HYPOPITUITARISM DUE TO COLON-CARCINOMA ME TASTASES ASSOCIATED WITH HYPOPHYSEAL ASPERGILLOSIS

Pituitary metastases constitute 1% to 8.3% of all metastatic brain tum ors. The most frequent localization is in the posterior lobe and diabe tes insipidus may be the only sympton of dysfunction. Cerebral aspergi llosis is an unusual disease and it has been described complicating an underlying malignancy or following intracraneal surgery. We describe a case of hypopituitarism and hyperprolactinemia in a patient with pit uitary metastases of a colon carcinoma and aspergillosis. Two years be fore a colon adenocarcinoma (Class C1 of Duke) had been resected. Ther e were no clinical signs of hypopituitarism or galactorrea. The labora tory findings showed deficiency of cortocotropin (ACTH), luteinizing h ormone (LH), follicle stimulating hormone (FSH) and slight hyperprolac tinemia (PRL). Cerebral magnetic resonance immage (MRI) revealed an in tra and suprasellar mass which extended to the hypothalamus. Chest Xra y film and computed tomographic scanning (TC) confirmed a macronodular mass at the apical segment of the inferior left lung lobule with medi astinal hypertrophic lymph nodes. A non functional pituitary tumor was diagnosed and transphenoidal surgery was carried out. At microscopic examination a malignant proliferation was found suggesting colonic dif ferentiation. Fragments of tumoral pituitary tissue showed hyphae of a spergillus in the form of abcesses. Aspergillosis complicating neoplas tic disease is more often present in leukemia and lymphoma than in sol id tumors. Central nervous system (CNS) aspergillosis is difficult to diagnose in live patients; it may appear as part of a disseminated asp ergillosis or as a single CNS infection, although in most cases a pulm onary aspergillosis is associated. As far as we know this is the first report of hypopituitarism with moderate hyperprolactinemia with an et iology of colon carcinoma pituitary metastases and coexisting aspergil losis.