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Treatment of a pituitary metastasis from a neuroendocrine tumour: case report and literature review

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Abstract

Herein we report a rare case of a pituitary metastasis from a neuroendocrine tumour mimicking an adenoma. Moreover, starting from this unusual case, the relevant literature concerning the diagnosis and management of patients with metastasis at pituitary level is reviewed. A 69-year-old woman was admitted to our Unit for severe headache, diplopia, and critical visual field impairment. MRI showed a large pituitary mass compressing the optic chiasm and infiltrating the cavernous sinus. Trans-sphenoidal biopsy revealed a pituitary metastasis from a neuroendocrine tumour, in line with the multiple liver lesions that were already considered metastases from an ileal primary neuroendocrine tumour. In vitro receptor characterisation of both pituitary and liver tissues by immunohistochemistry showed a heterogeneous somatostatin receptor subtype pattern, with a predominant expression of sst2 within the pituitary lesion. However, the liver metastasis receptor profile was completely different from the pituitary. Octreotide LAR was administered first, followed by receptor radiometabolic therapy with radiolabelled somatostatin analogues (90Y-DOTATOC and 177Lu-DOTATATE). After 16 months, MRI showed a significant shrinkage of the sellar mass. Moreover, disappearance of diplopia and visual defects, together with a considerable improvement in quality of life were gradually recorded. To our knowledge, this is the first case of combined treatment using “cold” and radiolabelled octreotide in a pituitary metastasis from a neuroendocrine tumour.

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Acknowledgements

This work was supported by research grants from Fondo per gli Investimenti della Ricerca di Base (FIRB RBAU019TMF_001), Ministero dell’Università e della Ricerca Scientifica (2002067251-001) and a research grant from CARIGE (assegno di ricerca).

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Authors and Affiliations

  1. Department of Endocrinological & Medical Sciences and Center of Excellence for Biomedical Research, University of Genova, Viale Benedetto XV, 6, Genova, 16132, Italy

    Umberto Goglia, Diego Ferone, Marilena Sidoti, Francesco Minuto & Massimo Giusti

  2. Department of Neurosurgery, University of Genova, Genova, Italy

    Renato Spaziante

  3. Department of Pathology, San Martino Hospital, Genova, Italy

    Patrizia Dadati & Jean-Luis Ravetti

  4. Department of Nuclear Medicine, San Martino Hospital, Genova, Italy

    Giuseppe Villa

  5. Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy

    Lisa Bodei & Giovanni Paganelli

Authors
  1. Umberto Goglia
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  2. Diego Ferone
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  3. Marilena Sidoti
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  4. Renato Spaziante
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  5. Patrizia Dadati
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  6. Jean-Luis Ravetti
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  7. Giuseppe Villa
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  8. Lisa Bodei
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  9. Giovanni Paganelli
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  10. Francesco Minuto
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  11. Massimo Giusti
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Corresponding author

Correspondence to Diego Ferone.

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Umberto Goglia and Diego Ferone contributed equally.

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Goglia, U., Ferone, D., Sidoti, M. et al. Treatment of a pituitary metastasis from a neuroendocrine tumour: case report and literature review. Pituitary 11, 93–102 (2008). https://doi.org/10.1007/s11102-007-0038-6

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