A Rare Prolactin-secreting Pituitary Carcinoma With Epidural and Thecal Metastases.
JCEM Case Rep
; 2(5): luae047, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-38660486
ABSTRACT
Pituitary carcinomas are rare but associated with significant morbidity and mortality. They remain challenging to diagnose and manage. In this case, we describe a 56-year-old man who presented with erectile dysfunction and binocular vertical diplopia. He had central hypogonadism, secondary adrenal insufficiency, and central hypothyroidism on biochemical testing. His serum prolactin was 1517 mcg/L (1517 ng/mL; reference range 4-15 mcg/L), and his sellar magnetic resonance imaging showed a 2.0 × 2.2 × 3.1 cm pituitary tumor. Pathology revealed a prolactin-secreting carcinoma. Despite treatment with a high-dose dopaminergic, 2 transsphenoidal resections, and 1 course of radiation, prolactin levels continued to rise. He developed metastases to the epidural space and thecal sac from the thoracic to sacral spine, for which he received 12 cycles of temozolomide chemotherapy with initial clinical and biochemical response. This was followed by disease escape and progression. We discuss the clinical and imaging features that warrant a high index of suspicion for pituitary carcinoma and review contemporary treatment.
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1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
JCEM Case Rep
Ano de publicação:
2024
Tipo de documento:
Article