甲状腺乳头状癌鞍区转移致卒中：1例报告并文献复习
Apoplexy in sellar metastasis from papillary thyroid cancer: A case report and literature review.
作者信息
Hirayama Masahiro, Ishida Atsushi, Inoshita Naoko, Shiramizu Hideki, Yoshimoto Haruko, Kato Masataka, Tanaka Satoshi, Matsuo Seigo, Miki Nobuhiro, Ono Masami, Yamada Shozo
机构信息
Department of Neurosurgery, Moriyama Memorial Hospital, Tokyo, Japan.
Hypothalamic and Pituitary Center, Moriyama Neurosurgical Center Hospital, Tokyo, Japan.
出版信息
Surg Neurol Int. 2022 Jun 17;13:253. doi: 10.25259/SNI_131_2022. eCollection 2022.
BACKGROUND
Pituitary metastasis from papillary thyroid cancer (PTC) is rare and only a few cases have been reported.
CASE DESCRIPTION
We report the case of a patient who presented with visual dysfunction and panhypopituitarism. Magnetic resonance imaging revealed a pituitary tumor and hydrocephalus. Transsphenoidal surgery had been indicated, but his surgery had been postponed due to COVID-19 pandemic. During that waiting period, he showed pituitary apoplexy with consciousness disturbance, resulting in acute adrenal insufficiency and diabetes insipidus. He was urgently hospitalized and underwent transsphenoidal surgery. Rapid and permanent pathological examinations have confirmed metastasis of PTC to the pituitary. The patient also underwent serial thyroidectomy. He was also suspected to have secondary hydrocephalus and underwent lumboperitoneal shunting after excluding cerebrospinal fluid metastasis. Thereafter, his cognitive dysfunction and performance status improved dramatically.
CONCLUSION
To the best of our knowledge, this is the first patient with PTC who developed pituitary apoplexy secondary to metastasis.
背景
甲状腺乳头状癌（PTC）垂体转移罕见，仅有少数病例报道。
病例描述
我们报告一例出现视力障碍和全垂体功能减退的患者。磁共振成像显示垂体肿瘤和脑积水。本应进行经蝶窦手术，但由于新冠疫情，其手术被推迟。在等待期间，他出现垂体卒中伴意识障碍，导致急性肾上腺功能不全和尿崩症。他被紧急收治并接受了经蝶窦手术。快速且持久的病理检查证实PTC转移至垂体。患者还接受了系列甲状腺切除术。他还被怀疑有继发性脑积水，在排除脑脊液转移后接受了腰大池腹腔分流术。此后，他的认知功能障碍和身体状况显著改善。
结论
据我们所知，这是首例因转移继发垂体卒中的PTC患者。
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