S. Dellacasa et al., INTRACRANIAL AND SPINAL DISSEMINATION OF AN ACTH-SECRETING PITUITARY NEOPLASIA - CASE-REPORT AND REVIEW OF LITERATURE, Annales d'Endocrinologie, 58(6), 1997, pp. 503-509
We report a case of a 52-year-old woman presenting with a recurrence o
f a large pituitary adenoma with suprasellar extension and an overt Cu
shing's clinical picture, five years after successful transsphenoidal
treatment. After transfrontal ablation of the tumour, followed by exte
rnal radiotherapy, she was asymptomatic for six years before she exhib
ited epileptic seizures. A left frontal intracranial neoplasm was diag
nosed and removed, and at histological examination it was found to be
constituted by a localization of the pituitary ACTH secreting neoplasi
a. One month later she exhibited spinal dissemination of the ACTH secr
eting neoplasia which was only partially removed. After four months a
Magnetic Resonance Image (MRI) revealed recurrence of the intracranial
localization and further spinal dissemination. Because of compressive
symptoms, spinal masses with the same histologic features, were parti
ally removed again in three successive surgical operations. Several me
dical treatments for obtaining the control of corticoid excess, caused
by the ACTH overproduction, were tried, but none were satisfactory. F
inally a bilateral adrenal venous embolization was performed thus obta
ining a critical transient fall of serum cortisol. Five months later t
he patient died. At necroscopy bilateral adrenal enlargement was found
, spinal disseminations were confirmed, and no metastatic lesions were
discovered.