Ach Taieb, Wojewoda Perrine, Toullet Flora, Ducloux Roxane, Avérous Véronique
Department of Endocrinology and Diabetology, Douai Hospital Center, Douai, France.
Department of Endocrinology, University Hospital of Farhat Hached Sousse, Sousse, Tunisia.
Endocrinol Diabetes Metab Case Rep. 2020 Apr 29;2020. doi: 10.1530/EDM-20-0024.
Multiple endocrine metastases are a rare but possible complication of lung adenocarcinoma (LAC). Pituitary metastasis is a rare condition with poor clinical expression. Diabetes insipidus (DI) is its most common presenting symptom. Here we report an original case of a pituitary stalk (PS) metastasis from LAC presenting as central DI followed by adrenal insufficiency (AI) from bilateral adrenal metastasis, without known evidence of the primary malignancy. A 45-year-old woman whose first clinical manifestations were polyuria and polydipsia was admitted. She was completely asymptomatic with no cough, no weight loss or anorexia. Chest radiography was normal. Brain MRI showed a thick pituitary stalk (PS). DI was confirmed by water restriction test and treated with vasopressin with great clinical results. Explorations for systemic and infectious disease were negative. Few months later, an acute AI led to discovering bilateral adrenal mass on abdominal CT. A suspicious 2.3 cm apical lung nodule was found later. Histopathological adrenal biopsy revealed an LAC. The patient received systemic chemotherapy with hormonal replacement for endocrinological failures by both vasopressin and hydrocortisone. We present this rare case of metastatic PS thickness arising from LAC associated with bilateral adrenal metastasis. Screening of patients with DI and stalk thickness for lung and breast cancer must be considered. Multiple endocrine failures as a diagnostic motive of LAC is a rare but possible circumstance.
Adrenal metastasis is a common location in lung adenocarcinoma; however, metastatic involvement of the pituitary stalk remains a rare occurrence, especially as a leading presentation to diagnose lung cancer. The posterior pituitary and the infundibulum are the preferential sites for metastases, as they receive direct arterial blood supply from hypophyseal arteries. Patients diagnosed with diabetes insipidus due to pituitary stalk thickness should be considered as a metastasis, after exclusion of the classical systemic and infectious diseases. The diagnosis of an endocrinological metastatic primary lung adenocarcinoma for patients without respiratory symptoms is often delayed due to a lack of correlation between endocrinological symptoms and lung cancer. The main originality of our case is the concomitant diagnosis of both endocrinological failures, as it was initiated with a diabetes insipidus and followed by an acute adrenal insufficiency.
多发性内分泌转移是肺腺癌（LAC）一种罕见但可能出现的并发症。垂体转移是一种临床症状表现不佳的罕见病症。尿崩症（DI）是其最常见的首发症状。在此，我们报告一例源自LAC的垂体柄（PS）转移病例，最初表现为中枢性尿崩症，随后出现双侧肾上腺转移导致的肾上腺功能不全（AI），且当时尚无原发性恶性肿瘤的已知证据。一名45岁女性因多尿和烦渴首次就诊入院。她完全没有咳嗽、体重减轻或厌食等症状。胸部X线检查正常。脑部磁共振成像（MRI）显示垂体柄增粗。通过禁水试验确诊为尿崩症，并使用加压素治疗，临床效果良好。全身和感染性疾病检查均为阴性。几个月后，一次急性肾上腺功能不全促使通过腹部CT发现双侧肾上腺肿块。随后发现一个可疑的2.3厘米肺尖部结节。肾上腺组织病理活检显示为LAC。患者接受了全身化疗，并针对尿崩症和氢化可的松导致的内分泌功能衰竭进行了激素替代治疗。我们呈现了这例源自LAC并伴有双侧肾上腺转移的罕见的转移性垂体柄增粗病例。对于患有尿崩症和垂体柄增粗的患者，必须考虑筛查肺癌和乳腺癌。多种内分泌功能衰竭作为LAC的诊断依据虽罕见但有可能。
肾上腺转移是肺腺癌常见的转移部位；然而，垂体柄的转移性受累仍然罕见，尤其是作为诊断肺癌的首要表现。垂体后叶和漏斗是转移的优先部位，因为它们直接接受垂体动脉的血液供应。在排除经典的全身性和感染性疾病后，因垂体柄增粗被诊断为尿崩症的患者应考虑为转移瘤。对于没有呼吸道症状的患者，内分泌转移性原发性肺腺癌的诊断往往因内分泌症状与肺癌之间缺乏关联而延迟。我们病例的主要独特之处在于同时诊断出两种内分泌功能衰竭，先是尿崩症，随后是急性肾上腺功能不全。
