Verhelst J, Vanden Broucke P, Dua G, Joosens E, Abs R, Verlooy J, Mahler C
Department of Endocrinology, Algemeen Ziekenhuis Middelheim, Antwerp, Belgium.
Acta Clin Belg. 1995;50(1):31-5. doi: 10.1080/17843286.1995.11718418.
The cases of two elderly women treated for temporal hemianopsia due to a large pituitary mass with suprasellar extension are presented. In both cases, the clinical picture, without diabetes insipidus and cranial nerve paralysis, as well the neuroimaging and endocrinological investigation showing hypopituitarism, were suggestive of a non-secreting pituitary adenoma. In the first patient malignant tissue was unexpectedly encountered during transsphenoidal surgery. Anatomopathological investigation confirmed the presence of a metastasis of a breast carcinoma for which she had been treated 17 years earlier. In the second patient, a preoperative chest X-ray before transsphenoidal surgery revealed an asymptomatic bronchial tumour. Subsequently a squamous cell carcinoma with a metastasis in the pituitary was confirmed. These two cases illustrate the fact that a pituitary metastasis can closely mimic a pituitary adenoma. Even in the absence of suggestive symptoms such as diabetes insipidus and/or cranial nerve paralysis the possibility of metastatic disease in the differential diagnosis of a pituitary mass should always be considered.
本文介绍了两名老年女性因巨大垂体肿块伴鞍上扩展导致颞侧偏盲而接受治疗的病例。在这两个病例中，临床表现（无尿崩症和颅神经麻痹）以及神经影像学和内分泌学检查显示垂体功能减退，提示为无分泌功能的垂体腺瘤。在第一例患者中，经蝶窦手术期间意外发现了恶性组织。解剖病理学检查证实存在乳腺癌转移，她17年前曾接受过乳腺癌治疗。在第二例患者中，经蝶窦手术前的胸部X光片显示有一个无症状的支气管肿瘤。随后证实为垂体转移的鳞状细胞癌。这两个病例说明了垂体转移瘤可酷似垂体腺瘤这一事实。即使没有尿崩症和/或颅神经麻痹等提示性症状，在垂体肿块的鉴别诊断中也应始终考虑转移性疾病的可能性。
