Journal of Endocrinological Investigation

, Volume 15, Issue 5, pp 387–391 | Cite as

Intracranial dissemination of an ACTH secreting pituitary neoplasm — A case report and review of the literature

  • D. Tonner
  • P. Belding
  • S. A. Moore
  • J. A. Schlechte
Case Report


A 52-year-old woman developed recurrent hypercortisolism 3 yr after successful surgical treatment of Cushing’s disease. At postmortem, eosinophilic pituitary tissue showing positive ACTH immunohistochemical staining was present in the frontal lobe and cerebellum but there was no tumor in the sella. In the absence of a pituitary tumor, ex-trasellar ACTH producing tissue could arise from seeding of the cerebrospinal fluid with tumor cells at the time of operation or from an atypical pituitary carcinoma. In this report we review the mechanisms of intracranial dissemination of pituitary tissue and ACTH-secreting pituitary carcinomas, including parasellar invasion, meningeal seeding, and cerebrospinal and hematogenous spread.


Pituitary neoplasm Cushing’s syndrome adrenocorticotropic hormone 


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  1. 1.
    Lloyd R.V. Endocrine pathology. Springer-Verlag, New York, 1990, p. 17.CrossRefGoogle Scholar
  2. 2.
    Findling J.W., Aron D.C., Tyrrell J.B., Shinsako J.H., Fitzgerald P.A., Norman D., Wilson C.B., Forsham P.H. Selective venous sampling for ACTH in Cushing’s syndrome. Differentiation between Cushing’s disease and the ectopic ACTH syndrome. Ann. Intern. Med. 94:647, 1981.PubMedCrossRefGoogle Scholar
  3. 3.
    Hsu S-M., Raine L, Fangen H. Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: A comparison between ABC and unlabeled antibody (PAP) procedures. J. Histochem. Cytochem. 29:577, 1981.PubMedCrossRefGoogle Scholar
  4. 4.
    Cairns H., Russel D.S. Intracranial and spine metastases in gliomas of the brain. Brain 54:377, 1931.CrossRefGoogle Scholar
  5. 5.
    Graf C.J., Blinderman E.E., Terplan K.L. Pituitary carcinoma in a child with distant metastases. J. Neurosurg. 19:254, 1962.PubMedCrossRefGoogle Scholar
  6. 6.
    Madonick M.J., Rubinstein L.J., Dacso M.R., Ribner H. Chromophobe adenoma of pituitary gland with subarachnoid metastases. Neurology 73:836, 1963.CrossRefGoogle Scholar
  7. 7.
    Epstein J.A., Epstein B.S., Molho L, Zimmerman H.M. Carcinoma of the pituitary gland with metastases to the spinal cord and roots of the cauda equina. J. Neurosurg. 21:844, 1964.Google Scholar
  8. 8.
    Solitare G.B., Jatlow P. Adenohypophyseal carcinoma. Case report. J. Neurosurg. 26:624, 1967.PubMedCrossRefGoogle Scholar
  9. 9.
    Fleischer A.S., Reagan T., Ransohoff J. Primary carcinoma of the pituitary with metastasis to the brain stem. J. Neurosurg. 36:781, 1972.PubMedCrossRefGoogle Scholar
  10. 10.
    Ogilvy K.M., Jakubowski J., Shortland J.R. Spinal subarachnoid spread of pituitary adenoma. J. Neurol. Neurosurg. Psychiatry 37:1186, 1974.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Newton T.H., Burhenne H.J., Palubinskas A.J. Primary carcinoma of the pituitary. Am. J. Roentgenol. 87:110, 1962.Google Scholar
  12. 12.
    Ogilvy K.M., Jakubowski J. Intracranial dissemination of pituitary adenomas. J. Neurol. Neurosurg. Psychiatry 36:199, 1973.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Hashimoto N., Handa J., Nishi S. Intracranial and intraspinal dissemination from a growth hormone-secreting pituitary tumor. J. Neurosurg. 64:140, 1986.PubMedCrossRefGoogle Scholar
