scholarly journals Hypopituitarism as the Initial Presentation of Pituitary Metastasis From Lung Cancer

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A587-A587
Author(s):  
Hazem Ayesh ◽  
Cameron Burmeister ◽  
Ahmed Abdelrahman ◽  
Azizullah Beran
Keyword(s):  
Lung Cancer ◽  
Pituitary Gland ◽  
Smoking History ◽  
Cerebellar Hemisphere ◽  
Free T4 ◽  
Primary Tumors ◽  
Mri Brain ◽  
Pituitary Enlargement ◽  
Biochemical Testing ◽  
Pituitary Metastasis

Abstract Introduction: The annual incidence of hypopituitarism 4.2 cases of 100,000. Causes include primary tumor, metastasis, and non-tumor causes such as radiation therapy, infiltrative lesions, infection, and traumatic brain injury. Metastatic pituitary tumors constitute about 7-9% of the cases, with lung and breast cancers are the most common primary tumors. Case Presentation: 48-year-old Caucasian female patient with 30 pack-year smoking history presented to the emergency department with abdominal pain, diarrhea, fatigue, and headache. Review of systems was significant for loss of appetite, left eye visual field defect, anorexia, cold intolerance, and shortness of breath. Physical examination was remarkable for decreased visual acuity. Vital signs notable for hypotension BP 92/63. Notable labs include glucose of 53 mg/dL, TSH 0.50 [0.49 - 4.67 uIU/mL], low free T4 0.52 ng/dL, low FSH 1.3 mIU/ml, low LH <0.2 mIU/ml, low ACTH 1.4 pg/mL, low morning cortisol 2.2 ug/dL, low DHEA-SO4 3ug/dL, low IGF-1 16 ng/ml. She was diagnosed with hypopituitarism and started on IV hydrocortisone 50 mg every 6 hours with 75 mcg levothyroxine daily. MRI brain showed interval growth of pituitary lesion into the suprasellar cistern with a mass-effect on the optic chiasm measuring 2.4 X1.6X 1.9 cm with a lesion in the right cerebellar hemisphere. Vertebral MRI showed multiple metastatic lesions in cervical/thoracic/lumbar vertebral bodies. On day two of hospital stay, she developed hypertonic hyponatremia (sodium 156 mmol/L, urine osmolarity 81 mOsm/kg, plasma osmolarity 328 mOsm/kg), and she was started on desmopressin 2 mg IV for diabetes insipidus. CT chest showed spiculated left upper lobe mass consistent with primary malignancy, and biopsy showed metastatic poorly differentiated epithelial malignancy likely from lung primary. Patient was discharged on desmopressin 100 mcg nightly, hydrocortisone 20 mg morning with 10 mg evening, levothyroxine 100 mcg daily with plans for further oncologic workup. Discussion: Patient’s 2011 MRI brain showed a mildly enlarged pituitary gland. MRI brain two months before admission showed a pituitary gland diameter of 1.6 cm, while an MRI at presentation showed a pituitary gland size of 2.4 cm with a new cerebellar lesion. She reported symptoms of nausea, vomiting, and weakness for more than one year ago but biochemical testing was not performed. The fact that the patient had pituitary enlargement eight years ago likely delayed the diagnosis of pituitary metastasis. Patient age precluded lung cancer screening despite smoking history and family history of lung cancer. Conclusion: Symptomatic patients with pituitary enlargement on brain imaging may benefit from a close follow-up and biochemical testing for early diagnosis and treatment, especially if they have risk factors for malignancy.

scholarly journals Hypopituitarism as an Initial Presentation of Silent Squamous Cell Carcinoma of Lung

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A586-A587
Author(s):  
Khin M Zin ◽  
Mostafa Meleis ◽  
Tiffany Purewal ◽  
Soemiwati W Holland ◽  
Jennifer Cheng
Keyword(s):  
Squamous Cell Carcinoma ◽  
Pituitary Gland ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Smoking History ◽  
Pathology Report ◽  
Free T4

