Abstract #1406407: A Rare Case of Pituitary Metastasis from Esophageal Adenocarcinoma

Metastases to the pituitary gland are uncommon. Metastatic lesions represent < 1 % of sellar masses (1). Breast and lungs most common primary tumors associated with metastasis, representing nearly 60% cases Esophageal adenocarcinoma is a very rare cause metastasis only few have been reported. We present case patient from esophageal adenocarcinoma. 49-year-old male presented 2-month history progressive fatigue, chills, lightheadedness, poor appetite, headaches, decreased peripheral vision. One month before admission he was diagnosed an invasive moderately differentiated Head CT showed heterogeneous hyperdense mass. Pituitary MRI confirmed 2.13 x 0.9 cm heterogeneously enhancing, lobulated mass suprasellar extension at least 2 sub-centimeters areas enhancement within right frontal lobe. chest, abdomen, pelvis splenomegaly, multiple in lungs, liver, bilateral adrenal glands, concerning for metastases. Laboratories cortisol level 1.2 mcg/dL, TSH 1.074 (0.46-4.7 uIU/mL), free T4 0.42 (0.7-1.30 ng/dL). Prolactin 3.9 (2.5-17.0 ng/mL)), LH 0.1 (0.8-7.6 mIU/mL), FSH (0.7-11.1 total testosterone 4.33 (240-871 ng/dL), IGF-1 76 (53.3-215 ng/mL). No evidence diabetes insipidus. The started on levothyroxine 150 mcg daily hydrocortisone 15 mg morning 5 afternoon. Ophthalmologic evaluation elevated retinal both eyes, metastatic implants. acute intervention per neurosurgery. After discharge, biopsy underwent whole brain radiotherapy (WBRT) FOLFOX, trastuzumab, pembrolizumab, zometa. 3 months later decrease size enhancing lesion suspicious lobe sella turcica. metastases usually 6th 7th decade life widespread disease. Patients may be asymptomatic, but others insipidus, visual disturbances, panhypopituitarism (2). Our younger age symptoms indicative failure. Although these nonspecific, it important maintain awareness them so that testing treatment can performed timely fashion.