Decanter C, Hober C, Hamon M, Lafitte J J, Lefebvre J, Vantyghem M C
Service d'Endocrinologie et Maladies Métaboliques, CHRU, Lille.
Ann Endocrinol (Paris). 1996;57(5):411-7.
Pituitary metastasis are rare but represent an important differential diagnosis of intrasellar tumorous syndromes. We report one case of intrasellar metastasis of a bronchial adenocarcinoma in a 50 year old woman. Clinical syndrome associated a tumorous syndrome (cephalalgia, bitemporal hemianopsia) and an anterior and posterior hypopituitarism biologically proven. A large intra and suprasellar mass which compressed the optic chiasma and highly enhanced after gadolinium injection was found by nuclear magnetic resonance imaging. The surgical biopsy displayed a pituitary metastasis of a right inferior lobar bronchial adenocarcinoma with bone secondary localizations. Cerebral radiotherapy and corticotherapy allowed recovery of visual loss but did not prevent rapid death. The clinical and radiological features which may evoke an intrasellar metastasis were: the tumorous syndrome associated with or revealed by diabetes insipidus, loss of spontaneous hypersignal of the neurohypophysis in nuclear magnetic resonance imaging, bulking pituitary stalk, bilobar character of the mass which is in favour of rapid cell proliferation, postero-superior extension, lowering of the V3 floor and very strong and homogeneous signal after gadolinium injection.
垂体转移瘤罕见，但却是鞍内肿瘤综合征的重要鉴别诊断。我们报告一例50岁女性支气管腺癌鞍内转移的病例。临床综合征表现为肿瘤综合征（头痛、双颞侧偏盲）以及经生物学证实的垂体前叶和后叶功能减退。核磁共振成像发现鞍内及鞍上有一巨大肿块，压迫视交叉，钆注射后强化明显。手术活检显示为右下叶支气管腺癌垂体转移，伴有骨转移。脑部放疗和皮质激素治疗使视力丧失有所恢复，但未能阻止患者迅速死亡。可能提示鞍内转移的临床和影像学特征包括：与尿崩症相关或由尿崩症揭示的肿瘤综合征、核磁共振成像中神经垂体自发高信号消失、垂体柄增粗、肿块呈双叶特征提示细胞增殖迅速、向后上延伸、V3层面下降以及钆注射后信号非常强且均匀。
