SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Lung Adenocarcinoma With Pituitary Metastasis Presenting as Headache and Hemoptysis: Diagnostic Challenges and Clinical Insights

Rare Case of Lung Adenocarcinoma With Pituitary Metastasis Presenting as Headache and Hemoptysis: Diagnostic Challenges and Clinical Insights

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This case describes a 70-year-old man with controlled HIV, tobacco use, ischemic cardiomyopathy, and mild cognitive impairment who presented with 2 weeks of hemoptysis and intermittent posterior headaches, along with chronic diplopia. Initial imaging showed a right lower lobe lung mass and cerebellar lesions concerning for hemorrhagic metastases. After lung biopsy, he developed persistent hypotension refractory to fluids and midodrine, prompting ICU transfer. Laboratory testing revealed very low ACTH and cortisol, consistent with secondary adrenal insufficiency, and further evaluation showed panhypopituitarism.<br /><br />Because his neurologic symptoms were initially attributed to cerebellar metastases, his diplopia was not fully investigated. Visual field testing later demonstrated peripheral deficits and a cranial VI nerve palsy. A dedicated sellar MRI revealed a 2 cm sellar mass extending into the right cavernous sinus, concerning for pituitary metastasis versus macroadenoma. Lung biopsy confirmed adenocarcinoma, making pituitary metastasis from lung cancer the likely diagnosis.<br /><br />The authors emphasize that standard brain MRI can miss sellar pathology and that dedicated pituitary/sella MRI protocols with thin sections are more sensitive for detecting pituitary lesions. They also note that the American College of Radiology recommends high-resolution sella MRI for suspected hypopituitarism. In this case, the combination of pituitary metastasis and physiologic stress from biopsy likely triggered adrenal crisis.<br /><br />The report highlights the importance of avoiding premature diagnostic closure, performing thorough neurologic and ocular examinations, and considering pituitary metastasis in patients with malignancy and endocrine abnormalities. Although rare, pituitary metastasis can be the presenting feature of an underlying cancer and may lead to serious complications if missed.

Asset Subtitle

Kawther Elsouri

Meta Tag

Author List Brianna Decker, Jeremy J. Gentile, Kawther Elsouri, Kawther Elsouri

Category Clinical Vignettes

Concept Pituitary Metastasis

Concept Adrenal Insufficiency

Concept Sellar MRI

Concept Hypopituitarism

Concept Premature Closure

Distinguished Non-Finalist

Presenter Organization Corewell Health West- Grand Rapids, MI/MSU-MI

Presenting Author Kawther Elsouri

Track Adult

Keywords

pituitary metastasis

lung adenocarcinoma

secondary adrenal insufficiency

panhypopituitarism

sellar MRI

adrenal crisis

cranial VI nerve palsy

hemoptysis

cerebellar lesions

hypotension

Pituitary Metastasis

Adrenal Insufficiency

Sellar MRI

Hypopituitarism

Premature Closure