J Korean Endocr Soc.  2007 Apr;22(2):125-129. 10.3803/jkes.2007.22.2.125.

A Case of Pituitary Metastasis of Breast Cancer Presenting as Diabetes Insipidus and Panhypopituitarism

• Kwak JW
• Jie BS
• Hong SH
• Kim JH
• Lee SH
• Jo JH
• Kwon HS
• Youn KH
• Cha BY
• Son HY

• KMID: 1523093
• DOI: http://doi.org/10.3803/jkes.2007.22.2.125

Abstract

Metastasis to the pituitary gland from systemic cancer is a rare condition. The breast and lung are the most common sites of primary tumor metastasis. Pituitary metastasis may present with diabetes insipidus, cranial nerve palsy and hypopituitarism, and diabetes insipidus is the most frequent symptom at presentation. We report here on a 44 year-old woman with pituitary metastasis from breast cancer, and she developed central diabetes insipidus and hypopituitarism. The clinical diagnosis was made by performing a water deprivation test, a combined pituitary test and a MRI brain scan, and the latter showed metastatic tumor in the pituitary gland with invasion of the pituitary stalk. Symptomatic relief was obtained with administration of desmopressin; the urine osmolarity was increased with this treatment. We report here on a case of pituitary metastasis from breast cancer and the patient developed central diabetes insipidus and hypopituitarism. We also include a review of the relevant literature.

Keyword

Breast cancer; Central diabetes insipidus; Panhypopituitarism; Pituitary metastasis

MeSH Terms

Adult
Brain
Breast Neoplasms*
Breast*
Cranial Nerve Diseases
Deamino Arginine Vasopressin
Diabetes Insipidus*
Diabetes Insipidus, Neurogenic
Diagnosis
Female
Humans
Hypopituitarism
Lung
Magnetic Resonance Imaging
Neoplasm Metastasis*
Osmolar Concentration
Pituitary Gland
Water Deprivation
Deamino Arginine Vasopressin

Figure

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  Fig. 1 Water deprivation test.

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  Fig. 2A, 2B 1.5 × 1.3 × 1.3 cm sized homogenous lobulated low signal intensity mass is noted on nonenhanced sagittal T1WI in pituitary stalk and suprasellar cistern, which shows heterogenous enhancement on gadolinum enhanced image.

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  Fig. 3A, 3B On contrast enhanced chest CT, left breast is not visualized and conglomerated nodules with decreased attenuation are noted in left paratracheal mediastinum and right hilum.

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  Fig. 4A, 4B, 4C On axial FLAIR and T2WI images, asymmetric two high signal intensity nodules are noted in left frontal lobe, suggesting brain metastasis. On coronal T1WI with enhancement, focal enhanced ovoid lesion is noted in right scalp representing scalp metastasis.

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