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Kwak, Jie, Hong, Kim, Lee, Jo, Kwon, Youn, Cha, and Son: A Case of Pituitary Metastasis of Breast Cancer Presenting as Diabetes Insipidus and Panhypopituitarism
Case Report
Journal of Korean Endocrine Society

Journal of Korean Endocrine Society 2007; 22(2): 125-129.

Published online: 20 April 2007

DOI: https://doi.org/10.3803/jkes.2007.22.2.125

A Case of Pituitary Metastasis of Breast Cancer Presenting as Diabetes Insipidus and Panhypopituitarism

Jae Wuk Kwak, Byung Soo Jie, Sun Hwa Hong, Ji Hyun Kim, Seung Hwan Lee, Jae Hyung Jo, Hyuk Sang Kwon, Kun Ho Youn, Bong Yun Cha, Ho Young Son

Department of Internal Medicine, The Catholic University of Korea College of Medicine, Korea.

Received 20 October 2006       Accepted 23 November 2006

Copyright © 2007 Korean Endocrine Society

Abstract

Metastasis to the pituitary gland from systemic cancer is a rare condition. The breast and lung are the most common sites of primary tumor metastasis. Pituitary metastasis may present with diabetes insipidus, cranial nerve palsy and hypopituitarism, and diabetes insipidus is the most frequent symptom at presentation. We report here on a 44 year-old woman with pituitary metastasis from breast cancer, and she developed central diabetes insipidus and hypopituitarism. The clinical diagnosis was made by performing a water deprivation test, a combined pituitary test and a MRI brain scan, and the latter showed metastatic tumor in the pituitary gland with invasion of the pituitary stalk. Symptomatic relief was obtained with administration of desmopressin; the urine osmolarity was increased with this treatment.
We report here on a case of pituitary metastasis from breast cancer and the patient developed central diabetes insipidus and hypopituitarism. We also include a review of the relevant literature.

Keywords: Breast cancer, Central diabetes insipidus, Panhypopituitarism, Pituitary metastasis

Figures and Tables

Fig. 1
Water deprivation test.
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Fig. 2A, 2B
1.5 × 1.3 × 1.3 cm sized homogenous lobulated low signal intensity mass is noted on nonenhanced sagittal T1WI in pituitary stalk and suprasellar cistern, which shows heterogenous enhancement on gadolinum enhanced image.
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Fig. 3A, 3B
On contrast enhanced chest CT, left breast is not visualized and conglomerated nodules with decreased attenuation are noted in left paratracheal mediastinum and right hilum.
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Fig. 4A, 4B, 4C
On axial FLAIR and T2WI images, asymmetric two high signal intensity nodules are noted in left frontal lobe, suggesting brain metastasis. On coronal T1WI with enhancement, focal enhanced ovoid lesion is noted in right scalp representing scalp metastasis.
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Table 1
Combined pituitary stimulation test
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Basal hormone level: estradiol 33.27 pg/mL testosterone 0.02 ng/mL progesterone 1.16 ng/mL T3 1.44 ng/mL free T4 1.0 ng/mL.

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