  14. 14.
    Hoi Sang U., Johnson C. Metastatic prolactin-secreting pituitary adenoma. Hum. Pathol. 75:94, 1984.CrossRefGoogle Scholar
  15. 15.
    Cohen D.L., Diengdoh J.V., Thomas D.G.T., Himsworth R.L. An intracranial metastasis from a PRL secreting pituitary tumour. Clin. Endocrinol. (Oxf.) 18:259, 1983.CrossRefGoogle Scholar
  16. 16.
    Martin N.A., Hales M., Wilson C.B. Cerebellar metastasis from a prolactinoma during treatment with bromocriptine. J. Neurosurg. 55:615, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    Feiring E.H., Davidoff L.M., Zimmerman H.M. Primary carcinoma of the pituitary. J. Neuropathol. Exp. Neurol. 12:205, 1953.PubMedCrossRefGoogle Scholar
  18. 18.
    Salassa R.M., Kearns T.P., Kernohan J.U., Sprague R.G., MacCarty C.S. Pituitary tumors in patients with Cushing’s syndrome. J. Clin. Endocrinol. Metab. 19:1523, 1959.PubMedCrossRefGoogle Scholar
  19. 19.
    Zafar M.S., Mellinger R.C., Chason J.L. Cushing’s disease due to pituitary carcinoma. Henry Ford Hosp. Med. J. 32:61, 1984.PubMedGoogle Scholar
  20. 20.
    McCarty K.S. Jr., Bredesen D.E., Vogel F.S. Neoplasms of the anterior pituitary. Neurosurgery 3: 96, 1978.PubMedCrossRefGoogle Scholar
  21. 21.
    Scholz D.A., Gastineau C.F., Harrison E.G. Jr. Cushing’s syndrome with malignant chromophobe tumor of the pituitary and extracranial metastasis. Am. J.Med. 77:134, 1962.Google Scholar
  22. 22.
    D’Abrera V.S.E., Burke W.J., Blessel K.F., Bader L. Carcinoma of the pituitary gland. J. Pathol. 709:335, 1973.CrossRefGoogle Scholar
  23. 23.
    Sheldon W.H., Golden A., Bondy P.K. Cushing’s syndrome produced by a pituitary basophilic carcinoma with hepatic metastasis. Am. J.Med. 77:134, 1954.CrossRefGoogle Scholar
  24. 24.
    Forbes W. Carcinoma of the pituitary gland with metastasis to the liver in a case of Cushing’s syndrome. J. Pathol. Bact. 59:137, 1947.CrossRefGoogle Scholar
  25. 25.
    Queiroz L.S., Facure N.O., Facure J.J., Modesto N.P., deFaria J.L. Pituitary carcinoma with liver metastases and Cushing’s syndrome. Arch. Pathol. 99:32, 1975.Google Scholar
  26. 26.
    Scheithauer B.W., Kovacs K.T., Laws E.R., Randall R.V. Pathology of invasive pituitary tumors with special reference to functional classification. J. Neurosurg. 65:733, 1986.PubMedCrossRefGoogle Scholar
  27. 27.
    Belsky J.L., Cuello B., Swanson L.W., Simmons D.M., Jarrett R.M., Braza F. Cushing’s syndrome due to ectopic production of corticotropin-releasing factor. J. Clin. Endocrinol. Metab. 60:496, 1985.PubMedCrossRefGoogle Scholar
  28. 28.
    Carey R.M., Varma S.K., Drake CR. Jr. Ectopic secretion of corticotropin-releasing factor as a cause of Cushing’s syndrome. N. Engl. J. Med. 377; 13, 1984.CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 1990

Authors and Affiliations

  • D. Tonner
    • 1
  • P. Belding
    • 2
  • S. A. Moore
    • 2
  • J. A. Schlechte
    • 1
  1. 1.Departments of Internal Medicine and PathologyUniversity of Iowa College of MedicineIowa CityUSA
  2. 2.Departments of Internal MedicineUniversity of Iowa College of MedicineIowa CityUSA

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