Diabetes insipidus as initial manifestation of adrenocortical adenocarcinoma onset and metastasis to both anterior and posterior lobe of pituitary gland

【作者】 卢刚； 赵元元； 楼林； 蔡学祥； 马杰； 祁小龙；

【机构】 浙江省人民医院神经外科；

【摘要】 Pituitary metastasis(PM)mostly located in the posterior lobe.Metastasis to the anterior lobe of pituitary gland is the rarest type of central nervous system involvement from cancer and pituitary metastasis from adrenocortical adenocarcinoma(AA)is also a rare clinical situation.A 53-year-old woman presented with a 6-month history of dizzy,weakness,diabetes insipidus(DI)and blurred vision in the right eye was diagnosed as invasive pituitary adenoma and adrenal tumor.Patients underwent transsphenoidal surgery and laparoscopic adrenalectomy for suprasellar and adrenal mass separately.The pathological examinations revealed a poorly differentiated adenocarcinoma.Immunohistochemical staining showed strongly positive expression of cytokeratin(CK),synaptophysin(Syn),neuron specific enolase(NSE),CD56 and negative of Thyroid Transcription Factor-1(TFF1),carcino-embryonic antigen(CEA),epithelia membrane antigen(EMA)and Chromogranin A(Cg-A).As an adrenal malignancy was suspected,laparoscopic adrenalectomy was then performed to have complete surgical removal of gross tumor.Pathological sections confirmed the adrenal mass lesion to be a poorly differentiated AA.The patients deteriorated gradually and died approximately 10 months after the demonstration of hypophyseal tumor.Considering the central DI might be the only symptom presented by the patients with AA onset and PM,special attention should be paid to such patients presenting with central DI in the absence of alternative etiology and a surgical approach to obtain histological diagnosis is deemed necessary.Hormonereplace therapy regarding secondary hypopituitarism would be administrated after surgery.更多还原

【Abstract】 Pituitary metastasis(PM) mostly located in the posterior lobe.Metastasis to the anterior lobe of pituitary gland is the rarest type of central nervous system involvement from cancer and pituitary metastasis from adrenocortical adenocarcinoma(AA) is also a rare clinical situation.A 53- year-old woman presented with a 6-month history of dizzy,weakness,diabetes insipidus(DI) and blurred vision in the right eye was diagnosed as invasive pituitary adenoma and adrenal tumor.Patients underwent transsphenoidal surgery and laparoscopic adrenalectomy for suprasellar and adrenal mass separately.The pathological examinations revealed a poorly differentiated adenocarcinoma.Immunohistochemical staining showed strongly positive expression of cytokeratin(CK),synaptophysin(Syn),neuron specific enolase(NSE),CD56 and negative of Thyroid Transcription Factor-1(TTF1),carcino- embryonic antigen(CEA),epithelia membrane antigen(EMA) and Chromogranin A(Cg-A).As an adrenal malignancy was suspected,laparoscopic adrenalectomy was then performed to have complete surgical removal of gross tumor.Pathological sections confirmed the adrenal mass lesion to be a poorly differentiated AA.The patients deteriorated gradually and died approximately 10 months after the demonstration of hypophyseal tumor.Considering the central DI might be the only symptom presented by the patients with AA onset and PM,special attention should be paid to such patients presenting with central DI in the absence of alternative etiology and a surgical approach to obtain histological diagnosis is deemed necessary.Hormonereplace therapy regarding secondary hypopituitarism would be administrated after surgery.更多还原