ACTH-PRODUCING PITUITARY CARCINOMA PRESENTING AS THE CAUDA-EQUINA SYNDROME

A 43-year-old woman presented with incontinence, weakness, and paresth esia, consistent with the cauda equina syndrome, 10 years after having a pituitary tumor surgically removed and 4 years after excision of tw o ''meningiomas'' of the cervical cord. The patient was also hypertens ive and had a cushingoid habitus. Emergent surgical decompression of t he spinal cord revealed intradural metastatic adrenocorticotropic horm one-producing pituitary carcinoma. Pituitary carcinomas are rare. The majority of reported cases of adrenocorticotropic hormone-producing ca rcinoma have exhibited metastases outside the central nervous system. To our knowledge, this represents the first case of an adrenocorticotr opic hormone-producing pituitary carcinoma presenting with the cauda e quina syndrome. A review of all reported cases of pituitary carcinoma indicated that central nervous system metastases were more common than metastases to distant sites, and patients with distant metastases exp erienced a shorter duration of disease than did those with central ner vous system metastases.