Clin Nephrol. 2022 Jul;98(1):49-53. doi: 10.5414/CN110503.
Malignant prolactinomas are very rare and are diagnosed when a prolactin-producing pituitary adenoma has metastasized. We report on a 54-year-old man with a history of macroprolactinoma transforming into a pituitary carcinoma secreting both prolactin and growth hormone with metastases to the stomach, bone, lungs, retroperitoneum, and kidney. Reviewing the literature, this case is the first reporting of a pituitary carcinoma with biopsy-proven paraneoplastic cast nephropathy. Symptoms and renal function improved following a course of palliative chemotherapy and radiotherapy. After 2 years, his disease progressed requiring further palliative treatment that was complicated by severe chest sepsis. He was not fit for further chemotherapy, receiving symptomatic relief in a hospice, and died soon after. The case highlights the importance of considering a patient's past medical history in the context of persistent unexplained renal impairment and systemic metastases when unexplained systemic symptoms and multi-organ involvement is present. The importance of renal biopsy for definitive diagnosis and before using potentially nephrotoxic chemotherapy is also highlighted. Renal diagnosis helped inform the decision to give chemotherapy, with the importance of this evidenced by an improvement in renal function following chemotherapy.
恶性泌乳素瘤非常罕见，当泌乳素分泌性垂体腺瘤发生转移时即可诊断。我们报告了一例 54 岁男性患者，他患有巨泌乳素瘤，后来转化为分泌泌乳素和生长激素的垂体癌，并发生胃、骨、肺、腹膜后和肾转移。通过文献复习，本例是首例经活检证实的副肿瘤性 casts 肾病的垂体癌病例报告。在接受姑息性化疗和放疗后，症状和肾功能均有所改善。2 年后，疾病进展，需要进一步姑息治疗，伴有严重的脓胸并发症。他不适合进一步化疗，在临终关怀病房接受对症治疗，不久后死亡。该病例强调了在持续不明原因的肾功能损害和全身转移的情况下，当出现不明原因的全身症状和多器官受累时，应考虑患者的既往病史。还强调了肾活检对明确诊断的重要性，以及在使用潜在肾毒性化疗之前进行肾活检的重要性。肾诊断有助于决定是否进行化疗，化疗后肾功能的改善证明了这一点。
