[Panhypopituitarism from pituitary metastases of breast cancer]. / Panipopituitarismo da metastasi ipofisarie di carcinoma mammario.

Metastases to the pituitary gland are uncommon causes of hypopituitarism, to be particularly considered in patients affected with disseminated cancers, arising in the breast or in the lung. Differential diagnosis could be correctly addressed by the concomitant presence of diabetes insipidus, due to the prominent involvement of the posterior lobe, and by some neuroradiological findings. We report the case of a 58-year-old woman, suffering from advanced breast cancer, who developed diabetes insipidus and anterior hypopituitarism. Magnetic resonance images showed diffuse encephalic metastatic lesions, with a thickened pituitary stalk, loss of high signal intensity of posterior lobe and a mildly enlarged and inhomogeneously enhanced adenohypophysis. Substitutive hormonal therapy was started, but the patient died five months later due to the progression of the neoplastic disease.

[An uncommon cause of gynecomastia: testicular Leydig cell tumor. Hormonal profile before and after orchiectomy]. / Una causa infrequente di ginecomastia: il leydigioma del testicolo. Profilo ormonale prima e dopo l'orchiectomia.

Leydig cell tumors (LTC) are uncommon neoplasms arising from gonadal stroma that account for 1-3% of all testicular tumors. We report a case of LCT in a 36 years old man who had been suffering from painful bilateral gynecomastia for one year. Endocrine function tests showed decreased gonadotropin concentrations, and reduction of testosterone/estradiol ratio. Ultrasonography revealed a 10-12 mm hypoechoic area in the right testis, not evident on physical examination. Right orchiectomy was performed and histological examination confirmed the supposed existence of a LCT. After surgery, the gynecomastia has completely disappeared and hormonal alterations returned to normal.

[Elevated concentration of serum carcinoembryonic antigen in hypothyroidism]. / Elevate concentrazioni sieriche di antigene carcinoembrionario in corso di ipotiroidismo.

In this case-report we describe two patients with hypothyroidism and increased carcinoembryonic antigen (CEA) serum concentration. The former patient was a woman affected by primary autoimmune hypothyroidism, the latter by secondary hypothyroidism in empty sella syndrome. In both of the patients we found no evidence of neoplastic disease and CEA serum concentrations reverted almost completely to the normal range values after the patients were given the hormonal replacement therapy with L-thyroxine. Although the association of hypothyroidism with elevated CEA serum concentrations has been already reported in the literature, hypothyroidism is usually disregarded when a physician is facing with a patient with increased CEA levels. On the contrary, our data suggest that hypothyroidism should be taken into account in the diagnostic work-up of these patients, such as smoking, cholestasis, impaired liver function, chronic inflammatory bronchial and bowel disease.