulted in a significant reduction in tumor size. Finally, a study by Caponnetto et al [ 13 ] confirmed that hyperprolactinemia may be one of the factors of poor prognosis of tumors metastatic to the pituitary gland.…”

Improved DenseNet-Based MRI in Pulmonary Nodules Diagnosis and Benign and Malignant Differentiation

“…Studies have shown that the convolutional neural network demonstrates good image segmentation results, indicating that it should be suggested in clinical MRI image analysis [17,18]. In this study, the traditional and improved DenseNet networks were applied to segment MRI images of PN patients.…”

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 ).…”