Abstract Background: Symptomatic metastasis to the pituitary gland is a rare, life-threatening condition. A better understanding of its clinical presentation could lead to early diagnosis and also improve quality of life. In this unusual case, we present a patient with hypopituitarism as the first manifestation of undiagnosed squamous cell carcinoma of the lung. Clinical Case: A 56-year-old Caucasian female with past medical history of pre-diabetes, hypertension, hyperlipidemia, and a chronic smoker for 40 years presented with recent onset of headache for two weeks and diplopia for three days. Initial CT head was negative but MRI of brain pituitary scan revealed a large heterogeneously enhancing sellar/suprasellar mass (1.5 x 2.8 x 2.4 cm) extending into the prepontine cistern with probable bilateral cavernous sinus invasion and contacting the optic chiasm without significant compression. Physical examination showed left abducens nerve (CN VI) palsy. Lab results showed elevated prolactin at 67.4 ng/ml (normal postmenopausal: 1.8 – 20.3 ng/ml), normal IGF-1 at 136 ng/ml (normal 48- 235 ng/ml), low TSH at 0.129 µIU/ml (normal 0.3 – 4.5 µIU/ml), low normal Free T4 at 0.50 ng/dl (normal 0.5 – 1.26 ng/dl), low ACTH at 5.1 pg/ml (normal 7.2 – 63.3 pg/ml), low am cortisol at 2.6 mcg/dl (normal 8.7 – 22.4 mcg/dl), low FSH at 2.6 mIU/ml (normal postmenopausal 23.0-116.3 mIU/ml) and low LH at 0.2 mIU/ml (normal postmenopausal 15.9 - 54.0 mIU/ml). She subsequently began treatment for hypopituitarism. Given her smoking history and unusual presentation of cranial nerve palsy, a chest x-ray was ordered and revealed a left upper lobe mass. CT chest confirmed the left upper lobe mass (4.0 x 3.3 x 2.9 cm), and biopsy reported poorly differentiated squamous cell carcinoma. Decompression of the pituitary macroadenoma was performed for symptomatic improvement but was complicated with the development of central diabetes insipidus. Pathology report disclosed metastatic pituitary carcinoma, compatible with primary lung carcinoma. Following surgical resection and radiation therapy to the pituitary gland, the patient remains stable and is currently tolerating all treatment. Conclusion: In a patient with occult malignancy, pituitary metastasis is an exceedingly rare and challenging diagnosis that carries a poor prognosis. The purpose of this abstract is to raise clinical suspicion for sellar metastasis in a patient presenting with hypopituitarism and cranial nerve palsy.

Differential Diagnosis in Hypophysitis: First Report on a Spindle Cell Rhabdomyosarcoma of the Pituitary Gland

2021 ◽  
Author(s):  
Hajrullah Ahmeti ◽  
Eva Jüttner ◽  
Christoph Röcken ◽  
Olav Jansen ◽  
Matthias Laudes ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
High Risk ◽  
Pituitary Gland ◽  
Poor Prognosis ◽  
Rare Case ◽  
Spindle Cell ◽  
Myogenic Differentiation ◽  
Primary Tumors ◽  
Risk Patients ◽  
Pituitary Metastasis

AbstractPituitary gland metastases are very rare. Most patients with pituitary gland metastases are asymptomatic; therefore, most cases of this disease are diagnosed during autopsies. Moreover, the four most common primary tumors that metastasize to the pituitary gland are breast, lung, thyroid, and renal carcinomas. We present a very rare case of pituitary metastasis of spindle cell rhabdomyosarcoma (RMS). Our patient presented with headache, visual disorder, panhypopituitarism, and diabetes insipidus. Due to tumor expansion, resection was not possible, so diagnosis was confirmed by biopsy, and chemotherapy and irradiation were administered. Our patient showed widespread spindle cell RMS, which harbors a mutation of myogenic differentiation 1 (MYOD1) and is associated with a poor prognosis. Even high-risk patients can show a remission after chemotherapy and irradiation. In the cases with indistinct lesions in the sella region, pituitary metastasis should always be considered.

Symptom-free T4 lung cancer with bilateral pulmonary artery infiltration

2005 ◽  
Vol 6 (1) ◽  
pp. 64-64
Author(s):  
A CESARIO ◽  
D ONORATI ◽  
V CARDACI ◽  
S MARGARITORA ◽  
V PORZIELLA ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Pulmonary Artery ◽  
Free T4 ◽  
T4 Lung Cancer

LUNGRADS AND UPDATE OF LUNG NODULES SCREENING BY LOW DOSE COMPUTED TOMOGRAPHY

2015 ◽  
pp. 12-19
Author(s):  
Thi Ngoc Ha Hoang ◽  
Trong Khoan Le
Keyword(s):  
Lung Cancer ◽  
Low Dose ◽  
False Negative ◽  
Lung Nodule ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Low Dose Ct ◽  
History Of ◽  
Chest X Ray ◽  
Low Dose Computed Tomography

