A case of ACTH-producing pituitary tumour with liver metastases

History and findings: A 57-year-old woman had an ACTH-producing pituitary a denoma twice resected, followed by bilateral adrenalectomy for recurrent hy percortisolism. She subsequently developed a secondary postadrenalectomy sy ndrome (Nelson's tumour) which required further surgery and radiotherapy. T he patient now presented for elucidation of a space-occupying lesion in the liver, found incidentally on abdominal ultrasonography. Investigations: Immunocytochemistry of the river biopsy revealed ACTH-produ cing cells that were structurally identical to the cells found in the speci men resected at the previous operation. Changes were also found in the lowe r thoracic vertebrae, suspicious of metastases, thus suggesting a metastasi zing hypophyseal carcinoma. Results and course: Resection of the primary tumour and subsequent radiothe rapy had arrested the corticotropic, thyrotropic, and gonadotropic function s of the pituitary, which had been adequately treated by administration of the corresponding hormones. Ocreotide, bromocriptin or cytostatics were not given because of their reported doubtful efficacy. At the time of diagnosi s of the malignancy a curative operation on the liver or palliative emboliz ation of the liver metastases were not possible because of their number and size. The bone metastases were managed palliatively by radiotherapy. Conclusion: No curative treatment has been found for the 66 cases of hypoph yseal carcinoma reported so far. Screening investigations in patients with operated pituitary adenoma with the aim of eliciting an early diagnosis of possible malignancy cannot, therefore, be recommended, particularly since r enewed tumour growth and local invasiveness do not constitute criteria for the diagnosis of pituitary carcinoma.