Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report.
Pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism: a case report.
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DOI：
10.1186/s12885-015-1831-7
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发表时间：
2015-11-06
期刊：
影响因子：
3.8
通讯作者：
Nakamoto Y
中科院分区：
文献类型：
--
作者：
Tanaka T;Hiramatsu K;Nosaka T;Saito Y;Naito T;Takahashi K;Ofuji K;Matsuda H;Ohtani M;Nemoto T;Suto H;Yamamoto T;Kimura H;Nakamoto Y
垂体转移极为罕见，通常通过与内分泌功能障碍相关的症状偶然发现。乳腺癌和肺癌是最常见的脑下垂体原发转移。肝细胞癌转移至垂体的情况极为罕见，此前仅报道过 10 例。我们在此介绍首例经磁共振成像诊断的肝细胞癌垂体转移伴全垂体功能减退症的病例。我们报道了一名 80 岁日本女性的病例，她在先前被诊断患有肝细胞癌后突然出现低血压和心动过缓。由于垂体激素水平较低，诊断为肝细胞癌转移至垂体引起的全垂体功能减退症。动脉自旋标记磁共振成像可有效鉴别鞍内肿瘤。尽管进行了激素替代治疗，患者还是因低血容量休克而死亡。垂体转移会引起各种非特异性症状，因此诊断困难。本病例强调了诊断成像在识别这些转移方面的重要性。对于表现出垂体功能低下的恶性肿瘤患者，临床医生应考虑垂体转移的可能性。
Metastasis to the pituitary gland is extremely rare and is often detected incidentally by symptoms associated with endocrine dysfunction. Breast and lung cancer are the most common primary metastasizing to pituitary gland. Metastasis from hepatocellular carcinoma to the pituitary gland is extremely rare, with only 10 cases having been previously reported. We present here the first case of pituitary metastasis of hepatocellular carcinoma presenting with panhypopituitarism diagnosed by magnetic resonance imaging. We report the case of an 80-year-old Japanese woman who presented with the sudden onset of hypotension and bradycardia after having previously been diagnosed with hepatocellular carcinoma. Based on low levels of pituitary hormones, she was diagnosed with panhypopituitarism caused by metastasis of the hepatocellular carcinoma to the pituitary gland. Magnetic resonance imaging with arterial spin-labeling was effective in the differential diagnosis of the intrasellar tumor. The patient died despite hormone replacement therapy because of hypovolemic shock. Metastasis to the pituitary gland causes various non-specific symptoms, so it is difficult to diagnose. The present case emphasizes the importance of diagnostic imaging in identifying these metastases. Clinicians should consider the possibility of pituitary metastasis in patients with malignant tumors who demonstrate hypopituitarism.