G. Stalldecker et al., HYPOPITUITARISM DUE TO COLON-CARCINOMA ME TASTASES ASSOCIATED WITH HYPOPHYSEAL ASPERGILLOSIS, Medicina, 54(3), 1994, pp. 248-252
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.