Background: A pulmonary nodule is defined as a rounded or irregular opacity, well or poorly defined, measuring up to 3 cm in diameter. Early detection the malignancy of nodules has a significant role in decreasing the mortality, increasing the survival time and consider as early diagnosis lung cancer. The main risk factors are those of current or former smokers, aged 55 to 74 years with a smoking history of at least 1 pack-day. Low dose CT: screening individuals with high risk of lung cancer by low dose CT scans could reduce lung cancer mortality by 20 percent compared to chest X-ray. Radiation dose has to maximum reduced but respect the rule of ALARA (As Low as Resonably Archivable). LungRADS 2014: Classification of American College of Radiology, LungRADS, is a newly application but showed many advantages in comparison with others classification such as increasing positive predict value (PPV), no result of false negative and cost effectiveness. Key words: LungRADS, screening lung nodule, low dose CT, lung cancer

scholarly journals Clinicopathological Profile of Patients with Lung Carcinoma in a Tertiary Care Center

2020 ◽  
Author(s):  
M.T. Chandramouli ◽  
Giridhar Belur Hosmane
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Lung Carcinoma ◽  
Care Center ◽  
Tertiary Care ◽  
Smoking History ◽  
Tertiary Care Center ◽  
Cell Type ◽  
Lung Cancer Patients ◽  
Incidence And Mortality

Abstract Introduction Among malignant diseases, lung carcinoma is the most common cancer in men worldwide in terms of both incidence and mortality. Its increasing incidence in developing countries like India is an important public health problem. This work aimed to study the demographic, clinical, radiological, and histological features of patients with confirmed lung cancer. Materials and Methods A total of 50 patients with histologically confirmed lung cancer at a tertiary care center in India from August 2016 to September 2018 were studied and analyzed. Results Out of 50 diagnosed lung cancer patients, 86% were men and 14% women; 31 (62%) patients were aged more than 60 years. Majority were smokers (84%) and all were men. Cough (94%) was the most common presenting symptom followed by dyspnea (68%), chest pain (48%), and hemoptysis (38%). Of the 50 patients, 29 (58%) had soft tissue density mass lesion on radiograph. Squamous cell carcinoma (SCC) was the diagnosed histological cell type in 24 (48%) patients and adenocarcinoma in 21 (42%) patients. Distant metastasis was observed in 20 (40%) patients. Conclusion In this study, the most common histopathological cell type is SCC. Patients aged more than 50 years and smokers are at high risk of lung cancer. Patients with a smoking history and persistent respiratory symptoms should be promptly evaluated for lung malignancy.

scholarly journals Mitochondria-Targeted Antioxidants MitoQ and MitoTEMPO Do Not Influence BRAF-Driven Malignant Melanoma and KRAS-Driven Lung Cancer Progression in Mice

Antioxidants ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 163
Author(s):  
Kristell Le Gal ◽  
Clotilde Wiel ◽  
Mohamed X. Ibrahim ◽  
Marcus Henricsson ◽  
Volkan I. Sayin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Malignant Melanoma ◽  
Cancer Cells ◽  
Cancer Progression ◽  
Nuclear Dna ◽  
Human Melanoma ◽  
Oxygen Species ◽  
Lung Cancer Cell ◽  
Primary Tumors ◽  
Anti Cancer

Cancer cells produce high levels of mitochondria-associated reactive oxygen species (ROS) that can damage macromolecules, but also promote cell signaling and proliferation. Therefore, mitochondria-targeted antioxidants have been suggested to be useful in anti-cancer therapy, but no studies have convincingly addressed this question. Here, we administered the mitochondria-targeted antioxidants MitoQ and MitoTEMPO to mice with BRAF-induced malignant melanoma and KRAS-induced lung cancer, and found that these compounds had no impact on the number of primary tumors and metastases; and did not influence mitochondrial and nuclear DNA damage levels. Moreover, MitoQ and MitoTEMPO did not influence proliferation of human melanoma and lung cancer cell lines. MitoQ and its control substance dTPP, but not MitoTEMPO, increased glycolytic rates and reduced respiration in melanoma cells; whereas only dTPP produced this effect in lung cancer cells. Our results do not support the use of mitochondria-targeted antioxidants for anti-cancer monotherapy, at least not in malignant melanoma and lung cancer.

Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers

2021 ◽  
pp. 003335492097171
Author(s):  
Lesley Watson ◽  
Megan M. Cotter ◽  
Shauna Shafer ◽  
Kara Neloms ◽  
Robert A. Smith ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Smoking History ◽  
Federally Qualified Health Centers ◽  
Cancer Society ◽  
Improved Outcomes

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology–designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January–June 2016) followed by 2 years of implementation (July 2016–June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

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